Rakai Community Cohort Study
Initiated in 1994, the Rakai Community Cohort Study (RCCS) is an open population-based cohort which enrolls all consenting adult residents aged 15-49 in ~50 communities distributed throughout the district. Participants respond to a detailed sociodemographic, behavioral, sexual network, mobility, health and service utilization interview, and provide a blood sample for HIV testing. Prior to each survey visit, a household census is performed in the study communities, it describes household membership, births, death since the last visit, duration of stay per member, household possession, dwelling characteristics and mobility data is captured first at this level. Approximately 18,000 individuals participate in the RCCS; the response rate among age eligible persons is about 78% and compliance to provision of specimen for tests is over 90%, the follow up is approximately 75%, with losses due primarily to out-migration, absentia due to work or school and aging beyond 49. (The latter is balanced by annual in-migration and aging into the cohort.) HIV prevalence ranges from ~12% in smaller rural trading villages, to ~20% in larger trading centers with serve as local and regional transport hubs, and to ~42% in high risk fishing communities on Lake Victoria. HIV incidence ranges from ~0.9/100 person years in the more rural communities to ~3.5-4/100 PY in the fishing villages.
All RCCS households are mapped by GPS which is updated at each visit depending on traceable household movements and individual migrations. As RHSP’s major machine, the RCCS is a great resource through which over 40 nested studies and sub studies have been conducted. It is also a great resource for evaluation of service delivery programs like the HIV care and treatment, voluntary medical male circumcision and other health promotion programs. Through the RCCS data, investigators are able to develop hypothesis that are tested through stand alone clinical trials. After the clinical trials are conducted, the RCCS provide a great avenue for long term follow up of clinical trial participants, and for open label studies.
Through over 150 peer reviewed Journal articles, data from RCCS has been central in contributing towards HIV prevention, care and treatment discourse locally and internationally. Some of the earlier HIV prevention analyses on mass treatment of sexually transmitted diseases for HIV prevention and very contemporary analysis of HIV sub-typing and analysis of heterogeneity of HIV epidemiology informed by geospatial data was and is still supported by RCCS data.