Changes in Population HIV RNA Levels in Mbarara, Uganda, during Scale-Up of HIV Antiretroviral Therapy Access

Jain, Vivek; Byonanebye, Dathan M.; Liegler, Teri J.; Kwarisiima, Dalsone; Chamie, Gabriel; Kabami, Jane; Petersen, Maya L.; Balzer, Laura B.; Clark, Tamara D.; Black, Douglas; Thirumurthy, Harsha; Geng, Elvin H.; Charlebois, Edwin D.; Amanyire, Gideon; Kamya, Moses R.; Havlir, Diane V.; & Collaboration, the SEARCH. (2014). Changes in Population HIV RNA Levels in Mbarara, Uganda, during Scale-Up of HIV Antiretroviral Therapy Access. Journal of Acquired Immune Deficiency Syndromes, 65(3), 327-32. PMCID: PMC4172444

Jain, Vivek; Byonanebye, Dathan M.; Liegler, Teri J.; Kwarisiima, Dalsone; Chamie, Gabriel; Kabami, Jane; Petersen, Maya L.; Balzer, Laura B.; Clark, Tamara D.; Black, Douglas; Thirumurthy, Harsha; Geng, Elvin H.; Charlebois, Edwin D.; Amanyire, Gideon; Kamya, Moses R.; Havlir, Diane V.; & Collaboration, the SEARCH. (2014). Changes in Population HIV RNA Levels in Mbarara, Uganda, during Scale-Up of HIV Antiretroviral Therapy Access. Journal of Acquired Immune Deficiency Syndromes, 65(3), 327-32. PMCID: PMC4172444

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OBJECTIVE: In a rural Ugandan community scaling up antiretroviral therapy (ART), we sought to determine if population based HIV RNA levels (population viral load) decreased from 2011-2012. DESIGN: Serial cross-sectional analyses (May 2011, May 2012) of a defined study community of 6,300 persons in a district with HIV prevalence of 8%. METHODS: We measured HIV-1 RNA (viral load, VL) levels on all individuals testing positive for HIV during a five-day high-throughput multi-disease community health campaign in May, 2012 that recruited two-thirds of the population. We aggregated individual-level VL results into population viral load metrics including the proportion of individuals with an undetectable VL, and compared these VL metrics to those we previously reported for this geographic region in 2011. RESULTS: In 2012, 223/2,179 adults were HIV-seropositive (10%). Overall, among 208/223 HIV-seropositive adults in whom VL was tested, 53% had an undetectable VL (95% CI 46-60%), up from 37% (95% CI 30-45%; p=0.02) in 2011. Seven (3%) individuals had a VL>100,000 copies/mL in 2012, down from 21 (13%) in 2011 (p=0.0007). Mean log(VL) [geometric mean] was 3.18 log (95% CI 3.06-3.29 log) in 2012, down from 3.62 log (95% CI 3.46-3.78 log) in 2011 (p<0.0001). Similar reductions in population VL were seen amongst males and females. CONCLUSIONS: Reductions in population VL metrics and a substantial increase in persons with an undetectable VL were observed in a rural Ugandan community from 2011-2012. These findings from a resource-limited setting experiencing rapid ART scale-up may reflect a population-level effectiveness of expanding ART access.


Population and Health Policies and Programs


JOUR



Jain, Vivek
Byonanebye, Dathan M.
Liegler, Teri J.
Kwarisiima, Dalsone
Chamie, Gabriel
Kabami, Jane
Petersen, Maya L.
Balzer, Laura B.
Clark, Tamara D.
Black, Douglas
Thirumurthy, Harsha
Geng, Elvin H.
Charlebois, Edwin D.
Amanyire, Gideon
Kamya, Moses R.
Havlir, Diane V.
Collaboration, the SEARCH



2014


Journal of Acquired Immune Deficiency Syndromes

65

3

327-32








PMC4172444


7983

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