Priorities for Local AIDS Control Efforts Uganda, 2013-2014

Author(s): MEASURE Evaluation

Year: 2014

Abstract:

Uganda has a long history of successful HIV prevention that saw the decrease of HIV prevalence from its peak in 1990-1992 when HIV prevalence among women attending urban antenatal clinics ranged from 20% -30% to under 6% in the new millennium. However, despite the earlier registered success in the fight against HIV/AIDs and the marked increase in HIV treatment and care programs in Uganda, new HIV infections are on the rise. The 2011 Uganda AIDS Indicator Survey (UAIS) found that HIV prevalence in the general population increased nationally from 6.4% to 7.3% since the previous survey in 2004. Prevalence increased among both men and women and is higher in urban than in rural areas. According to modes of transmission assessments, a high proportion of new infections may be occurring in stable sero-discordant couples, but the “upstream” drivers of the epidemic are not well characterized. Given the wide variation in HIV prevalence across the country, it is likely that drivers of the epidemic are local and not only concentrated in urban and along major highways as previously thought. Consequently, effective district level responses would be most effective if they were tailored to local epidemics. Unfortunately, however, there is little information on most at risk populations outside of Kampala and other major urban areas.

The Priorities for Local AIDS Control Efforts (PLACE) method is a monitoring tool to identify priority prevention areas (PPAs) in a country and the specific venues within these areas where AIDS prevention pro-grams should be focused. The method translates the scientific principles of HIV/STI transmission epidemiology and applies new technologies in spatial analysis and HIV rapid testing into a step-by-step rapid assessment and planning tool for use at the local level. Scientific principles, available data, and information from experts are used to identify districts likely to have high incidence of HIV infection. Within these dis-tricts, a rapid assessment identifies gaps in HIV prevention programs. PLACE maps specific risk sites and provides indicators of the characteristics and behaviors of key populations that are critical to designing effective prevention programs.

Thirty districts in Uganda participated in the PLACE activities, carried out from July 2013 through July 2014. Districts were selected based on criteria determined by national-level stakeholders from the UAC, MOH, and USAID.