CROI 2016 Abstract eBook

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Poster Abstracts

Africa, its use has not been well described in HIV-infected women in the post-seroconversion period. We aim to examine factors associated with discontinuation of IC following seroconversion in the VOICE trial. Methods: Following seroconversion during an HIV prevention trial (VOICE), 255 African women enrolled in a longitudinal observational study (MTN-015). Family planning method was assessed by self-report via face-to-face interview at MTN-015 entry and at 3, 12, and 24 months (m) post-seroconversion. Women reporting IC use at baseline were evaluated longitudinally for continued use from time of seroconversion. Correlates of IC discontinuation were examined by Cox proportional hazard modeling. Results: The majority of women were from South Africa (93%), young (median age 23 years (y), IQR 21-26y) and unmarried (93%). Median follow-up was 24m (IQR 13-26m) post- seroconversion. IC use was reported at baseline by 198 (78%) women, of whom 182 (91%) had follow-up family planning data available (Figure 1). During follow-up 34% (61/182) of women discontinued use of IC completely without a non-barrier substitution. Baseline factors associated with lower rates of IC discontinuation were having children (HR 0.39, CI 0.20-0.82, p= 0.01) and earning one’s own income (HR 0.51, CI 0.30-0.87, p= 0.02). Initiation of antiretroviral therapy (ART) (HR 0.51, CI 0.26-0.95, p=0.03) during follow-up was also associated with a lower rate of IC discontinuation. Other baseline demographic factors, partnership status and characteristics, depression, and disclosure of HIV status were not significantly associated with IC discontinuation in time-dependent analyses. Conclusions: Discontinuation of effective contraception was common post-seroconversion in HIV-infected women despite onsite provision of family planning services. Many women with recently acquired HIV face complex decision-making regarding family planning. Linkages between HIV testing, HIV/ART care, and family planning services is essential.

862 Correlation Between Cotherapy of Efavirenz-Based ART and Pregnancy AmongWomen Stephen Okoboi ; Eunice Ajambo; Irene Bagala; Ronald Oceng; Sophie Nantume; Robinah Acham; Bernard Etukoit TASO-Uganda, Kampala, Uganda

Background: Uncertainties exist around potential interactions between hormonal contraceptive implants (HCI) and antiretroviral therapy (ART). In Swaziland, 12.4% of women taking Efavirenz (EFV)-based regimens while using the Jadelle implant became pregnant and EFV co-therapy was the only variable that significantly correlated with pregnancy outcomes. We examined the association between EFV and non-EFV based ART regimens and pregnancy outcomes among women who were on HCI in a peri-urban HIV clinic in Tororo, Uganda. Methods: Using a retrospective review, we extracted routinely collected data from the TASO Tororo HIV clinic family planning register. All women >18 years of age and on ART who received HCI between January, 2012 and June, 2014 were included in the study. Our primary outcome of interest was confirmed recorded pregnancy. The association between ART regimen and pregnancy outcome was assessed using fisher’s exact statistics Results: A total of 148 HCI users were identified, 62 (41.9%) on an EFV- based regimen and 86 (58.1%) on a non EFV-based regimen. The median age of the women was 33.7 years (IQR 22-48); mean weight was 57.76kg (IQR 28-95) and median duration on ART was 22.7 months (IQR 17-37). For women that conceived, the median duration between HCI placement and confirmed pregnancy was 22.6 months (1QR 16-29). Of the 148 women identified during the review period, 9 (6.1%) conceived. All women who conceived were on an EFV-based regimen, while none of the women on non-EFV based regimens conceived (p=0.0003). Conclusions: We observed a significant association (p=0.0003) between HIV-positive HCI users on EFV-based ART regimens as compared to HIV-positive HCI users on non-EFV based ART regimens. This association is similar to findings in other studies, and strengthens the evidence that women on EFV-based regimens desiring contraception may need to be cautioned about a potential increased risk of pregnancy with use of HCI. A more systematic national surveillance of pregnancy among women on both ART and hormonal contraception may help to confirm a correlation and inform potential guidance on hormonal contraceptive use among women on ART 863 Is Menopause AssociatedWith Unprotected Sex in High-Risk HIV-Positive KenyanWomen? Marielle S. Goyette 1 ; Kate S.Wilson 1 ; Ruth Deya 1 ; Linnet Masese 2 ; Juma Shafi 3 ; Barbra A. Richardson 1 ; Kishor Mandaliya 4 ;Walter Jaoko 3 ; Scott McClelland 1 1 Univ of Washington, Seattle, WA, USA; 2 Kenya Rsr Prog at the Univ of Washington, Nairobi, Kenya; 3 Univ of Nairobi, Nairobi, Kenya; 4 Coast Province General Hosp, Mombasa, Kenya Background: Many HIV-positive women now live well beyond menopause. Postmenopausal women are no longer at risk for pregnancy, and some studies suggest that they may use condoms less often than premenopausal women. This study tested the hypothesis that unprotected sex is more common at postmenopausal visits than at premenopausal visits among HIV-positive women who reported trading sex for cash or in-kind payment in Mombasa, Kenya. Methods: Women in this prospective cohort study were HIV-positive, ≥18 years old, and reported transactional sex. At enrollment and monthly follow-up visits, participants completed a standardized interview and received comprehensive risk reduction counseling. Study clinicians collected genital samples at enrollment and quarterly visits. Menopause was assessed using a clinical decision tool. The primary outcome of unprotected sex was determined by the presence of prostate specific antigen (PSA) in vaginal secretions. Log-binomial generalized estimating equation (GEE) models, with working independence correlation structure and robust standard errors, were used to estimate relative risks (RRs) and 95% confidence intervals (CI). Models were adjusted for age. Results: We followed 403 HIV-positive women who contributed 2753 quarterly examination visits. Detection of PSA was less frequent at postmenopausal visits compared to premenopausal visits (55/540,10.2% versus 397/2210, 18.0%; RR 0.57, 95%CI 0.38-0.86) (Table 1). After adjusting for age, this association was no longer statistically significant (adjusted RR 0.70, 95%CI 0.45-1.11). Women were more likely to report no sex in the past week at postmenopausal visits (RR 1.67, 95%CI 1.44-1.95). When sexually active, women reported the same rate of condom use at postmenopausal and premenopausal visits (RR 0.97, 95%CI 0.84-1.12). Conclusions: In this population of high-risk HIV-positive Kenyan women, postmenopausal status was not associated with an increased risk of unprotected sex. The relationship between menopause and unprotected sex is likely to be context-specific and may differ with varying risk groups, regions, and levels of exposure to sexual health education.

Poster Abstracts

362

CROI 2016