Modelling the impact of combining HIV prevention interventions on HIV dynamics in fishing communities in Uganda

BackgroundIn countries with mature generalized HIV epidemics such as Uganda, there are still groups of individuals that are disproportionately affected. These most at risk populations (MARPs) have high HIV prevalence compared to the general population. Among the MARPs in Uganda are fishing communities, which make up about 10% of the population. MethodsWe investigated the impact of combined HIV prevention interventions on HIV transmission dynamics in high-risk fishing communities in Uganda using a deterministic compartmental model. The model was calibrated to seroprevalence data from a census performed in 2014. To account for remaining uncertainty in the calibrated model parameters, an additional 50 000 simulated scenarios were modelled to investigate the impact of combined interventions. ResultsThe projected HIV incidence decreased from 1.87 per 100 PY without intervention scale-up to 0.25 per 100 PY after 15 years (2014-2029) of intervention scale-up. A potential combination achieving this 87% reduction in incidence included condom use in about 60% of sexual acts, 23% of susceptible men circumcised, 87% of people living with HIV aware of their status, 75% of those on ART, and about 3% of susceptible individuals on oral PrEP. Uncertainty analysis revealed relative reductions in incidence ranging from 30.9% to 86.8%. Sensitivity analyses suggested that condom use and early ART were the most important intervention components. ConclusionsReducing HIV incidence, and consequently prevalence and AIDS-related mortality, in these high-risk fishing communities in Uganda is attainable in the long-run with a combination prevention package. Our projected intervention coverage levels are well within the national targets set by the Uganda government and close to reaching the UNAIDS 95-95-95 goal to end AIDS by 2030.