CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

761 MOTHER-TO-CHILD TRANSMISSION OF HIV IN KENYA: A MULTIYEAR NATIONAL EVALUATION

Lucy Ng’ang’a 1 , Christine J. McGrath 2 , Agnes Langat 1 , Jillian Pintye 3 , Mary Schmitz 1 , Abraham Katana 1 , Rose Wafula 4 , John Kinuthia 5 , Grace John-Stewart 3 , Kevin De Cock 1 1 US CDC, Nairobi, Kenya, 2 Univ of Texas Med Branch, Galveston, TX, USA, 3 Univ of Washington, Seattle, WA, USA, 4 Natl AIDS and STD Control Prog, Ministry of Hlth, Nairobi, Kenya, 5 Kenyatta Natl Hosp, Nairobi, Kenya Background: With the efforts toward elimination of mother to child transmission (EMTCT), the number of infants with HIV has declined sharply. However, EMTCT programs need to be monitored to identify gaps and design interventions to further reduce MTCT. This study determined MTCT at 6 weeks, 9 and 18 months, and cofactors for MTCT in a multi-year, nationwide registry-based survey in Kenya. Methods: We conducted a retrospective chart review of HIV Exposed Infants (HEI) enrolled in 62 randomly selected facilities in Kenya between 2011-2013. MTCT was defined as infant positive DNA PCR test. Cohort analysis included infants with PCR result at <3 months of age followed to last known visit. Cox regression determined correlates of MTCT. Estimates were weighted to account for survey design. Results: Overall, 8773 HEI were identified of whom 6034 (87.5%) had PCR results at <3 months and were included in the analysis. At 9 months, 75.4% of HEI remained in care and 57.1% at 18 months. By 18 months, 39.5%were lost, 0.9% reported dead, and 2.5% had transferred care. Overall MTCT was 2.7% at 6 weeks, 3.8% at 9 months, and 5.5% at 18 months (Table 1). From 2011 to 2013, 6 week MTCT declined from 3.5% to 2.8%; 9 month MTCT from 4.8% to 3.8%; and 18 month MTCT from 7.4% to 5.2%. Overall, 73.1% of HEI-mother pairs received maternal and infant ARVs, 10.6%maternal ARVs only, 8.7% infant ARVs only, and 7.7% no ARVs. Most women (68.6%) received HAART, 13.5% received short course prophylaxis (AZT+NVP+3TC), 1.5% single dose NVP (sdNVP) and 16.4% no ARVs. Among infants, 72.3% received NVP for 6 weeks during breastfeeding, 4.1% NVP+AZT+3TC for 7 days, 5.3% sdNVP only, and 18.3% no ARVs. MTCT was associated with older infant age (months) at enrollment (HR=1.02, 95% CI 1.00-1.04). Compared to complete PMTCT (maternal and infant ARVs), no maternal or infant ARVs, maternal ARVs only, and infant ARVs only were associated with increased MTCT [HR=7.4 (4.6-11.9), HR=2.3 (1.4-3.9), HR=2.0 (1.2-3.2), respectively]. MTCT was highest in women receiving short course prophylaxis and sdNVP compared to HAART [HR=2.5 (1.7-3.7) and HR=2.6 (1.0-6.5), respectively]. Conclusion: Despite decreases from 2011-2013, MTCT remains high underscoring the benefit of early HEI enrollment and need for rapid expansion of HAART to all HIV-infected women irrespective of immune status. The high loss to follow-up at 18 months underscores the need for better strategies to improve retention and the implementation of interventions to track and retain HEI in care.

Poster and Themed Discussion Abstracts

762 MISSED OPPORTUNITIES FOR REPEAT HIV TESTING AND EARLY ART INITIATION IN PREGNANCY

Anna Joy Rogers 1 , Eliud Akama 2 , Elly Weke 3 , Justin Blackburn 1 , George Owino 4 , Elizabeth A. Bukusi 3 , Patrick Oyaro 2 , Zachary A. Kwena 2 , Craig Cohen 5 , Janet M. Turan 1 1 Univ of Alabama at Birmingham, Birmingham, AL, USA, 2 Kenya Med Rsr Inst, Kisumu, Kenya, 3 Kenya Med Rsr Inst, Nairobi, Kenya, 4 Kenya Med Rsr Inst, Rongo, Kenya, 5 Univ of California San Francisco, San Francisco, CA, USA Background: It is estimated that a third of all mother-to-child transmission (MTCT) of HIV occurs among women with incident infection during pregnancy, making repeat HIV testing during the late antenatal period a crucial time to identify and initiate treatment for women who acquire HIV infection. International recommendations, adopted as part of the Kenya HIV Testing Services guidelines, suggest that pregnant women in generalized epidemic settings be offered retesting three months after an initial negative HIV test early in pregnancy. Methods: Longitudinal analyses were conducted in a sample of 2164 women attending antenatal care (ANC) at a rural district hospital in Migori County, Kenya. Data were abstracted from registers for all women who attended ANC from the years 2011 to 2014. Results: The majority of women (1954/2164, 90.2%) presented for their first ANC visit early enough (≤ 28 weeks gestation) to later be eligible for retesting, but several missed opportunities were noted including: (a) 310 (15.8%) women never returned to ANC and thus were considered to have an unknown HIV status at delivery; of the 495 women who returned to ANC when eligible, (b) only 132 (36.6%) were retested and (c) 126 (25.5%) failed to be retested even though eligible at two or more visits. On retest, two women tested HIV-positive, suggesting a seroconversion rate of 1.5% from early to late pregnancy. Although most women came early in pregnancy and a quarter had at least 4 ANC visits, 59.7% of all women had unknown HIV status at delivery. For a minority of women (210/2164, 9.8%) who presented later (>28 weeks gestation) for their first ANC visit, retesting is not standard protocol. However, among them 8 (3.8%) tested HIV-positive, possibly constituting a missed opportunity for early antiretroviral therapy (ART) initiation. Conclusion: Missed opportunities for repeat HIV testing and early ART initiation among pregnant women may contribute to continuing high rates of MTCT in Kenya and similar settings in sub-Saharan Africa, particularly in light of current recommendations that all pregnant women who test HIV-positive be started immediately on ART. Extrapolating the seroconversion rate to all women who missed a retest would suggest that potential cases of MTCT are slipping through the cracks. Contributors to missed opportunities include patient factors, such as not returning to ANC after testing negative for HIV early in pregnancy, and health system factors, such as a failing to retest eligible women. 763 LOW HIV INCIDENCE IN SOUTH AFRICAN PREGNANT WOMEN RECEIVING A PREVENTION INTERVENTION Geoffrey Fatti 1 , Ashraf Grimwood 1 , Bon Egbujie 1 , Eula Mothibi 1 , Najma Shaikh 1 , Debra Jackson 2 , Brian Eley 3

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