title: Heterogeneity of HIV incidence: a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control.
abstract: To describe HIV heterogeneity in rural Uganda using incidence data collected between January 2012 and December 2014 among fishing cohort (FC) and in an adjacent rural general population cohort (GPC).
  
  
  
  In the FC, eligible HIV high-risk adults aged 18+ years were enrolled, followed and HIV tested every 3 months. Demographic and sexual behaviour data were also collected. The GPC, approximately 47 km away from the FC, was followed through annual surveys, and sociodemographic and behavioural data collected. A subset of GPC with comparable risk profiles to the FC was selected. We presented sociodemographic and risk profiles and also computed stratified HIV incidence. Cox regression was used to assess factors associated with HIV incidence.
  
  
  
  Overall HIV incidence was higher in the FC than in the 'high-risk' GPC, 6.04 and 0.56 per 100 person years at risk, respectively, with a rate ratio (RR) of 10.83 (95% CI 6.11 to 19.76). This was higher among those aged 18-24 years, unmarried and those with more than two sex partners in the past year, RR of 15.44, 22.99 and 19.29, respectively. In the FC, factors associated with high incidence in multivariate analysis were duration in the community and unprotected sex. The factors in the GPC were ethnicity, marital status and duration in the community.
  
  
  
  We have observed a substantial heterogeneity in HIV incidence. The high incidence in fishing communities is contributing greatly to the overall HIV burden in Uganda, and thus urgent combination prevention efforts are needed towards national goal to reduce HIV epidemic.
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Kamali
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: R N
authors.initials: RN
authors.lastname: Nsubuga
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: E
authors.initials: E
authors.lastname: Ruzagira
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: U
authors.initials: U
authors.lastname: Bahemuka
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: G
authors.initials: G
authors.lastname: Asiki
authors.affiliation: International AIDS Vaccine Initiative, New York, New York, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Price
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda Department of Health Sciences, University of York, York, UK.
authors.forename: R
authors.initials: R
authors.lastname: Newton
authors.affiliation: Medical Research Council/Uganda Virus Research Council, Uganda Research Unit on AIDS, Entebbe, Uganda London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Kaleebu
authors.affiliation: International AIDS Vaccine Initiative, New York, New York, USA.
authors.forename: P
authors.initials: P
authors.lastname: Fast
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005398:Fisheries; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D006266:Health Education / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: AFRICA; EPIDEMIOLOGY (GENERAL); HIV