Using HIV voluntary counseling and testing data for monitoring the Uganda HIV epidemic, 1992-2000.
OBJECTIVE
To assess trends in the prevalence of HIV infection among voluntary counseling and testing (VCT) clients in Uganda and to describe the utility of VCT data for monitoring the HIV epidemic in 1992-2000.


METHODS
We analyzed routinely collected data from first-time VCT clients not reporting illness as a reason for testing. We developed a model adjusting for test site, couple testing, and premarital testing, assessed trends in adjusted prevalence of HIV infection and shifts in age-specific peak prevalence, and compared antenatal clinic (ANC) surveillance data and VCT prevalence trends.


RESULTS
Among 201,741 clients, adjusted prevalence of HIV infection declined from 23% in 1992 to 13% in 2000 (P < 0.001) (men, 17%-9% [P < 0.001]; women, 31%-18% [P < 0.001]). The prevalence declined for all age groups except men older than 39 years and women older than 34 years. The prevalence increased for women older than 39 years (P < 0.003). Between 1992 and 2000, peak prevalence declined for both men (31% to 24%) and women (44% to 41%), whereas the age at which the peak occurred increased for both men (36 to 41 years) and women (31 to 36 years). VCT and ANC prevalence trends were similar.


CONCLUSIONS
In Uganda, the prevalence of HIV infection among male and female VCT clients declined from 1992 to 2000, similar to ANC surveillance data, but did not decline in older age groups. In regions with well-established VCT programs, VCT data may provide a useful and convenient tool for monitoring the HIV epidemic.
CDC-Uganda, Global AIDS Program, National Center for HIV/AIDS, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Fulgentius
F
Baryarama
Rebecca E
RE
Bunnell
Raymond L
RL
Ransom
John Paul
JP
Ekwaru
Josephine
J
Kalule
Esther B
EB
Tumuhairwe
Jonathan H
JH
Mermin
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003376:Counseling; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D011295:Prenatal Care; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology