Browsing by Author "Nakigozi, G."

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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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    The validity of self-reported antiretroviral use in persons living with HIV: a population-based study
    (AIDS, 2018) Grabowski, M.K.; Reynolds, S.J.; Kagaayi, J.; Gray, R.H.; Clarke, W.; Chang, L.C.; Nakigozi, G.; Laeyendecker, O.; Redd, A.D.; Goud-Billoux, V.; Ssekubugu, R.; Nalugoda, F.; Wawer, M.J.; Serwadda, D.; Quinn, T.C.; Tobian, A.A.R.
    To assess the validity of self-reported antiretroviral therapy use (ART) using population-based cohort data. Methods—Self-reported ART use and non-use was compared to a validated laboratory assay in 557 HIV-positive participants in the Rakai Community Cohort Study surveyed between September and December 2011 in Rakai, Uganda. The study population included participants from seven communities, including one fishing community with high HIV prevalence (~41%). ART use was assayed using liquid chromatography-tandem mass spectrometry which detects 20 antiretroviral (ARV) drugs. HIV viral load measurements were also obtained. Individuals with ≥2 antiretroviral (ARV) drugs detected were considered to be using ART. Results—153 (27%) participants self-reported ART use of whom 148 (97%) had ≥2 ARV drugs detected. There were ≥2 ARV drugs detected in 11% (n=44/404) of individuals with no self-reported ART use. Overall, the specificity of self-reported ART use was 99% (95%CI:97–100%) and the sensitivity was 77% (70–83%). Positive and negative predictive values were 97% (95%CI: 93–99%) and 89% (95%CI: 86–92%), respectively. Non-disclosure of ART use was significantly more common in younger persons (<30 years) and among those in trading occupations, but did not vary by community of residence. Conclusions—Self-reported ART use has high specificity and moderate sensitivity providing reasonable, but conservative estimates of population-based ART use. There is more under- reporting of ART use among younger persons and traders suggesting a need for more research on barriers to self-reporting of ART use in these sub-groups.