Mapping hotspots, trends, and drivers of recent HIV infections among TASO clients in Uganda (2021-2024)

Abstract

Background Despite significant progress on HIV control in Uganda, the population-level viral suppression rate remains low at 74.9% and Uganda now records about 50,000 new HIV infections annually, which underscores the need to detect geographic hotspots and programmatically relevant drivers among clients entering care. . Recent HIV infections, defined as those acquired within twelve months, are important indicators of ongoing transmission and the extent of prevention efforts. However, data at the subnational level regarding recent infections, their geographic clustering, temporal trends, and risk factors are limited. This study aimed to map the spatial distribution, identify temporal trends, and explore the drivers of recent HIV infections among clients of The AIDS Support Organization (TASO) in Uganda from 2021 to 2024. Methods: A retrospective, multiple-methods study design was employed, utilizing routinely collected HIV recency testing data from 11 TASO centers across Uganda. Individuals newly diagnosed with HIV were classified according to the national recent infection testing algorithm (RITA) detailed in Figure 1-3. Spatial analysis involved empirical Bayesian smoothing, Global and Local Moran’s I, and Getis-Ord Gi* techniques to identify hotspots. Temporal trends were evaluated using Mann-Kendall tests and time-series clustering. Multivariable logistic regression identified individual-level predictors of recent HIV infection. Data were extracted from electronic medical records and analyzed with ArcGIS Pro, R, and Stata. Results: A total of 8,276 HIV-positive clients were analyzed for hotspot and temporal trend detection, and 5,422 clients for identifying drivers of recent HIV infection. Spatial analysis revealed persistent and emerging hotspots, including a new outbreak in Kyenjojo (2024) and sporadic clusters along the southwestern and eastern cattle corridors. No district showed sustained or increasing hotspots, while districts in the Lake Victoria basin experienced episodic surges. Temporal patterns were mostly oscillatory. Sixty-four districts maintained near-zero incidence over 48 months, indicating epidemic control through stable treatment and low-risk behavior. Forty-five districts showed a gradual increase from late 2022, peaking in mid-2023 before declining, reflecting mobility-driven surges linked to the post-COVID-19 reopening. Another 37 districts experienced short-lived urban and peri-urban spikes in mid-2022 and early 2023, which were quickly contained through responsive health interventions. In multivariable analysis, male clients had significantly lower odds of recent HIV infection compared to females (OR = 0.74; 95% CI: 0.57–0.96; p = 0.021). Other variables, age, education, HIV testing approach, delivery model, pre-test counseling, and ARV adherence, were not significantly associated with HIV recency (p > 0.05). Conclusion: The study found an overall HIV recency prevalence of 10.5% among TASO clients, with significant variation across centers and over time. Centers in the southwestern and eastern regions, especially along the Cattle Corridor and the Lake Victoria basin, experienced episodic surges. At the same time, most other districts consistently maintained low or zero recency rates. A new hotspot appeared in Kyenjojo in 2024, indicating localized outbreaks amid general epidemic control. Temporal analysis revealed oscillating trends, with brief peaks in mid-2022 and early 2023, corresponding to post-COVID mobility and economic reopening. These findings emphasize the fragmented and changing nature of recent HIV infections across Uganda. Targeted surveillance, rapid response, and geographically focused prevention strategies are critical to maintaining epidemic control and progressing toward the 2030 HIV elimination goals.