Heterogeneity of HIV incidence: a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control

Abstract

ObjectivesTo 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).MethodsIn 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.ResultsOverall 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.ConclusionsWe 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-1 transmission networks in high risk fishing communities on the shores of Lake Victoria in Uganda: A phylogenetic and epidemiological approach

“…Data from recent studies (2011–2014) in Uganda shows that HIV incidence is still much higher among the fisherfolk community than other high risk or general population [5, 11]. In 2013 ART national guidelines included Fisherfolk as a key population eligible to receive ART at the time of diagnosis.…”

“…New HIV infections continue to occur in Uganda despite the country's wide roll out of HIV-related services and other interventions [5–8]. As in other sub-Saharan countries, the HIV epidemic is characterised by significant disparities in age, sex and geographical areas [9].…”

Retention of adults from fishing communities in an HIV vaccine preparedness study in Masaka, Uganda

“…The HIV incidence amongst study participants in this cohort of 6.04 per 100 224 person years at risk (95% confidence interval: 4.36 -8.37) has been reported previously (15).…”

Comparison of HIV Risk Behaviors Between Clinical Trials and Observational Cohorts in Uganda

“…Occupational subpopulations, such as Fisherfolks (FF) and female sex workers (FSW), are suitable for HIV vaccine efficacy trials [9][10][11][12]. The incidence of HIV is much higher in these subpopulations, with incidence rates as high as 11 per 100 persons at risk in Uganda [9][10][11][12][13][14]. These groups have shown high willingness to participate in HIV prevention research [15,16] and have good retention in study follow up [17,18].…”