Thomas Quinn Uganda Bloomberg School of Public Health, MHS program Two-thirds of HIV-infected individuals in the world reside in Sub-Saharan Africa. Recent attention has focused on improving access to antiretroviral drugs (ARVs) in this region, but prevalence data for many countries is scarce or incomplete, complicating decisions regarding the location and extent to which ARVs should be distributed. Therefore, there is an urgent need for HIV surveillance instruments that can be used to prioritize HIV-infected individuals for ARVs and are practical in resource-limited settings. Dried blood spots (DBS) have been shown to be an effective method for collection of blood that obviates the need for cold chain transport or storage. In this proposal, we describe a real-time PCR based technique to quantify TCR gene rearrangements from DBS as a surrogate for a total lymphocyte count (TLC). Given that TLCs have been shown to be useful in predicting eligibility for HAART based on WHO CD4+ T cell count guidelines, we hypothesize that this procedure will provide a practical, efficient way to target ARV rollout. We propose to test the utility and validity of this technique by assessing the correlation between the percentage of cells that have undergone TCR recombination and CD4+ T cell counts calculated using flow cytometry in 2,000 patients at the Rakai Health Services Program clinic in Uganda. | 
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