CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Figure 1: The intervention group is defined as being a member of a household which received the gift voucher in 2010, while the control group is defined as being a member of a household which did not receive the voucher in 2010. Mean consent to test is the number of residents in each group who consented to take a HIV test, divided by the number of residents who were eligible for participation and were successfully contacted by the surveillance surveyors in each group. Conclusions: The provision of gift vouchers to surveillance participants is likely to be a cost-effective tool for raising consent rates for home-based HIV testing. In addition, by persuading respondents who would ordinarily refuse to test in the absence of the voucher effect, this approach can potentially be used to assess the extent of selection bias in the population. 1103 Acceptability and Uptake of Home-Based HIV Self-Testing in Lesotho Background: With 61% of men and 31% of women aged 15-49 never tested as of 2009, HIV testing is a priority in Lesotho. HIV self-testing is one potential strategy to address low testing rates and achieve universal testing coverage, by complementing voluntary and provider-initiated testing. However, little is known about the acceptability of self-testing in Lesotho. This feasibility study explored the acceptability and uptake of home-based self-testing (HBST) in a sample of Basotho women and men. Methods: Between December 2013 and May 2014, 45 HIV-positive index participants (IPs) were recruited from 4 health centers in Mafeteng and Mohale’s Hoek in Lesotho as part of the NIH-funded Enhanced Prevention in Couples (EPIC) study. Home visits were scheduled with IPs to offer HIV testing to their household (HH) members. HH members were offered two options for testing: (1) standard HIV counseling and testing (SCT); or (2) HBST with OraQuick ADVANCE HIV-1/2, followed by confirmatory standard HIV testing. Demographic and acceptability measures were collected through in-person surveys. Results: Seventy-three percent of IPs were recruited from antenatal and 24% from TB clinics; 84% of IPs were women. A total of 88 HH members were offered testing, and 59 (67%) accepted; 78% of men and 61% of women agreed to test. Almost all (98%) participants chose the HBST option. All HBST participants described the self-testing process as “easy” or “very easy”; 12% required extra instruction. Participants were asked to identify positive and negative aspects of HBST. Ninety-eight percent of participants reported only positive qualities, including the home visit itself (32%); the openness and respectfulness of the study team (25%); the pain-free testing method without need for a prick or blood- draw (25%); the ability to test oneself (19%); being the first to know one’s status (14%); the simplicity of the testing procedure (14%); the privacy and confidentiality of testing at home (7%); having an option for testing (standard or self) (7%); and the rapidity of the test (7%). Nearly all participants reported that they would recommend HBST to friends and family. Thirteen percent of participants were newly diagnosed as HIV-positive. Conclusions: This study demonstrates high levels of uptake and acceptability for HBST and the feasibility of utilizing HIV-positive index individuals as a way to reach others in their households, who may not access health facilities. Successfully reaching men is an added advantage. 2:30 pm– 4:00 pm Costs and Cost Effectiveness 1104 The Lifetime Medical Cost Savings From Preventing HIV in the United States Bruce R. Schackman 1 ; John Fleishman 6 ; Amanda Su 2 ; Richard Moore 5 ; RochelleWalensky 2 ; David Paltiel 3 ; MiltonWeinstein 4 ; Kenneth Freedberg 2 ; Kelly Gebo 5 ; Elena Losina 2 1 Weill Cornell Medical College, New York, NY, US; 2 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US; 3 Yale School of Public Health, New Haven, CT, US; 4 Harvard School of Public Health, Boston, MA, US; 5 Johns Hopkins University School of Medicine, Baltimore, MD, US; 6 Agency for Healthcare Research and Quality, Rockville, MD, US Background: Enhanced HIV prevention interventions, such as pre-exposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting one HIV infection in the United States. Methods: We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing one HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV- infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range $1,854-$4,545/month) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range $73-$628/month). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 US dollars). Allison V. Zerbe 1 ; Abby L. DiCarlo 1 ; Joanne E. Mantell 2 ; Robert H. Remien 2 ; Danielle D. Morris 1 ; Koen Frederix 1 ; Blanche Pitt 1 ; Zachary J. Peters 1 ;Wafaa M. El-Sadr 1 1 ICAP at Columbia University, New York, NY, US; 2 HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute & Columbia University, New York, NY, US TUESDAY, FEBRUARY 24, 2015 Session P-Z1 Poster Session Poster Hall

Poster Abstracts

641

CROI 2015