CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Conclusions: A higher proportion of older clients (20 years or older) accessed VMMC services through mobile teams compared to other modalities. Mobile teams are circumcising in lower volume settings than campaigns where it’s easier to offer more privacy to older clients. Introduction of mobile teams could be an efficient strategy to attract older clients who have not previously accessed services. With the slightly high proportion of HIV positive clients, linkage to care and treatment must be ensured. Follow-up rates were very high in the mobile setting, probably because of active client follow-up. 1087 High Acceptability of PrePex™ Device in Routine Programmatic Settings in Rwanda Eugene Rugwizangoga 1 ; Beata Mukarugwiro 1 ; Jovite Sinzahera 1 ; Alphonse Mutabaruka 1 ; Gloriose Abayisenga 1 ; J.D. Ntakakirabose 1 ; Ngeruka Leon 4 ; Eugene Zimulinda 3 ; Kelly Curran 2 ;Tigistu Ashengo 2 1 Jhpiego/Rwanda, Kigali, Rwanda; 2 Jhpiego, an Affiliate of Johns Hopkins University, Washington, DC, US; 3 US Department of Defense, Rwanda, Kigali, Rwanda; 4 Rwanda Military Hospital, Kigali, Rwanda Background: The PrePex™ device offers an alternative to conventional surgical methods of male circumcision. Because it does not require injectable anesthesia or the cutting of vital tissue, PrePex™ requires less surgical capacity and may be more acceptable to men, potentially increasing uptake of this proven HIV prevention intervention. In May 2013, PrePex™ received WHO prequalification for adults aged 18 and above. Rwanda was the first country to conduct PrePex™ safety and acceptability studies and is now the first to scale-up PrePex™ in programmatic settings. PrePex™ currently comes in five adult sizes, A through E. Since 2009, Jhpiego, with PEPFAR funding through the US Department of Defense, has supported the Rwanda Defense Force (RDF) to provide VMMC to soldiers, their dependents and civilians living near base clinics. Since February 2014 PrePex™ has been offered alongside conventional surgery to adult VMMC clients at Jhpiego-supported RDF sites. Methods: We reviewed routine program data from Jhpiego-supported RDF sites from program inception in October 2009 through August 2014. Results: Between October 2009 and August 2014 86,284 adolescent boys and adult men were circumcised at Jhpiego-supported RDF sites, with 20,877 of these clients served in the seven months since PrePex™ was added. Since PrePex™ was introduced nearly two thirds of circumcisions have used the device, with 13,148 (63%) of clients receiving PrePex™ and 7,729 (37%) conventional surgery. Overall uptake has been increasing year to year; the number of clients served doubled from 2012 to 2013 thanks to efficiency approaches such as task shifting to nurses and use of mobile (outreach) teams. PrePex™ introduction appears to have accelerated this trend although in July 2014 the program experienced device stockouts especially in sizes A,D and E.

Oral Abstracts

PrePex™ and Surgical VMMCs Conducted at Jhpiego-supported RDF Sites, Feb-Aug 2014 Conclusions: The introduction of the PrePex™ device in routine programmatic settings is well accepted by adult VMMC clients in Rwanda, with 63% of this age group choosing PrePex™. The acceptance rate would have likely have been higher if not for a stock out of PrePex™ devices beginning in July 2014. Programs planning to scale up PrePex™ should anticipate the supply chain implications of this device which is currently available in five adult sizes. 1089 Potential Protection FromHIV Transmission by Penile Cuttings in Papua New Guinea Ivy H. Shih 1 ; Lester Asugeni 2 ; Matthew David 5 ; Paul Horwood 5 ; Parana Hewage Mangalasir 3 ; David Mc Laren 3 ; RachaelTommbe 2 ; AndrewVallely 1 ; ArnoldWaine 4 ; Stuart G.Turville 1 1 The Kirby Institute, Sydney, Australia; 2 Pacific Adventist University, Port Moresby, Papua New Guinea; 3 James Cook University, Cairns, Australia; 4 University of Papua New Guinea, Port Moresby, Papua New Guinea; 5 Papua New Guinea Institute of Medical Health, Goroka, Papua New Guinea Background: Male circumcision reduces HIV acquisition by 66% but there has yet to be a scientific consensus on the protective mechanism. Current hypotheses implicate the inner foreskin due to a thinner primary barrier and greater target cell density. Unique to Papua New Guinea (PNG), ethnographic studies documented widespread non-medical penile cutting practices. The dorsal slit (DS) is the most common and leads to exposure of glans and inner foreskin and provides an opportunity to study a scenario where the inner foreskin is exposed but not removed. We present results from a cohort study assessing histological changes to thin skin that may aid prevention in both circumcised and dorsal slit men. Methods: Foreskin samples were obtained frommen with or without existing DS following elective enrolment at a free circumcision service offered at Port Moresby, PNG. Histological evaluation on frozen and paraffin embedded foreskin sections assessed primary barrier parameters that potentially afford HIV protection. Phenotypes were measured on hematoxylin and eosin stained sections: Stratum corneum thickness (SC), epithelial surface area (SA) and epithelial adhesion to the dermis, the latter two used to evaluate foreskin fragility. Alkaline expansion was conducted to representatively measure SC architecture. Imaging with a high- resolution slide scanner generated an entire tissue section image and epithelium SA was quantified with a recognition algorithm. Density and distribution of HIV target cells foreskin tissue was determined by immunofluorescence to establish foreskin vulnerability.

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CROI 2015