CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

1063 Use of the Seroadaptive Strategies of Sexual Positioning and Serosorting by MSM in Nigeria Cristina M. Rodriguez-Hart 1 ; Hongjie Liu 2 ; Ifeanyi K. Orazulike 3 ; Sam Zorowitz 4 ; Sylvia Adebajo 5 ; Lindsay Hughes 6 ; Stefan Baral 7 ; Merlin L. Robb 6 ;William Blattner 1 ; Manhattan Charurat 1 1 University of Maryland School of Medicine, Baltimore, MD, US; 2 University of Maryland School of Public Health, College Park, MD, US; 3 International Center on Advocacy and Rights to Health, Abuja, Nigeria; 4 Massachusetts General Hospital and Harvard Medical School, Boston, MA, US; 5 Population Council, Abuja, Nigeria; 6 US Military HIV Research Program, Bethesda, MD, US; 7 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US Background: Sexual positioning and serosorting are two seroadaptive strategies adopted by some men who have sex with men (MSM) as HIV harm reduction strategies. The current analysis investigated these factors among MSM in Nigeria, where rates of infection are 10 fold higher than in the general population, who participated in the TRUST study. Methods: Using respondent-driven sampling, 392 eligible MSM were interviewed. A subject was considered to be engaged in sexual positioning if an HIV positive MSM who knew his status prior to the study reported only receptive anal sex for the previous 12 months or an HIV negative MSM who knew his status prior to the study reported only insertive anal sex for the previous 12 months. A subject was considered to be engaged in serosorting if he knew his HIV status prior to the study and reported having only sex partners of the same HIV status. Logistic regression with generalized estimating equations was used to analyze factors associated with engagement in positioning or serosorting. Results: Of the 390 participants with HIV testing history and who were tested for HIV at baseline, 21% (85/390) were HIV positive and reported knowing their status, 29% (114/390) were HIV negative and reported knowing their status, 23% (89/390) were HIV positive and reported not knowing their status, and 25% (97/390) were HIV negative and reported not knowing their status. Among HIV positive MSM who knew their HIV status, 21% (18/85) practiced receptive sex only. Among HIV negative MSMwho knew their status, 39% (44/114) practiced insertive sex only. Engagement in sexual positioning was associated with older age (OR=2.15; 95%CI: 1.07-4.32), not being married to a woman (OR=2.94; 95%CI: 1.03-8.33), and communication with partners about HIV status (OR=1.84; 95%CI: 1.01-3.36). The 384 MSMwho reported any sex partner data generated 1565 sex partner dyads. Serosorting took place only among 192 dyads (12%). Engagement in serosorting was associated with communication with partners about HIV status (OR=3.78; 95%CI: 2.12-6.75) and stronger friendship (OR=1.40; 95%CI: 1.11-1.76).

Oral Abstracts

Conclusions: With this low level of engagement in harm reduction strategies among Nigerian MSM, interventions that promote communication between sex partners to adopt harm reduction and engage the full spectrum of combination prevention strategies promoted by the TRUST intervention are a focus of ongoing study, including how to influence normative behaviors in sexual networks. 1104 The Lifetime Medical Cost Savings From Preventing HIV in the United States Bruce R. Schackman 1 ; John Fleishman 6 ; Amanda Su 2 ; Richard Moore 5 ; RochelleWalensky 2 ; David Paltiel 3 ; MiltonWeinstein 4 ; Kenneth Freedberg 2 ; Kelly Gebo 5 ; Elena Losina 2 1 Weill Cornell Medical College, New York, NY, US; 2 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US; 3 Yale School of Public Health, New Haven, CT, US; 4 Harvard School of Public Health, Boston, MA, US; 5 Johns Hopkins University School of Medicine, Baltimore, MD, US; 6 Agency for Healthcare Research and Quality, Rockville, MD, US Background: Enhanced HIV prevention interventions, such as pre-exposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting one HIV infection in the United States. Methods: We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing one HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV- infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range $1,854-$4,545/month) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range $73-$628/month). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 US dollars). Results: The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% for non-drug costs). For individuals who remain uninfected, but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding one HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided.

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CROI 2015