CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

subjects were enrolled. Participants completed a survey and were tested for HIV. We assessed the ability of RDS to identify HIV-positive persons unaware of their status across recruitment waves and created zip code maps of recruitment using ArcGIS. Results: We recruited 26,503 participants (12,022 MSM and 14,481 PWID) from 27 cities, over a median (range) of 112 days (52–200) and 21 recruitment waves (11–50). Of 4,065 HIV-positive persons identified, 2,325 (57%) were unaware of their status. While HIV prevalence was relatively stable across recruitment waves (~15%), the percentage of HIV-positive persons unaware of their status increased from 47% in waves 1-5 to 78% in waves >25 (p<0.001), suggesting identification of persons with poor service access as recruitment progressed deeper within networks. Further, despite recruiting from a single venue in each city, RDS reached individuals across all zip codes, with most zones reached within 5 recruitment waves (Figure). For example, in Chennai, participants were recruited from a median of 4.2 km from the study site, with 50 participants recruited from>20 km away. Conclusions: Beginning with 2 or 3 “seeds” and recruiting from a single venue, RDS demonstrated the ability 1) to efficiently identify HIV-positive persons who were unaware of their status (with an increasing likelihood of identifying such persons in later recruitment waves), and 2) to reach MSM and PWID throughout all geographical regions in medium to large cities. Combined with evidence-based linkage strategies, RDS has the potential to improve the care continuum in key populations in low- and middle-income countries.

900 10 Years of HIV and STI Testing at Silom Community Clinic (SCC) in Bangkok, Thailand Eileen Dunne1; Kevin Weiss2; Sarika Pattanasin3; Boonyos Raengsakulrach3; Warunee Thienkrua3; Kanokpan Pancharoen3; Pachara Sirivongrangson3; Anchalee Varangrat3; Chaiwat Ungsedhapand3; Timothy H. Holtz1 1CDC, Atlanta, GA, USA; 2Emory Univ Rollins Sch of PH, Atlanta, GA, USA; 3Thailand Ministry of PH US CDC Collab, Nonthaburi, Thailand 
 Background: The Silom Community Clinic (SCC) conducts voluntary counseling and testing (VCT) for men who have sex with men (MSM) and transgender (TG) women in Bangkok, Thailand. We describe 10 years of human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevalence, and risk factors for prevalent HIV infection. Methods: We offered all clients attending SCC from 2005–2015 testing for HIV, syphilis, and hepatitis B virus (HBV). VCT HIV testing followed a 3 step algorithm using rapid HIV tests on blood specimens. Syphilis testing included non-treponemal (rapid plasma reagin, RPR) and treponemal-specific testing; RPR titer >1:8 or reactivity on treponemal test was considered syphilis infection. Hepatitis B testing included hepatitis B surface antibody. We assessed HIV and syphilis prevalence over 10 years using a Cochran-Armitage test for trend, and risk factors for prevalent HIV and STIs at the baseline visit using bivariate and multivariable logistic regression analysis. Results: There were 8,945 unique clients attending VCT from Sept, 2005– May, 2015; the mean age was 28.2 years and 3905 (43.7%) had been tested before for HIV. At the first visit for VCT, 1217 (13.6%) did not have an HIV test done. Most (67.9%) had a least one follow-up visit and 1972 (22.1%) had more than 6 visits. Overall, 2390 (30.9%) tested positive for HIV, 1159 (15.0%) tested positive for syphilis, and 3587 (47.8%) tested positive for HBV surface antibody. HIV and syphilis prevalence changed significantly by year ( p <0.01), with an increase from 12.7% to 24.5% in syphilis in the last 5 years (p<0.01). Risk factors in multivariable analysis for prevalent HIV infection were age ≥25 years (25–29 years: aOR 1.5, 95% CI 1.3–1.7; >30 years: aOR 1.6, 95% CI 1.4–1.8), testing positive for HBV surface antibody (aOR 1.3, 95% CI 1.2–1.5), syphilis (aOR 5.9, 95% CI 5.1–6.9), and having moved to Bangkok since birth (aOR 1.5, 95% CI 1.3–1.7). A protective factor for prevalent HIV infection was past HIV testing (aOR 0.4, 95% CI 0.4–0.5). Conclusions: Ten years of comprehensive HIV and STI testing of MSM and TG women in Bangkok, Thailand demonstrate nearly 1 in 3 clients present with HIV infection; significant increases in syphilis in the last 5 years have occurred. Risk factors for prevalent HIV may support targeted efforts to identify MSM and TG women with HIV who would benefit from treatment as prevention. 901 Why Are Trends in HIV Diagnoses in Sub-Saharan African Migrants in Europe Changing? Julia Del Amo 1 ; Inmaculada Jarrín 1 ;Vicky Hernando 1 ; Debora Alvarez Del Arco 1 ; Susana Monge 2 ; Belen Alejos 1 ; Francisco Bolumar 2 ; Andrew Amato 3 ;Teymur Noori 3 ; Anastasia Pharris 3 1 Inst de Salud Carlos III, Madrid, Spain; 2 Univ de Alcalá, Madrid, Spain; 3 European CDC, Stockholm, Sweden Background: Sustained declines in HIV diagnoses in migrants from Sub-Saharan Africa (SSA) have been reported in countries of the European Union/Economic Area (EU/EEA) but reasons for the decline are not well understood. We aim to describe whether declines are homogeneous for migrants from different regions within SSA and if they are associated with delays in HIV testing. Methods: HIV reports to the European Surveillance System (TESSy) from 30 EU/EEA countries from 2004 till 2013 were analysed. Cases from SSA were further divided into UN regions: Western, Central, Eastern and Southern Africa. Differences in CD4 counts at HIV diagnosis over time for each SSA region were used as a measure of HIV testing delay; these were analyzed using median regression adjusting for transmission category, age and sex. Results: Of 252 609 cases reported from 2004 to-2013 with data on country of origin, 57 405 (23%) were from SSA; 35% fromWestern SSA, 32% from Eastern, 23% from Central, 5% from Southern SSA, 5% from unknown SSA regions. HIV had been acquired heterosexually in 88% of cases. HIV reports declined from 2004 to 2012 (2013 data removed when analysing trends due to reporting delay) both in absolute (and relative) terms by 2824 (37%) for SSA globally; 60 (3%) for Western, 1571 (57%) for Eastern, 563 (33%) for Central, and 250 (59%) for Southern SSA. Variations within EU/EEA countries were observed. Declines were more pronounced in women. Median CD4 count at diagnosis in the 33 129 SSA migrants with this information showed steady increases from 241 cells/mm 3 in 2004 to 280 cells/mm 3 in 2012 for all SSA migrants. Increases were seen for the different regions (less pronounced in Western SSA origin), in univariate and multivariate analyses (Table). Results were largely unchanged taking into account reporting heterogeneity of HIV cases and CD4 counts. Conclusions: The decreases of HIV reports in migrants from SSA in the EU/EEA from 2004 to 2012 are influenced most by declines in cases from Central and Eastern SSA, while cases in migrants fromWestern SSA are stable. Median CD4 count has increased over the years and for all SSA regions. These results do not suggest increases in delayed HIV testing. Other explanations for the different trends are changes in migratory flows into the EU/EEA – decreasing numbers from Central and Eastern SSA and increasing fromWestern SSA - and the impact of changes in HIV incidence in the SSA regions of origin of these migrant populations.

Poster Abstracts

378

CROI 2016