1. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Targeting Zero new HIV infections: Determinants of HIV sero conversion (HIVSC) among individuals receiving HIV testing and Counseling (HTC) at The AIDS Support Organization (TASO) Uganda Ssali Livingstone, Nantume Sophie, Okoboi Stephen, Ouculu Lazarus, Dr. Etukoit B. Michael 18 th International Conference on AIDS & STI’s in Africa(ICASA), 29 th November to 4 th December 2015, Harare, Zimbabwe Theme: “ AIDS in post 2015: Linking Leadership, Science and Human Rights” Reference Number: TUAC0506

2. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Objectives  Few studies have evaluated the determinants of HIV sero conversion among patients receiving HIV testing in resource limited settings, especially SSA  TASO initiated the HIV testing program in 2004.  Factors studied: Gender, type of venue, marital status, age, type of population, access of HTC by spouse, and TASO site over a 2 year period.  To demonstrate how data can be used to improve programming.

3. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Uganda 1. Population: 35.6M 2. Population living with HIV: 1.6M 3. HIV prevalence: 7.3% 4. GDP per capita: US$696.4 5. Per capita health expenditure: US$59 Citations:1,2,3: National HIV Strategic Plan 2015/2016 - 2019/2020 4,5: World Bank, 2015 Photo : Uganda Bureau of statistics 2014

4. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org The AIDS Support Organisation (TASO)  NNGO Founded in 1987.  Vision: “A world without HIV and AIDS”.  Mission: To contribute to the process of preventing HIV infection, restoring hope & improving the quality of life of PLHIV & their families.  PLHIV cared for Annually :120,000

5. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Methodology-1  Study Design Retrospective Cohort Study.  Data sources Routine program data HTC datasets from 4 TASO centers for the period 2012- 2013. HTC records of 101,053 individuals

6. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Methodology-2  Data extraction  Four TASO centres are located in the four regions of the country  Northern-TASO Gulu;  Central-TASO Mulago,  Eastern-TASO Tororo  Western-TASO Masindi  Individuals who had previously tested HIV negative at 3 months or 6months or 12months and had been re-tested at the time of analysis

7. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Methodology-3  Demographics details of age, sex, site, marital status  Outcomes of HIVSC among Key populations (MSM, CSW)  Outcomes of HIVSC among priority populations (Incarcerated populations, youth in school, and youth out of school, Clients of sex workers, Orphanage, market vendors and couples)  Descriptive statistics and multivariate logistic regression assessing associations in demographic and status on major outcomes.

8. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Socio-demographic characteristics of HTC Individuals CharacteristicsNumber of casesPercent(%) Sex Female 33,181(33) Male 67,872(67) Type of Venue Outreach 80,944(80) Static 20,109(20) Marital Status Married37,699(37) Single61,852(61) Widowed1,502(2) Age group of Individuals Less than 9 years (Children) 1,241(1) 10-19 years (Adolescents) 42,190(42) 20+ years (Adults) 57,620(57)

9. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Socio-demographic characteristics of HTC Individuals CharacteristicsNumber of cases Percent(%) Type of Population Priority Population 96,783(96) Key Population (MSM, SW) 4,270(4) Spouse/Sexual partner Tested for HIV No 77,791(77) Yes 23,262(23) Approach to HTC Client Initiated Testing and Counselling (CITC)92,917(92) Provider Initiated Testing and Counselling (PITC)6,479(6) Home-based HIV Counselling and Testing (HBHCT)514(1) Prevention of Mother to Child Transmission (PMTCT)1,096(1) Mandatory Testing including PEP47(0) TASO sites used in the Assessment11,724(12) TASO Gulu36,424(36) TASO Masindi20,861(20) TASO Mulago32,044(32) TASO Tororo11,724(12)

10. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Socio-demographic factors associated with HIV Sero conversion Multivariate Covariate AOR (95% CI)p-value Sex Female (Ref) Male 0.63(0.60-0.66)0.000 Type of Venue Outreach(Ref) Static 0.76(0.72-0.80)0.000 Marital Status Married(Ref) Single0.67(0.64-0.71)0.000 Widowed0.98(0.86-1.12)0.770 Age group of Individuals Less than 9 years (Children) (Ref) 10-19 years (Adolescents)0.80(0.65-0.98)0.032 20+ years (Adults)1.96(1.59-2.39)0.000

11. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Individual/ Health facility factors associated with HIV Sero conversion Multivariate Covariate AOR (95% CI)p-value Type of Population Priority Population(Ref) Key Population (MSM, SW)1.06(0.97-1.16)0.154 Spouse/Sexual partner Tested for HIV No(Ref) Yes1.17(1.12-1.23)0.000 Approach to HTC Client Initiated Testing and Counselling (CITC)- Provider Initiated Testing and Counselling (PITC)- Home-based HIV Counselling and Testing (HBHCT)- Prevention of Mother to Child Transmission (PMTCT)- Mandatory Testing including PEP- TASO sites used in the Assessment TASO Gulu (Ref) TASO Masindi 0.71(0.67-0.75)0.000 TASO Mulago 0.65(0.61-0.69)0.000 TASO Tororo 0.57(0.53-0.60)0.000

12. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Couple Counseling Session

13. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Conclusion - 1 Gender: Men had reduced chances of HIVSC compared to females. Type of venue: Individuals who received HTC at static sites had reduced chances of HIVSC compared to those at outreach sites. Marital Status: Individuals who were single had reduced chances of HIVSC, compared to those who were married/cohabiting. Age: Adults had increased chances of HIVSC, compared to Adolescents.

14. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Conclusion - 2 Access of HTC by partner: Individuals with partners of known HIV sero status had increased chances of HIVSC, compared to those with partners of unknown HIV Counselor conducting Home-based HIV counseling and testing (HBHCT)

15. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Take home message  Sexual prevention programs should target the continuum of HIV prevention among individuals that test HIV negative.  Targeted Behaviour Change Communication programs should address differences observed in Gender, marital status, age, site of HTC, and sexual partners in relation to HIVSC.  Intensify data use to enhance programs.

16. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Limitation  The study did not cover all the 11 TASO CoE

17. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Acknowledgements  TASO Co-authors  TASO Staff  TASO Management  Conference Organizers for the full scholarship

18. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org  THANK YOU FOR YOUR ATTENTION

19. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org In Partnership With;