Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

作者：Oliver Ratmann, Joseph Kagaayi, Matthew Hall, Tanya Golubchick, Godfrey Kigozi, Xiaoyue Xi, Chris Wymant, Gertrude Nakigozi, Lucie Abeler‐Dörner, David Bonsall, Astrid Gall, Anne Hoppé, Paul Kellam, Jeremiah Mulamba Bazaale, Sarah Kalibbala, Oliver Laeyendecker, Justin Lessler, Fred Nalugoda, Larry W. Chang, Túlio de Oliveira, Deenan Pillay, Thomas C. Quinn, Steven J. Reynolds, Simon E. F. Spencer, Robert Ssekubugu, David Serwadda, Maria J. Wawer, Ronald H. Gray, Christophe Fraser, M. Kate Grabowski, Helen Ayles, Rory Bowden, Vincent Cálvez, Myron S. Cohen, Anne Dennis, Max Essex, Sarah Fidler, Dan Frampton, Richard Hayes, Josh Herbeck, Pontiano Kaleebu, Cissy Kityo, Jairam R. Lingappa, Vladimir Novitsky, Nick Paton, Andrew Rambaut, Janet Seeley, Deogratius Ssemwanga, Frank Tanser, Tom Lutalo, Ronald M. Galiwango, Fred Makumbi, Nelson K. Sewankambo, Dorean Nabukalu, Anthony Ndyanabo, Joseph Ssekasanvu, Hadijja Nakawooya, Jessica Nakukumba, Grace N. Kigozi, Betty Nantume, Nampijja Resty, Jedidah Kambasu, Margaret Nalugemwa, Regina Nakabuye, Lawrence Ssebanobe, Justine Nankinga, Adrian Kayiira, Gorreth Nanfuka, Ruth Ahimbisibwe, Stephen Tomusange, Ronald M. Galiwango, Margaret Nakalanzi, Joseph Ouma Otobi, Denis Ankunda, Joseph Lister Ssembatya, John B. Ssemanda, Emmanuel Kato, Robert Kairania, Alice Kisakye, James Batte, James Ludigo, Abisagi Nampijja, Steven Watya, Kighoma Nehemia, Sr. Margaret Anyokot, Joshua Mwinike, George Kibumba, Paschal Ssebowa, George Mondo, Francis Wasswa, Agnes Nantongo, Rebecca Kakembo, Josephine Galiwango, Geoffrey Ssemango, Andrew D. Redd, John Santelli, Caitlin E. Kennedy, Jennifer A. Wagman, Aaron A.R. Tobian · 发表于：The Lancet HIV · 年份：2020 · DOI：10.1016/s2352-3018(19)30378-9 · 被引用次数：105 · 研究领域：HIV/AIDS Research and Interventions、Adolescent Sexual and Reproductive Health、HIV Research and Treatment

BACKGROUND: International and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda. METHODS: We did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15-49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population. FINDINGS: Between Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positi...