CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

33 A RANDOMIZED TRIAL OF NOVEL STRATEGIES TO INCENTIVIZE HIV TESTING AMONG MEN IN UGANDA Gabriel Chamie 1 , Elisabeth Schaffer 2 , Alex Ndyabakira 3 , Devy Emperador 1 , Dalsone Kwarisiima 4 , Diane V. Havlir 1 , James Kahn 1 , Moses R. Kamya 5 , Harsha Thirumurthy 2 1 Univ of California San Francisco, San Francisco, CA, USA, 2 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Makerere Univ and Univ of California San Francisco Rsr Collab, Mbarara, Uganda, 4 Makerere Univ Joint AIDS Prog, Kampala, Uganda, 5 Makerere Univ Coll of Hlth Scis, Kampala, Uganda Background: Despite expansion of HIV testing services in sub-Saharan Africa, men test for HIV at lower rates than women. Standard, gain-framed incentives have been shown to increase HIV testing uptake, but the comparative effectiveness of novel incentive strategies informed by behavioral economics is unknown. Methods: From April-June 2016 we enumerated 4 rural Ugandan parishes and enrolled men aged ≥18 years. Participants were randomized to 6 groups that received incentives of

varying type and amount for HIV testing at a 13-day community health campaign (CHC) in June-July 2016 (NCT02890459). Incentive types were (1) gain-framed incentives (control) in which participants were told they would receive a small prize if they came for HIV testing; (2) loss-framed incentives in which participants were told they had won a small prize, shown the prize, and told they would lose the prize if they did not come for HIV testing; or (3) lotteries in which those who came for HIV testing had a chance to instantly win large prizes. Each incentive type had a low and high amount with a program cost per participant of about US$1 and US$5, respectively. The primary outcome was HIV testing uptake at the CHC.

Oral Abstracts

Results: Overall, 2,530 participants were enrolled: 1,929 (76%) tested for HIV and prevalence among those tested was 7.6%. HIV testing uptake ranged from 72% in the low-cost, gain-framed incentive group to 80% in the low-cost, lottery incentive group. Although HIV testing uptake was higher in the two lottery groups (78%; p=0.08) and the two loss-framed groups (77%; p=0.22) than in the two gain-framed groups (74%), these differences were not statistically significant. Across incentive types, there was no significant difference in testing uptake in high- vs. low-cost (76% vs. 75%; p=0.41) groups. However, among participants in the low-cost groups, testing uptake was significantly higher in the lottery than the gain-framed incentive group (80% vs. 72%; p<0.01), but not in the loss- vs. gain-framed groups (76% vs. 72%; p=0.20). Among participants in the high-cost groups, HIV testing uptake in the lottery (76%) and loss-framed (78%) groups were not significantly different than in the gain-framed incentive group (76%). Conclusion: Low-cost, lottery-based incentives were significantly more effective in increasing HIV testing uptake among men than standard gain-framed incentives of comparable cost. Offering lottery-based rewards that have a low per-person cost is a promising way to achieve high HIV testing coverage among men. 34LB COMBINATION HIV PREVENTION AND HIV INCIDENCE IN RAKAI, UGANDA Mary K. Grabowski 1 , Gertrude Nakigozi 2 , Fred Nalugoda 2 , Thomas Quinn 1 , Godfrey Kigozi 2 , Ronald H. Gray 1 , David Serwadda 3 , Maria Wawer 1 , Steven J. Reynolds 4 , Larry W. Chang 1 1 Johns Hopkins Univ, Baltimore, MD, USA, 2 Rakai Health Sciences Prog, Kalisizo, Uganda, 3 Makerere Univ, Kampala, Uganda, 4 NIAID, Washington, DC, USA Background: To assess the impact of combination HIV prevention (CHP) on HIV incidence, we measured long-term trends in HIV incidence based on observed seroconversion data in a prospective population-based cohort in Rakai, Uganda, and evaluated their associations with antiretroviral therapy use (ART), male circumcision (MC) scale-up, population- level viral load suppression, and sexual behaviors. Methods: Between 1999 and 2016, data were collected in 12 surveys from 30 communities in the Rakai Community Cohort Study (RCCS), an open population-based longitudinal cohort of persons aged 15-49. Poisson regression was used to assess trends in HIV incidence, self-reported ART/MC coverage, population-level HIV viral load suppression (proportion of HIV-positive population with <1000 copies/ml), and sexual behaviors. Poisson multivariate regression with generalized estimating equations and robust variance estimators was used to estimate incidence rate ratios (IRR) and 95%CI of HIV incidence at each survey interval following the availability of ART/MC compared to the period prior to ART/MC scale-up. Results: Over the analysis period, 33,937 individuals participated in the RCCS, including 17,870 HIV-negative persons who contributed 94,427 person-years of follow-up and 931 incident HIV cases. ART was introduced in 2004 and by 2016 coverage was 69%. Increasing ART coverage was accompanied by significant changes in HIV viral load suppression rising from 42% in 2009 to 75% by 2016 among all HIV-positive persons (p<0.001). MC coverage increased from 15% in 1999 to 59% by 2016 (p<0.001). The only substantive changes in sexual behaviors occurred among persons 15-19 years reporting never having sex, which rose from 30% to 55% over the study period (p<0.001). Beginning in 2012, HIV incidence significantly declined as population-level coverage of CHP interventions were increased (Figure 1); by 2016 there was a 41% reduction in HIV incidence relative to the pre-ART/MC scale-up period from 1.17/100 py to 0.66/100 py (IRR: 0.56; 95%CI: 0.44-0.72; p<0.001; adjIRR:0.59: 95%CI: 0.45-0.77). Conclusion: In this large prospective population-based study, HIV incidence significantly declined as ART and MC were scaled and sexual activity in young persons declined. These results provide empiric evidence that HIV control efforts utilizing combination interventions can have a substantial population-level impact

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CROI 2017