The Uganda Refugee Population-based HIV Impact Assessment (RUPHIA 2021) measured the impact of the national HIV response among adults living in refugee settlements in Uganda – beginning to unlock some of the greater implications of forced displacement on health outcomes.
The Uganda Refugee Population-based HIV Impact Assessment (RUPHIA 2021) was led by the Government of Uganda through the Ministry of Health (MOH) with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and with support from ICAP at Columbia University and technical assistance from the Centers for Disease Control and Prevention (CDC). RUPHIA 2021 was implemented in collaboration with other Government of Uganda entities including the Uganda Virus Research Institute (UVRI), Office of the Prime Minister (OPM), and the Uganda Bureau of Statistics (UBOS) as well as with the United Nations High Commissioner for Refugees (UNHCR), regional referral hospitals and local government authorities.
In recent years, increased conflict, climate change, food insecurity, and other factors have exacerbated forced displaced around the world. While mobility is not necessarily associated with HIV risk, refugees are often exposed to unique socioeconomic and environmental factors that may contribute to increased risk behaviors or inability to utilize prevention modalities.
RUPHIA 2021 surveyed adults aged 15 years and older living in refugee settlements in the West Nile and Western regions of Uganda, the country with the highest proportion of refugees in Africa. A total of 2,705 participants were interviewed for the survey and tested for HIV. RUPHIA 2021 demonstrated that among adult refugees living with HIV in Uganda, achievement of the first and second 95 UNAIDS targets – that 95 percent of persons living with HIV were aware of their status, and, among those aware of their status, 95 percent were on antiretroviral treatment (ART) – had not yet been reached, as 81.8 percent of adult refugees were aware of their HIV-positive status and 89.5 percent of those aware of their status were on ART.
The survey also showed, however, that refugee populations in Uganda are approaching the third 95 target – that 95 percent of persons receiving ART have viral load suppression (VLS) – as 92.5 percent of adult refugees in Uganda had VLS.
“This finding shows us that there is a need to improve case finding strategies and increase linkage to HIV treatment within refugee communities in Uganda,” said Samuel Biraro, country representative for ICAP in Uganda. “This will result in significantly improved health outcomes among the refugee populations living with HIV in Uganda.”
Prevalence of HIV among adults aged 15 years and older living in Uganda’s refugee settlements was 1.5 percent. HIV prevalence among adults in refugee settlements did not differ significantly by region. The prevalence of VLS among all adults living with HIV in Uganda’s refugee settlements (inclusive of those not on ART) was 72.4 percent. The number of adults living with HIV identified in the survey were too few to estimate regional differences in the prevalence of VLS or differences in the prevalence of VLS by sex.
Although the small sample size of the survey limited the ability to generate estimates for some indicators reported in the UPHIA national survey results released in 2021, the first PHIA to be conducted among adults in refugee settlements of Uganda provides critical information for tailoring the HIV response to these communities.
“As national programs aim for epidemic control,” said David Hoos, PHIA project director, “household surveys oriented towards specific sub-populations, such as those who live in refugee settlements in Uganda, provide important data on HIV risk and program success and gaps among particular vulnerable populations, which is needed to go the last mile.”
“This assessment marks a significant milestone in addressing the needs of the refugee population in Uganda,” said Julius Kasozi, public health officer at UNHCR, the UN Refugee Agency. “It offers invaluable insights that will enhance our understanding of epidemic control strategies and guide humanitarian responders in effectively targeting critical areas during program implementation. By doing so, it empowers the Ministry of Health, UNAIDS, and our partners to amplify preventive interventions and ensure the sustained delivery of crucial treatments, thereby fostering more efficient programming overall.”
June 20, 2023, commemorates World Refugee Day, an international day dedicated to honoring people who have been forced to flee their homes. On this day, ICAP will feature a Grand Rounds Webinar exploring refugee health, with guest speakers presenting on the topic, including representatives who will present on RUPHIA 2021 summary findings. Learn more about the program on the ICAP website events page.
A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies.