Scale-Up of HIV Antiretroviral Therapy and Estimation of Averted Infections and HIV-Related Deaths - Uganda, 2004-2022

Abstract

On January 28, 2003, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to address a single disease in history, was announced.* In April 2004, the first person in the world to receive PEPFAR-supported antiretroviral therapy (ART) was a man aged 34 years in Uganda. Effective ART reduces morbidity and mortality among persons with HIV infection (1) and prevents both mother-to-child transmission (MTCT) (2) and sexual transmission once viral load is suppressed to undetectable levels (<200 viral copies/mL) (3). By September 2022, more than 1.3 million persons with HIV infection in Uganda were receiving PEPFAR-supported ART, an increase of approximately 5,000% from September 2004. As indicators of the ART program's effectiveness, a proxy MTCT rate decreased 77%, from 6.4% in 2010 to 1.5% in 2022, and the viral load suppression rate (<1,000 viral copies/mL) increased 3%, from 91% in 2016 to 94% in September 2022. During 2004-2022, ART scale-up helped avert nearly 500,000 HIV infections, including more than 230,000 infections among HIV-exposed infants, and approximately 600,000 HIV-related deaths. Going forward, efforts will focus on identifying all persons with HIV infection and rapidly linking them to effective ART. PEPFAR remains committed to continued strong partnership with the Government of Uganda, civil society, and other development partners toward sustainable solutions aligned with the Joint United Nations Programme on HIV/AIDS (UNAIDS) fast-track strategy to ending the global AIDS epidemic by 2030^† and safeguarding impact achieved in the long term.

FIGURE 1

Cumulative number of persons with HIV infection receiving PEPFAR-supported antiretroviral therapy, with percentage who are adults and who are female — Uganda, fiscal years 2004–2022 Abbreviations: ART = antiretroviral therapy; PEPFAR = President’s Emergency Plan for AIDS Relief. * Before October 2018, persons with HIV infection on ART were defined as clients at a PEPFAR-supported site with ≤90 days since last appointment; in October 2018, this definition changed to ≤28 days since last appointment. “Option B+” expanded ART eligibility to all pregnant and breastfeeding women with HIV. “Treat All” expanded ART eligibility to all persons with HIV infection regardless of disease severity or other criteria. The main dolutegravir-based regimen used in Uganda is tenofovir-lamivudine-dolutegravir. The first case of COVID-19 in Uganda was identified in March 2020. † Data on percentages of age and sex to calculate percentage adults (aged ≥15 years) and female of any age available for 2005–2022. ^§ October–September. Data represent number of persons with HIV infection on PEPFAR-supported ART on September 30 of each fiscal year.

FIGURE 2

Proxy mother-to-child transmission rate (A) and viral load suppression rate (B) reported by PEPFAR-implementing partners — Uganda, fiscal years 2010–2022^§ Abbreviations: ART = antiretroviral therapy; MTCT = mother-to-child transmission; PEPFAR = President’s Emergency Plan for AIDS Relief; VL = viral load. * Number of HIV-exposed infants during pregnancy or the breastfeeding period (i.e., 18 months postpartum) who received a positive HIV test result among those who were tested. Data were available for fiscal years 2010–2022. “Option B+” expanded ART eligibility to all pregnant and breastfeeding women with HIV infection. “Treat All” expanded ART eligibility to all persons with HIV infection regardless of disease severity or other criteria. The main dolutegravir-based regimen used in Uganda is tenofovir-lamivudine-dolutegravir. The first case of COVID-19 in Uganda was identified in March 2020. ^† VL suppression defined as <1,000 viral copies/mL; suppression rate calculated as number of persons with HIV infection with VL suppression among those who had a VL test. Data available for fiscal years 2016–2022. ^§ October 1–September 30. Data represent number of persons with HIV infection on PEPFAR-supported ART on September 30 of each fiscal year.

FIGURE 3

Numbers of HIV infections and deaths averted — Uganda, mid-years 2004–2022 Abbreviation: UNAIDS = United Nations Programme on HIV/AIDS. * Using the 2021 UNAIDS Spectrum AIDS Impact Model and Goals ASM model to estimate the number of infections (including among HIV-exposed infants) and deaths averted. https://www.avenirhealth.org/software-spectrum.php ^† Mid-years are July–June.