Rakai Community Cohort Study (RCCS)

Surveillance operations are conducted by the Rakai Health Sciences Program (RHSP) within a strategically important region bordering Lake Victoria and adjacent to international trading borders with some of the highest HIV burdens worldwide. The HIV epidemic is predominantly characterized by HIV-1 group M subtypes A and D, and recombinant forms.

The RCCS conducts a population census and surveys of ~25,000 respondents across diverse geographic settings, including rural agrarian, semiurban trading, and Lake Victoria fishing communities. Key objectives encompass: A) Monitoring of: 1. The HIV epidemic, and of behavioral, immunological, and virological determinants of infection, 2. Rates of other infections, sexually transmitted infections, and other diseases (e. g.

malaria and TB), and the assessment of their association with HIV, 3. Reproductive health, including fertility, pregnancy rates, and pregnancy outcomes, 4. General health, including other infectious and non-communicable diseases, 5. Health status throughout the lifespan, including infancy, childhood, and in older persons, 6. Demographic trends, including mortality, fertility, population structure, mobility and migration, and their associations with HIV, 7.

Behavioral studies, including trends in sexual risk behaviors, 8. Emerging and re-emerging diseases (e. g, COVID-19, MPOX, Marburg, and others), 9. Employ advanced genomic sequencing to characterize HIV subtypes, recombinant forms, and emerging variants. This genomic insight informs treatment efficacy, guides drug resistance management, and advances global research initiatives, 10.

To monitor Climate Change and its effect on the population and environment, and 11. Pulmonary health, including the impact of tuberculosis on pulmonary health. B) Provision of a framework for intervention trials, nested observational studies, and for implementation science research on service delivery, including combination HIV prevention, community mobilization, family planning, prevention of mother-to-child HIV transmission, and cervical cancer screening.

(Separate IRB submissions and separate participant consent forms are prepared for each such nested study, as needed.

) C) Provision of a framework for service delivery in this population, including, but not limited to: voluntary HIV counseling and testing (HCT), health education, condom promotion and provision, family planning services, STD treatment, general health care, palliative and opportunistic infections (OI) treatment in HIV+ persons, ART, male circumcision, reproductive health education, NCD screening and services for adolescents.

Evaluation of service delivery, including collection of data on community-level knowledge of and attitudes towards these services, rates of service utilization, adherence, and the monitoring of potential behavioral changes at the population level as a result of the new services.

D) Provision of a field training site for Ugandan and international students, including those of medicine, nursing, public health and allied health, social science, and service professions. E) Maintaining long-term archives of interview-based data in longitudinal databases (Datamart) and maintaining archives of biological samples in Uganda and other collaborating institutions, for future studies.