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Original article
Heterogeneity of HIV incidence: a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control
  1. A Kamali1,
  2. R N Nsubuga1,
  3. E Ruzagira1,
  4. U Bahemuka1,
  5. G Asiki1,
  6. M A Price2,
  7. R Newton1,3,
  8. P Kaleebu1,4,
  9. P Fast2
  1. 1Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda
  2. 2International AIDS Vaccine Initiative, New York, New York, USA
  3. 3Department of Health Sciences, University of York, York, UK
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr A Kamali, Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, 51-59, Nakiwogo Road, PO Box 49, Entebbe, Uganda; anatoli.kamali{at}mrcuganda.org

Abstract

Objectives To describe HIV heterogeneity in rural Uganda using incidence data collected between January 2012 and December 2014 among fishing cohort (FC) and in an adjacent rural general population cohort (GPC).

Methods In the FC, eligible HIV high-risk adults aged 18+ years were enrolled, followed and HIV tested every 3 months. Demographic and sexual behaviour data were also collected. The GPC, approximately 47 km away from the FC, was followed through annual surveys, and sociodemographic and behavioural data collected. A subset of GPC with comparable risk profiles to the FC was selected. We presented sociodemographic and risk profiles and also computed stratified HIV incidence. Cox regression was used to assess factors associated with HIV incidence.

Results Overall HIV incidence was higher in the FC than in the ‘high-risk’ GPC, 6.04 and 0.56 per 100 person years at risk, respectively, with a rate ratio (RR) of 10.83 (95% CI 6.11 to 19.76). This was higher among those aged 18–24 years, unmarried and those with more than two sex partners in the past year, RR of 15.44, 22.99 and 19.29, respectively. In the FC, factors associated with high incidence in multivariate analysis were duration in the community and unprotected sex. The factors in the GPC were ethnicity, marital status and duration in the community.

Conclusions We have observed a substantial heterogeneity in HIV incidence. The high incidence in fishing communities is contributing greatly to the overall HIV burden in Uganda, and thus urgent combination prevention efforts are needed towards national goal to reduce HIV epidemic.

  • HIV
  • AFRICA
  • EPIDEMIOLOGY (GENERAL)

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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