Ratmann O, Kagaayi J, Hall M, et al. - In view of promoting targeting interventions to areas of high HIV prevalence (ie, hotspots) by International and global organizations, researchers sought to understand the potential benefits of geo-targeted control via investigating the extent to which HIV hotspots along Lake Victoria sustain transmission in neighboring populations in south-central Uganda. They used data from the Rakai Community Cohort Study to perform this population-based survey in Rakai, Uganda. All individuals aged 15–49 years in four high-prevalence Lake Victoria fishing communities and 36 neighboring inland communities were surveyed in this study. Participants were 25,882 individuals, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. Among these, 5,142 participants were HIV-positive (2,703 [13·7%] in inland and 2,439 [40·1%] in fishing communities). Antiretroviral therapy use was not reported in 3,878 (75·4%) people who were HIV-positive; of these, 2,652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. They reconstructed 446 transmission networks, including 293 linked pairs with the inferred direction of transmission. Lake Victoria hotspots and surrounding inland populations exhibited infrequent cross-community HIV transmissions and when they occur, virus more commonly flows into rather than out of hotspots. This result suggests that the epidemic in inland populations will not be controlled with targeted interventions only to these hotspots, where most transmissions occur. Thus, for broader epidemic control depending on underlying epidemic dynamics, geographical targeting of high prevalence areas might not be effective.