Changes in Viral Load after Home-based HIV Testing and Counseling - Swaziland Naomi Bock 1, Ruth Emerson 2, Velephi Okello 3, Neena Philip 4, Deborah Donnell 2, George Bicego 1, Peter Ehrenkranz 1, Rejoice Nkambule 3, Azih Charles Ikechi 3, Yen Duong 1, Jessica Justman 4 1 Centers for Disease Control and Prevention, Atlanta, USA and Mbabane, Swaziland, 2 Statistical Center for HIV/AIDS Research and Prevention and the Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, USA, 3 Ministry of Health, Swaziland, 4 ICAP-Columbia, Mailman School of Public Health, Columbia University, New York, USA

Participated 18,172 (74%) HIV+ 5,803 (32%) HIV-Neg 12,367 (68%) Selected for sub-group return visit 8-12 months after baseline FU 1,067 (15%) No contact/Refused 6384 (26%) Total potential participants in 2011: 24, 556 Viral load at baseline and FU; & CD4 at FU 922 (86%) 2 Random sample of adults who tested HIV+ at HBHTC as part of SHIMS underwent repeat viral load testing 8-12 months later

Total N VL < 1000 Baseline: (%) VL < 1000 at FU: (%) Change TOTAL 92241%47%7% HIV Aware at Baseline 65454%60%6% ART use at baseline 37286%85%-1% Initiated ART between baseline and FU 6018%78%60% No ART use 2239%12%3% Unaware at Baseline (newly diagnosed) 2687%15%8% Initiated ART between baseline and FU 3910%67%57% No reported ART use 2297%6%-1% Change in proportion with VL suppression by HIV awareness and by ART use at baseline and follow-up of 922 adults

Total N VL < 1000 Baseline: (%) VL < 1000 at FU: (%) Change TOTAL 92241%47%7% HIV Aware at Baseline 65454%60%6% ART use at baseline 37286%85%-1% Initiated ART between baseline and FU 6018%78%60% No ART use 2239%12%3% Unaware at Baseline (newly diagnosed) 2687%15%8% Initiated ART between baseline and FU 3910%67%57% No reported ART use 2297%6%-1% Change in proportion with VL suppression by HIV awareness and by ART use at baseline and follow-up of 922 adults

Total N VL < 1000 Baseline: (%) VL < 1000 at FU: (%) Change TOTAL 92241%47%7% HIV Aware at Baseline 65454%60%6% ART use at baseline 37286%85%-1% Initiated ART between baseline and FU 6018%78%60% No ART use 2239%12%3% Unaware at Baseline (newly diagnosed) 2687%15%8% Initiated ART between baseline and FU 3910%67%57% No reported ART use 2297%6%-1% Change in proportion with VL suppression by HIV awareness and by ART use at baseline and follow-up of 922 adults

Total N VL < 1000 Baseline: (%) VL < 1000 at FU: (%) Change TOTAL 92241%47%7% HIV Aware at Baseline 65454%60%6% ART use at baseline 37286%85%-1% Initiated ART between baseline and FU 6018%78%60% No ART use 2239%12%3% Unaware at Baseline (newly diagnosed) 2687%15%8% Initiated ART between baseline and FU 3910%67%57% No reported ART use 2297%6%-1% Change in proportion with VL suppression by HIV awareness and by ART use at baseline and follow-up of 922 adults

Total N VL < 1000 Baseline: (%) VL < 1000 at FU: (%) Change TOTAL 92241%47%7% HIV Aware at Baseline 65454%60%6% ART use at baseline 37286%85%-1% Initiated ART between baseline and FU 6018%78%60% No ART use 2239%12%3% Unaware at Baseline (newly diagnosed) 2687%15%8% Initiated ART between baseline and FU 3910%67%57% No reported ART use 2297%6%-1% Change in proportion with VL suppression by HIV awareness and by ART use at baseline and follow-up of 922 adults

Total N VL < 1000 Baseline: (%) VL < 1000 at FU: (%) Change TOTAL 92241%47%7% HIV Aware at Baseline 65454%60%6% ART use at baseline 37286%85%-1% Initiated ART between baseline and FU 6018%78%60% No reported ART use 2239%12%3% Unaware at Baseline (newly diagnosed) 2687%15%8% Initiated ART between baseline and FU 3910%67%57% No reported ART use 2297%6%-1% Change in proportion with VL suppression by HIV awareness and by ART use at baseline and follow-up of 922 adults

Conclusions  HBHTC increased knowledge of HIV-infected status and the proportion of those on ART in the study population.  Although VL suppression was high among those on ART, including among those who had started between baseline and follow up, the overall increase in proportion with viral suppression was small, from 40 to 47%.  The results of this study indicate that stronger linkage interventions and broader ART eligibility criteria are necessary to realize the potential of HBHTC for lowering population VL.