CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Though retention in care for patients with early HIV disease is slowly improving over time, <50% have been retained in care over the past decade. The median time for CD4 count decline to ≤ 500 cells/mm 3 is 19.9 months. Further studies on the impact of ART on retention in care for patients with early HIV are urgently needed. 1013 Awareness of HIV Diagnosis in the Swaziland HIV Incidence Measurement Survey Tanya M. Ellman 1 ; Ruth Emerson 4 ; Deborah Donnell 4 ; Neena M. Philip 1 ; Rejoice Nkambule 2 ; Naomi Bock 3 ; Peter Ehrenkranz 5 ; George Bicego 3 ; Jessica E. Justman 1 1 ICAP at Columbia University, New York, NY, US; 2 Ministry of Health, Mbabane, Swaziland; 3 US Centers for Disease Control and Prevention, Atlanta, GA, US; 4 Fred Hutchinson Cancer Research Center, Seattle, WA, US; 5 Centers for Disease Control and Prevention, Mbabane, Swaziland Background: Awareness of HIV diagnosis at the population level may be a useful way to gauge effectiveness of testing programs. In a 2007 household-based national survey, 31% of adults aged 15-49 were HIV-infected, and of these, 55% reported no prior HIV testing and were therefore unaware of their diagnosis. We report on the prevalence of undiagnosed HIV among HIV-infected adults in Swaziland in 2011. Methods: In the Swaziland HIV Incidence Measurement Survey (SHIMS), a nationally representative sample of 18,172 men and women aged 18-49, completed household-based counseling and rapid HIV testing and provided clinical and demographic information, including self-reported results of prior HIV tests. Seropositive individuals who reported a prior positive test were defined as aware of their diagnosis; seropositive individuals who reported no prior HIV testing or a prior negative, unknown or indeterminate test, were defined as unaware. Data were weighted to adjust for sampling methods and differences in non-response to achieve population representativeness. Characteristics of those aware and unaware were compared using logistic regression models. Results: 5,829 (32%) adults tested HIV-seropositive in SHIMS, and of these 2,238 (38%) were unaware of their diagnosis. Undiagnosed HIV was more common among men than women (50% vs 32%, p <0.001) and among younger adults, 18-29 y, than older adults, 40-49 y (46% vs 31%, p <0.001); neither current pregnancy nor circumcision status correlated with awareness. Adjusting for marital status, education background, and current employment, men were more than twice as likely to be unaware of their HIV diagnosis compared to women (aOR 2.54, 95% CI 2.25, 2.87) and younger adults more than twice as likely as older adults to be unaware (aOR 2.44, 95% CI 2.04, 2.86). Among all seropositive individuals, 960 of 5829 (16.5%) reported no prior HIV testing. Among those unaware of their diagnosis, 576 of 2238 (26%) reported a negative HIV test in the year prior to SHIMS. Conclusions: While over one-third of HIV-infected adults in Swaziland were unaware of their diagnosis, only one-sixth reported no prior testing, reflecting considerable testing uptake since 2007, when more than half reported this. Men and younger individuals should be targeted for testing in the community, opportunities for testing during contact with the health care system should not be missed, and annual testing of all adults in high prevalence countries should be considered. 1014 Who Is at Risk of Being Untested and Unaware of HIV-Positive Status in KwaZulu-Natal? Helena Huerga 1 ; GillesVan Cutsem 2 ; Jihane Ben Farhat 1 ; Malika Bouhenia 1 ; Matthew Reid 2 ; David Maman 1 ; Jean-François Etard 1 ;Thomas Ellman 2 1 Epicentre, Paris, France; 2 Médecins Sans Frontières, Cape Town, South Africa Background: HIV prevalence in KwaZulu-Natal (KZN) is one of the highest in the world. HIV testing and positive status awareness are key aspects in the control of the epidemic. We assessed HIV testing and positive status awareness rates as well as associated factors in Mbongolwane and Eshowe, KZN, South Africa. Methods: Cross-sectional population-based survey. A cluster sampling and geospatial random selection was used to identify households visited. Individuals aged 15-59 years living in the area were eligible. Face-to-face interviews were carried out followed by rapid HIV testing on site and blood collection for other HIV related tests. Results: In total, 5649 (84.5%) of 6688 eligible individuals were included: 62.3%women and 37.7%men. Overall HIV prevalence was 25.2% (95%CI: 23.6-26.9): 30.9% in women and 15.9% in men. Among all individuals, 4598 (81.4%, 95%CI: 79.8-82.9) declared to ever having had an HIV test prior to the survey (88.4% of women vs 69.8% of men, p<0.001). In total, 25.6% (95%CI: 23.4-27.9) of participants aged 15-19 years and 30.0% (95%CI: 27.7-32.5) of men less than 30 years had never tested. Participants had been tested a median of 3 times (IQR: 2-4) and 48.2% had their last test done in the previous 6 months. A majority, 78.6%, were tested in the public sector, 18.9% by MSF and 2.5% by others. In total, 1065 of 1416 HIV positive participants, 75.2% (95%CI: 72.9-77.4), were aware of their HIV positive status. Of HIV positive participants aged 20-24 years, 47.2% (95%CI: 40.2-54.3) overall and 83.3% of men were unaware of their status. In multivariate analyses, young people (<35 years), men and those with more than one sexual partner in the 12 months prior to the survey, were more at risk of being untested for HIV and unaware of their HIV infection (table). In addition, individuals over 45 years were less likely to have tested for HIV and those never married less likely to be aware of their positive status.

Poster Abstracts

Factors associated with not being tested for HIV and not being aware of HIV positive status Conclusions: HIV testing and positive status awareness are high in KwaZulu-Natal. However, a considerable proportion of young men were not tested and the majority of positive men aged 20-24 years were not aware of their status. Youth, men and people with more than one sexual partner are groups at risk of not being tested for HIV and not aware of their HIV status. HIV testing strategies should target these groups in order to improve their access to treatment and more effectively control the epidemic.

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CROI 2015