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 and Ronald H. Gray
Additional contact information
Mary Kate Grabowski: Johns Hopkins School of Medicine
Justin Lessler: Johns Hopkins Bloomberg School of Public Health
Jeremiah Bazaale: Rakai Health Sciences Program
Dorean Nabukalu: Rakai Health Sciences Program
Justine Nankinga: Rakai Health Sciences Program
Betty Nantume: Rakai Health Sciences Program
Joseph Ssekasanvu: Johns Hopkins Bloomberg School of Public Health
Steven J. Reynolds: Rakai Health Sciences Program
Robert Ssekubugu: Rakai Health Sciences Program
Fred Nalugoda: Rakai Health Sciences Program
Godfrey Kigozi: Rakai Health Sciences Program
Joseph Kagaayi: Rakai Health Sciences Program
John S. Santelli: Columbia University
Caitlin Kennedy: Johns Hopkins Bloomberg School of Public Health
Maria J. Wawer: Johns Hopkins Bloomberg School of Public Health
David Serwadda: Rakai Health Sciences Program
Larry W. Chang: Johns Hopkins Bloomberg School of Public Health
Ronald H. Gray: Johns Hopkins Bloomberg School of Public Health

Nature Communications, 2020, vol. 11, issue 1, 1-12

Abstract: 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.

Date: 2020
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DOI: 10.1038/s41467-020-14636-y

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