The Epidemiology of HIV around Open Access

Abstract

Background: HIV remains a major public health concern, particularly in sub-Saharan Africa (SSA), where most of the global burden is concentrated. Communities surrounding Lake Victoria in East Africa are considered high-risk populations. We analyzed HIV and viral load metrics in Kenya, Uganda, and Tanzania using population-based HIV impact assessment (PHIA) surveys. Monitoring viral load is crucial to achieving targets like UNAIDS 90-90-90 and reducing the global HIV burden.

 

Objective: This study aims to describe HIV epidemiology around Lake Victoria using PHIA surveys, comparing age and sex-specific population viremia levels as a marker for transmission in SSA.

 

Methods: We conducted an analysis of cross-sectional data from PHIA surveys in Kenya, Uganda, and Tanzania from 2016 to 2019, focusing on adults aged 15-64 (or up to 80 in Tanzania). A stratified two-stage cluster sampling design was used, and data were collected through interviews and biological measures. The study received ethics approval in all three countries.

 

Results: Our analysis revealed substantial differences in HIV prevalence and viral load suppression (VLS) rates across the three countries. Uganda had the highest HIV prevalence (6.3%, 95% CI: 5.8%, 6.7%), followed by Kenya (4.9%, 95% CI: 4.5%, 5.3%), and Tanzania (4.9%, 95% CI: 4.5, 5.2). Kenya had the highest VLS rate (71.6%), Uganda had 59.6%, and Tanzania had the lowest (51.8%). Females consistently had higher HIV prevalence and VLS rates than males. Viremia estimates varied by age and gender, with younger males experiencing the lowest rates and older females attaining the highest. Lake regions within these countries consistently reported higher viremia, HIV prevalence and VLS rates compared to non-lake regions.

 

Conclusion: This study highlights the importance of population viremia as a proxy for HIV transmission, revealing disparities in community viral load around Lake Victoria and between genders. These findings emphasize the need for targeted interventions to address higher HIV prevalence in lake regions and improve VLS rates, particularly among young males. By addressing gender-specific challenges and age-related disparities in VLS, we can develop more effective strategies to reduce HIV transmission. A comprehensive, multi-sectoral approach is necessary to address the unique challenges faced by communities around Lake Victoria.

 

Table of Contents

INTRODUCTION 1

METHODS 2

RESULTS 5

DISCUSSION 8

REFERENCES 11

APPENDIX 14

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Epidemiology of HIV HIV in Tanzania HIV around Lake Victoria in Tanzania Public health Factors affecting HIV prevalence in Kenya, Uganda and Tanzania Lake Victoria HIV prevalence HIV in East Africa HIV around Lake Victoria in Kenya HIV in Uganda HIV in Kenya HIV around Lake Victoria in Uganda Public health in East Africa
Committee Chair / Thesis Advisor	Dr. Andrew Voetsch, CDC Dr. Patrick S. Sullivan, Emory University
Partnering Agencies	CDC

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