CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: The DS confers a degree of protection due to the inner foreskin SC thickening similar to the protective thick skin SC phenotype of outer foreskin. Beyond the protective primary barrier, the increased fragility of the inner foreskin in comparison to outer foreskin presents a new parameter that may account for the inner foreskin being a more vulnerable area.

WEDNESDAY, FEBRUARY 25, 2015 Session P-Y2 Poster Session

Poster Hall

2:30 pm– 4:00 pm Linkage to Care and ART Initiation 1090 Linkage to HIV Care Following Home-Based Testing and CD4 in Rural Malawi Sophie Masson 1 ; Jihane Ben Farhat 1 ; Charles Masiku 4 ; Benson Chilima 2 ; Elisabeth Szumilin 3 ; Leon Salumu 3 ; Jean-François Etard 1 ; David Maman 1 1 Epicentre/Médecins Sans Frontières, Paris, France; 2 Ministry of Health, Lilongwe, Malawi; 3 Médecins Sans Frontières, Paris, France; 4 Médecins Sans Frontières Malawi, Lilongwe, Malawi Background: HIV diagnosis and linkage to care are critical steps along the HIV continuum of care. We assessed HIV-positive status awareness and subsequent linkage to care of the newly diagnosed in a representative sample of Chiradzulu, Malawi, after 10 years of ART scale-up. Methods: A nested cohort study within a population-based survey of persons aged 15 to 59 years old was conducted between February and May 2013. During the survey, each consenting participant was interviewed and tested for HIV. Individuals found to be HIV positive had their CD4 tested at home using a point of care test. Those who were unaware of their status were included in the nested cohort study. Linkage to HIV care was defined as attending HIV care within 3 months of HIV diagnosis among newly diagnosed individuals. Among all HIV-positive, a logistic model explored factors associated with status awareness prior to the survey. Then, among the newly diagnosed, a Weibull model was fitted to explore factors associated with linkage to care. Results: Among the 8,277 individuals eligible for the survey, 7,270 were included and tested for HIV. A total of 1,233 participants were found to be HIV-positive, corresponding to an overall prevalence of 17.0% (95%CI 16.1-17.9). Prevalence was higher among women than men (19.7% vs 13.0%, p<0.01). Among HIV-positive individuals, 77.0% (95%CI 74.4- 79.3) were aware of their status and 72.8% (95%CI 70.1-75.3) in care. In the multivariate analysis, women and older people were more likely to be aware of their diagnosis. Among the newly-diagnosed, linkage to care occurred most frequently during the first weeks after diagnosis. The linkage probabilities after 2 weeks, 1 month and 3 months were 30.3%, 36.5% and 47.5%, respectively. In multivariate analysis, older persons (40-59vs15-29, aHR 3.39, 95%CI 1.83-6.26, p<0.01), women (vs men, aHR 1.73, 95%CI 1.12-2.67, p<0.01) and those in need of ART (vs those not in need, aHR 1.61, 95%CI 1.03-2.52, p=0.04) were more likely to link to care after diagnosis.

Poster Abstracts

Conclusions: Half of newly diagnosed individuals had linked to care in the three months following home based testing and CD4 assays in a population where three quarters of HIV-positive persons were already on care. It provides new evidence that a large proportion of the HIV-positive population can be on care in sub-Saharan Africa. Men and younger individuals were less likely to be diagnosed and less likely to link to care after diagnosis. New testing and linkage to care strategies should target these groups. 1091 Rapid ART Initiation Reduces Loss Between HIV Testing and Treatment: The RapIT Trial Sydney Rosen 1 ; Mhairi Maskew 2 ; Matt P. Fox 1 ; Cynthia Nyoni 2 ; Constance Mongwenyana 2 ; Given Malete 2 ; Ian Sanne 2 ; Julia K. Rohr 1 ; Lawrence Long 2 1 Boston University, Boston, MA, US; 2 University of the Witwatersrand, Johannesburg, South Africa Background: Very high rates of patient attrition from HIV care between HIV testing and ART initiation have been documented in sub-Saharan Africa. Accelerating the steps required for ART initiation has been proposed as a way to reduce attrition and achieve earlier treatment initiation. Methods: The RapIT randomized controlled trial evaluated the effect of immediate ART initiation on ART uptake in two public sector clinics in South Africa. Adult, non-pregnant patients receiving a positive HIV test or first CD4 count were randomized to standard or immediate (rapid) initiation. On the day of HIV test or first CD4 count, patients in the rapid arm received a point-of-care CD4 count if needed; those ART eligible then received a rapid TB test if symptomatic, rapid blood tests, physical exam, accelerated education

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CROI 2015