Estimation of the HIV basic reproduction number in rural south west Uganda: 1991-2008

• Published in: PloS one 2014-01, Vol.9 (1), p.e83778-e83778
• Main Authors: Nsubuga, Rebecca N, White, Richard G, Mayanja, Billy N, Shafer, Leigh Anne
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; AIDS treatment; Basic Reproduction Number - statistics & numerical data; Biology; Condoms; Councils; Development and progression; Disease transmission; Drug therapy; Epidemics; Estimates; Female; Health aspects; HIV; HIV Infections - epidemiology; HIV-1; Human immunodeficiency virus; Humans; Infection; Infections; Infectious diseases; Male; Mathematics; Medical research; Medicine; Methods; Mortality; Population; Reproduction; Risk; Rural areas; Rural Population; Sexual Behavior; Sexual Partners; Sexually transmitted diseases; STD; Uganda - epidemiology; Virus replication
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0083778

The basic reproduction number, [Formula: see text], is one of the many measures of the epidemic potential of an infection in a population. We estimate HIV [Formula: see text] over 18 years in a rural population in Uganda, examine method-specific differences in estimated [Formula: see text], and estimate behavioural changes that would reduce [Formula: see text] below one. Data on HIV natural history and infectiousness were collated from literature. Data on new sexual partner count were available from a rural clinical cohort in Uganda over 1991-2008. [Formula: see text] was estimated using six methods. Behavioural changes required to reduce [Formula: see text] below one were calculated. Reported number of new partners per year was 0 to 16 (women) and 0 to 80 (men). When proportionate sexual mixing was assumed, the different methods yielded comparable [Formula: see text] estimates. Assuming totally assortative mixing led to increased [Formula: see text] estimates in the high sexual activity class while all estimates in the low-activity class were below one. Using the "effective" partner change rate introduced by Anderson and colleagues resulted in [Formula: see text] estimates all above one except in the lowest sexual activity class. [Formula: see text] could be reduced below one if: (a) medium risk individuals reduce their partner acquisition rate by 70% and higher risk individuals reduce their partner acquisition rate by 93%, or (b) higher risk individuals reduce the partner acquisition rate by 95%. The estimated [Formula: see text] depended strongly on the method used. Ignoring variation in sexual activity leads to an underestimation of [Formula: see text]. Relying on behaviour change alone to eradicate HIV may require unrealistically large reductions in risk behaviour, even though for a small proportion of the population. To control HIV, complementary prevention strategies such as male circumcision and HIV treatment services need rapid scale up.