Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Aug;3(8):e388-e396.
doi: 10.1016/S2352-3018(16)30034-0. Epub 2016 Jul 9.

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Larry W Chang  1 , Mary K Grabowski  2 , Robert Ssekubugu  3 , Fred Nalugoda  3 , Godfrey Kigozi  3 , Betty Nantume  3 , Justin Lessler  4 , Sean M Moore  4 , Thomas C Quinn  5 , Steven J Reynolds  5 , Ronald H Gray  2 , David Serwadda  6 , Maria J Wawer  2
Affiliations
Observational Study

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Larry W Chang et al. Lancet HIV. 2016 Aug.

Abstract

Background: Understanding the extent to which HIV burden differs across communities and the drivers of local disparities is crucial for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda.

Methods: The Rakai Community Cohort Study (RCCS) is an open, population-based cohort of people aged 15-49 years in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioural, and health information. RCCS data from Aug 10, 2011, to May 30, 2013, were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fishing sites (n=4). We mapped HIV prevalence with Bayesian methods, and characterised variability across and within community classifications. We also assessed differences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types.

Findings: 17 119 individuals were included, 9215 (54%) of whom were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fishing communities. Median HIV prevalence was higher in fishing communities (42%, range 38-43) than in trading (17%, 11-21) and agrarian communities (14%, 9-26). Antiretroviral therapy use was significantly lower in both men and women in fishing communities than in trading (age-adjusted prevalence risk ratio in men 0·64, 95% CI 0·44-0·97; women 0·53, 0·42-0·66) and agrarian communities (men 0·55, 0·42-0·72; women 0·65, 0·54-0·79), as was circumcision coverage among men (vs trading 0·48, 0·42-0·55; vs agrarian 0·64, 0·56-0·72). Self-reported risk behaviours were significantly higher in men than in women and in fishing communities than in other community types.

Interpretation: Substantial heterogeneity in HIV prevalence, risk factors, and service uptake in Rakai, Uganda, emphasises the need for local surveillance and the design of targeted HIV responses. High HIV burden, risk behaviours, and low use of combination HIV prevention in fishing communities make these populations a priority for intervention.

Funding: National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Development, and the National Institute for Allergy and Infectious Diseases Division of Intramural Research, National Institutes of Health; the Bill & Melinda Gates Foundation; and the Johns Hopkins University Center for AIDS Research.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

We declare that we have no conflicts of interest.

Figures

Figure 1
Figure 1. HIV disease burden in the Rakai region
A) Map of the Rakai region with RCCS study communities (agrarian=green triangle, trading community=yellow circle, fishing landing site=blue diamond) and Demographic and Health survey sites (red star) shown. B) Barplot of community HIV prevalence in 40 RCCS study communities. C) Interpolated map of HIV prevalence (1 km2 resolution). D) Interpolated map of the number of persons living with HIV (1 km2 resolution).
Figure 2
Figure 2
Age-specific HIV prevalence in men and women in agrarian communities (green), trading communities (yellow), and fish landing sites (blue).
Figure 3
Figure 3
RCCS community ART and male circumcision coverage in non-Muslim men. *p<0.05; **p<0.01
See this image and copyright information in PMC

Comment in

References

    1. PEPFAR 3.0. [accessed August 18, 2015]; http://www.pepfar.gov/documents/organization/234744.pdf.
    1. Puskas C, Hogg RS, Ferrand R, et al. Fast track to 2030: granularity at a global scale. The Lancet. 2015;2(1):e1–e32. - PubMed
    1. World AIDS Day 2015 Report. Focus on location and population. UNAIDS. 2015
    1. Anderson SJ, Cherutich P, Kilonzo N, et al. Maximising the effect of combination HIV prevention through prioritisation of the people and places in greatest need: a modelling study. Lancet. 2014;384(9939):249–256. - PubMed
    1. Kerr CC, Stuart RM, Gray RT, et al. Optima: A Model for HIV Epidemic Analysis, Program Prioritization, and Resource Optimization. J Acquir Immune Defic Syndr. 2015;69(3):365–376. - PubMed

Publication types

MeSH terms

Substances