Abstract
BACKGROUND: Adolescent girls and young women (AGYW) in rural Uganda face overlapping socio-economic, educational, and behavioral vulnerabilities that heighten their risks of HIV, unintended pregnancies, gender-based violence (GBV), and other adverse health outcomes. Establishing baseline risk profiles is essential for designing targeted interventions. METHODS: This study analyzed secondary data collected through the Uganda DREAMS and OVC Tracking System (UDOTS) during program enrollment between July 2017 and December 2023 in four districts of Central Uganda (Mubende, Mityana, Luwero, and Kassanda). UDOTS screening tools captured socio-economic, educational, and behavioral indicators. K-means cluster analysis was applied to classify participants into High-Risk and Low-Risk groups, followed by bivariate validation. Logistic regression was used to identify predictors of high-risk classification. RESULTS: Of the 124,259 AGYW screened, 24.7% were categorized as High-Risk. This group was predominantly aged 20-25, out of school, engaged in transactional sex, and exposed to violence. In contrast, the 9-14 age group largely clustered as Low-Risk, reflecting delayed sexual debut, stronger school retention, and lower exposure to economic pressures. Education was strongly protective: AGYW enrolled in school had substantially greater odds of being classified as Low-Risk (AOR = 108.15, 95% CI: 93.84-124.65, p < 0.001). Conversely, transactional sex strongly predicted High-Risk classification (AOR = 1599.97, 95% CI: 769.09-3328.47, p < 0.001). CONCLUSION: AGYW in rural Uganda particularly those aged 20-25, face compounded vulnerabilities linked to poverty, violence, and school dropout. Strengthening education, economic empowerment, and GBV prevention is critical to reducing these risks and fostering resilience.