Published in PLOS One on 2026-05-08, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Sylvia Kusemererwa, Sheila Kansiime, Gertrude Mutonyi, Ayoub Kakande, Shamim Nabukenya, Aeron Namirembe, Naphtal Erima, Doreen Joan Asio, Elizabeth Mbabazi Atuhura, Shamim Ssendagire, Martin Onyango, Julie Fox, Sheena McCormack, Pontiano Kaleebu, Eugene Ruzagira, on behalf of the PrEPVacc Study Team
Source: PLOS One • DOI 10.1371/journal.pone.0348769
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Despite global reports of declining HIV incidence, current data are limited. This study presents findings on HIV incidence and risk factors in a HIV trial preparedness cohort.
Between 18 July 2018 and 13 October 2022, individuals 18–45-year-old were recruited from communities along the trans-African highway and the shores of Lake Victoria in Masaka district, Uganda. Eligible individuals were HIV-negative and met at least one of the following criteria: suspected or confirmed sexually transmitted infection (STI), unprotected sex with ≥2 partners, unprotected sex with a new partner in the past 3 months, or unprotected sex in exchange for money/goods in the past month. Baseline data included demographics, sexual behaviour, and HIV risk factors. Follow-up assessments of HIV risk and sexual behaviour were conducted every six months, while HIV counselling and testing (HCT) were provided every 3 months, with linkage to care for those testing positive. Data were summarised descriptively, and associations with HIV incidence were analysed using uni-variable and multi-variable Poisson regression models.
Of the 1422 individuals enrolled, 1115 (78.4%) attended ≥1 follow-up visit; 69% were female and 55% were aged ≤24 years. Over 900.3 person-years of observation (PYO), 24 individuals acquired HIV, yielding an incidence rate (IR) of 2.7 PYO [95% Confidence Interval (CI): 1.8–4.0]. Baseline factors independently associated with incident HIV included female sex [adjusted incidence rate ratio (aIRR) = 6.84 PYO, 95% CI 1.60–29.30], residence in a fishing community [aIRR = 3.04 PYO, 95% CI 1.05–8.78] and recreational drug use in the past 3 months [aIRR = 3.08 PYO, 95% CI 1.19–7.99]. In a separate analysis, using time-updated variables assessed during follow-up, HIV acquisition was associated with sex after alcohol consumption [aIRR = 2.65 PYO, 95% CI 1.11–6.31], and STI diagnosis/treatment within the past 3 months [aIRR = 2.52 PYO, 95% CI 1.09–5.80].
HIV incidence remains high among women, fishing community residents, and individuals with high risk behaviours, underscoring the need for targeted interventions to reduce the burden in these populations.
Introduction
Human immunodeficiency virus (HIV) continues to be a significant global health challenge despite decades of research and intervention efforts. In 2023, there were 1.3 million new infections, with about half occurring in sub-Saharan Africa [1]. A substantial proportion (55%) of these infections were among key populations and their partners [2], including men who have sex with men, female sex workers, injecting drug users, and others. HIV prevention research, particularly on interventions like vaccines, focus on enrolling key populations at high risk of HIV acquisition to assess efficacy [3,4]. The success of these trials depends on factors such as HIV incidence, participant accrual, duration of participant follow-up, and maximising retention [5]. However, in the past, studies were prematurely terminated due to unexpectedly low HIV incidence leading to insufficient statistical power [6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Sylvia Kusemererwa, Sheila Kansiime, Gertrude Mutonyi, Ayoub Kakande, Shamim Nabukenya, Aeron Namirembe, Naphtal Erima, Doreen Joan Asio, Elizabeth Mbabazi Atuhura, Shamim Ssendagire, Martin Onyango, Julie Fox, Sheena McCormack, Pontiano Kaleebu, Eugene Ruzagira, on behalf of the PrEPVacc Study Team. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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