HIV testing and prevalence in fishing communities in rural Uganda: a cross-sectional study of 3197 individuals within SchistoTrack
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Introduction
Fisherfolk are recognised as a priority population for HIV control in generalised epidemic settings, yet information on differences in testing, diagnosis, and care cascade engagement compared to the general population remain limited.
Methods
We conducted a cross-sectional analysis of 3197 participants aged 5-92 years within the SchistoTrack community-based cohort in rural Uganda. From 15 January to 12 February 2024, participants from 52 shoreline villages in Pakwach, Buliisa, and Mayuge districts were tested for HIV using rapid diagnostic tests following the national testing algorithm and completed a structured HIV history survey with a district HIV counsellor. Six definitions of fisherfolk were assessed among 1931 adult participants using univariate and adjusted logistic regressions (controlling for age, gender, and district) of ever testing for HIV, testing in the past 12 months, and HIV status. Backward stepwise selection based on the lowest Bayesian Information Criterion was used to select fisherfolk and other participant variables.
Results
Overall, 6.94% (134/1931) of adult participants were living with HIV (PLHIV), of whom 22.39% (30/134) were newly diagnosed. 6.02% (25/415) of adults reporting fishing activities were HIV-positive. Of those, 80% (20/25) were status-aware, 76% (19/25) were on ART, and 100% (8/8) of those who knew their viral load reported viral suppression. No significant differences in care cascade engagement were found between PLHIV reporting fishing activities and the general population. Measured viral suppression was 70.59% (72/102) among PLHIV, with no significant differences by fishing activities. Fishing activities were significantly associated with higher odds of ever testing for HIV (OR 1.76, 95% CI 1.22-2.54), but not with testing in the past 12 months or HIV status. No consistent district-level differences were observed.
Conclusion
Individuals reporting fishing activities had higher lifetime testing and comparable HIV prevalence and care cascade engagement to the general population, although neither population met UNAIDS 95-95-95 targets.
