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close this bookEmerging Patterns of HIV Incidence in Uganda and other East African Countries (International Center for Migration and Health - ICMH, 1997, 97 pages)
close this folder3.0 HIV prevalence declines in antenatal sentinel surveillance sites in Uganda
close this folder3.1 External validation of apparent declining HIV prevalence in Uganda: Identification and analyses of collateral data.
View the document(introductory text...)
View the document3.1.1 HIV prevalence trends in blood donors: - National Blood Transfusion Services, Nakasero Blood Bank, and Ministry of Health, Kampala, Uganda.
View the document3.1.2 HIV prevalence and incidence trends in Military recruits
View the document3.1.3 HIV prevalence trends in attendees of an AIDS counselling and testing service: - The AIDS Information Centre (AIC)
View the document3.1.4 HIV prevalence trends in Mulago Hospital ANC, Kampala, 1989-96.
View the document3.1.5 HIV/TPHA prevalence trends in ANC population: Basic Health Services project, Kabarole District, Western Uganda.
View the document3.1.6 HIV incidence and prevalence trends in a rural cohort, Masaka district: Medical Research Council (MRC) Programme on AIDS.
View the document3.1.7 HIV prevalence trends in Rakai District: Makerere, Johns Hopkins, and Columbia Universities.

3.1.4 HIV prevalence trends in Mulago Hospital ANC, Kampala, 1989-96.

The Department of OB/GYN, at Makarere University in collaboration with Case Western Reserve University, WHO, and Johns Hopkins University have been involved in cohort studies of HIV and reproductive health among women attending clinics at Mulago Hospital since 1989. Patient selection methods differ from those used at antenatal clinic sentinel surveillance in that study entry is voluntary, involves informed consent, is restricted to women living within 15 km of Kampala, and involves women who agree to HIV testing (notification of results is voluntary). Study participation rates are high and there appear to be no notable differences between participants and non-participants.

This study population provides a comparative ANC population to that at Nsambya and Rubaga, which are the Kampala ANC sentinel sites. The study population may be less influenced by the potential of changing population denominator characteristics such as residence (in migration of persons from areas with lower HIV prevalence rates which could result in a "dilution effect" and hence an apparent decline in HIV prevalence). Figures 8 and 9 show trends in ANC sentinel sites in Kampala according to time and age, and also provide a comparison of age-specific prevalence over time at the Kampala ANC sentinel and the Mulago ANC clinic population.

Figure 8: Trends in HIV prevalence (%) overall and by age at the Nsambya and Rubaga antenatal sentinel surveillance sites (urban Kampala), 1991-96.

Figure 8: Trends in HIV prevalence (%) overall and by age at the Nsambya and Rubaga antenatal sentinel surveillance sites (urban Kampala), 1991-96.

Figure 9: Trends in HIV prevalence (%) by age at the urban Kampala sentinel surveillance sites (Nsambya and Rubaga) compared to the Mulago clinic antenatal cohort (urban Kampala), 1992-96.

The data illustrate decreasing prevalence rates among 15-19 and 20-24 year olds that are similar to those observed in the sentinel sites. Only data for Mulago were available for the 1994-96 period. Data for Mulago for 1991-93 are currently being analysed by WHO/HRP in Geneva.

Differences in prevalence in the age group 25-29 are statistically significant and most likely reflect differences in patient selection, the Mulago cohort being a non-random selection from stable residents. The fact that the observed trends are in all other respects similar to those of ANC sentinel sites suggest that migration into Kampala is not influencing HIV prevalence declines.