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HIV retesting and risk behaviors among high-risk, HIV-uninfected adults in Uganda
Kara Marson1, Alex Ndyabakira2, Dalsone Kwarisiima2
1Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA.
Insights
High-risk adults in Uganda commonly engage in HIV risk behaviors, but frequent HIV retesting is low, especially among men. Targeted interventions are needed to increase retesting rates in this population.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- Limited data exists on HIV retesting patterns among high-risk adults in sub-Saharan Africa.
- Understanding retesting behaviors is crucial for HIV prevention and control efforts in the region.
Purpose of the Study:
- To characterize HIV retesting frequency and associated risk factors among high-risk adults in Southwest Uganda.
- To identify disparities in HIV testing behaviors between men and women in this population.
Main Methods:
- A cross-sectional study was conducted in Southwest Uganda from October-December 2018.
- Recruitment involved distributing cards at venues frequented by at-risk individuals, leading to health evaluations and HIV testing.
- Data collected included HIV testing history, risk factors (e.g., multiple partners, transactional sex), and demographic information.
Main Results:
- Of 1,482 adults attending the clinic, 23% were HIV-positive. Among 1,148 HIV-negative adults, 29% were classified as highest risk (≥3 risk factors).
- Frequent HIV testing (≥3 tests/year) was reported by 18% of HIV-negative adults, with similar rates in women (19%) and men (16%).
- Among women, highest-risk individuals were more likely to report any HIV testing (90% vs. 81%) and frequent testing (25% vs. 18%) compared to lower-risk individuals. Among men, testing frequency did not differ by risk level.
Conclusions:
- Despite high prevalence of HIV risk behaviors in peri-urban Uganda, frequent HIV retesting remains low.
- Interventions promoting HIV retesting are necessary, with a particular focus on engaging men.
- Addressing barriers to retesting, especially for men, is critical for effective HIV prevention strategies.
Abstract:
There are limited data characterizing HIV retesting among high-risk adults in sub-Saharan Africa. From October-December 2018, we distributed recruitment cards offering health evaluations with HIV testing at venues frequented by individuals at-risk of HIV infection in Southwest Uganda. Those who attended were asked about their HIV testing history and risk factors: having >1 sexual partner, an HIV+ partner, STIs, and/or transactional sex. We defined "highest risk" as ≥3 risk factors and "frequent testing" as ≥3 tests within the past year. Of 1,777 cards distributed, 1,482 (83%) adults came to clinic: median age was 26(IQR: 22-31), 598 (40%) were men, and 334 (23%) were HIV+. Of 1,148 HIV-negative adults, 338 (29%) were highest risk and 205 (18%) were frequent testers. Frequent testing was similar in women (19%) and men (16%, p = 0.22). Among women, those at highest risk were more likely to report any testing (90% vs. 81%, p = 0.01) and frequent testing (25% vs. 18%, p = 0.06) than those at lower risk. Among men, any testing and frequent testing were similar between risk levels. Among adults recruited from high-risk venues in peri-urban Uganda, HIV risk behaviors were commonly reported, yet frequent retesting remained low. Interventions to promote retesting are needed, particularly among men.
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