Abstract
BackgroundFew studies have been conducted in Uganda to identify and quantify the determinants of HIV-1 infection. We report results from a community-based cohort study, whose primary objectives were to determine HIV-1 prevalence, incidence, and determinants of these infections, among other objectives.MethodologyConsenting volunteers from the rural district of Kayunga in Uganda aged 15–49 years were enrolled between March and July 2006. Participants were evaluated every six months. A questionnaire that collected information on behavioral and other HIV-1 risk factors was administered, and a blood sample obtained for laboratory analysis at each study visit.Principal FindingsHIV-1 prevalence among the 2025 participants was 9.9% (95% CI = 8.6%–11.2%). By the end of 12 months of follow-up, 1689.7 person-years had been accumulated, with a median follow-up time of 11.97 months. Thirteen HIV-1 incident cases were detected giving an annual HIV-1 incidence of 0.77% (95% CI = 0.35–1.19). Prevalence of HSV-2 infection was 57% and was strongly associated with prevalent HIV-1 infection (adjusted Odds Ratio = 3.9, 95% CI = 2.50–6.17); as well as incident HIV-1 infection (adjusted Rate Ratio (RR) = 8.7, 95% CI = 1.11–67.2). The single most important behavioral characteristic associated with incident HIV infection was the number of times in the past 6 months, a participant had sex with person(s) they suspected/knew were having sex with others; attaining statistical significance at 10 times and higher (adjusted RR = 6.3, 95% CI = 1.73–23.1). By the end of 12 months of follow-up, 259 participants (13%) were lost to follow-up, 13 (0.6%) had died, and 2 (0.1%) had withdrawn consent.ConclusionsDespite relatively low HIV-1 incidence observed in this community, prevalence remains relatively high. In the presence of high prevalence of HSV-2 infection and the behavioral characteristic of having sex with more than one partner, there is potential for increase in HIV-1 incidence.
Highlights
Accurate estimates of HIV-1 infection rates, and identification of associated risk factors in a population is important for determining appropriate interventions
Prevalence of Herpes Simplex Virus Type 2 (HSV-2) infection was 57% and was strongly associated with prevalent HIV-1 infection; as well as incident HIV-1 infection (adjusted Rate Ratio (RR) = 8.7, 95% confidence intervals (95% CI) = 1.11–67.2)
Despite relatively low HIV-1 incidence observed in this community, prevalence remains relatively high
Summary
Accurate estimates of HIV-1 infection rates (prevalence and incidence), and identification of associated risk factors in a population is important for determining appropriate interventions. Few community-based studies have been conducted in Uganda to assess HIV-1 infection rates and determinants of these infections. Reported HIV-1 prevalence and incident estimates have primarily been based on sentinel surveillance data at antenatal clinics. Some validation studies have shown that HIV-1 trends among women attending antenatal clinics provide a fairly accurate reflection of trends in HIV-1 infection among females in the general population, it may not correctly reflect the overall. Other validation studies have shown that HIV-1 surveillance based on antenatal clinic data overestimate trends in HIV-1 infection in some age-groups in the general population, whereas in other age-groups it underestimates [2]. Community-based studies provide more accurate estimates of HIV-1 infection rates in the general population. We report results from a community-based cohort study, whose primary objectives were to determine HIV-1 prevalence, incidence, and determinants of these infections, among other objectives
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