Estimating HIV incidence and assessing associated risk factors among adults: Evidence from the 2018-2022 HIV vaccine preparedness cohort in Masaka, Uganda.

Abstract

Despite global reports of declining HIV incidence, current data are limited. This study presents findings on HIV incidence and risk factors in a HIV trial preparedness cohort. Between 18 July 2018 and 13 October 2022, individuals 18-45-year-old were recruited from communities along the trans-African highway and the shores of Lake Victoria in Masaka district, Uganda. Eligible individuals were HIV-negative and met at least one of the following criteria: suspected or confirmed sexually transmitted infection (STI), unprotected sex with ≥2 partners, unprotected sex with a new partner in the past 3 months, or unprotected sex in exchange for money/goods in the past month. Baseline data included demographics, sexual behaviour, and HIV risk factors. Follow-up assessments of HIV risk and sexual behaviour were conducted every six months, while HIV counselling and testing (HCT) were provided every 3 months, with linkage to care for those testing positive. Data were summarised descriptively, and associations with HIV incidence were analysed using uni-variable and multi-variable Poisson regression models. Of the 1422 individuals enrolled, 1115 (78.4%) attended ≥1 follow-up visit; 69% were female and 55% were aged ≤24 years. Over 900.3 person-years of observation (PYO), 24 individuals acquired HIV, yielding an incidence rate (IR) of 2.7 PYO [95% Confidence Interval (CI): 1.8-4.0]. Baseline factors independently associated with incident HIV included female sex [adjusted incidence rate ratio (aIRR) = 6.84 PYO, 95% CI 1.60-29.30], residence in a fishing community [aIRR = 3.04 PYO, 95% CI 1.05-8.78] and recreational drug use in the past 3 months [aIRR = 3.08 PYO, 95% CI 1.19-7.99]. In a separate analysis, using time-updated variables assessed during follow-up, HIV acquisition was associated with sex after alcohol consumption [aIRR = 2.65 PYO, 95% CI 1.11-6.31], and STI diagnosis/treatment within the past 3 months [aIRR = 2.52 PYO, 95% CI 1.09-5.80]. HIV incidence remains high among women, fishing community residents, and individuals with high risk behaviours, underscoring the need for targeted interventions to reduce the burden in these populations.