A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife.

This study aims at estimating the recent trends in HIV-1 prevalence and the factors associated with infection among pregnant women in the Gulu District of north Uganda, a rural area severely affected by civil strife. In 2000-2003, a total of 4459 antenatal clinic attendees of Lacor Hospital were anonymously tested for HIV-1 infection. The overall and age-specific prevalence did not show any significant trend over time. The age-standardized prevalence slightly declined, from 12.1% in 2000 to 11.3% in 2003. Increased age [20-24 years: adjusted odds ratio (AOR) 1.63; 95% CI 1.18-2.25; >or=25 years: AOR 2.56; 95% CI 1.91-3.44], residence in urban areas (AOR 1.76; 95% CI 1.41-2.18), being unmarried (AOR 1.60; 95% CI 1.27-2.01), increased age of partner (25-34 years: AOR 1.87; 95% CI 1.29-2.73; >or=35 years: AOR 2.68; 95% CI 1.72-4.16), modern occupation of partner (AOR 1.98; 95% CI 1.53-2.58), and short time of residence at the current address (AOR 1.36; 95% CI 1.05-1.76) were associated with infection. The HIV-1 prevalence in this rural district is high and similar to that observed in urban antenatal clinics, probably reflecting the effect of the last 18 years of civil strife.

HIV-1 prevalence and factors associated with infection in the conflict-affected region of North Uganda.

BACKGROUND: Since 1986, northern Uganda has been severely affected by civil strife with most of its population currently living internally displaced in protected camps. This study aims at estimating the HIV-1 prevalence among this population and the factors associated with infection. METHODS: In June-December 2005, a total of 3051 antenatal clinics attendees in Gulu, Kitgum and Pader districts were anonymously tested for HIV-1 infection as part of routine sentinel surveillance. Factors associated with the infection were evaluated using logistic regression models. RESULTS: The age-standardised HIV-1 prevalence was 10.3%, 9.1% and 4.3% in the Gulu, Kitgum and Pader district, respectively. The overall prevalence in the area comprised of these districts was 8.2% when data was weighted according to the districts' population size. Data from all sites combined show that, besides older women [20-24 years: adjusted odds ratio (AOR) = 1.96, 95% confidence interval (CI): 1.29-2.97; 25-29 years: AOR = 2.01, 95% CI: 1.30-3.11; > or = 30 years: AOR = 1.91, 95% CI: 1.23-2.97], unmarried women (AOR = 1.47, 95% CI: 1.06-2.04), and those with a partner with a non-traditional occupation (AOR = 1.62, 95% CI: 1.18-2.21), women living outside of protected camps for internally displaced persons have a higher risk of being HIV-1 infected than internally displaced women (AOR = 1.55, 95% CI: 1.15-2.08). CONCLUSION: Although published data from Gulu district show a declining HIV-1 prevalence trend that is consistent with that observed at the national level since 1993, the prevalence in North Uganda is still high. Internally displaced women have a lower risk of being infected probably because of their reduced mobility and accessibility, and increased access to health prevention services.

Adjusting HIV prevalence data from a program for the prevention of mother-to-child transmission for surveillance purposes in Uganda.

OBJECTIVES: To evaluate a method for adjusting estimates of HIV prevalence based on data from a program for the prevention of mother-to-child transmission (PMTCT) of HIV infection for the potential bias attributable to refusal of PMTCT-related testing. METHODS: Age-specific logistic regression models were used to estimate the HIV risk coefficients for 10 predictor variables among women who accepted the PMTCT-related testing (n = 1874) at an antenatal clinic in northern Uganda. These risk coefficients were used to predict the prevalence among women who were not tested (n = 1719) and to adjust the PMTCT-based prevalence for nonparticipation bias. Crude and adjusted PMTCT-based prevalence estimates were compared with the prevalence among women who were anonymously tested as part of routine sentinel surveillance (n = 2225). RESULTS: The PMTCT-based prevalence represented an underestimate compared with that based on anonymous surveillance in 2004 (9.0% vs. 10.5%); in 2005, it constituted an overestimate (11.8% vs. 10.9%). Adjusting the PMTCT-based prevalence reduced the difference attributable to nonparticipation bias by approximately 70% in both years, so that the adjusted prevalence (10.1% in 2004 and 11.2% in 2005) was similar to the surveillance-based prevalence. CONCLUSIONS: The adjustment method was effective in reducing the nonparticipation bias. Further studies are needed to assess the utility of PMTCT program data for HIV surveillance.