TY - JOUR
T1 - Household wealth and HIV incidence over time, rural Uganda, 1994-2018
AU - Santelli, John S.
AU - Chen, Ivy
AU - Makumbi, Fred
AU - Wei, Ying
AU - Nalugoda, Fred
AU - Lutalo, Tom
AU - Spindler, Esther
AU - Grilo, Stephanie A.
AU - Deisher, Andrea
AU - Grabowski, Katherine
AU - Hoffman, Susie
AU - Kagaayi, Joseph
AU - Chang, Larry W.
AU - Gray, Ronald
AU - Wawer, Maria
AU - Serwadda, David
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objective:To examine the relationship between household wealth and HIV incidence in rural Uganda over time from 1994 to 2018. In research conducted early in the epidemic, greater wealth (i.e. higher socioeconomic status, SES) was associated with higher HIV prevalence in sub-Saharan Africa (SSA); this relationship reversed in some settings in later years.Design:Analysis of associations over time in a population-based open cohort of persons 15-49 years from 17 survey-rounds in 28 continuously followed communities of the Rakai Community Cohort Study (RCCS).Methods:The RCCS sample averaged 8622 individuals and 5387 households per round. Principal components analysis was used to create a nine-item asset-based measure of household wealth. Poisson regression with generalized estimating equation (GEE) and exchangeable correlation structure was used to estimate HIV incidence rate ratios (IRRs) by SES quartile, survey-round, sex, and age group.Results:From 1994 to 2018, SES rose considerably, and HIV incidence declined from 1.45 to 0.40 per 100 person-years (IRR = 0.39, 95% CI = 0.32 - 0.47, P < 0.001). HIV incidence was similar by SES category in the initial survey intervals (1994-1997); however, higher SES groups showed greater declines in HIV incidence over time. Multivariable analyses showed significant associations between HIV incidence and SES (IRR = 0.55 for highest compared with lowest quartile, 95% CI = 0.45 - 0.66, P < 0.001) controlling for time, sex, and age group.Conclusion:Beyond the early years of the RCCS, higher SES was associated with lower HIV incidence and SES gradients widened over time. The poor, like other key populations, should be targeted for HIV prevention, including treatment as prevention.
AB - Objective:To examine the relationship between household wealth and HIV incidence in rural Uganda over time from 1994 to 2018. In research conducted early in the epidemic, greater wealth (i.e. higher socioeconomic status, SES) was associated with higher HIV prevalence in sub-Saharan Africa (SSA); this relationship reversed in some settings in later years.Design:Analysis of associations over time in a population-based open cohort of persons 15-49 years from 17 survey-rounds in 28 continuously followed communities of the Rakai Community Cohort Study (RCCS).Methods:The RCCS sample averaged 8622 individuals and 5387 households per round. Principal components analysis was used to create a nine-item asset-based measure of household wealth. Poisson regression with generalized estimating equation (GEE) and exchangeable correlation structure was used to estimate HIV incidence rate ratios (IRRs) by SES quartile, survey-round, sex, and age group.Results:From 1994 to 2018, SES rose considerably, and HIV incidence declined from 1.45 to 0.40 per 100 person-years (IRR = 0.39, 95% CI = 0.32 - 0.47, P < 0.001). HIV incidence was similar by SES category in the initial survey intervals (1994-1997); however, higher SES groups showed greater declines in HIV incidence over time. Multivariable analyses showed significant associations between HIV incidence and SES (IRR = 0.55 for highest compared with lowest quartile, 95% CI = 0.45 - 0.66, P < 0.001) controlling for time, sex, and age group.Conclusion:Beyond the early years of the RCCS, higher SES was associated with lower HIV incidence and SES gradients widened over time. The poor, like other key populations, should be targeted for HIV prevention, including treatment as prevention.
KW - AIDS
KW - HIV incidence
KW - socioeconomic status
KW - sub-Saharan Africa
KW - wealth
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U2 - 10.1097/QAD.0000000000002989
DO - 10.1097/QAD.0000000000002989
M3 - Article
C2 - 34132219
AN - SCOPUS:85114521794
SN - 0269-9370
VL - 35
SP - 1835
EP - 1843
JO - AIDS
JF - AIDS
IS - 11
ER -