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Spatial accessibility and the spread of HIV-1 subtypes and recombinants

Tatem, Andrew J.a,b,c; Hemelaar, Jorisd; Gray, Rebecca R.e; Salemi, Marcob,f

doi: 10.1097/QAD.0b013e328359a904
Epidemiology and Social

Objective/design: The global spread of HIV-1 main group (group M) has resulted in differential distributions of subtypes and recombinants, with the greatest diversity being found in sub-Saharan Africa. The explanations for the current subtype distribution patterns are likely multifactorial, but the promotion of human migrations and movements through transportation link availability and quality, summarized through ‘accessibility’, have been consistently cited as strong drivers. We sought to address the question of whether accessibility has been a significant factor in HIV-1 spread across mainland Africa through spatial analyses of molecular epidemiology, transport network and land cover data.

Methods: The distribution of HIV-1 subtypes and recombinants in sub-Saharan Africa for the period 1998–2008 was mapped using molecular epidemiology data at a finer level of detail than ever before. Moreover, hypotheses on the role of distance, road network structure and accessibility in explaining the patterns seen were tested using spatial datasets representing African transport infrastructure, land cover and an accessibility model of landscape travel speed.

Results: Coherent spatial patterns in HIV-1 subtype distributions across the continent exist, and a substantial proportion of the variance in the distribution and diversity pattern seen can be explained by variations in regional spatial accessibility.

Conclusion: The study confirms quantitatively the influence of transport infrastructure on HIV-1 spread within Africa, presents an approach for examining potential future impacts of road development projects and, more generally, highlights the importance of accessibility in the spread of communicable diseases.

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aDepartment of Geography

bEmerging Pathogens Institute, University of Florida, Gainesville, Florida

cFogarty International Center, National Institutes of Health, Bethesda, Maryland, USA

dNuffield Department of Obstetrics and Gynaecology

eDepartment of Zoology, University of Oxford, Oxford, UK

fDepartment of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA.

Correspondence to Dr Andrew J. Tatem, Emerging Pathogens Institute, P.O. Box 100009, 2055 Mowry Road, University of Florida, Gainesville, FL 32610, USA. E-mail:

Received 18 June, 2012

Revised 30 July, 2012

Accepted 23 August, 2012

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© 2012 Lippincott Williams & Wilkins, Inc.