CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

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.

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. 1088 Self-Selection of Circumcision Acceptors, Risk Compensation and Effectiveness of Circumcision Among Service Recipients, Rakai, Uganda Joseph Kagaayi 1 ; Xiangrong Kong 2 ; Godfrey Kigozi 1 ; Fred Nalugoda 1 ; Steven J. Reynolds 3 ; David Serwadda 4 ; Nelson K. Sewankambo 5 ; Maria J.Wawer 2 ; Ronald H. Gray 2 1 Rakai Health Sciences Program, Entebbe, Uganda; 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US; 3 Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, US; 4 Makerere University School of Public Health, Kampala, Uganda; 5 Makerere University College of Health Sciences, Kampala, Uganda Background: There are limited data on characteristics of acceptors of safe male circumcision (SMC), risk compensation and effectiveness of SMC service programs. We compared baseline characteristics of SMC acceptors and non-acceptors, determined the effectiveness of SMC and compared trends in sexual behaviors of the two groups using data on men aged 15-49 years enrolled in the Rakai community cohort study in Uganda. Methods: 1192 non-Muslim HIV-negative SMC acceptors were compared to a stratified random sample of 2384 uncircumcised men. Baseline behaviors and trends over time were compared using multivariable modified Poisson with generalized estimating equations. HIV incidence rates between the groups were compared using the incidence rate ratio (IRR) from a multivariable Poisson regression model. Results: Overall SMC acceptors were younger, less likely to be currently or previously married, and had higher education attainment. Among sexually active men, baseline sexual behaviors were comparable between the groups. However SMC acceptors had 26 percent higher prevalence of genital ulcers compared to non-acceptors (p=0.025). After circumcision, the rate of increase in prevalence of sexual activity was 2.6 percent higher among SMC acceptors (p<0.001) compared to non-acceptors. On stratification by age, the difference was 3.2 percent higher, p=0.08 among youths (15-24) but no difference was seen above 24 years. The prevalence of sexual activity with women in higher risk occupations (bar attendants, alcohol brewers, restaurant workers, itinerant traders, fisher folk, housemaids), increased by 10.2 percent per year among SMC acceptors (p=0.007) but no change occurred among uncircumcised men. Trends in other sexual behaviors were similar between the groups. HIV incidence among SMC acceptors was 0.61/100 person years and 1.11/ 100 person years among non-acceptors (adj. IRR=0.50, p=0.05, 95 percent CI=0.25-1.01). Conclusions: The higher prevalence of genital ulcers among sexually active SMC acceptors suggests that higher risk sexually active men self-selected to receive SMC. The suggestion of faster increase in sexual activity among circumcised youths and the increase in partnerships with higher risk women suggest possible behavioral disinhibition and need to be investigated in other settings. Though these behaviors, did not attenuate the effectiveness of SMC, there is need to add avoidance of high risk partners to the current SMC messaging. 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. Results: Men with DS had significantly thicker SC in their inner foreskin than uncircumcised men: 12.09um ± 2.92 versus 9.87um ± 2.54 respectively (n=16; p<0.001; 500 total measurements). In DS individuals, the inner and outer foreskin epithelium SA collectively showed significant difference (outer: 0.0457 ± 0.0108mm 2 ; inner:0.0285 ± 0.0078mm 2 ) (p<0.001; 160 total measurements)). This observation was shared with epithelium-dermis adhesion (outer: 2.4583 ± 0.7891;inner: 1.7878 ± 0.5510) (p<0.01). CD4 T cells were also observed in the inner and outer foreskin.

Poster Abstracts

634

CROI 2015