The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda

Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models

Mary Grabowski, Justin T Lessler, Andrew Redd, Joseph Kagaayi, Oliver B. Laeyendecker, Anthony Ndyanabo, Martha I. Nelson, Derek A T Cummings, John Baptiste Bwanika, Amy C. Mueller, Steven James Reynolds, Supriya Munshaw, Stuart Campbell Ray, Tom Lutalo, Jordyn Manucci, Aaron A Tobian, Larry Chang, Christopher Beyrer, Jacky Jennings, Fred Nalugoda & 4 others David Serwadda, Maria J Wawer, Thomas C Quinn, Ronald H Gray

Research output: Contribution to journalArticle

Abstract

Background:It is often assumed that local sexual networks play a dominant role in HIV spread in sub-Saharan Africa. The aim of this study was to determine the extent to which continued HIV transmission in rural communities-home to two-thirds of the African population-is driven by intra-community sexual networks versus viral introductions from outside of communities.Methods and Findings:We analyzed the spatial dynamics of HIV transmission in rural Rakai District, Uganda, using data from a cohort of 14,594 individuals within 46 communities. We applied spatial clustering statistics, viral phylogenetics, and probabilistic transmission models to quantify the relative contribution of viral introductions into communities versus community- and household-based transmission to HIV incidence. Individuals living in households with HIV-incident (n = 189) or HIV-prevalent (n = 1,597) persons were 3.2 (95% CI: 2.7-3.7) times more likely to be HIV infected themselves compared to the population in general, but spatial clustering outside of households was relatively weak and was confined to distances

Original languageEnglish (US)
Article numbere1001610
JournalPLoS Medicine
Volume11
Issue number3
DOIs
StatePublished - 2014

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Uganda
Cluster Analysis
HIV
Community Networks
Africa South of the Sahara
Statistical Models
Rural Population
Population
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda : Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models. / Grabowski, Mary; Lessler, Justin T; Redd, Andrew; Kagaayi, Joseph; Laeyendecker, Oliver B.; Ndyanabo, Anthony; Nelson, Martha I.; Cummings, Derek A T; Bwanika, John Baptiste; Mueller, Amy C.; Reynolds, Steven James; Munshaw, Supriya; Ray, Stuart Campbell; Lutalo, Tom; Manucci, Jordyn; Tobian, Aaron A; Chang, Larry; Beyrer, Christopher; Jennings, Jacky; Nalugoda, Fred; Serwadda, David; Wawer, Maria J; Quinn, Thomas C; Gray, Ronald H.

In: PLoS Medicine, Vol. 11, No. 3, e1001610, 2014.

Research output: Contribution to journalArticle

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abstract = "Background:It is often assumed that local sexual networks play a dominant role in HIV spread in sub-Saharan Africa. The aim of this study was to determine the extent to which continued HIV transmission in rural communities-home to two-thirds of the African population-is driven by intra-community sexual networks versus viral introductions from outside of communities.Methods and Findings:We analyzed the spatial dynamics of HIV transmission in rural Rakai District, Uganda, using data from a cohort of 14,594 individuals within 46 communities. We applied spatial clustering statistics, viral phylogenetics, and probabilistic transmission models to quantify the relative contribution of viral introductions into communities versus community- and household-based transmission to HIV incidence. Individuals living in households with HIV-incident (n = 189) or HIV-prevalent (n = 1,597) persons were 3.2 (95{\%} CI: 2.7-3.7) times more likely to be HIV infected themselves compared to the population in general, but spatial clustering outside of households was relatively weak and was confined to distances",
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AU - Redd, Andrew

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AU - Ndyanabo, Anthony

AU - Nelson, Martha I.

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AU - Bwanika, John Baptiste

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AU - Reynolds, Steven James

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AU - Lutalo, Tom

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AU - Tobian, Aaron A

AU - Chang, Larry

AU - Beyrer, Christopher

AU - Jennings, Jacky

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