Abstract

TULBE04 - Oral Abstract Session

Changes in population-level HIV RNA distribution one year after implementation of key components of an HIV ´test and treat´ strategy in rural Uganda

Presented by Vivek Jain (United States).

V. Jain^1,2, D. Kwarisiima^2,3, T. Liegler¹, T. Clark^1,2, G. Chamie^1,2, J. Kabami², D. Black^1,2, G. Amanyire^2,3, D. Byonanebye^2,3, E. Geng^1,2, H. Thirumurthy^2,4, M. Petersen^2,5, E. Charlebois^2,6, M. Kamya^2,7, D. Havlir^1,2, and the SEARCH Collaboration

¹University of California San Francisco, HIV/AIDS Division, San Francisco General Hospital, San Francisco, United States, ²Makerere University-UCSF Research Collaboration, Kampala, Uganda, ³Mulago-Mbarara Joint AIDS Program, Mbarara, Uganda, ⁴Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States, ⁵School of Public Health, University of California, Berkeley, Division of Biostatistics, Berkeley, United States, ⁶Center for AIDS Prevention Studies (CAPS), University of California San Francisco, San Francisco, United States, ⁷Makerere University School of Medicine, Kampala, Uganda

Background: 'Test-and-treat' programs combining expanded HIV diagnosis, linkage to care, and ART delivery are under consideration, but real-world experience is lacking. During 2011, in rural southwestern Uganda, implementation of ART eligibility to CD4< 350/uL began. Concomitantly, we (A) conducted a community-wide HIV testing/linkage-to-care campaign, and (B) offered ART to adults with CD4≥350 via a research study (EARLI: NCT01479634). One year later, we conducted a second health campaign and examined the population distribution of HIV RNA levels.
Methods: During weeklong campaigns in May 2011 and 2012, all Kakyerere Parish residents were offered HIV testing (Determine, Inverness) in multi-disease diagnosis and linkage “health fairs”. In HIV+ individuals, HIV RNA levels were measured by a validated fingerprick blood collection method and RT-PCR (Abbott). We assessed population HIV RNA levels by computing (1) the proportion of persons with an undetectable VL, (2) the median VL, and (3) the mean log(VL) among HIV+ persons.
Results: After community mobilization, 4,343 and 4,872 persons attended the 2011 and 2012 campaigns, respectively. We estimated 69% and 71% community participation based on census data from 2011 and 2012, respectively. Adult HIV prevalence (≥18yrs.) was 7.8% in 2011 (179/2,282 adults) and 9.4% in 2012 (210/2271 adults). Prevalence was 18.6% on the final day of the health fair located at the parish trading center, and 8.2% across prior days (p< 0.001). A substantially higher proportion of HIV+ individuals had an undetectable HIV RNA level in 2012 vs. 2011 (55% vs. 37%), and both median VL and mean log(VL) were lower in 2012 (see table).

	May 2011 Health Campaign (n=165 HIV+ adultsa)	May 2012 Health Campaign (n=210 HIV+ adults)
Undetectable VL, n (%)	62 (37%)	115 (55%)
VL 486-10,000 copies/mL, n (%)	40 (24%)	48 (23%)
VL 10,000-100,000 copies/mL, n (%)	42 (25%)	40 (19%)
VL >100,000 copies/mL, n (%)	21 (13%)	7 (3%)
Median VL (IQR), copies/mL	2185 (<486?33,045)	<486 (<486?7,903)
Mean log(VL) (95% CI), copies/mL	3.62 log (3.46?3.78 log)	3.20 log (3.09?3.31 log)
Footnote a: 165/179 adults tested had a VL completed.

[2011 and 2012 HIV Testing Campaigns]


Conclusions: In this ongoing study, we demonstrate that key components of a test-and-treat strategy are feasible in a resource-limited setting. One year after implementing intensified community-based HIV testing and linkage, with ART eligibility regardless of CD4 count, over half of HIV+ persons attending a health campaign had undetectable HIV RNA.