Skip to main content

Advertisement

SpringerLink
Log in

HIV Incidence and Factors Associated with Seroconversion in a Rural Community Home Based Counseling and Testing Program in Eastern Uganda

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We estimated HIV incidence and identified risk factors for seroconversion following a rural community home based HIV counseling and testing program in Uganda. We analyzed data from two rounds of testing at least a year apart. Of 19,401 initially seronegative participants, 106 seroconverted in Round 2. Overall HIV incidence was 0.55 per 100 person years (95 % CI: 0.45 –0.66) with no gender difference. Among men, being widowed or divorced (aRR 4.4), and having HIV related symptoms (aRR 11.5) were associated with seroconversion; having primary level education (aRR 0.2) was protective. Among women, being aged 35–59 years (aRR 2.3) and having HIV related symptoms (aRR 9.2) were associated with seroconversion; having couples’ posttest counseling in Round 1 (aRR 0.4) was protective. HIV incidence is lower than estimates from elsewhere in Uganda. Nevertheless, focused prevention programs are still needed, targeting previously married men and older women, and including couples’ counseling.

Resumen

Se ha estimado la incidencia del VIH e identificado los factores deriesgo de seroconversión siguiendo un programa de consejería y pruebasde VIH basadas en casa en una comunidad rural en Uganda. Se han analizado los datos obtenidos a partir de dos rondas de pruebasseparadas por un mínimo de un año. De los 19.401 participantesinicialmente seronegativos, 106 se seroconvertiron en la segundaronda. La media de incidencia de VIH resultó en un 0,55 por cada 100personas año (95 % CI: 0.45–0.66) sin diferencia en el genero. Entrelos hombres, ser viudo o divorciado (aRR 4,4), y mostrar síntomas relacionados al VIH (aRR 11,5), se asoció a la seroconversión; tenerun nivel de educación primario (aRR 0,2) fue protectivo. Entre lasmujeres, tener entre 35–59 años (aRR 23) y mostrar síntomasrelacionados al VIH (aRR 9,2) se asoció a la seroconversión: tenerconsejería de pareja después de la prueba de la primera ronda, (aRR0,4) fue protectivo. La incidencia del VIH es menor de lo estimadas encualquier otro lugar de Uganda. Sin embargo, aun son necesarios losprogramas específicos de prevención, focalizados en los hombreanteriormente casados y las mujeres mayores, incluyendo consejería de parejas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. UNAIDS. Global HIV/AIDS response: epidemic update and health sector progress towards universal access, progress report 2011. UNAIDS 2011.

  2. MOH. Uganda AIDS Indicator Survey 2011, preliminary report. Kampala. Ministry of Health 2012.

  3. Asiki G, Mpendo J, Abaasa A, et al. HIV and syphilis prevalence and associated risk factors among fishing communities of Lake Victoria, Uganda. Sex Transm Infect. 2011;87(6):511–5.

    Article  PubMed  Google Scholar 

  4. MOH. The crane survey: high risk groups survey conducted in Kampala Uganda. Makerere University School of Public Health 2010.

  5. Wabwire-Mangen F, Kirungi W, Kisitu DK, Wanyama JO. Uganda HIV prevention response and modes of transmission analysis. Kampala: Uganda AIDS Commission; 2009.

    Google Scholar 

  6. Ruzagira E, Wandiembe S, Abaasa A, et al. HIV incidence and risk factors for acquisition in HIV discordant couples in Masaka, Uganda: an HIV vaccine preparedness study. PLoS One. 2011;6(8):e24037.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Kim AA, Hallett T, Stover J, et al. Estimating HIV incidence among adults in Kenya and Uganda: a systematic comparison of multiple methods. PLoS One. 2011;6(3):e17535.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Shafer LA, Biraro S, Nakiyingi-Miiro J, et al. HIV prevalence and incidence are no longer falling in southwest Uganda: evidence from a rural population cohort 1989–2005. AIDS. 2008;22(13):1641–9.

    Article  PubMed  Google Scholar 

  9. Low-Beer D. HIV-1 incidence and prevalence trends in Uganda. Lancet. 2002;360(9347):1788 author reply 1788–1789.

    Article  PubMed  Google Scholar 

  10. Ruzagira E, Wandiembe S, Abaasa A, et al. Prevalence and incidence of HIV in a rural community-based HIV vaccine preparedness cohort in Masaka, Uganda. PLoS One. 2011;6(6):e20684.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Mermin J, Musinguzi J, Opio A, et al. Risk factors for recent HIV infection in Uganda. JAMA. 2008;300(5):540–9.

    Article  CAS  PubMed  Google Scholar 

  12. Menzies N, Abang B, Wanyenze R, et al. The costs and effectiveness of four HIV counseling and testing strategies in Uganda. AIDS. 2009;23(3):395–401.

    Article  PubMed  Google Scholar 

  13. Yoder PS, Katahoire AR, Kyaddondo D, Akol Z, Bunnell R, and Kaharuza F. Home-based HIV testing and counselling in a survey context in Uganda. 2006.

  14. Sekandi JN, Sempeera H, List J, et al. High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda. BMC Public Health. 2011;11:730.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Were W, Mermin J, Bunnell R, Ekwaru JP, Kaharuza F. Home-based model for HIV voluntary counselling and testing. Lancet. 2003;361(9368):1569.

    Article  PubMed  Google Scholar 

  16. Matovu JK, Kigozi G, Nalugoda F, Wabwire-Mangen F, Gray RH. The Rakai Project counselling programme experience. Trop Med Int Health. 2002;7(12):1064–7.

    Article  PubMed  Google Scholar 

  17. Health Mo. Uganda HIV Counselling and Testing Policy. In: Program AC, ed. Vol 3. 3rd ed. Kampala; 2012:16.

  18. Guwatudde D, Wabwire-Mangen F, Eller LA, et al. Relatively low HIV infection rates in rural Uganda, but with high potential for a rise: a cohort study in Kayunga District, Uganda. PLoS One. 2009;4(1):e4145.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Wolff B, Nyanzi B, Katongole G, Ssesanga D, Ruberantwari A, Whitworth J. Evaluation of a home-based voluntary counselling and testing intervention in rural Uganda. Health Policy Plan. 2005;20(2):109–16.

    Article  PubMed  Google Scholar 

  20. Statistics UBo. 2002 Uganda population and housing census. http://www.ubos.org/onlinefiles/uploads/ubos/pdf%20documents/2002%20CensusPopnSizeGrowthAnalyticalReport.pdf. 2002. Accessed on 14 May 2012.

  21. MOH. The Status of the HIV/AIDS Epidemic in Uganda. The HIV/AIDS epidemiological surveillance report 2010. Kampala: Ministry of Health; 2010.

  22. Health UMo. Uganda national policy guidelines for HIV counselling and testing. In: ACP, editor. Kampala; 2005.

  23. Negin J, Wariero J, Mutuo P, Jan S, Pronyk P. Feasibility, acceptability and cost of home-based HIV testing in rural Kenya. Trop Med Int Health. 2009;14(8):849–55.

    Article  PubMed  Google Scholar 

  24. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000;342(13):921–9.

    Article  CAS  PubMed  Google Scholar 

  25. Amornkul PN, Vandenhoudt H, Nasokho P, et al. HIV prevalence and associated risk factors among individuals aged 13–34 years in Rural Western Kenya. PLoS One. 2009;4(7):e6470.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Auvert B, Buve A, Ferry B, et al. Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection. AIDS. 2001;15(suppl 4):S15–30.

    Article  PubMed  Google Scholar 

  27. Sateren WB, Foglia G, Renzullo PO, et al. Epidemiology of HIV-1 infection in agricultural plantation residents in Kericho, Kenya: preparation for vaccine feasibility studies. J Acquir Immune Defic Syndr. 2006;43(1):102–6.

    Article  PubMed  Google Scholar 

  28. Sullivan PS, Fideli U, Wall KM, et al. Prevalence of seroconversion symptoms and relationship to set-point viral load: findings from a subtype C epidemic, 1995–2009. AIDS. 2012;26(2):175–84.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Carpenter LM, Kamali A, Ruberantwari A, Malamba SS, Whitworth JA. Rates of HIV-1 transmission within marriage in rural Uganda in relation to the HIV sero-status of the partners. AIDS. 1999;13(9):1083–9.

    Article  CAS  PubMed  Google Scholar 

  30. Curran K, Baeten JM, Coates TJ, Kurth A, Mugo NR, Celum C. HIV-1 prevention for HIV-1 serodiscordant couples. Curr HIV/AIDS Rep. 2012;9(2):160–70.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Matovu JK. Preventing HIV transmission in married and cohabiting HIV-discordant couples in sub-Saharan Africa through combination prevention. Curr HIV Res. 2010;8(6):430–40.

    Article  CAS  PubMed  Google Scholar 

  32. Baryarama F, Bunnell R, McFarland W, et al. Estimating HIV incidence in voluntary counseling and testing clients in Uganda (1992–2003). J Acquir Immune Defic Syndr. 2007;44(1):99–105.

    Article  PubMed  Google Scholar 

  33. Kellogg T, McFarland W, Katz M. Recent increases in HIV seroconversion among repeat anonymous testers in San Francisco. AIDS. 1999;13(16):2303–4.

    Article  CAS  PubMed  Google Scholar 

  34. Kellogg TA, Loeb L, Dilley J, Adler B, Louie BT, McFarland W. Comparison of three methods to measure HIV incidence among persons seeking voluntary, anonymous counseling and testing. J Acquir Immune Defic Syndr. 2005;39(1):112–20.

    Article  PubMed  Google Scholar 

  35. Kellogg TA, McFarland W, Perlman JL, et al. HIV incidence among repeat HIV testers at a county hospital, San Francisco, California, USA. J Acquir Immune Defic Syndr. 2001;28(1):59–64.

    CAS  PubMed  Google Scholar 

  36. McFarland W, Kellogg TA, Dilley J, Katz MH. Estimation of human immunodeficiency virus (HIV) seroincidence among repeat anonymous testers in San Francisco. Am J Epidemiol. 1997;146(8):662–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We wish to thank Centres for Disease Control and Prevention (CDC)-Uganda for funding the HBHCT program in Kumi district; Kumi district local government for granting permission to use the data for this publication; and Wolfgang Hladik, Felix Ocom, and the Kumi HBHCT evaluation team for initial development of the HBHCT protocol. Writing of this manuscript was supported through the University of California San Francisco from the following grants from the U.S. National Institutes of Health (NIH): Fogarty International Center (FIC), D43TW005799; National Institute for Mental Health (NIMH), P30MH062246, R25MH064712; and the FIC AIDS International Training and Research Program (AITRP), D43TW000003. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, NIMH, or FIC.

Conflict of interest

The authors declare no competing interests.

Author information

Authors and Affiliations

  1. Department of Health Policy, Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

    Alfred G. Okiria, O. Okui, M. Dutki, R. Baryamutuma, C. K. Nuwagaba, E. Kansiime & W. Bazeyo

  2. District Health Office, Kumi District Local Government, Kumi, Uganda

    G. Ojamuge & J. Mugweri

  3. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    J. Fleuret, R. King & C. Lindan

Authors
  1. Alfred G. Okiria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Okui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Dutki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Baryamutuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. K. Nuwagaba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Kansiime
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Ojamuge
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Mugweri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Fleuret
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R. King
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. W. Bazeyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C. Lindan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alfred G. Okiria.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Okiria, A.G., Okui, O., Dutki, M. et al. HIV Incidence and Factors Associated with Seroconversion in a Rural Community Home Based Counseling and Testing Program in Eastern Uganda. AIDS Behav 18 (Suppl 1), 60–68 (2014). https://doi.org/10.1007/s10461-013-0502-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0502-4

Keywords

Palabras clave

Search

Navigation