Uganda Virus Research Institute

The contribution of HIV incidence and antiretroviral (ART) accessibility to HIV prevalence trends among adults in rural South West Uganda

Jessica Nakiyingi-MiiroMRC/UVRI Uganda Research Unit on AIDSDate: 22 July 2014

Methods• Annual census and socio-demographic data from

approx 10,000 adults• Annual health data and HIV serology until 2011,

then biennial • Free ART introduced in the area in 2004; 42% on

ART by end of 2012.

Background• In the 1990s, HIV prevalence and

incidence declined in Uganda; attributed primarily to a reduction in risky sexual behaviour.

• The latest Uganda sero-behavioural survey indicates that national HIV prevalence increased from 6.4% in 2004/05 to 7.3% in 2011.

Study site

Objective• To obtain the association of HIV incidence trends

and ART uptake with HIV prevalence trends using longitudinal data from rural Uganda

Males FemaleResidents 6.5% 7.8%In-migrants 9.7% 15.2%Out-migrants 10.7% 15.4%Deaths 42.6% 59.3%All adults 6.9% 8.5%

Fig 1: Age at joining cohort

16-19yrs20-24yrs25-34yrs35-49yrs50+ yrs

• 27,257 participants: 46% males; 61% resident at joining• Average annual migration: 8.2% in-migrants; 10.3% out-migrants

Table 1: HIV prevalence

Results

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0

2

4

6

8

10

12Fig 3: HIV incidence trends

Males Linear (Males)

Inci

denc

e ra

te (p

er 1

000

PYAR

)

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

020406080

100120140

Fig 4: Mortality trends

Males

Mor

talit

y ra

te (p

er 1

000

PYOs

)

0

4

8

12

16

20

Figure 2: HIV prevalence trends, 1990-2012

Males (all)Females (all)Male in-migrantsFemale in-migrantsMale out-migrantsFemale out-migrants

HIV

pre

vale

nce

(%)

DiscussionRecent increase in HIV prevalence may be due to:

• the increasing ART uptake; • declining mortality among HIV-infected adults; and • higher HIV prevalence among in/out-migrants

Fig 5: Distribution of HIV positive cases

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0

100

200

300

400

500

600

700

800

(b): Numbers contributing

IncidentIn-migrantIn-migrant (ART)Became adultPrevalentPrevalent (ART)

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

(a): % contribution

Acknowledgement

• This research is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement.

• Study participants from the MRC General Population Cohort

• Staff of MRC/UVRI Uganda• Prof. Ziv Shkedy of Hasselt

university, Belgium• Conference attendance

funded by AIDS 2014

Uganda Virus Research Institute

RESIDENTS AND NEW-BORNS

Additional slides

0

4

8

12

16

20

24Fig 2.1: HIV prevalence trends in initial residents

Male residentsFemale residentsMale in-migrantsFemale in-migrantsMale out-migrantsFemale out-migrants

HIV

pre

vale

nce

(%)

Fig 2.2: Distribution of HIV positive cases in resident population

1990

1993

1996

1999

2002

2005

2008

2011

0%

20%

40%

60%

80%

100%

(a): % contribution

1990

1993

1996

1999

2002

2005

2008

2011

050

100150200250300350

(b): Numbers contributing

IncidentIn-migrantIn-migrant (ART)Became adultPrevalentPrevalent (ART)