What question did this study set out to answer?

This study aims to estimate HIV incidence and identify associated risk factors among adults in Uganda.

May 10, 2026PLoS ONE0 citationsOpen Access

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

SKSylvia KusemererwaUganda Virus Research Institute SKSheila KansiimeLondon School of Hygiene & Tropical Medicine GMGertrude MutonyiUganda Virus Research Institute

Key Points

This study aims to estimate HIV incidence and identify associated risk factors among adults in Uganda.
Individuals aged 18–45, HIV-negative, recruited between July 2018 and October 2022.
Follow-up assessments on HIV risk and sexual behaviour every six months, and HIV counselling and testing every three months.
Data analysed using uni-variable and multi-variable Poisson regression models.
Among 1422 individuals, 24 acquired HIV, yielding an incidence rate of 2.7 per 900.3 person-years.
Factors associated with HIV included female sex (aIRR = 6.84, 95% CI 1.60–29.30), residence in fishing communities (aIRR = 3.04, 95% CI 1.05–8.78), and recreational drug use (aIRR = 3.08, 95% CI 1.19–7.99).
HIV acquisition was linked to sex after alcohol consumption (aIRR = 2.65, 95% CI 1.11–6.31) and recent STI diagnosis (aIRR = 2.52, 95% CI 1.09–5.80).

Abstract

Introduction 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. Methods 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. Results 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. Conclusion 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.

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