Browsing by Author "Lutalo, T."

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    HIV Prevention Efforts and Incidence of HIV in Uganda
    (New England Journal of Medicine, 2017) Grabowski, M.K.; Serwadda, D.M.; Gray, R.H.; Nakigozi, G.; Kigozi, G.; Kagaayi, J.; Ssekubugu, R.; Nalugoda, F.; Lessler, J.; Lutalo, T.; Galiwango, R.M.; Makumbi, F.; Kong, X.; Kabatesi, D.; Alamo, S.T.; Wiersma, S.; Sewankambo, N.K.; Tobian, A.A.R.; Laeyendecker, O.; Quinn, T.C.; Reynolds, S.J.; Wawer, M.J.; Chang, L.W.
    To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participantreported male circumcision, viral-load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) — from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94). CONCLUSIONS In this longitudinal study, the incidence of HIV infection declined significantly with the scale-up of a combination strategy for HIV prevention, which provides empirical evidence that interventions for HIV prevention can have a populationlevel effect. However, additional efforts are needed to overcome disparities according to sex and to achieve greater reductions in the incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others.)
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    Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai
    (Sexually transmitted infections, 2009) Slaymaker, E.; Bwanika, J. B.; Kasamba, I.; Lutalo, T.; Maher, D.; Todd, J.
    To derive the best possible estimates of trends in age at first sex (AFS) among successive cohorts of Ugandan men and women based on all the data available from the Demographic and Health Surveys (DHS) and cohort studies in Masaka and Rakai districts. Methods: The datasets from the DHS, Masaka cohort and Rakai cohort were analysed separately. Survival analysis methods were used to estimate median AFS for men and women born in the 1950s–1980s and to compute hazard ratios for first sex, comparing later cohorts with earlier cohorts. Results: The DHS and Masaka data showed an increase in AFS in women in the more recent birth cohorts compared with those born before 1970, but this was less apparent in the Rakai data. Successive male cohorts in Masaka appeared first to have an increased AFS which subsequently decreased, a trend that was also apparent (but not significant) in the DHS data. Younger men in Rakai had an earlier AFS than those born before 1980.
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    Trends in marriage and time spent single in sub- Saharan Africa: a comparative analysis of six population-based cohort studies and nine Demographic and Health Surveys
    (Sexually transmitted infections, 2009) Marston, M.; Slaymaker, E.; Cremin, I.; Floyd, S.; McGrath, N.; Kasamba, I.; Lutalo, T.; Nyirenda, M.; Ndyanabo, A.; Mupambireyi, Z.; Zaba, B.
    To describe trends in age at first sex (AFS), age at first marriage (AFM) and time spent single between events and to compare age-specific trends in marital status in six cohort studies. Methods: Cohort data from Uganda, Tanzania, South Africa, Zimbabwe and Malawi and Demographic and Health Survey (DHS) data from Uganda, Tanzania and Zimbabwe were analysed. Life table methods were used to calculate median AFS, AFM and time spent single. In each study, two surveys were chosen to compare marital status by age and identify changes over time. Results: Median AFM was much higher in South Africa than in the other sites. Between the other populations there were considerable differences in median AFS and AFM (AFS 17–19 years for men and 16–19 years for women, AFM 21–24 years and 18–19 years, respectively, for the 1970–9 birth cohort). In all surveys, men reported a longer time spent single than women (median 4–7 years for men and 0–2 years for women). Median years spent single for women has increased, apart from in Manicaland. For men in Rakai it has decreased slightly over time but increased in Kisesa and Masaka. The DHS data showed similar trends to those in the cohort data. The age-specific proportion of married individuals has changed little over time.