The expansion of HIV treatment and prevention initiatives has significantly reduced orphanhood rates in Rakai, Uganda, according to a study conducted by Columbia University Mailman School of Public Health. The research, published in The Lancet Global Health, analyzed data from the Rakai Community Cohort Study (RCCS), which monitored 92,441 children and adolescents under age 18 across 28 communities from 1995 to 2022.
Between 2003–04 and 2020–22, the prevalence of orphanhood dropped from 21.5 percent to 6.3 percent in Rakai, marking a reduction of about 70 percent. Incidence rates—the number of new orphans—also declined sharply over this period.
The most pronounced improvements were observed after antiretroviral therapy (ART) became fully available between 2015 and 2022. During this time, the proportion of new orphan cases linked to maternal HIV status fell from 67 percent in 2004 to just 11 percent in 2022. Similarly, attribution to parental HIV status decreased from 71 percent to 12 percent.
"Importantly, these programs have not just extended the lives of parents living with HIV but have also protected children from the devastating social and health consequences of losing their parents," said Debbie Malden, DPhil and epidemiologist at the Columbia Population Research Center as well as co-lead author.
Researchers highlighted that while ART access has played a crucial role in reducing orphanhood across sub-Saharan Africa, challenges remain for adolescents who continue to face significant risks. The authors recommend that public health policies focus on sustained investment in HIV treatment and prevention efforts, increased accessibility to ART services, and adaptation of programs targeting vulnerable children at risk for orphanhood.
The RCCS project involved collaboration among several institutions: Columbia University Mailman School of Public Health; Rakai Health Sciences Program; Imperial College London; The Alan Turing Institute; Johns Hopkins University; Makerere University; City University of New York; University of Oxford; and Uganda Virus Research Institute.
Co-authors include John Santelli and Philip Kreniske (Columbia University); Oliver Ratmann (Imperial College London); Yu Chen (Imperial College London/Johns Hopkins); Susan Hillis (The Alan Turing Institute); M. Kate Grabowski (Johns Hopkins/Makerere); Larry W. Chang (Rakai Health Sciences/Makerere); A.F. Nalugoda et al., G. Kigozi et al., N.K .Sewankambo et al., F Makumbi et al., D Serwadda et al., R Ssekubugu et al., A Ssettuba et al., H Nakawooya et al.; P Kreniske (Makerere); F Makumbi/D Serwadda/The Global Reference Group for Children Affected by Crisis/University of Oxford; S Hillis (Uganda Virus Research Institute).
Funding was provided by several organizations including the National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Development, Gates Foundation, National Institute of Mental Health, and National Institutes of Health Fogarty International Center.
