CROI 2016 Abstract eBook

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Oral Abstracts

Results: Among 12,686 completers, 6182 were male (47%) and the mean age was 30 years. The majority (89%) lived in rural areas, 38%were single and 57%were married or cohabitating. In total, 24% of males was circumcised and 6.7% of women were pregnant. Over the year, 33 cohort members sero-converted resulting in an HIV incidence of 0.27% (95% confidence interval: 0.18-0.35%); 0.21% among men and 0.32% among women. The distribution of HIV cases was indicative of multiple breakouts, with 3 villages and 2 households having multiple sero-conversions. Incidence was highest in adults aged 46-55 years (0.38%); however the most cases (12) occurred among those aged 16-25 years. Similarly, incidence was highest among the widowed (1.30%), single (0.35%) and divorced (0.38%). HIV incidence showed urban rural variation with higher incidence (0.65%) in urban areas. Conclusions: The HIV incidence in Rwanda was slightly higher than model estimates used in the past. Moreover, this household survey demonstrates that young adults and singles are the among largest contributors to HIV incidence in Rwanda and that outbreak contribute to the ongoing epidemic. The national HIV program should plan for HIV preventive interventions tailored to those populations. 167 Antiretroviral Therapy and HIV Acquisition in a South African Population-Based Cohort Catherine Oldenburg 1 ;Till Bärnighausen 1 ; FrankTanser 2 ;Victor De Gruttola 1 ; George R. Seage 1 ; Matthew Mimiaga 3 ; Kenneth H. Mayer 4 ; Deenan Pillay 2 ; Guy Harling 1 1 Harvard Sch of PH, Boston, MA, USA; 2 Africa Cntr for Hlth and Pop Studies, Mtubatuba, South Africa; 3 Brown Univ Sch of PH, Providence, RI, USA; 4 The Fenway Inst, Fenway Hlth, Boston, MA, USA Background: Antiretroviral therapy (ART) is highly efficacious in preventing HIV in randomized trials of volunteer serodiscordant couples with full serostatus awareness. However, evidence of the effectiveness of ART in preventing HIV in population-based samples, where serostatus may not be known to the individual or their partner, is lacking. Here, we assess the effect of ART on HIV acquisition in a population-based cohort in rural KwaZulu-Natal, South Africa. In this cohort, couples are linked via surveillance rather than via clinics, allowing for estimation of the effect of ART in a “real-world” setting where individuals are not necessarily aware of their HIV status or the status of their partner. Methods: All HIV-uninfected individuals present between January 2005 and December 2013 (n=17,016) with at least two HIV tests were included, regardless of whether or not they had a cohabitating partner. Individuals with cohabitating partners were categorized as having an HIV-uninfected partner, an HIV-infected partner who was not on ART, or an HIV-infected partner who was on ART. ART status of HIV-infected partners was determined via public-sector ART clinic data. Interval-censored time-varying parametric proportional hazards regression was used to assess how the partner’s ART status affected HIV acquisition risk. Results: Of the 17,016 individuals, 1,846 had an HIV-uninfected and 196 had an HIV-infected partner over the follow-up period, of whom 76 initiated ART during follow-up. HIV incidence was 0.3 per 100 person-years among individuals with an HIV-uninfected partner (95% confidence interval [CI] 0.2-0.5), compared to 5.6 per 100 person-years (95% CI 3.5-8.4) among individuals with an HIV-infected partner who was not on ART, and 1.4 per 100 person-years (95% CI 0.4-3.5) among individuals with an HIV-infected partner who was on ART. In an adjusted model, HIV-infected partner’s use of ART was associated with a 77% decrease in HIV acquisition risk amongst serodiscordant couples (aHR=0.23, 95% CI 0.07-0.80). Conclusions: ART initiation was associated with substantially reduced HIV incidence, but less than has been seen in more controlled settings. Achieving effective population control of HIV incidence, and thus elimination of the epidemic, may not be possible only through ART provision to seropositive persons. A combination of additional interventions is likely to be necessary.

Oral Abstracts

168LB Option B+ in Malawi: Have 4 Years of “Treat All”Shown That 90-90-90 Is Achievable? BethTippett Barr 1 ; Andreas Jahn 2 ; Sundeep K. Gupta 3 ; Alice Maida 3 ; Frank Chimbwandira 3 1 CDC, Harare, Zimbabwe; 2 Ministry of Hlth, Lilongwe, Malawi; 3 CDC, Lilongwe, Malawi

Background: In 2014, UNAIDS released the 90-90-90 objectives: 90% of persons living with HIV (PLHIV) are identified, 90% of known PLHIV (or 82% of all) are on sustained ART, of whom 90% (or 73% of all) are virally suppressed by 2020. In September 2015, WHO released guidance endorsing ‘Treat All’ as a critical strategy for epidemic control. Reaching 73% viral suppression by 2020 implicitly assumes that ‘Start All’ will facilitate a rapid increase in the identification of PLHIV to reach the first step in the cascade. We reviewed Malawi’s national data on PMTCT Option B+ as an early ‘Treat All’ model to understand progress towards 90-90-90 in a defined population. Methods: The Malawi Ministry of Health collects, validates and publishes all HIV program data on a quarterly basis (www.hiv.health.gov.mw). Quarterly report data was analyzed to compare the six month period prior to implementation of Option B+ with the same six month period four years later. Comparisons on cascade coverage were made using the Spectrummodel population denominator as the point of comparison for each 90. The contributions of initiation and retention were separated under the 2 nd 90, and those lost to follow-up were considered not to be virally suppressed. Results: Between 2011 and 2015, the proportion of all estimated pregnant PLHIV who knew their HIV status increased from 49% to 80%. The proportion of known positive and on ART increased from 6.5% to 98%, or 78% of all pregnant PLHIV nationally. Retention on ART at 12 months was 72% (56% of all ), and of the 23% of ART patients who received a routine VL test, 85%were virally suppressed (or 48% of all ), resulting in Malawi attaining an estimated 80-56-48 on the 90-90-90 cascade, compared to 49-3-2 in 2011 (Figure 1).

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CROI 2016