CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

1101 Universal HIV Testing Using a “Hybrid”Approach in East Africa in the SEARCH Trial Gabriel Chamie 1 ;Tamara Clark 1 ; Jane Kabami 3 ; Kevin Kadede 2 ; Dalsone Kwarisiima 3 ; Norton Sang 2 ; Maya Petersen 4 ; Moses R. Kamya 3 ; Diane Havlir 1 ; Edwin Charlebois 5 1 University of California San Francisco, San Francisco, CA, US; 2 Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya; 3 Makerere University - University of California Research Collaboration, Kampala, Uganda; 4 University of California Berkeley School of Public Health, Berkeley, CA, US; 5 University of California San Francisco (UCSF), San Francisco, CA, US Background: Rapid scale-up of HIV testing to reach the 2014 UNAIDS testing target of 90% coverage in sub-Saharan Africa will likely require concurrent implementation of multiple mobile testing approaches. We sought to test the effectiveness of a “hybrid” mobile HIV testing approach of multi-disease community health campaigns followed by home-based testing (HBT), to achieve population-wide coverage. Methods: From 2013-2014, we enumerated 168,336 adult ( ≥ 15 years) residents of 32 communities in eastern (N=10) and southwestern (N=10) Uganda, and western Kenya (N=12) using a 2-4 week door-to-door census as part of a cluster-randomized HIV test and treat trial (SEARCH: NCT01864603). “Stable” residence was defined as living in a community for ≥ 6 months over the past year. In each community we performed a 2-week mobile, multi-disease community health campaign (CHC) that included HIV testing, counseling (HTC) and linkage to care; CHC non-participants were then approached for HBT over an average of 1-2 months. We measured population HIV testing coverage and determined characteristics associated with CHC vs. home testing, and associated with no testing, using multivariable logistic regression and accounting for clustering by household. Results: HIV testing was achieved in 89% (130,051) of stable adult residents (N=146,513), and 80% (134,697) of all adults. Adult HIV prevalence was 9.4%, with a median adult CD4+ count of 516 (IQR: 356-705) cells/ μ L. Of adults tested, 43% reported no prior HIV testing. Among CHC attendees, 99% accepted HIV testing. Overall, 103,503 stable adult residents tested via CHCs (80%), and 26,548 tested via HBT (20%). CHC-based HTC uptake varied by community, ranging from 60-93% of stable adults tested. In multivariate analyses of stable adults who tested, predictors of not attending the CHC (i.e., needing HBT) were: male gender, single marital status, HIV infection, non-farming occupation, higher education status, study region, and more time away from community in the year prior to study initiation (Table: Model 1). Predictors of failure to HIV test at either CHC or HBT were similar to those associated with CHC non-participation (Table: Model 2).

Conclusions: We achieved rapid, near-universal HTC coverage (89%) of 146,513 stable adult residents across 32 communities in Uganda and Kenya using a hybrid, mobile approach of multi-disease community health campaigns and home-based testing. Despite high HIV testing coverage, men and mobile populations remain challenges for universal testing. 1102 A Household Food Voucher Increases Consent to Home-Based HIV Testing in Rural KwaZulu-Natal Mark McGovern 1 ; David Canning 1 ; FrankTanser 2 ; Kobus Herbst 2 ; Dickman Gareta 2 ;Tinofa Mutevedzi 2 ; Deenan Pillay 2 ;Till Barnighausen 1 1 Harvard University, Cambridge, MA, US; 2 Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa Background: Despite the importance of HIV testing for controlling the HIV epidemic, testing rates remain low in many countries. Growing emphasis on HIV treatment-as- prevention will require increases in the frequency and coverage of testing to place individuals on treatment rapidly after diagnosis, and new waves of testing will need to reach populations who have not previously tested. Home based testing is one potentially promising approach for supporting this goal. However, testing rates during home visits can be low, particularly in settings with high HIV prevalence, and there is little existing evidence on the effectiveness of interventions to increase testing rates for home based visits. This study tests the hypothesis that unconditional gift vouchers can be used to increase consent rates for home-based HIV testing. Methods: This study uses data on 18,478 men and women who participated in the 2009 and 2010 Africa Center HIV surveillance cohorts in rural KwaZulu-Natal, South Africa. In 2010, HIV prevalence was 24%, and 41% consented to test for HIV. All residents aged 15 and older are eligible for the HIV surveillance. A subset of households in the 2010 cohort were provided with a gift in the form of a food voucher worth 50 South African Rand (5 USD) which was not conditional on consenting to test. We compare the change in HIV test consent rates between 2009 and 2010 for residents in households that received a voucher in 2010, with the change in HIV test consent rates for residents in households that did not receive a voucher in 2010. Our approach corrects for unobserved confounding using a quasi-experimental difference-in-differences design. Results: Allocation of the voucher to a household in 2010 increased the probability of household members consenting to test in 2010 by 29 percentage points (risk difference 95% CI 23 - 35; p<.001). We also find an attenuated effect of treatment on consent rates in 2011. Rates of consent to test by intervention group (being a member of a household which received the voucher in 2010) are shown in figure 1. We estimate the cost of the program at 7 USD per additional HIV test obtained.

Poster Abstracts

640

CROI 2015