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

Physics and Astronomy(all)
Chemistry(all)
Biochemistry, Genetics and Molecular Biology(all)

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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), [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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title = "Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda",

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.",

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

note = "Funding Information: We thank the Rakai Health Sciences Program as well as the participants of the Rakai Community Cohort Study who made this study possible. This study was supported by, the National Institute of Allergy and Infectious Diseases (R01AI110324, U01AI100031, R01AI110324, R01AI102939, K01AI125086-01), the National Institute of Child Health and Development (R01HD070769, R01HD050180), and the National Institute for Allergy and Infectious Diseases Division of Intramural Research, and the Johns Hopkins University Center for AIDS Research (P30AI094189). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the paper. Funding Information: Data and ethics approval. We used data from the RCCS, an open population-based census and cohort. Individuals, including migrants, can enter or exit the study population between surveys. The RCCS surveys individuals aged 15–49 in 40 communities in and near the predominately rural Rakai District of south central Uganda. RCCS communities are classified as agrarian (n = 27), trading (n = 7), and Lake Victoria fishing communities (n = 4). HIV-prevalence is significantly higher in fishing communities (~42%) than in either trading (~14%) or agrarian communities (12%). The study was reviewed and approved by the Ugandan Virus Research Institute{\textquoteright}s Scientific and Ethics Committee (HS540), the Uganda Council on Science and Technology (GC/127/15/11/137), and Western Institutional Review Board, Olympia WA (20031318). Study participants provided written informed consent at each visit. Antiretroviral therapy and voluntary medical male circumcision were provided by the RHSP and the Ministry of Health through support from the U.S. President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR). Publisher Copyright: {\textcopyright} 2020, The Author(s).",

year = "2020",

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doi = "10.1038/s41467-020-14636-y",

language = "English (US)",

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T1 - Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

AU - Kate Grabowski, Mary

AU - Lessler, Justin

AU - Bazaale, Jeremiah

AU - Nabukalu, Dorean

AU - Nankinga, Justine

AU - Nantume, Betty

AU - Ssekasanvu, Joseph

AU - Reynolds, Steven J.

AU - Ssekubugu, Robert

AU - Nalugoda, Fred

AU - Kigozi, Godfrey

AU - Kagaayi, Joseph

AU - Santelli, John S.

AU - Kennedy, Caitlin

AU - Wawer, Maria J.

AU - Serwadda, David

AU - Chang, Larry W.

AU - Gray, Ronald H.

N1 - Funding Information: We thank the Rakai Health Sciences Program as well as the participants of the Rakai Community Cohort Study who made this study possible. This study was supported by, the National Institute of Allergy and Infectious Diseases (R01AI110324, U01AI100031, R01AI110324, R01AI102939, K01AI125086-01), the National Institute of Child Health and Development (R01HD070769, R01HD050180), and the National Institute for Allergy and Infectious Diseases Division of Intramural Research, and the Johns Hopkins University Center for AIDS Research (P30AI094189). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the paper. Funding Information: Data and ethics approval. We used data from the RCCS, an open population-based census and cohort. Individuals, including migrants, can enter or exit the study population between surveys. The RCCS surveys individuals aged 15–49 in 40 communities in and near the predominately rural Rakai District of south central Uganda. RCCS communities are classified as agrarian (n = 27), trading (n = 7), and Lake Victoria fishing communities (n = 4). HIV-prevalence is significantly higher in fishing communities (~42%) than in either trading (~14%) or agrarian communities (12%). The study was reviewed and approved by the Ugandan Virus Research Institute’s Scientific and Ethics Committee (HS540), the Uganda Council on Science and Technology (GC/127/15/11/137), and Western Institutional Review Board, Olympia WA (20031318). Study participants provided written informed consent at each visit. Antiretroviral therapy and voluntary medical male circumcision were provided by the RHSP and the Ministry of Health through support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Publisher Copyright: © 2020, The Author(s).

PY - 2020/12/1

Y1 - 2020/12/1

N2 - 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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Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda

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