XIX International AIDS Conference


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TULBE04 - Oral Abstract

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. Jain1,2, D. Kwarisiima2,3, T. Liegler1, T. Clark1,2, G. Chamie1,2, J. Kabami2, D. Black1,2, G. Amanyire2,3, D. Byonanebye2,3, E. Geng1,2, H. Thirumurthy2,4, M. Petersen2,5, E. Charlebois2,6, M. Kamya2,7, D. Havlir1,2, 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/mL2185 (<486?33,045)<486 (<486?7,903)
Mean log(VL) (95% CI), copies/mL3.62 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.

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