HIV epidemic and cascade of care in 12 east African rural fishing communities: results from a population-based survey in Uganda.

backgroundIn East Africa, fishing communities are considered most-at-risk populations for the acquisition of HIV. We estimated HIV prevalence and assessed progress towards the UNAIDS 90-90-90 targets along the HIV treatment cascade in 12 fishing communities surrounding Lakes Edward and George, Uganda.

methodsWe conducted a cross-sectional household-based survey between September and November 2016. All adults between 15 and 69 years old were eligible to participate. Children below 15 years old were eligible for HIV testing if either parent was HIV-positive. Viral load testing was done for all HIV-infected individuals. Logistic regression models adjusted for sociodemographic-behavioral variables were used to assess the association between occupation and HIV positivity.

resultsOverall, 1738 adults (959 women, 779 men) and 148 children were included. Adult inclusion rate was 96.0%. Of the men, 58% reported to be fishermen. The HIV-prevalence among adults was 17.5% (95%CI: 15.8-19.4) and 6.1% (95%CI: 3.1-11.4) among HIV-exposed children. HIV prevalence was higher among women than among men (20.9% vs. 13.5%, p < 0.001). Among men, fishermen had a higher HIV prevalence (18.7%; 95%CI: 15.1-22.3) and a higher risk of being HIV-positive (aOR: 4.2; 95%CI: 2.0-9.1) than men of other occupations (p < 0.001). Progress towards the UNAIDS 90-90-90 targets was as follows: 86.5% (95%CI: 82.3-90.1%) of the HIV-positive participants were diagnosed, 98.7% (95%CI: 96.1-99.6%) of those aware were on antiretroviral therapy (ART), and 87.3% (95%CI: 82.3-91.0%) of those on ART were virally suppressed. Overall, 73% of all HIV-positive individuals were virally suppressed. Viral suppression was lower among individuals 15-24 years (45.5%) than among those 25-44 years (74.0%) and 45-69 years (85.0%), p < 0.001. Fishermen did not to have significant differences in the HIV cascade of care compared to men with other occupations.

conclusionsHIV prevalence was high in these fishing communities, particularly among women and fishermen. Important progress has been made along the HIV treatment cascade, and the UNAIDS goal for viral suppression in population was achieved. However, gaps remain and HIV care strategies focusing on young people are urgently needed. HIV preventive interventions should target particularly women, young people and fishermen though HIV preventive and care services should remain available to the whole fishing communities.