Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method

Jain, Vivek; Liegler, Teri J.; Kabami, Jane; Chamie, Gabriel; Clark, Tamara D.; Black, Douglas; Geng, Elvin H.; Kwarisiima, Dalsone; Wong, Joseph K.; Abdel-Mohsen, Mohamed; Sonawane, Nitin; Aweeka, Francesca T.; Thirumurthy, Harsha; Petersen, Maya L.; Charlebois, Edwin D.; Kamya, Moses R.; & Havlir, Diane V., for the SEARCH Collaboration. (2013). Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method. Clinical Infectious Diseases, 56(4), 598-605. PMCID: PMC3552523

Jain, Vivek; Liegler, Teri J.; Kabami, Jane; Chamie, Gabriel; Clark, Tamara D.; Black, Douglas; Geng, Elvin H.; Kwarisiima, Dalsone; Wong, Joseph K.; Abdel-Mohsen, Mohamed; Sonawane, Nitin; Aweeka, Francesca T.; Thirumurthy, Harsha; Petersen, Maya L.; Charlebois, Edwin D.; Kamya, Moses R.; & Havlir, Diane V., for the SEARCH Collaboration. (2013). Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method. Clinical Infectious Diseases, 56(4), 598-605. PMCID: PMC3552523

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Background. Population-based human immunodeficiency virus type 1 (HIV-1) RNA levels (viral load [VL]) are proposed metrics for antiretroviral therapy (ART) program effectiveness. We estimated population-based HIV RNA levels using a fingerprick-based approach in a rural Ugandan community implementing rapid ART scale-up. Methods. A fingerprick-based HIV RNA measurement technique was validated against standard phlebotomy. This technique was deployed during a 5-day community-wide health campaign in a 6300-person community. Assessments included rapid HIV antibody testing, VL, and CD4+ T-cell count via fingerprick. We estimated population HIV RNA levels and the prevalence of undetectable RNA, assessed predictors of VL via linear regression, and mapped RNA levels within community geographic units. Results. During the community-wide health campaign, 179 of 2282 adults (7.8%) and 10 of 1826 children (0.5%) tested seropositive for HIV. Fingerprick VL was determined in 174 of 189 HIV-positive persons (92%). The mean log(VL) was 3.67 log (95% confidence interval [CI], 3.50–3.83 log copies/mL), median VL was 2720 copies/mL (interquartile range, <486–38 120 copies/mL), and arithmetic mean VL was 64 064 copies/mL. Overall, 64 of 174 of individuals had undetectable RNA (37% [95% CI, 30%–44%]), 24% had VL 486–10 000; 25% had VL 10 001–100 000; and 15% had VL>100 000 copies/mL. Among participants taking ART, 83% had undetectable VL. Conclusions. We developed and implemented a fingerprick VL testing method and provide the first report of population HIV RNA levels in Africa. In a rural Ugandan community experiencing ART scale-up, we found evidence of population-level ART effectiveness, but found a substantial population to be viremic, in need of ART, and at risk for transmission.




JOUR



Jain, Vivek
Liegler, Teri J.
Kabami, Jane
Chamie, Gabriel
Clark, Tamara D.
Black, Douglas
Geng, Elvin H.
Kwarisiima, Dalsone
Wong, Joseph K.
Abdel-Mohsen, Mohamed
Sonawane, Nitin
Aweeka, Francesca T.
Thirumurthy, Harsha
Petersen, Maya L.
Charlebois, Edwin D.
Kamya, Moses R.
Havlir, Diane V., for the SEARCH Collaboration



2013


Clinical Infectious Diseases

56

4

598-605








PMC3552523


5682

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