CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

for antiretroviral treatment (ART) through the Botswana government program. Consenting mothers were assessed for MTCT risk factors by their obstetric card or verbally. Risk factors included < 8 weeks ART in pregnancy, last CD4 known to be <250 cells/mm³, last HIV RNA known to be > 400 copies/mL, poor maternal ART adherence, lack of maternal zidovudine in labor, or lack of infant post-exposure prophylaxis. Infants underwent heel stick and 3-5 dried blood spots were collected for testing by Roche Cobas Ampliprep/Cobas Taqman HIV-1 qualitative PCR. Results: In the first year of the study (April 2015 to April 2016), 4086 HIV-exposed infants were delivered at the screening maternities, of whom 3541 (87%) had not been discharged, 2580 (63%) were eligible, and 2303 (56%) agreed to be screened for HIV. Of the 2303 infants screened, 369 (16%) were identified as high-risk for HIV infection. In total, 12 (0.5%) of the 2303 infants were identified as HIV positive at birth. All 12 positive infants were identified as high risk at the time of screening, and all were identifiable as high risk by either < 8 weeks of maternal ART in pregnancy (75%) or lack of maternal HIV suppression at last test (25%) (Table 1). Conclusion: In utero MTCT occurred only among infants identified as high risk at the time of delivery, using information available from the mother or her obstetric record. Birth testing that targets high risk infants is likely to identify the large majority of in utero HIV transmissions, and allows early ART initiation for these infants. 791 IMPACT OF BIRTH PCR ON RETENTION IN CARE OF HIV-EXPOSED INFANTS IN PRIMARY CARE Background: The World Health Organization (WHO) recently recommended birth testing for all HIV-exposed infants (July 2016). Birth polymerase chain reaction (PCR) in this population was introduced in June 2015 in South Africa. There is an increased interest in point of care (POC) technology for birth testing to improve immediate retention in care and early treatment initiation. However, there is little data on the impact of either birth PCR or POC technology on longer term retention in care. We describe the impact of birth PCR (including POC) on retention in care at 6-10 weeks. Methods: We compared the completion of routine 6-10 weeks testing (range:5-15 weeks) for three groups of HIV-exposed infants with varying risk of HIV transmission born in a primary care clinic, Khayelitsha, South Africa : a) historical control group born between August 2013 and March 2014 (n=321), without birth HIV testing; b) prospective group born between November 2014 and July 2015, (n=336) with a birth PCR done in a central laboratory (Roche CAP/CTM assays); c) prospective group born between August 2015 and April 2016 (n=321), tested with POC Alere Q birth PCR. Infants of the two latter groups received extra counselling, by a nurse employed for this study, on further routine infant testing. Return for PCR at 6-10 weeks of age was determined using a national laboratory database. Tracing (phone calls and home visits) was done for groups b and c. For the purposes of this analysis, those who returned only after tracing were not classified as completing 6-10 weeks PCR to improve comparability between the three groups. Summary statistics and relative risks were calculated in STATA. Results: For the group without birth PCR, 197 (62%) returned for 6-10 weeks PCR at a median of 46 (IQR 43-50) days. For the group with birth PCR in central laboratory, 339 (78.1%) returned for the 6-10 weeks PCR at a median of 44 (IQR 42-47) days. For the group tested by birth POC, 241 (75%) returned for 6-10 weeks PCR at a median of 45 (IQR 43-50) days. Overall, the two groups with birth PCRs were more likely to return than the historical controls (RR: 1.3 [95% CI:1.07-1.5]) Conclusion: Birth PCR did not negatively impact return for further testing at 6-10 weeks. Limitations to this study include using a historical control. The extra counseling the two latter groups received could have also influenced positively their return for further infant’s testing. 792 IMPACT OF EXPANDED SCREENING AND POC ON INFANT DIAGNOSIS AND ART INITIATION Alliance Nikuze 1 , Stephen Wanjala 2 , Jihane Ben-Farhat 1 , Willis Omwoyo 3 , Laura Oyiengo 4 , Elisabeth Szumilin 5 , Leon Salumu 5 , Alexandra Vandenbulcke 5 , Valarie S. Opollo 6 , David Maman 7 1 Epicentre, Paris, France, 2 MSF, Nairobi, Kenya, 3 Ministry of Hlth, Homa bay, Kenya, 4 Natl AIDS/STI Control Prog, Nairobi, Kenya, 5 MSF France, Paris, France, 6 Kenya Med Rsr Inst, Kisumu, Nyanza, 7 Epicentre, Cape Town, South Africa Background: High HIV incidence among young women during pregnancy and breastfeeding periods necessitate systematic retesting. Furthermore, long turnaround time of early infant diagnosis can delay ART initiation in children. We assessed the impact of expanded women/child HIV testing outside PMTCT coupled to the introduction of near Point of Care early infant diagnosis devices on children diagnosis and ART initiation Methods: A cross-sectional facility-based survey recruited mother-infant pairs seeking expanded programs of immunization (EPI), maternity, in and outpatient department services between February and July 2016, in 26 selected facilities of Ndhiwa sub-county, Kenya. Infants aged 0 (at birth), between 2 to 10 weeks and 8 to 10 months were eligible and if exposed to HIV, tested for HIV using GenXpert and Roche. The questionnaires collected information on participants’ background, ANC attendance, and HIV/AIDS, including ART coverage. All HIV-positive mothers and children had their VL measured, regardless of their ART status Results: A total of 3,970 mother/infant pairs were enrolled. Mothers had a median age of 23 years [IQR 19-29] and an overall prevalence of 24.9% (95%CI 23.5-26.4). Out of 909 exposed infants, 34 were HIV-positive (MTCT rate 3.5%; 95%CI 2.5-4.9). Of them, 9 had a mother who never initiated ART (MTCT 13.2%), 14 had a mother who initiated during the last trimester or after delivery (MTCT 8.2%) and 10 had a mother on ART initiated before the last trimester with a VL>1,000 cp/mL (MTCT 5.9%). Among HIV-positive women who initiated ART before the last trimester and had a VL<1,000 cp/mL, only 3 infants were HIV-positive (MTCT 0.5%). Out of 34 HIV-infected infants identified during the survey, 28 were undiagnosed. Of them, 12 (42.2%) had initiated treatment less than 1 month after the first test and 19(67.8%) less than three months after the first test Conclusion: Expanding mother and infant screening outside PMTCT and introducing POC can help rapidly diagnosing and initiating HIV-positive infants. We found a MTCT rate of 3.5%mostly because of late/non initiation of ART or virological failure among mothers. As option B+ seems necessary but insufficient to eradicate MTCT in high incidence settings, more investment in improving infant diagnosis are needed 793 DELAYED HIV DNA PCR DETECTION AMONG INFANTS WHO RECEIVED COMBINATION ART PROPHYLAXIS Thanyawee Puthanakit 1 , Archawin Rojanawiwat 2 , Tanawan Samleerat 3 , Hansa Thaisri 2 , Jiratchaya Sophonphan 4 , Sarawut Boonsuk 5 , Sumet Ongwandee 5 , Varunee Jinarat 2 , for theThailand ACC Program 1 Chulalongkorn Univ, Bangkok, Thailand, 2 Ministry of Pub Hlth, Nonthaburi, Thailand, 3 Chiang Mai Univ, Chiang Mai, Thailand, 4 HIV Netherlands Australia Thailand Rsr Collab,Thai Red Cross AIDS Rsr, Bangkok, Thailand, 5 Ministry of Pub Hlth, Nonthaburi, Thailand Background: Early infant diagnosis (EID) for HIV-exposed infants is performed by DNA PCR assays. In utero transmission can be detected by HIV DNA PCR at birth, while peri- partum transmission is detected during the first 6 months of life. Triple drug antiretroviral regimens may be associated with delayed HIV DNA PCR detection, and this was assessed in the Thai National PMTCT program. Methods: Retrospective chart reviews of HIV-infected infants reported in the “National Active Case Management Network to promote early ART initiation” (ACC), were conducted. According to the Thai national guidelines 2014; infants with high risk of vertical transmission (mother received ART< 4 weeks during pregnancy or has HIV RNA viral load > 50 copies/ml near time delivery) receive zidovudine(AZT)/lamivudine(3TC)/nevirapine(NVP) for 6 weeks and testing for HIV DNA PCR at birth,1,2 and 4 months, while infants with a standard risk of vertical transmission receive AZT for 4 weeks and HIV DNA PCR testing at 1, and 2-4 months. Infants who had their first or second HIV DNA PCR at age > 2 or > 4 month were excluded from the analysis. HIV DNA PCR was performed by either real time PCR or conventional assays on samples collected as dried blood spot (DBS;18-50 uL) or whole blood (WB;200 ul). The limit of detection of the assays is 1 copy/reaction. HIV DNA PCR tests were performed by the national EID network including 16 laboratories. Results: From August 2014 to August 2016, 95 HIV-infected infants were diagnosed with HIV (73 high –risk and 22 standard-risk). Samples at birth (all DBS) from 37 neonates in the high-risk group were obtained, of which 17 were positive. The sensitivity of the DBS test was 46% (95% CI 29-63). Among the remaining 78 infants, the time to first positive Aurelie Nelson 1 , Laura Trivino Duran 1 , Tali Cassidy 1 , Gilles van Cutsem 2 , Sarah Jane Steele 2 , Mark Cotton 3 , Janet Giddy 4 , Jean Maritz 3 1 MSF, Khayelitsha, South Africa, 2 MSF, Cape Town, South Africa, 3 Stellenbosch Univ, Cape Town, South Africa, 4 KESS, Cape Town, South Africa

Poster and Themed Discussion Abstracts

CROI 2017 343