Kiwanuka Noah, Mpendo Juliet, Nalutaaya Annet, Wambuzi Matthias, Nanvubya Annet, Kitandwe Paul K, Muyanja Enoch, Ssempiira Julius, Balyegisawa Apolo, Ssetaala Ali
Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda.
BMC Public Health. 2014 Sep 22;14:986. doi: 10.1186/1471-2458-14-986.
BACKGROUND: An effective HIV vaccine is still elusive. Of the 9 HIV preventive vaccine efficacy trials conducted to-date, only one reported positive results of modest efficacy. More efficacy trials need to be conducted before one or more vaccines are eventually licensed. We assessed the suitability of fishing communities in Uganda for future HIV vaccine efficacy trials. METHODS: A community-based cohort study was conducted among a random sample of 2191 participants aged 18-49 years. Data were collected on socio-demographic characteristics, HIV risky behaviors, and willingness to participate in future HIV vaccine trials (WTP). Venous blood was collected for HIV serological testing. Retention/follow rates and HIV incidence rates per 100 person years at-risk (pyar) were estimated. Adjusted prevalence proportion ratios (PPRs) of retention and odds ratios (ORs) of lack of WTP were estimated using log-binomial and logistic regression models respectively. RESULTS: Overall retention rate was 76.9% (1685/2191), highest (89%) among participants who had spent 5+ years in the community and lowest (54.1%) among those with <1 year stay. Significant predictors of retention included tribe/ethnicity, baseline HIV negative status, and longer than 1 year stay in the community. Overall WTP was 89.1% (1953/2191). Lack of WTP was significantly higher among women than men [adj.OR = 1.51 (95% CI, 1.14- 2.00)] and among participants who had stayed in fishing communities for 10 or more years relative to those with less than one year [adj.OR = 1.78 (95% CI, 1.11 - 2.88)]. Overall HIV incidence rate per 100 pyar was 3.39 (95% CI; 2.55 - 4.49). Participants aged 25-29 years had highest incidence rates (4.61 - 7.67/100 pyar) and high retention rates between 78.5 and 83.1%. In a combined analysis of retention and incidence rates participants aged 30+ years had retention rates ~80% but low incidence rates (2.45 - 3.57 per 100 pyar) while those aged 25-29 years had the highest incidence rates (4.61 - 7.67/100 pyar) and retention rates 78.5 - 83.1%. CONCLUSIONS: There is high HIV incidence, retention and WTP among fishing communities around L. Victoria, Uganda which make these communities appropriate for future HIV prevention efficacy studies including vaccine trials.
背景：有效的HIV疫苗仍难以实现。在迄今为止进行的9项HIV预防性疫苗效力试验中，只有一项报告了适度效力的阳性结果。在一种或多种疫苗最终获得许可之前，需要进行更多的效力试验。我们评估了乌干达渔业社区对未来HIV疫苗效力试验的适用性。 方法：在2191名年龄在18 - 49岁的参与者的随机样本中进行了一项基于社区的队列研究。收集了社会人口学特征、HIV危险行为以及参与未来HIV疫苗试验的意愿（WTP）等数据。采集静脉血进行HIV血清学检测。估计了保留/随访率以及每100人年危险暴露（pyar）的HIV发病率。分别使用对数二项式回归模型和逻辑回归模型估计了保留率的调整患病率比例比（PPR）和缺乏WTP的优势比（OR）。 结果：总体保留率为76.9%（1685/2191），在社区居住5年以上的参与者中最高（89%），而居住时间不足1年的参与者中最低（54.1%）。保留的显著预测因素包括部落/种族、基线HIV阴性状态以及在社区居住超过1年。总体WTP为89.1%（1953/2191）。女性中缺乏WTP的比例显著高于男性[调整后OR = 1.51（95%CI，1.14 - 2.00）]，并且在渔业社区居住10年或更长时间的参与者相对于居住时间不足1年的参与者中缺乏WTP的比例也更高[调整后OR = 1.78（95%CI，1.11 - 2.88）]。每100 pyar的总体HIV发病率为3.39（95%CI；2.55 - 4.49）。年龄在25 - 29岁的参与者发病率最高（4.61 - 7.67/100 pyar），保留率在78.5%至83.1%之间。在保留率和发病率的综合分析中，30岁及以上的参与者保留率约为80%，但发病率较低（每100 pyar为2.45 - 3.57），而25 - 29岁的参与者发病率最高（4.61 - 7.67/100 pyar），保留率为78.5% - 83.1%。 结论：乌干达维多利亚湖周边渔业社区的HIV发病率、保留率和WTP都很高，这使得这些社区适合未来包括疫苗试验在内的HIV预防效力研究。
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