Knowledge of HIV status in a rural Ugandan population with a sustained, generalised HIV epidemic.

Abstract

For people living with HIV, knowledge of their status is essential to access antiretroviral therapies (ART). This knowledge can be measured by population surveys that record self-reported HIV status before offering HIV testing. We conducted a survey among residents of 25 villages in the rural sub-county of Kyamulibwa in Southwest Uganda where there has been a sustained, generalised HIV epidemic. Through the survey we determined the proportions of those living with HIV who knew their status (with reference to UNAIDS targets), exposures associated with knowledge of HIV status, and the proportions of those who knew their HIV status who reported taking ART. Data were collected from June 2019 to July 2021. Among survey participants, 39.7% of men and 28.7% of women had never tested for HIV. This was associated with older age, male sex, lower education and never having been married. All participants consented to HIV testing and 99.9% had a result. 83.6% of men and 88.0% of women living with HIV already knew their status. Of these, 99% of men and women reported taking ART. Of those never previously tested, 2.5% of men and 2.7% of women received a positive diagnosis. HIV prevalence was 8.1% among men and 10.5% among women. While significant proportions of survey participants did not know their HIV status they did not represent a large source of undiagnosed HIV infection. The proportions of men and women living with HIV who already knew their status were below current UNAIDS targets to end AIDS by 2030, and the study highlighted groups for whom participation in testing needs to increase. Among those with HIV who knew their status almost all reported taking ART, suggesting high acceptance and good availability of treatment. The overall prevalence of HIV among survey participants means that reliable access to sufficient ART is essential.