The HIV positivity rate among AGYW declined during 2017-2021, but specific Western Ugandan districts had comparatively elevated rates. Nearly one in seven HIV infections assessed by RTRI among AGYW aged 15-24 years were recent, with clusters of recent HIV infections in some sub-counties. The Ministry of Health could strengthen targeted HIV prevention among AGYW in the most affected districts. Subsequent viral load testing of the persons testing positive by RTRI could provide additional evidence of recent infections.