HIV-1 transmission networks in high risk fishing communities on the shores of Lake Victoria in Uganda: A phylogenetic and epidemiological approach

Sylvia Kiwuwa-Muyingo*, Jamirah Nazziwa, Deogratius Ssemwanga, Pauliina Ilmonen, Harr Njai, Nicaise Ndembi, Chris Parry, Paul Kato Kitandwe, Asiki Gershim, Juliet Mpendo, Leslie Neilsen, Janet Seeley, Heikki Seppälä, Fred Lyagoba, Anatoli Kamali, Pontiano Kaleebu

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

18 Citations (Scopus)
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Abstract

Background: Fishing communities around Lake Victoria in sub-Saharan Africa have been characterised as a population at high risk of HIV-infection. Methods: Using data from a cohort of HIV-positive individuals aged 13–49 years, enrolled from 5 fishing communities on Lake Victoria between 2009–2011, we sought to identify factors contributing to the epidemic and to understand the underlying structure of HIV transmission networks. Clinical and socio-demographic data were combined with HIV-1 phylogenetic analyses. HIV-1 gag-p24 and env-gp-41 sub-genomic fragments were amplified and sequenced from 283 HIV-1-infected participants. Phylogenetic clusters with 2 highly related sequences were defined as transmission clusters. Logistic regression models were used to determine factors associated with clustering. Results: Altogether, 24% (n = 67/283) of HIV positive individuals with sequences fell within 34 phylo-genetically distinct clusters in at least one gene region (either gag or env). Of these, 83% occurred either within households or within community; 8/34 (24%) occurred within household partnerships, and 20/34 (59%) within community. 7/12 couples (58%) within households clustered together. Individuals in clusters with potential recent transmission (11/34) were more likely to be younger 71% (15/21) versus 46% (21/46) in un-clustered individuals and had recently become resident in the community 67% (14/21) vs 48% (22/46). Four of 11 (36%) potential transmission clusters included incident-incident transmissions. Independently, clustering was less likely in HIV subtype D (adjusted Odds Ratio, aOR = 0.51 [95% CI 0.26–1.00]) than A and more likely in those living with an HIV-infected individual in the household (aOR = 6.30 [95% CI 3.40–11.68]). Conclusions: A large proportion of HIV sexual transmissions occur within house-holds and within communities even in this key mobile population. The findings suggest localized HIV transmissions and hence a potential benefit for the test and treat approach even at a community level, coupled with intensified HIV counselling to identify early infections.

Original languageEnglish
Article numbere0185818
Pages (from-to)1-23
JournalPloS one
Volume12
Issue number10
DOIs
Publication statusPublished - 1 Oct 2017
MoE publication typeA1 Journal article-refereed

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