CROI 2016 Abstract eBook

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Oral Abstracts

50 Effectiveness of Partner Services for HIV in Kenya: A Cluster Randomized Trial Peter Cherutich 1 ; Mathew R. Golden 2 ; BeatriceWamuti 3 ; Barbra A. Richardson 1 ; Kristjana H. Ásbjörnsdóttir 1 ; Felix A. Otieno 3 ; Betsy Sambai 3 ; Matt Dunbar 1 ; Carey Farquhar 1 ; for the aPS Study Group 1 Univ of Washington, Seattle, WA, USA; 2 Univ of Washington Sch of Med, Seattle, WA, USA; 3 Kenyatta Natl Hosp, Nairobi, Kenya Background: Case finding using HIV assisted partner services (aPS) is widely practiced in the United States and Europe but less so in Africa due to limited data on effectiveness in routine health settings. We report preliminary results of a cluster randomized trial to assess the effect of immediate aPS on rates of 1) HIV testing, 2) case-finding of HIV-infected individuals, and 3) linkages to HIV care for sexual partners. Methods: In this cluster randomized trial, eligible HIV-infected adults were recruited from 18 HIV testing sites randomized to immediate (intervention) or delayed (control) aPS. In both intervention and control arms, index cases were asked to provide names and contact information of sexual partners in the preceding three years. Notification, testing and referral to care (if HIV-infected) of sexual partners occurred immediately in the intervention arm and 6 weeks after enrollment in the control arm. Generalized estimating equations with a Poisson link and independent correlation structure were used to evaluate the effect of the intervention on outcomes. The study was registered in ClinicalTrials.gov (NCT01616420). Results: The study enrolled 1119 index cases from 18 different clusters (550 immediate arms; 569 delayed arm) who mentioned 1872 sexual partners. Among these mentioned sexual partners, 1292 (69%), [620 immediate arm; 672 delayed arm] were enrolled. Enrollment and follow-up data were available for 579 (63%) and 672 (70%) of sexual partners mentioned in the immediate and delayed arms, respectively. Among 913 partners mentioned, 388 (42.5%) tested for HIV in the immediate arm, and among 959 partners mentioned, 118 (12.3%) tested in the delayed arm. Immediate aPS increased testing rates four-fold (Incidence rate ratio (IRR) 3.78, 95% CI: 3.08-4.65). The IRR comparing rates of first-time testers between immediate and delayed arms was 11.50 (95% CI: 5.56-23.78). Immediate aPS also significantly increased the number testing positive and enrolling into HIV care (IRR 3.22 [95% CI: 2.26-4.61] and 3.95 [95% CI: 2.48-6.28] respectively). Conclusions: aPS was highly effective and resulted in increased HIV case finding and linkage to care for HIV-infected sexual partners in this sub-Saharan African setting. aPS should be considered as a key strategy to improve delivery of HIV testing and counseling in Kenya and other high HIV prevalence settings where large numbers of the HIV-infected individuals do not know their status. 51 Optimal Timing of Home-Based HIV Testing inWestern Kenya Jack J. Olney 1 ; Paula Braitstein 2 ; JeffreyW. Eaton 1 ; Edwin Sang 3 ; Monicah Nyambura 3 ; Sylvester Kimaiyo 4 ; Ellen McRobie 1 ; Joseph Hogan 5 ;Timothy Hallett 1 1 Imperial Coll London, London, UK; 2 Univ of Toronto, Toronto, ON, Canada; 3 Academic Model Providing Access to Hlthcare, Eldoret, Kenya; 4 Moi Univ, Eldoret, Kenya; 5 Brown Univ, Providence, RI, USA Background: Achieving UNAIDS 90-90-90 goals for ART coverage will require new strategies for diagnosing and linking HIV positive persons to care. Home-based counselling and testing is one strategy that has been piloted and considered in sub-Saharan Africa. We used mathematical modelling to evaluate how HBCT campaigns can be improved, through the optimal-timing and enhancement of testing rounds, to bring about greater health outcomes over a 20 year period. Methods: We created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among HIV-infected adults in the data rich example setting of Kenya. We calibrated the model to a longitudinal dataset from the Academic Model Providing Access To Healthcare (AMPATH) programme describing the routes into care, losses, and clinical outcomes. We simulated various permutations of HBCT campaigns between 2016 and 2036, and for each assessed the impact and total cost of care cost for a further 20 years. Results: We find that simulating five equally spaced rounds of population-wide HBCT between 2016 and 2036, averts 1.59m DALYs at a cost of $1,018 per DALY averted. By altering the timing of HBCT rounds for a range of campaigns containing different numbers of rounds, we find that four testing rounds in 2016, 2017, 2020 and 2032 reduces the cost per DALY averted by 10%, and maximises the health impact by averting 2.5%more DALYs than the five-round status quo campaign. By improving linkage to care for individuals testing through HBCT to clinics, the space between optimally-timed HBCT rounds increases, and we find that four rounds, avert over two million DALYs (51%more than the status quo). However, achieving the UNAIDS 90-90-90 targets by 2020 also requires other aspects of care to be strengthened. For these targets to be met, the addition of active outreach for individuals lost from ART care is required. An HBCT campaign consisting of two rounds (2016 and 2017) and active outreach will avert 6.58m DALYs at a cost per DALY of $220 (78% less than the status quo). Conclusions: HBCT campaigns can improve health outcomes for patients when rounds are optimally timed and structurally enhanced. Countries implementing HBCT should avoid naively-spaced testing rounds, tailor campaigns to individual settings and further strengthen other aspects of the care cascade to achieve UNAIDS 90-90-90 goals.

Oral Abstracts

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CROI 2016

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