Source-sink dynamics could sustain HIV epidemics in rural communities in sub-Saharan Africa: the case of Malawi

BioRxiv : the Preprint Server for Biology
Justin T OkanoSally Blower

Abstract

Background: Approximately 25.5 million individuals are infected with HIV in sub-Saharan Africa (SSA). Epidemics in this region are generalized, show substantial geographic variation in prevalence, and are driven by heterosexual transmission; populations are highly mobile. We propose that generalized HIV epidemics should be viewed as a series of micro-epidemics occurring in multiple connected communities. Using a mathematical model, we test the hypothesis that travel can sustain HIV micro-epidemics in communities where transmission is too low to be self-sustaining. We use Malawi as a case study. Methods: We first conduct a mapping exercise to visualize geographic variation in HIV prevalence and population-level mobility. We construct maps by spatially interpolating georeferenced HIV-testing and mobility data from a nationally representative population-level survey: the 2015-16 Malawi Demographic and Health Survey. To test our hypothesis, we construct a novel HIV epidemic model that includes three transmission pathways: resident-to-resident, visitor-caused and travel-related. The model consists of communities functioning as sources and sinks. A community is a source if transmission is high enough to be self-sustaining, and a sink...Continue Reading

Related Concepts

Case-Control Studies
Health Surveys
HIV Infections
Hospitals, Urban
Rural Area
Disease Transmission
Strategy
Population Study (Research Activity)
Population Group
Human Immunodeficiency Virus Test

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