TY - JOUR
T1 - Relatively low HIV infection rates in rural Uganda, but with high potential for a rise
T2 - A cohort study in Kayunga District, Uganda
AU - Guwatudde, David
AU - Wabwire-Mangen, Fred
AU - Eller, Leigh Anne
AU - Eller, Michael
AU - McCutchan, Francine
AU - Kibuuka, Hannah
AU - Millard, Monica
AU - Sewankambo, Nelson
AU - Serwadda, David
AU - Michael, Nelson
AU - Robb, Merlin
N1 - Funding Information:
In this article the authors report results from a community-based closed cohort study, which is part of preparatory research for Phase III HIV vaccine efficacy trials being conducted by the Makerere University-Walter Reed Project in Uganda, a project sponsored by the US Military HIV Vaccine Research Program network. The study was conducted in Kayunga District, a rural district located in the mid-central part of Uganda, with an estimated population of 320,000 . The district has nine Sub-Counties, and six of these were randomly selected as the study area. The estimated population of individuals aged 15–49 years in the six sub-counties is 111,394 people . The main objectives of the study were to determine HIV-1 prevalence, incidence and risk factors associated with HIV-1 infection, to identify HIV-1 viral subtypes circulating in this part of Uganda, and determine cohort participant retention and willingness to participate in future HIV vaccine efficacy trials.
PY - 2009/1/7
Y1 - 2009/1/7
N2 - Background: Few 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. Methodology: Consenting 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 Findings: HIV-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. Conclusions: Despite 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.
AB - Background: Few 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. Methodology: Consenting 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 Findings: HIV-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. Conclusions: Despite 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.
UR - http://www.scopus.com/inward/record.url?scp=58149498945&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0004145
DO - 10.1371/journal.pone.0004145
M3 - Article
C2 - 19127290
AN - SCOPUS:58149498945
SN - 1932-6203
VL - 4
JO - PLoS ONE
JF - PLoS ONE
IS - 1
M1 - e4145
ER -