XIX International AIDS Conference

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TUAC0103 - Oral Abstract Session


Lack of effectiveness of antiretroviral therapy (ART) as an HIV prevention tool for serodiscordant couples in a rural ART program without viral load monitoring in Uganda

Presented by Josephine Birungi (Uganda).

J. Birungi1, H. Wang2, M.H. Ngolobe3, K. Muldoon4, S. Khanakwa3, R. King5, P. Kaleebu6, K. Shannon4,7, R. Ochai8, J. Montaner4,7, E. Mills9, L. Laurenco7, N. Abdallar8, D. Moore4,7


1The AIDS Support Organisation (TASO), Research and Medical Capacity Building, Kampala, Uganda, 2University of British Columbia BC, Vancouver, Canada, 3The AIDS Support Organisation (TASO), Jinja, Uganda, 4University of British Columbia, Division of AIDS, Vancouver, Canada, 5University of California at San Francisco, San Francisco, United States, 6Uganda Virus Research Institute, Entebbe, Uganda, 7British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 8The AIDS Support Organisation (TASO), Kampala, Uganda, 9University of Ottawa, Ottawa, Canada

Background: Clinical trials have demonstrated antiretroviral therapy (ART) is highly efficacious in preventing HIV transmission among sero-discordant couples. We examined the effectiveness of ART as prevention in a rural program in Uganda where viral load (VL) testing is not available.
Methods: We conducted a cohort study of HIV sero-discordant couples aged ≥18 years, where the positive partner was a client of The AIDS Support Organization in Jinja, Uganda. In one group of couples the positive partner was eligible for ART because of CD4 cell count ≤250 cells/ µL or a WHO Stage III or IV disease. In the second group, the infected partner was not yet ART-eligible. Both groups received regular HIV risk-reduction counseling and condoms. The uninfected partner was HIV tested every three months. We conducted VL testing and genotyping of transmitted viruses.
Results: A total of 586 couples were enrolled, of which 352 (60%) of the positive participants received ART during the study. The median duration of ART-use at enrollment was 2.5 years and the median duration of follow-up was 1.3 years. ART couples were older than non-ART couples (median 42 vs. 40 years for men; 36 vs. 33 years for women; p< 0.001, for both). ART couples were more likely to report condom-use at last sex (74% vs. 66%; p = 0.038) and had longer duration in relationships than non-ART couples (median 12 vs. 9 years; p=0.003). There were no differences between the two groups in terms of male circumcision status, polygymy status, pregnancy intentions or injectable contraception-use. We found 9 new infections among partners of ART participants and 8 new infections in partners of non-ART participants, for an incidence rate ratio of 1.16 (p=0.564).
Conclusions: ART-use was not associated with reduced risk of HIV transmission in sero-discordant couples in a rural program in Uganda without VL testing.


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