title: Assessment of population-based HIV RNA levels in a rural east African setting using a fingerprick-based blood collection method.
abstract: BACKGROUND
  Population-based human immunodeficiency virus type 1 (HIV-1) RNA levels (viral load [VL]) are proposed metrics for antiretroviral therapy (ART) program effectiveness. We estimated population-based HIV RNA levels using a fingerprick-based approach in a rural Ugandan community implementing rapid ART scale-up.
  
  
  METHODS
  A fingerprick-based HIV RNA measurement technique was validated against standard phlebotomy. This technique was deployed during a 5-day community-wide health campaign in a 6300-person community. Assessments included rapid HIV antibody testing, VL, and CD4+ T-cell count via fingerprick. We estimated population HIV RNA levels and the prevalence of undetectable RNA, assessed predictors of VL via linear regression, and mapped RNA levels within community geographic units.
  
  
  RESULTS
  During the community-wide health campaign, 179 of 2282 adults (7.8%) and 10 of 1826 children (0.5%) tested seropositive for HIV. Fingerprick VL was determined in 174 of 189 HIV-positive persons (92%). The mean log(VL) was 3.67 log (95% confidence interval [CI], 3.50-3.83 log copies/mL), median VL was 2720 copies/mL (interquartile range, <486-38 120 copies/mL), and arithmetic mean VL was 64 064 copies/mL. Overall, 64 of 174 of individuals had undetectable RNA (37% [95% CI, 30%-44%]), 24% had VL 486-10 000; 25% had VL 10 001-100 000; and 15% had VL>100 000 copies/mL. Among participants taking ART, 83% had undetectable VL.
  
  
  CONCLUSIONS
  We developed and implemented a fingerprick VL testing method and provide the first report of population HIV RNA levels in Africa. In a rural Ugandan community experiencing ART scale-up, we found evidence of population-level ART effectiveness, but found a substantial population to be viremic, in need of ART, and at risk for transmission.
authors.affiliation: HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA 94143-0874, USA. vivek.jain@ucsf.edu
authors.forename: Vivek
authors.initials: V
authors.lastname: Jain
authors.forename: Teri
authors.initials: T
authors.lastname: Liegler
authors.forename: Jane
authors.initials: J
authors.lastname: Kabami
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chamie
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Clark
authors.forename: Douglas
authors.initials: D
authors.lastname: Black
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Geng
authors.forename: Dalsone
authors.initials: D
authors.lastname: Kwarisiima
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Wong
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Mohsen
authors.forename: Nitin
authors.initials: N
authors.lastname: Sonawane
authors.forename: Francesca T
authors.initials: FT
authors.lastname: Aweeka
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.forename: Maya L
authors.initials: ML
authors.lastname: Petersen
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D018962:Phlebotomy / Q000379:methods; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood*; D012424:Rural Population; D014454:Uganda; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral