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

Citation

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, et al. (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), 327-332. PMCID: PMC4172444

Abstract

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.

URL

http://dx.doi.org/10.1097/QAI.0000000000000021

Reference Type

Journal Article

Year Published

2014

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

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.
The SEARCH Collaboration,

PMCID

PMC4172444

ORCiD

Thirumurthy - 0000-0002-3308-7603