1. Uganda Virus Research Institute The contribution of HIV incidence and antiretroviral (ART) accessibility to HIV prevalence trends among adults in rural South West Uganda Jessica Nakiyingi-Miiro MRC/UVRI Uganda Research Unit on AIDS Date: 22 July 2014

2. Methods Annual census and socio-demographic data from approx 10,000 adults Annual health data and HIV serology until 2011, then biennial Free ART introduced in the area in 2004; 42% on ART by end of 2012. Background In the 1990s, HIV prevalence and incidence declined in Uganda; attributed primarily to a reduction in risky sexual behaviour. The latest Uganda sero-behavioural survey indicates that national HIV prevalence increased from 6.4% in 2004/05 to 7.3% in 2011. Study site Objective To obtain the association of HIV incidence trends and ART uptake with HIV prevalence trends using longitudinal data from rural Uganda

3. MalesFemale Residents6.5%7.8% In-migrants9.7%15.2% Out-migrants10.7%15.4% Deaths42.6%59.3% All adults6.9%8.5% 27,257 participants: 46% males; 61% resident at joining Average annual migration: 8.2% in-migrants; 10.3% out-migrants Table 1: HIV prevalence Results

5. Discussion Recent increase in HIV prevalence may be due to: the increasing ART uptake; declining mortality among HIV-infected adults; and higher HIV prevalence among in/out-migrants Fig 5: Distribution of HIV positive cases

6. Acknowledgement This research is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. Study participants from the MRC General Population Cohort Staff of MRC/UVRI Uganda Prof. Ziv Shkedy of Hasselt university, Belgium Conference attendance funded by AIDS 2014

8. Uganda Virus Research Institute RESIDENTS AND NEW-BORNS Additional slides

9. Fig 2.2: Distribution of HIV positive cases in resident population