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Avila-Rios S, García-Morales C, Reyes-Terán G, González-Rodríguez A, Matías-Florentino M, Mehta SR, Chaillon A. Phylodynamics of HIV in the Mexico City Metropolitan Region. J Virol 2022; 96:e0070822. [PMID: 35762759 PMCID: PMC9327710 DOI: 10.1128/jvi.00708-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
Evolutionary analyses of viral sequences can provide insights into transmission dynamics, which in turn can optimize prevention interventions. Here, we characterized the dynamics of HIV transmission within the Mexico City metropolitan area. HIV pol sequences from persons recently diagnosed at the largest HIV clinic in Mexico City (between 2016 and 2021) were annotated with demographic/geographic metadata. A multistep phylogenetic approach was applied to identify putative transmission clades. A data set of publicly available sequences was used to assess international introductions. Clades were analyzed with a discrete phylogeographic model to evaluate the timing and intensity of HIV introductions and transmission dynamics among municipalities in the region. A total of 6,802 sequences across 96 municipalities (5,192 from Mexico City and 1,610 from the neighboring State of Mexico) were included (93.6% cisgender men, 5.0% cisgender women, and 1.3% transgender women); 3,971 of these sequences formed 1,206 clusters, involving 78 municipalities, including 89 clusters of ≥10 sequences. Discrete phylogeographic analysis revealed (i) 1,032 viral introductions into the region, over one-half of which were from the United States, and (ii) 354 migration events between municipalities with high support (adjusted Bayes factor of ≥3). The most frequent viral migrations occurred between northern municipalities within Mexico City, i.e., Cuauhtémoc to Iztapalapa (5.2% of events), Iztapalapa to Gustavo A. Madero (5.4%), and Gustavo A. Madero to Cuauhtémoc (6.5%). Our analysis illustrates the complexity of HIV transmission within the Mexico City metropolitan area but also identifies a spatially active transmission area involving a few municipalities in the north of the city, where targeted interventions could have a more pronounced effect on the entire regional epidemic. IMPORTANCE Phylogeographic investigation of the Mexico City HIV epidemic illustrates the complexity of HIV transmission in the region. An active transmission area involving a few municipalities in the north of the city, with transmission links throughout the region, is identified and could be a location where targeted interventions could have a more pronounced effect on the entire regional epidemic, compared with those dispersed in other manners.
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Affiliation(s)
- Santiago Avila-Rios
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Claudia García-Morales
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Coordinating Commission of the National Institutes of Health and High Specialty Hospitals, Ministry of Health, Mexico City, Mexico
| | | | | | - Sanjay R. Mehta
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
- Veterans Affairs Health System, San Diego, California, USA
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
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Chen X, Zhou YH, Ye M, Wang Y, Duo L, Pang W, Zhang C, Zheng YT. Burmese injecting drug users in Yunnan play a pivotal role in the cross-border transmission of HIV-1 in the China-Myanmar border region. Virulence 2018; 9:1195-1204. [PMID: 30001176 PMCID: PMC6086311 DOI: 10.1080/21505594.2018.1496777] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Injecting drug users (IDUs) are the major risk group for HIV-1 infection in the China-Myanmar border area. There are a large number of Burmese IDUs living in Yunnan (Yunnan-mIDUs) who might be associated with the cross-border transmission of HIV-1. From 2010 to 2013, 617 Yunnan-mIDUs were recruited from three counties of Yunnan, 19.0% of whom were detected to be HIV-1 positive by serological testing. Partial HIV-1 p17, pol, vif-env, and env genes were amplified from the positive samples and were sequenced. Phylogenetic and HIV-1 subtyping analyses revealed that HIV-1 recombinant forms (RFs), including RF_BC (36.4%), RF_01BC (26.1%), RF_01C (9.1%) and RF_01B (1.1%), were predominant among this cohort. Of the identified HIV-1 strains, 14.8%, 9.1% and 3.4% belonged to subtype C, CRF01_AE and subtype B, respectively. Transmission cluster analysis showed that sequences from the Yunnan-mIDUs formed transmission clusters not only with those from Burmese IDUs but also with those from Chinese IDUs, indicating that Yunnan-mIDUs might acquire HIV-1 infection from or spread HIV-1 to both Burmese and Chinese IDUs. Phylogeographic analyses revealed three cross-border transmission patterns associated with Yunnan-mIDUs, in which Yunnan-mIDUs served as the crucial nodes linking the Burmese and Chinese IDUs. These results suggest that Yunnan-mIDUs are a potential viral reservoir for the diffusion of HIV-1 in Yunnan and play a pivotal role in the bidirectional cross-border transmission of HIV-1 in the China-Myanmar border region. More intervention efforts that focus on Yunnan-mIDUs are recommended in Yunnan’s campaign against HIV/AIDS.
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Affiliation(s)
- Xin Chen
- a Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, National Kunming High Level Biosafety Research Center for Non-human Primate, Kunming Institute of Zoology , Chinese Academy of Sciences , Kunming , China
| | - Yan-Heng Zhou
- b College of Life Sciences , Yan'an University , Yan'an , China
| | - Mei Ye
- a Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, National Kunming High Level Biosafety Research Center for Non-human Primate, Kunming Institute of Zoology , Chinese Academy of Sciences , Kunming , China
| | - Yu Wang
- c KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences , Soochow University , Suzhou , China
| | - Lin Duo
- d Section of Science and Education, The Second People's Hospital of Yunnan Province , Kunming , China
| | - Wei Pang
- a Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, National Kunming High Level Biosafety Research Center for Non-human Primate, Kunming Institute of Zoology , Chinese Academy of Sciences , Kunming , China
| | - Chiyu Zhang
- e Pathogen Discovery and Evolution Unit, Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai , Chinese Academy of Sciences , Shanghai , China
| | - Yong-Tang Zheng
- a Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, National Kunming High Level Biosafety Research Center for Non-human Primate, Kunming Institute of Zoology , Chinese Academy of Sciences , Kunming , China.,c KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences , Soochow University , Suzhou , China
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Mehta SR, Chaillon A, Gaines TL, Gonzalez-Zuniga PE, Stockman JK, Almanza-Reyes H, Chavez JR, Vera A, Wagner KD, Patterson TL, Scott B, Smith DM, Strathdee SA. Impact of Public Safety Policies on Human Immunodeficiency Virus Transmission Dynamics in Tijuana, Mexico. Clin Infect Dis 2018; 66:758-764. [PMID: 29045592 PMCID: PMC5848227 DOI: 10.1093/cid/cix884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background North Tijuana, Mexico is home to many individuals at high risk for transmitting and acquiring human immunodeficiency virus (HIV). Recently, policy shifts by local government impacted how these individuals were handled by authorities. Here we examined how this affected regional HIV transmission dynamics. Methods HIV pol sequences and associated demographic information were collected from 8 research studies enrolling persons in Tijuana and were used to infer viral transmission patterns. To evaluate the impact of recent policy changes on HIV transmission dynamics, qualitative interviews were performed on a subset of recently infected individuals. Results Between 2004 and 2016, 288 unique HIV pol sequences were obtained from individuals in Tijuana, including 46.4% from men who have sex with men, 42.1% from individuals reporting transactional sex, and 27.8% from persons who inject drugs (some individuals had >1 risk factor). Forty-two percent of sequences linked to at least 1 other sequence, forming 37 transmission clusters. Thirty-two individuals seroconverted during the observation period, including 8 between April and July 2016. Three of these individuals were putatively linked together. Qualitative interviews suggested changes in policing led individuals to shift locations of residence and injection drug use, leading to increased risk taking (eg, sharing needles). Conclusions Near real-time molecular epidemiologic analyses identified a cluster of linked transmissions temporally associated with policy shifts. Interviews suggested these shifts may have led to increased risk taking among individuals at high risk for HIV acquisition. With all public policy shifts, downstream impacts need to be carefully considered, as even well-intentioned policies can have major public health consequences.
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Affiliation(s)
- Sanjay R Mehta
- Departments of Medicine University of California, La Jolla
- Departments of Pathology, University of California, La Jolla
- San Diego Veterans Affairs Medical Center, California
| | | | - Tommi L Gaines
- Departments of Medicine University of California, La Jolla
| | | | | | - Horatio Almanza-Reyes
- Escuela de Ciencias de la Salud Valle de Las Palmas, Universidad Autónoma de Baja California, Tijuana, Baja California, México
| | - Jose Roman Chavez
- Escuela de Ciencias de la Salud Valle de Las Palmas, Universidad Autónoma de Baja California, Tijuana, Baja California, México
| | - Alicia Vera
- Departments of Medicine University of California, La Jolla
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno
| | | | - Brianna Scott
- Departments of Medicine University of California, La Jolla
| | - Davey M Smith
- Departments of Medicine University of California, La Jolla
- San Diego Veterans Affairs Medical Center, California
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Paraskevis D, Nikolopoulos GK, Magiorkinis G, Hodges-Mameletzis I, Hatzakis A. The application of HIV molecular epidemiology to public health. INFECTION GENETICS AND EVOLUTION 2016; 46:159-168. [PMID: 27312102 DOI: 10.1016/j.meegid.2016.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 02/02/2023]
Abstract
HIV is responsible for one of the largest viral pandemics in human history. Despite a concerted global response for prevention and treatment, the virus persists. Thus, urgent public health action, utilizing novel interventions, is needed to prevent future transmission events, critical to eliminating HIV. For public health planning to prove effective and successful, we need to understand the dynamics of regional epidemics and to intervene appropriately. HIV molecular epidemiology tools as implemented in phylogenetic, phylodynamic and phylogeographic analyses have proven to be powerful tools in public health planning across many studies. Numerous applications with HIV suggest that molecular methods alone or in combination with mathematical modelling can provide inferences about the transmission dynamics, critical epidemiological parameters (prevalence, incidence, effective number of infections, Re, generation times, time between infection and diagnosis), or the spatiotemporal characteristics of epidemics. Molecular tools have been used to assess the impact of an intervention and outbreak investigation which are of great public health relevance. In some settings, molecular sequence data may be more readily available than HIV surveillance data, and can therefore allow for molecular analyses to be conducted more easily. Nonetheless, classic methods have an integral role in monitoring and evaluation of public health programmes, and should supplement emerging techniques from the field of molecular epidemiology. Importantly, molecular epidemiology remains a promising approach in responding to viral diseases.
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Affiliation(s)
- D Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - G K Nikolopoulos
- Hellenic Center for Diseases Control and Prevention, Maroussi, Greece
| | - G Magiorkinis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Zoology, University of Oxford, South Parks Road, OX1 3PS, Oxford, United Kingdom
| | | | - A Hatzakis
- Hellenic Center for Diseases Control and Prevention, Maroussi, Greece
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Junqueira DM, de Medeiros RM, Gräf T, Almeida SEDM. Short-Term Dynamic and Local Epidemiological Trends in the South American HIV-1B Epidemic. PLoS One 2016; 11:e0156712. [PMID: 27258369 PMCID: PMC4892525 DOI: 10.1371/journal.pone.0156712] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/18/2016] [Indexed: 01/07/2023] Open
Abstract
The human displacement and sexual behavior are the main factors driving the HIV-1 pandemic to the current profile. The intrinsic structure of the HIV transmission among different individuals has valuable importance for the understanding of the epidemic and for the public health response. The aim of this study was to characterize the HIV-1 subtype B (HIV-1B) epidemic in South America through the identification of transmission links and infer trends about geographical patterns and median time of transmission between individuals. Sequences of the protease and reverse transcriptase coding regions from 4,810 individuals were selected from GenBank. Maximum likelihood phylogenies were inferred and submitted to ClusterPicker to identify transmission links. Bayesian analyses were applied only for clusters including ≥5 dated samples in order to estimate the median maximum inter-transmission interval. This study analyzed sequences sampled from 12 South American countries, from individuals of different exposure categories, under different antiretroviral profiles, and from a wide period of time (1989–2013). Continentally, Brazil, Argentina and Venezuela were revealed important sites for the spread of HIV-1B among countries inside South America. Of note, from all the clusters identified about 70% of the HIV-1B infections are primarily occurring among individuals living in the same geographic region. In addition, these transmissions seem to occur early after the infection of an individual, taking in average 2.39 years (95% CI 1.48–3.30) to succeed. Homosexual/Bisexual individuals transmit the virus as quickly as almost half time of that estimated for the general population sampled here. Public health services can be broadly benefitted from this kind of information whether to focus on specific programs of response to the epidemic whether as guiding of prevention campaigns to specific risk groups.
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Affiliation(s)
- Dennis Maletich Junqueira
- Centro Universitário Ritter dos Reis—Uniritter, Departamento de Ciências da Saúde, Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Centro de Desenvolvimento Científico e Tecnológico (CDCT), Fundação Estadual de Produção e Pesquisa em Saúde (FEPPS), Porto Alegre, RS, Brazil
- * E-mail: ;
| | - Rubia Marília de Medeiros
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Centro de Desenvolvimento Científico e Tecnológico (CDCT), Fundação Estadual de Produção e Pesquisa em Saúde (FEPPS), Porto Alegre, RS, Brazil
| | - Tiago Gräf
- Centro de Desenvolvimento Científico e Tecnológico (CDCT), Fundação Estadual de Produção e Pesquisa em Saúde (FEPPS), Porto Alegre, RS, Brazil
- Programa de Pós-graduação em Biotecnologia e Biociências, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Sabrina Esteves de Matos Almeida
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Centro de Desenvolvimento Científico e Tecnológico (CDCT), Fundação Estadual de Produção e Pesquisa em Saúde (FEPPS), Porto Alegre, RS, Brazil
- Instituto de Ciências da Saúde, Universidade FEEVALE, Novo Hamburgo, RS, Brazil
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Mehta SR, Wertheim JO, Brouwer KC, Wagner KD, Chaillon A, Strathdee S, Patterson TL, Rangel MG, Vargas M, Murrell B, Garfein R, Little SJ, Smith DM. HIV Transmission Networks in the San Diego-Tijuana Border Region. EBioMedicine 2015; 2:1456-63. [PMID: 26629540 PMCID: PMC4634195 DOI: 10.1016/j.ebiom.2015.07.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND HIV sequence data can be used to reconstruct local transmission networks. Along international borders, like the San Diego-Tijuana region, understanding the dynamics of HIV transmission across reported risks, racial/ethnic groups, and geography can help direct effective prevention efforts on both sides of the border. METHODS We gathered sociodemographic, geographic, clinical, and viral sequence data from HIV infected individuals participating in ten studies in the San Diego-Tijuana border region. Phylogenetic and network analysis was performed to infer putative relationships between HIV sequences. Correlates of identified clusters were evaluated and spatiotemporal relationships were explored using Bayesian phylogeographic analysis. FINDINGS After quality filtering, 843 HIV sequences with associated demographic data and 263 background sequences from the region were analyzed, and 138 clusters were inferred (2-23 individuals). Overall, the rate of clustering did not differ by ethnicity, residence, or sex, but bisexuals were less likely to cluster than heterosexuals or men who have sex with men (p = 0.043), and individuals identifying as white (p ≤ 0.01) were more likely to cluster than other races. Clustering individuals were also 3.5 years younger than non-clustering individuals (p < 0.001). Although the sampled San Diego and Tijuana epidemics were phylogenetically compartmentalized, five clusters contained individuals residing on both sides of the border. INTERPRETATION This study sampled ~ 7% of HIV infected individuals in the border region, and although the sampled networks on each side of the border were largely separate, there was evidence of persistent bidirectional cross-border transmissions that linked risk groups, thus highlighting the importance of the border region as a "melting pot" of risk groups. FUNDING NIH, VA, and Pendleton Foundation.
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Affiliation(s)
- Sanjay R Mehta
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States ; Division of Infectious Diseases, San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Joel O Wertheim
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States
| | - Kimberly C Brouwer
- Division of Global Public Health, University of California San Diego, #0507, La Jolla, CA 92093, United States
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada Reno, Lombardi Building, 203, MS 0274, Reno, NV 89557, United States
| | - Antoine Chaillon
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States
| | - Steffanie Strathdee
- Division of Global Public Health, University of California San Diego, #0507, La Jolla, CA 92093, United States
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego #0680, La Jolla, CA 92093, United States
| | - Maria G Rangel
- El Colegio de la Frontera Norte, San Antonio del Mar, Baja California, Mexico
| | - Mlenka Vargas
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States
| | - Ben Murrell
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States
| | - Richard Garfein
- Division of Global Public Health, University of California San Diego, #0507, La Jolla, CA 92093, United States
| | - Susan J Little
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States
| | - Davey M Smith
- Division of Infectious Diseases, University of California San Diego, #8208 200 W. Arbor St. San Diego, CA 92103, United States ; Division of Infectious Diseases, San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
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7
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Beyrer C, Crago AL, Bekker LG, Butler J, Shannon K, Kerrigan D, Decker MR, Baral SD, Poteat T, Wirtz AL, Weir BW, Barré-Sinoussi F, Kazatchkine M, Sidibé M, Dehne KL, Boily MC, Strathdee SA. An action agenda for HIV and sex workers. Lancet 2015; 385:287-301. [PMID: 25059950 PMCID: PMC4302059 DOI: 10.1016/s0140-6736(14)60933-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The women, men, and transgender people who sell sex globally have disproportionate risks and burdens of HIV in countries of low, middle, and high income, and in concentrated and generalised epidemic contexts. The greatest HIV burdens continue to be in African female sex workers. Worldwide, sex workers still face reduced access to needed HIV prevention, treatment, and care services. Legal environments, policies, police practices, absence of funding for research and HIV programmes, human rights violations, and stigma and discrimination continue to challenge sex workers' abilities to protect themselves, their families, and their sexual partners from HIV. These realities must change to realise the benefits of advances in HIV prevention and treatment and to achieve global control of the HIV pandemic. Effective combination prevention and treatment approaches are feasible, can be tailored for cultural competence, can be cost-saving, and can help to address the unmet needs of sex workers and their communities in ways that uphold their human rights. To address HIV in sex workers will need sustained community engagement and empowerment, continued research, political will, structural and policy reform, and innovative programmes. But such actions can and must be achieved for sex worker communities everywhere.
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Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Research Centre, University of Cape Town, Cape Town, South Africa
| | - Jenny Butler
- United Nations Population Fund, New York, NY, USA
| | - Kate Shannon
- BC Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Deanna Kerrigan
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brian W Weir
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | - Michel Kazatchkine
- UN Special Envoy for HIV in eastern Europe and central Asia, Geneva, Switzerland
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Taylor BS, Reyes E, Levine EA, Khan SZ, Garduño LS, Donastorg Y, Hammer SM, Brudney K, Hirsch JS. Patterns of geographic mobility predict barriers to engagement in HIV care and antiretroviral treatment adherence. AIDS Patient Care STDS 2014; 28:284-95. [PMID: 24839872 DOI: 10.1089/apc.2014.0028] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Migration and geographic mobility increase risk for HIV infection and may influence engagement in HIV care and adherence to antiretroviral therapy. Our goal is to use the migration-linked communities of Santo Domingo, Dominican Republic, and New York City, New York, to determine the impact of geographic mobility on HIV care engagement and adherence to treatment. In-depth interviews were conducted with HIV+Dominicans receiving antiretroviral therapy, reporting travel or migration in the past 6 months and key informants (n=45). Mobility maps, visual representations of individual migration histories, including lifetime residence(s) and all trips over the past 2 years, were generated for all HIV+ Dominicans. Data from interviews and field observation were iteratively reviewed for themes. Mobility mapping revealed five distinct mobility patterns: travel for care, work-related travel, transnational travel (nuclear family at both sites), frequent long-stay travel, and vacation. Mobility patterns, including distance, duration, and complexity, varied by motivation for travel. There were two dominant barriers to care. First, a fear of HIV-related stigma at the destination led to delays seeking care and poor adherence. Second, longer trips led to treatment interruptions due to limited medication supply (30-day maximum dictated by programs or insurers). There was a notable discordance between what patients and providers perceived as mobility-induced barriers to care and the most common barriers found in the analysis. Interventions to improve HIV care for mobile populations should consider motivation for travel and address structural barriers to engagement in care and adherence.
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Affiliation(s)
- Barbara S. Taylor
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Emily Reyes
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Elizabeth A. Levine
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Shah Z. Khan
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - L. Sergio Garduño
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Yeycy Donastorg
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Scott M. Hammer
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Karen Brudney
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
| | - Jennifer S. Hirsch
- Department of Medicine/Infectious Diseases, University of Texas Health Science Center San Antonio (UTHSCSA), San Antonio, Texas
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9
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Pagán I, Holguín A. Reconstructing the timing and dispersion routes of HIV-1 subtype B epidemics in the Caribbean and Central America: a phylogenetic story. PLoS One 2013; 8:e69218. [PMID: 23874917 PMCID: PMC3706403 DOI: 10.1371/journal.pone.0069218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/05/2013] [Indexed: 01/05/2023] Open
Abstract
The Caribbean and Central America are among the regions with highest HIV-1B prevalence worldwide. Despite of this high virus burden, little is known about the timing and the migration patterns of HIV-1B in these regions. Migration is one of the major processes shaping the genetic structure of virus populations. Thus, reconstruction of epidemiological network may contribute to understand HIV-1B evolution and reduce virus prevalence. We have investigated the spatio-temporal dynamics of the HIV-1B epidemic in The Caribbean and Central America using 1,610 HIV-1B partial pol sequences from 13 Caribbean and 5 Central American countries. Timing of HIV-1B introduction and virus evolutionary rates, as well as the spatial genetic structure of the HIV-1B populations and the virus migration patterns were inferred. Results revealed that in The Caribbean and Central America most of the HIV-1B variability was generated since the 80 s. At odds with previous data suggesting that Haiti was the origin of the epidemic in The Caribbean, our reconstruction indicated that the virus could have been disseminated from Puerto Rico and Antigua. These two countries connected two distinguishable migration areas corresponding to the (mainly Spanish-colonized) Easter and (mainly British-colonized) Western islands, which indicates that virus migration patterns are determined by geographical barriers and by the movement of human populations among culturally related countries. Similar factors shaped the migration of HIV-1B in Central America. The HIV-1B population was significantly structured according to the country of origin, and the genetic diversity in each country was associated with the virus prevalence in both regions, which suggests that virus populations evolve mainly through genetic drift. Thus, our work contributes to the understanding of HIV-1B evolution and dispersion pattern in the Americas, and its relationship with the geography of the area and the movements of human populations.
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Affiliation(s)
- Israel Pagán
- Centro de Biotecnología y Genómica de Plantas (UPM-INIA) and E.T.S.I. Agrónomos, Universidad Politécnica de Madrid, Madrid, Spain.
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Carrel M, Emch M. Genetics: A New Landscape for Medical Geography. ANNALS OF THE ASSOCIATION OF AMERICAN GEOGRAPHERS. ASSOCIATION OF AMERICAN GEOGRAPHERS 2013; 103:1452-1467. [PMID: 24558292 PMCID: PMC3928082 DOI: 10.1080/00045608.2013.784102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The emergence and re-emergence of human pathogens resistant to medical treatment will present a challenge to the international public health community in the coming decades. Geography is uniquely positioned to examine the progressive evolution of pathogens across space and through time, and to link molecular change to interactions between population and environmental drivers. Landscape as an organizing principle for the integration of natural and cultural forces has a long history in geography, and, more specifically, in medical geography. Here, we explore the role of landscape in medical geography, the emergent field of landscape genetics, and the great potential that exists in the combination of these two disciplines. We argue that landscape genetics can enhance medical geographic studies of local-level disease environments with quantitative tests of how human-environment interactions influence pathogenic characteristics. In turn, such analyses can expand theories of disease diffusion to the molecular scale and distinguish the important factors in ecologies of disease that drive genetic change of pathogens.
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Affiliation(s)
| | - Michael Emch
- Department of Geography, University of North Carolina-Chapel Hill
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