CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

p=0.65). The proportion of HIV+ PW that received ART increased from 37% to 94% (p=0.05). Among 1,041 HEI enrolled pre-B+ and 1,220 HEI enrolled post-B+, a significantly lower proportion of HEI tested (<=2months of age) had a positive PCR (6% vs 4%, p=0.03). However in both periods, fewer than half the HEIs had PCR tests (41%and 46%of expected HEI).

Weighted paired t-test analyses of PMTCT cascade pre and post B+ implementation Conclusions: In Mozambique, Option B+ implementation resulted in higher number of HIV+ PW initiating ART. However, significant bottlenecks in testing infants remain as less than half of HEI received early diagnostic tests. Although our finding of a lower proportion of HIV positive young infants among those tested is encouraging, more data are needed to assess the impact of option B+ on HIV-free child survival. 874 Option B+ Scale Up and Comprehensive PMTCT Service Delivery in Central Malawi Michael E. Herce 1 ;Tiwonge Mtande 2 ; Frank Chimbwandira 3 ; Innocent Mofolo 2 ; Christine Chingondole 2 ; Nora Rosenberg 4 ; Kathryn Lancaster 4 ; Mina C. Hosseinipour 1 ; Charles M. van der Horst 1 Safeguard the Family—Malawi Ministry of Health Partnership 1 University of North Carolina, Lusaka, Zambia; 2 UNC Project-Malawi, Lilongwe, Malawi; 3 Malawi Ministry of Health, Lilongwe, Malawi; 4 University of North Carolina, Chapel Hill, NC, US Background: Prior to the Ministry of Health (MoH) introducing life-long antiretroviral therapy (ART) for all HIV-positive pregnant women (Option B+) in Malawi, only one-third of HIV-positive pregnant women received ART for the prevention of mother-to-child transmission of HIV (PMTCT). We launched Safeguard the Family (STF) to support Option B+ scale up and strengthen the PMTCT continuum of care in 5 districts with 3.8 million people. We implemented facility-level quality improvement interventions to address gaps in the delivery of HIV testing and counseling (HTC), infant nevirapine (NVP) prophylaxis, and early infant HIV diagnosis (EID). We hypothesized that performance for STF districts on MoH PMTCT indicators would improve with time and outperform national averages, and that HIV-1 prevalence among exposed infants would be lower in STF districts than the national average. Methods: We conducted a cross-sectional study using quarterly (Q) programmatic data and infant HIV-1 DNA PCR test results from STF years (Y) 1–3: Y1, April—December 2011; Y2, January—December 2012; Y3, January—December 2013. Results: Facility-level uptake of ART, HTC, and infant NVP prophylaxis among HIV-positive pregnant women increased from baselines of 22% (n/N= 442/1,981), 66% (n/N= 32,433/48,804), and 1% (n/N= 16/1,157) to 96% (n/N= 2,046/2,121), 87% (n/N= 39,458/45,324), and 100% (n/N= 2,121/2,121), respectively, at project end (p<0.01). ART, HTC, and infant NVP prophylaxis uptake outperformed national averages by a mean of 9.8% (standard error: 2.3%), over the last 5 project quarters. STF provided interim first-time HIV-1 DNA PCR testing for 2,256 of 14,347 exposed infants (16%) enrolled in the MoH EID program in STF districts from EID program start (Y1 Q4) through Y3. Of these 2,256 infants, 79 (3.5%) tested HIV-positive. Among infants with complete EID documentation (n=615), median age at first DNA PCR testing decreased from 109 days (IQR: 57–198) in Y1/Y2 to 76 days (IQR: 46–152) in Y3 (p<0.01). During Y3 (only year with national data available for comparison), fewer HIV-exposed infants (3.6%) tested HIV-positive at first DNA PCR testing in STF districts than the national average (4.1%) (p=0.3).

Poster Abstracts

Quarterly (Q) comparison of infant nevirapine prophylaxis uptake in antenatal clinics (ANC) among HIV-positive pregnant women presenting to health facilities in the Safeguard the Family (STF) catchment area versus the national average (MoH) for project years (Y) 1 to 3 (April 2011 through December 2013). Conclusions: Delivering comprehensive PMTCT services within an Option B+ program achieved high uptake of HTC, ART, and infant NVP prophylaxis, and a low proportion of exposed infants found HIV-positive at first testing. Continued investments are needed to strengthen the PMTCT continuum of care in Malawi, particularly around EID. 875 Retention Amongst HIV-Infected Pregnant Women Initiating Lifelong Antiretroviral Treatment (Option B+) in Haiti JeanW. Domercant 2 ; Nancy Puttkammer 3 ; Lydia Lu 1 ; Kesner Francois 4 ; Olbeg Desinor 5 ; Reginald Jean_Louis 2 ; Michelle Adler 1 ; Barbara Marston 1 ; Reynold Grand’Pierre 4 1 US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US; 2 US Centers for Disease Control and Prevention (CDC), Port au Prince, Haiti; 3 International Training and Education Center for Health, Seattle, WA, US; 4 Ministry of Health of the Government of Haiti, Port au Prince, Haiti; 5 US Agency for International Development, Port au Prince, Haiti Background: In 2012, Haiti adopted and implemented Option B+ for prevention of mother-to-child transmission of HIV (PMTCT), starting all HIV-infected pregnant women on lifelong antiretroviral therapy (ART) regardless of their CD4 count.

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CROI 2015