CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

1085 Association Between Foreskin Microbiota and Local Cytokines in Men From Rakai, Uganda Cindy M. Liu 1 ; Aaron A.Tobian 1 ; Jessica Prodger 2 ; David Serwadda 3 ; Godfrey Kigozi 3 ; Fred Nalugoda 3 ; Maria J.Wawer 2 ; Lance Price 4 ; Rupert Kaul 5 ; Ronald H. Gray 2 1 Johns Hopkins University School of Medicine, Baltimore, MD, US; 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US; 3 Rakai Health Sciences Program, Rakai, Uganda; 4 Translational Genomics Research Institute, Flagstaff, AZ, US; 5 University of Toronto, Toronto, Canada Background: Male circumcision (MC) reduces the risk of HIV. Foreskin inflammation induced by specific genital bacteria could elicit local immune responses, promoting inflammation and recruitment of HIV target cells. MC decreases genital anaerobes; however, direct associations between penile microbiota and inflammatory markers have not been demonstrated. We assessed the penile microbiota and cytokine levels in 138 uncircumcised men from Rakai, Uganda. Methods: Microbiota were characterized using DNA extracted from a coronal sulcus swab eluent by 16S rRNA gene-based qPCR and V3V4 pyrosequencing, obtaining a total of 371,653 sequences. Genital bacteria present at >0.05% of total sequences were included in the analysis. Using the total microbiota density measured by qPCR and microbiota proportional abundance from sequencing, we calculated the microbiota absolute abundance. Eluent levels of 14 cytokines were measured using an electrochemiluminescent detection platform, and correlated with the absolute abundance of genital bacteria using a quasi-Poisson regression model. Model comparisons were performed by chi-square test. Results: Only IL-8 levels were sufficient to permit quantitative correlation ( Median = 0.72 log 10 , IQR = 0.18-1.38 log 10 ). Among penile bacteria significantly reduced by MC in prior studies, 11 were positively correlated with IL-8 levels in univariate analyses, including Prevotella , Porphyromonas , Finegoldia , Peptoniphilus , Peptostreptococcus , Anaerococcus , Dialister , Mobiluncus , Actinomyces , Sutterella , and Unclassified Clostridiales Family XI. In multivariate analysis Prevotella ( Δ =+49.6% in IL-8 per 10-fold increase in Prevotella spp , P= 0.048) and Peptostreptococcus ( Δ =+34.0%, in IL-8 per 10-fold increase, P< 0.001) abundances were associated with increased IL-8 levels, with a similar trend for Staphylococcus ( Δ =+21.5%, P= 0.062). In contrast Corynebacterium , which are increased post-MC, were associated with lower IL-8 levels ( Δ = -22.8%, P= 0.0058). Conclusions: Prevotella and Peptostreptococcus , which are decreased by MC, were associated with significant increases in penile IL-8, while Corynebacterium , which increases post-MC, was associated with lower IL-8. These findings suggest that post-MC changes in microbiota may reduce inflammatory cytokines and HIV susceptibility. 1086 Mobile VMMC Teams in Tanzania See Older Clients and Have Higher Followup Rates Augustino M. Hellar 1 ; Dorica Boyee 1 ; Hally Mahler 1 ; Marya Plotkin 1 ;Touma Ng’wanakilala 1 ; Kelly Curran 2 ;Tigistu Ashengo 2 ; Hawa Mziray 1 ; Erick Mlanga 3 ; Sifuni Koshuma 4 1 Jhpiego, Dar es Salaam, United Republic of Tanzania; 2 Jhpiego, Baltimore, MD, US; 3 US Agency for International Development, Dar es Salaam, United Republic of Tanzania; 4 Ministry of Health and Social Welfare, Iringa, United Republic of Tanzania Background: Tanzania has rolled out Voluntary Medical Male Circumcision (VMMC) since 2009 in 12 priority regions with high HIV and lowmale circumcision rates. More than 390,000 clients have been served in Iringa, Njombe and Tabora regions with support from Jhpiego and USAID. Nearly 80% of clients reached are aged 10-19 years. Iringa and Njombe are approaching their original 80% coverage target. Service delivery modalities include routine, in which services are delivered in larger health facilities, typically at low volume, and campaigns where teams of providers move into new communities and do 1-3 week bursts of intense, high-volume provision of services. In May 2014, mobile services were introduced specifically to serve the hard-to-reach clients not reached by other modalities. This roving team of providers, move along villages to provide VMMC services even in non-facility settings. The analysis presents findings on differences in the three modalities. Methods: Secondary data review was conducted on 148,880 individual records, stripped-of identifiers from all three regions from October 2013-August 2014, the year when mobile teams were introduced. Records were broken into three modalities: campaign, routine and mobile. Frequencies were compared between the modalities and Chi 2 was used to test for the significance of the differences. Results: 76% of the 148,880clients circumcised during the year were aged <20 years. Mobile teams reached older clients compared to other service delivery modalities (p<0.001), as shown below. Overall HIV testing uptake was high (97%) regardless of the modality. A higher proportion tested HIV positive in the routine followed by mobile modalities (2.1% and 1.4% respectively). Follow-up rates were significantly higher in the mobile modality both for 1 st and 2 nd visits (91.7% and 63.1% respectively) compared to static modality (70% and 36% respectively); p-value < 0.001). 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™

Poster Abstracts

633

CROI 2015