title: Changes in population HIV RNA levels in Mbarara, Uganda, during scale-up of HIV antiretroviral therapy access.
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 (VL)] decreased from 2011 to 2012.
  
  
  METHODS
  Serial cross-sectional analyses (May 2011 and May 2012) of a defined study community of 6300 persons in a district with HIV prevalence of 8%.
  
  
  METHODS
  We measured HIV-1 RNA (VL) levels on all individuals testing positive for HIV during a 5-day high-throughput multidisease community health campaign in May 2012 that recruited two-thirds of the population. We aggregated individual-level VL results into population VL 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 of 2179 adults were HIV-seropositive adults (10%). Overall, among 208 of 223 HIV-seropositive adults in whom VL was tested, 53% had an undetectable VL [95% confidence interval (CI): 46 to 60], up from 37% (95% CI: 30 to 45; P = 0.02) in 2011. Seven (3%) individuals had a VL of >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 to 3.29 log) in 2012, down from 3.62 log (95% CI: 3.46 to 3.78 log) in 2011 (P < 0.0001). Similar reductions in population VL were seen among men and women.
  
  
  CONCLUSIONS
  Reductions in population VL metrics and a substantial increase in the proportion of persons with an undetectable VL were observed in a rural Ugandan community from 2011 to 2012. These findings from a resource-limited setting experiencing rapid ART scale-up may reflect a population-level effectiveness of expanding ART access.
authors.affiliation: *HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA; †Makerere University-University of California, San Francisco Research Collaboration, Kampala, Uganda; ‡Makerere University Joint AIDS Program, Kampala, Uganda; §Division of Biostatistics, University of California, Berkeley, Berkeley, CA; ‖Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC; ¶Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA; and #Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Vivek
authors.initials: V
authors.lastname: Jain
authors.forename: Dathan M
authors.initials: DM
authors.lastname: Byonanebye
authors.forename: Teri
authors.initials: T
authors.lastname: Liegler
authors.forename: Dalsone
authors.initials: D
authors.lastname: Kwarisiima
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chamie
authors.forename: Jane
authors.initials: J
authors.lastname: Kabami
authors.forename: Maya L
authors.initials: ML
authors.lastname: Petersen
authors.forename: Laura B
authors.initials: LB
authors.lastname: Balzer
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Clark
authors.forename: Douglas
authors.initials: D
authors.lastname: Black
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Geng
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Gideon
authors.initials: G
authors.lastname: Amanyire
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; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000097:blood*; D012424:Rural Population; D014454:Uganda; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral