Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

Mary Kate Grabowski; Justin Lessler; Jeremiah Bazaale; Dorean Nabukalu; Justine Nankinga; Betty Nantume; Joseph Ssekasanvu; Steven J. Reynolds; Robert Ssekubugu; Fred Nalugoda; Godfrey Kigozi; Joseph Kagaayi; John S. Santelli; Caitlin Kennedy; Maria J. Wawer; David Serwadda; Larry W. Chang; Ronald H. Gray

doi:10.1038/s41467-020-14636-y

Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

Mary Kate Grabowski, Justin Lessler, Jeremiah Bazaale, Dorean Nabukalu, Justine Nankinga, Betty Nantume, Joseph Ssekasanvu, Steven J. Reynolds, Robert Ssekubugu, Fred Nalugoda, Godfrey Kigozi, Joseph Kagaayi, John S. Santelli, Caitlin Kennedy, Maria J. Wawer, David Serwadda, Larry W. Chang, Ronald H. Gray

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6 Scopus citations

Abstract

HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.

Original language	English (US)
Article number	976
Journal	Nature communications
Volume	11
Issue number	1
DOIs	https://doi.org/10.1038/s41467-020-14636-y
State	Published - Dec 1 2020

ASJC Scopus subject areas

General Chemistry
General Biochemistry, Genetics and Molecular Biology
General Physics and Astronomy

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Kate Grabowski, M., Lessler, J., Bazaale, J., Nabukalu, D., Nankinga, J., Nantume, B., Ssekasanvu, J., Reynolds, S. J., Ssekubugu, R., Nalugoda, F., Kigozi, G., Kagaayi, J., Santelli, J. S., Kennedy, C., Wawer, M. J., Serwadda, D., Chang, L. W., & Gray, R. H. (2020). Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda. Nature communications, 11(1), Article 976. https://doi.org/10.1038/s41467-020-14636-y

Kate Grabowski, M , Lessler, J, Bazaale, J, Nabukalu, D, Nankinga, J, Nantume, B, Ssekasanvu, J, Reynolds, SJ, Ssekubugu, R, Nalugoda, F, Kigozi, G, Kagaayi, J, Santelli, JS, Kennedy, C, Wawer, MJ, Serwadda, D, Chang, LW & Gray, RH 2020, 'Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda', Nature communications, vol. 11, no. 1, 976. https://doi.org/10.1038/s41467-020-14636-y

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abstract = "HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.",

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AU - Nantume, Betty

AU - Ssekasanvu, Joseph

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AU - Nalugoda, Fred

AU - Kigozi, Godfrey

AU - Kagaayi, Joseph

AU - Santelli, John S.

AU - Kennedy, Caitlin

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Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

Abstract

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