Impact of Antiretroviral Therapy on Adult HIV Prevalence in a Low-Income Rural Setting in Uganda: A Longitudinal Population-Based Study

Nsubuga, Rebecca N. BSc, MSc, PhD*; Maher, Dermot MA, BM BCh, DM*; Todd, Jim E. MA, MSc†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 April 2013 - Volume 62 - Issue 5 - p 562–568
doi: 10.1097/QAI.0b013e3182847033
Epidemiology and Prevention

Objective: To estimate the contribution to HIV prevalence of lives saved due to the introduction of antiretroviral therapy (ART) in rural Uganda in 2004.

Design: Open population-based cohort study.

Methods: An open general population cohort with annual demographic and HIV serostatus data is used to estimate annual HIV prevalence, HIV incidence, and mortality from 2000 to 2010. We calculated standardized mortality rates among HIV-positive adults and the expected number of deaths in the cohort if ART had not been available during 2004–2010, based on the average mortality rate in the 4 years (2000–2003) before ART introduction.

Results: During 2004–2010, the estimated prevalence increased by 29% from 6.9% to 8.9%. HIV incidence was 5.6 cases per 1000 person-years in 2004, falling to 3.9 cases per 1000 person-years in 2006, and slightly rising to 5.1 in 2010. There was an increase of 182 in the number of HIV-positive participants during that period, cumulatively 228 lives were saved due to ART. Expected lives saved due to ART accounted for an increasing proportion of the estimated HIV prevalence from 4.0% in 2004 to 29.4% in 2010.

Conclusions: Expected lives saved due to ART largely accounted for the increased estimated HIV prevalence from 2004 to 2010. Because HIV prevalence survey results are important for planning, programming, and policy, their interpretation requires consideration of the increasing impact of ART in decreasing mortality.

*Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda;

Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and

TAZAMA Project, National Institute of Medical Research, Mwanza, Tanzania.

Correspondence to: Rebecca N. Nsubuga, PhD, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda (e-mail:

This study was part of a program of research funded by the Medical Research Council (United Kingdom).

The authors have no conflicts of interest to disclose.

D.M. had the idea for the study, which was developed in collaboration with R.N.N. and J.T. All the authors contributed to study design and to analysis and interpretation of data. D.M. wrote the first draft, with contributions by R.N.N. and J.T. to subsequent iterations, and R.N.N. edited the final article. All the authors have seen and approved the final article.

Received July 24, 2012

Accepted December 20, 2012

© 2013 Lippincott Williams & Wilkins, Inc.