AEGiS-15IAC: Sustained declines in HIV incidence and associated prevalence in rural southwest Uganda: 13 years of follow up.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Sustained declines in HIV incidence and associated prevalence in rural southwest Uganda: 13 years of follow up.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrC1421)

Ruberantwari AJ, Nakiyingi J, Mbulaiteye SM, Biraro SJ, Kamali A, Grosskurth H
Medical Research Council (UK) Programme on AIDS/Uganda Virus Research Institute, Entebbe, Uganda

BACKGROUND: Three decades since the HIV epidemic was first described, it continues to expand most in sub-saharan Africa at an alarming rate. In Uganda, encouraging declines in HIV incidence and prevalence have been reported. Infection rates declined significantly in a rural population in southwest Uganda observed over 10 years of follow up. Whether these declines will be sustained is unclear. We report trends in rates over 13 years of follow up.

METHODS: The adult population(13 years or older) in 15 neighbouring villages has been followed since Jan 1990 through annual censuses and serological surveys. Dates of seroconversion were calculated as the mid-point between the last seronegative test and the first seropositive test. HIV incidence [per 1000 person years at risk(PYAR) was calculated by calendar year from 1990-2002. Chi square tests for trends were calculated to determine significance of linear trends.

RESULTS: We observed 258 sero-conversions over 63172 PYAR. Overall, HIV incidence declined significantly from 6.7 in 1990 to 4.7 in 2002 (p<0.001). This decline was greater among females (5.6 in 1990 to 3.9 in 2002 p=0.002). A significant drop was observed among females aged 20-24 years from 7.4 to 4.2, p=0.02). Incidence declined among adults aged 35 years and above from 8.0 to 2.9 in 2002, p=0.02). Overall HIV prevalence declined significantly from 8.2% to 5.1% in 2002 (p<0.001) prevalence declines were greatest among those aged 20-24 years. (11.3% to 2.9% for boys, p=0.01). Age specific decline was greatest among girls aged 20-24 years (21% to 5% in 2002 p<0.001). A decline was observed in males aged 25-34 from 18.3% to 9% in 2002, p=0.02)

CONCLUSIONS: These findings report significant declines in overall adult HIV incidence and prevalence rates particularly among the young adults. These are reliable indicators of an encouraging decline in incidence and prevalence rates and provides a role model of hope to AIDS control initiatives globally and specifically to the sub-Saharan African continent where rates of HIV-1 infections remain alarmingly high.

Keywords: AEGIS, Prevalence, Incidence, HIV Seropositivity, Acquired Immunodeficiency Syndrome, HIV Infections, Rural Population, Disease Outbreaks, Africa South of the Sahara, Uganda, Humans, Female, Male, Adult, epidemiology, organization & administration, methods

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ThOrC1421