UGANDA POPULATION-BASED HIV IMPACT ASSESSMENT (UPHIA) 2016-2017

The Uganda Population-based HIV Impact Assessment (UPHIA) 2016-2017 was a nationally representative, cross-sectional, population-based survey of households across Uganda. UPHIA focused on measuring key biological endpoints to provide direct estimates of HIV infection, risk, and burden and of the effectiveness and population-level impact of the HIV-related prevention, care, and treatment interventions implemented in the country. Its primary objectives were to estimate the national-level annual HIV incidence among adults (defined as those aged 15-64 years in this survey), and the national and subnational prevalence of HIV and HIV viral load (VL) suppression (VLS) (defined as less than 1,000 copies per milliliter [mL]) among HIV-positive adults. In addition, UPHIA measured CD4 counts, antiretroviral (ARV) drugs in blood, transmitted HIV drug resistance, pediatric HIV and VLS prevalence, prevalence of syphilis and hepatitis B in adults, and progress toward the 90-90-90 targets as defined by the Joint United Nations (UN) Programme on HIV/AIDS (UNAIDS). The survey also collected information on behaviors associated with HIV acquisition and transmission, common HIV co-morbidities, and other health conditions.

The survey used a two-stage, stratified cluster sample design, in which census enumeration areas (EA) (clusters) were selected in the first stage and households in the second stage. The sample was stratified by ten geographical regions: Central 1, Central 2, Kampala, East-Central, Mid-Eastern, North-East, West Nile, Mid-North, Mid-West, and South-West. Data collection began at the end of August 2016 and was completed at the end of March 2017. The survey was administered to 12,386 households. In the households surveyed, 30,581 adults aged 15-64 years and 10,793 children (defined as those aged 0-14 years) were eligible to participate. Altogether, 96% (29,383) of eligible adults were interviewed and 99% (29,024) of interviewed adults, 96% (9,641) of eligible children aged 0-12 years, and 99% (704) of eligible children aged 13-14 years provided blood for biomarker assessment to determine HIV status.

UPHIA provided home-based testing and counseling (HBTC) with return of results and point-of-care (POC) CD4 counts for those who were HIV positive. HIV VL results were returned to participants through health facilities of their choice. The estimates in UPHIA were weighted for sample selection probabilities and were adjusted for nonresponse and non-coverage.