|dc.identifier.citation||Kagaayi, J., Chang, L. W., Ssempijja, V., Grabowski, M. K., Ssekubugu, R., Nakigozi, G., ... & Reynolds, S. J. (2019). Impact of combination HIV interventions on HIV incidence in hyperendemic fishing communities in Uganda: a prospective cohort study. The lancet HIV, 6(10), e680-e687. http://dx.doi.org/10.1016/S2352-3018(19)30190-0||en_US
|dc.description.abstract||Targeting combination HIV interventions to locations and populations with high HIV burden is a global
priority, but the impact of these strategies on HIV incidence is unclear. We assessed the impact of combination HIV
interventions on HIV incidence in four HIV-hyperendemic communities in Uganda.
Methods We did an open population-based cohort study of people aged 15–49 years residing in four fishing
communities on Lake Victoria. The communities were surveyed five times to collect self-reported demographic,
behavioural, and service-uptake data. Free HIV testing was provided at each interview, with referral to combination
HIV intervention services as appropriate. From November, 2011, combination HIV intervention services were rapidly
expanded in these geographical areas. We evaluated trends in HIV testing coverage among all participants,
circumcision coverage among male participants, antiretroviral therapy (ART) coverage and HIV viral load among
HIV-positive participants, and sexual behaviours and HIV incidence among HIV-negative participants.
Findings From Nov 4, 2011, to Aug 16, 2017, data were collected from five surveys. Overall, 8942 participants contributed
20 721 person-visits; 4619 (52%) of 8942 participants were male. HIV prevalence was 41% (1598 of 3870) in the
2011–12 baseline survey and declined to 37% (1740 of 4738) at the final survey (p<0·0001). 3222 participants who were
HIV-negative at baseline, and who had at least one repeat visit, contributed 9477 person-years of follow-up, and
230 incident HIV infections occurred. From the first survey in 2011–12 to the last survey in 2016–17, HIV testing
coverage increased from 68% (2613 of 3870) to 96% (4526 of 4738; p<0·0001); male circumcision coverage increased
from 35% (698 of 2011) to 65% (1630 of 2525; p<0·0001); ART coverage increased from 16% (254 of 1598) to
82% (1420 of 1740; p<0·0001); and population HIV viral load suppression in all HIV-positive participants increased
from 34% (546 of 1596) to 80% (1383 of 1734; p<0·0001). Risky sexual behaviours did not decrease over this period.
HIV incidence decreased from 3·43 per 100 person-years (95% CI 2·45–4·67) in 2011–12 to 1·59 per 100 person-years
(95% CI 1·19–2·07) in 2016–17; adjusted incidence rate ratio (IRR) 0·52 (95% CI 0·34–0·79). Declines in HIV
incidence were similar among men (adjusted IRR 0·53, 95% CI 0·30–0·93) and women (0·51, 0·27–0·96). The risk
of incident HIV infection was lower in circumcised men than in uncircumcised men (0·46, 0·32–0·67).
Interpretation Rapid expansion of combination HIV interventions in HIV-hyperendemic fishing communities is
feasible and could have a substantial impact on HIV incidence. However, incidence remains higher than HIV
epidemic control targets, and additional efforts will be needed to achieve this global health priority.
Funding The National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, the
National Institute of Child Health and Development, the National Cancer Institute, the National Institute for Allergy
and Infectious Diseases Division of Intramural Research, Centers for Disease Control and Prevention Uganda,
Karolinska Institutet, and the Johns Hopkins University Center for AIDS Research.||en_US