title: Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement.
abstract: The instability faced by refugees may place them at increased risk of exposure to HIV infection. Nakivale Refugee Settlement in southwestern Uganda hosts 68,000 refugees from 11 countries, many with high HIV prevalence. We implemented an HIV screening program in Nakivale and examined factors associated with new HIV diagnosis.
  
  
  
  From March 2013-November 2014, we offered free HIV screening to all clients in the Nakivale Health Center while they waited for their outpatient clinic visit. Clients included refugees and Ugandan nationals accessing services in the settlement. Prior to receiving the HIV test result, participants were surveyed to obtain demographic information including gender, marital status, travel time to reach clinic, refugee status, and history of prior HIV testing. We compared variables for HIV-infected and non-infected clients using Pearson's chi-square test, and used multivariable binomial regression models to identify predictors of HIV infection.
  
  
  
  During the HIV screening intervention period, 330 (4%) of 7766 individuals tested were identified as HIV-infected. Refugees were one quarter as likely as Ugandan nationals to be HIV-infected (aRR 0.27 [0.21, 0.34], p < 0.0001). Additionally, being female (aRR 1.43 [1.14, 1.80], p = 0.002) and traveling more than 1 h to the clinic (aRR 1.39 [1.11, 1.74], p = 0.003) increased the likelihood of being HIV-infected. Compared to individuals who were married or in a stable relationship, being divorced/separated/widowed increased the risk of being HIV-infected (aRR 2.41 [1.88, 3.08], p < 0.0001), while being single reduced the risk (aRR 0.60 [0.41, 0.86], p < 0.0001). Having been previously tested for HIV (aRR 0.59 [0.47, 0.74], p < 0.0001) also lowered the likelihood of being HIV-infected.
  
  
  
  In an HIV screening program in a refugee settlement in Uganda, Ugandan nationals are at higher risk of having HIV than refugees. The high HIV prevalence among clients seeking outpatient care, including Ugandan nationals and refugees, warrants enhanced HIV screening services in Nakivale and in the surrounding region. Findings from this research may be relevant for other refugee settlements in Sub-Saharan Africa hosting populations with similar demographics, including the 9 other refugee settlements in Uganda.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. kolaughlin@partners.org.|Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA. kolaughlin@partners.org.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. kolaughlin@partners.org.|Harvard Humanitarian Initiative, Cambridge, MA, USA. kolaughlin@partners.org.
authors.forename: Kelli N
authors.initials: KN
authors.lastname: O'Laughlin
authors.affiliation: MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.affiliation: United Nations High Commissioner for Refugees, Representation in Uganda, PO Box 3813, Kampala, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Kasozi
authors.affiliation: Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.|MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.|Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Parker
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Nirma D
authors.initials: ND
authors.lastname: Bustamante
authors.affiliation: Bugema University, Kasese Campus, PO Box 6529, Kampala, Uganda.
authors.forename: Zikama M
authors.initials: ZM
authors.lastname: Faustin
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Kelsy E
authors.initials: KE
authors.lastname: Greenwald
authors.affiliation: Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.|Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.|Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.|Division of Infectious Disease, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.affiliation: Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114-2698, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.|Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.|Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012036:Refugees; D012044:Regression Analysis; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; HIV screening; HIV testing; Refugee; sub-Saharan Africa