Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study.
Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study.
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DOI：
10.1016/s2352-3018(16)30034-0
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
Wawer MJ
中科院分区：
文献类型：
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作者：
Chang LW;Grabowski MK;Ssekubugu R;Nalugoda F;Kigozi G;Nantume B;Lessler J;Moore SM;Quinn TC;Reynolds SJ;Gray RH;Serwadda D;Wawer MJ
了解艾滋病毒负担在不同社区之间的差异程度以及地方差异的驱动因素对于有效和有针对性的艾滋病毒应对至关重要。我们评估了乌干达Rakai的艾滋病毒流行率、风险因素以及治疗和预防服务吸收的社区水平差异。Rakai社区队列研究（RCCS）是一项开放的、基于人口的队列研究，对40个社区15-49岁的人进行了调查。参与者进行艾滋病毒检测和采访，以获得社会人口，行为和健康信息。2011年8月至2013年5月的RCCS数据用于将社区分类为农业（n=27），贸易（n=9）或湖边捕鱼点（n=4）。使用贝叶斯方法绘制了艾滋病毒流行率图，并对社区分类之间和社区分类内部的变异性进行了表征。评估了社区类型之间艾滋病毒风险因素和抗逆转录病毒治疗和男性包皮环切术的差异。纳入17，119人; 9，215人（54%）为女性。9，931人居住在农业社区，3，318人居住在贸易社区，3，870人居住在渔业社区。艾滋病毒流行率差异很大，各社区从9%到43%不等。渔业社区的艾滋病毒感染率中位数（41%，范围：37-43%）高于贸易社区（17%，范围：11-22%）和农业社区（14%，范围：9-26%）;渔业社区的抗逆转录病毒疗法和男性包皮环切术覆盖率明显较低。男性自我报告的风险行为明显高于女性，渔业社区的风险行为明显高于其他社区类型。在乌干达的一个地区内，各社区的艾滋病毒流行率、风险因素和服务接受情况存在很大差异。这些发现强调了地方监测的必要性，并对设计有针对性的艾滋病毒应对措施具有重要意义。特别是，渔业社区极高的艾滋病毒负担和风险行为，以及艾滋病毒预防组合的使用率低，使这些地区成为干预的优先事项。
Understanding the extent to which HIV burden differs across communities and the drivers of local disparities is critical for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda. The Rakai Community Cohort Study (RCCS) is an open, population-based cohort surveying persons aged 15–49 in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioral, and health information. RCCS data from August 2011 to May 2013 were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fishing sites (n=4). HIV prevalence was mapped using Bayesian methods, and variability across and within community classifications was characterized. Differences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types were assessed. 17,119 individuals were included; 9215 (54%) were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fishing communities. There was large variation in HIV prevalence, ranging from 9% to 43% across communities. Fishing communities had a higher median HIV prevalence (41%, range: 37–43%) compared to trading (17%, range: 11–22%) and agrarian communities (14%, range: 9–26%); ART and male circumcision coverage were significantly lower in fishing communities. Self-reported risk behaviors were significantly higher in men compared to women and in fishing communities compared to other community types. There is substantial heterogeneity in HIV prevalence, risk factors, and service uptake across communities within one region of Uganda. These findings underscore the need for local surveillance and have important implications for the design of targeted HIV responses. In particular, the extremely high HIV burden and risk behaviors, and low use of combination HIV prevention in fishing communities make these areas a priority for intervention.