title: Spatial accessibility and the spread of HIV-1 subtypes and recombinants.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Geography, University of Florida, Gainesville, USA. andy.tatem@gmail.com
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.forename: Joris
authors.initials: J
authors.lastname: Hemelaar
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Gray
authors.forename: Marco
authors.initials: M
authors.lastname: Salemi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D017954:Africa South of the Sahara / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology / Q000821:virology; D004196:Disease Outbreaks; D024882:Drug Resistance, Viral; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D019143:Evolution, Molecular; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D015497:HIV-1 / Q000235:genetics* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D058974:Phylogeography; D011158:Population Growth; D011995:Recombination, Genetic; D014195:Travel