CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: Adolescent girls and young women 15-24 years old were recruited from four government-run health clinics in Lilongwe, Malawi to participate in a study evaluating four models of HIV service delivery. They completed a baseline survey assessing risk factors, and if HIV-uninfected or HIV-unknown, their risk perception. Risk perception was elicited by assessing lifetime chances of acquiring HIV with three possible responses: “no chance”, “small chance”, or “high chance”. This variable was then dichotomized for analysis into “any chance” or “no chance”. We analyzed associations between risk perception and five HIV risk factors: inconsistent or no condom use, more than one lifetime sexual partner, >5 year age difference with a current partner, transactional sex, and forced sex with a current partner. Results: In a cohort of 1000 adolescent girls and young women, 967 reported being HIV-negative or of unknown status at baseline and were included in this analysis. The median age of respondents was 19 (IQR 17–21). 69% used condoms inconsistently or not at all; 54% had >1 lifetime sexual partner; 15% had a partner >5 years older; 21% reported current transactional sex; and 46% reported forced sex from a current partner. 41% reported no perceived lifetime risk of HIV. Inconsistent condom use (OR 1.86, 95% CI 1.40–2.47), >1 lifetime partner (OR 1.65, 95% CI 1.26–2.15), transactional sex (OR 1.50, 95% CI 1.07–2.11), and forced sex (OR 1.71, 95% CI 1.30–2.25) were associated with any perceived lifetime risk of HIV. Despite association between risk factors and risk perception, 35% of those with one or more risk factor perceived no lifetime risk of acquiring HIV. Conclusion: Adolescent girls and young women in this cohort have a high prevalence of HIV risk factors. However, many participants with these risk factors perceive no risk of HIV acquisition. As a critical gap in the HIV prevention cascade, accurate risk perception is needed to tailor effective and sustained combination prevention strategies for this vulnerable population. 860 GENDERED PATTERNS OF MOBILITY PREDICT HIV PREVALENCE IN UGANDA/KENYA IN SEARCH STUDY Carol S. Camlin 1 , Tor Neilands 1 , Jane Kabami 2 , Gabriel Chamie 1 , Elizabeth A. Bukusi 3 , Tamara D. Clark 1 , Moses R. Kamya 4 , Maya L. Petersen 5 , Diane V. Havlir 1 , Edwin D. Charlebois 1 1 Univ of California San Francisco, San Francisco, CA, USA, 2 Infectious Diseases Rsr Collab, Kampala, Uganda, 3 Kenya Med Rsr Inst, Nairobi, Kenya, 4 Makerere Univ, Kampala, Uganda, 5 Univ of California Berkeley, Berkeley, CA, USA Background: Geographic mobility is highly prevalent in Sub-Saharan Africa and challenges HIV prevention and treatment goals: it can break bonds between individuals and care systems, link geographically separate epidemics, and intensify transmission. However, research on links between mobility and HIV has yielded discordant findings, due in part to suboptimal measures that do not capture the full dimensions of mobility, including its gender-specific forms. We therefore sought to characterize relationship between HIV prevalence and mobility in an ongoing HIV test and treat study (SEARCH, NCT01864603). Methods: We examined associations between measures of mobility and baseline HIV prevalence among 134,752 census-enumerated adults aged ≥15 years in 32 rural communities in Uganda and Kenya participating in the ongoing Sustainable East Africa Research in Community Health (SEARCH) trial. Multilevel logistic regression analyses, containing random intercepts for community, were conducted with Stata 13 stratified by gender. Results: Controlling for region, age, education level, marital status and household wealth index, HIV prevalence was significantly associated with number of nights spent in main household of residence in past month and migrated in past year in both men and women. Relative to those with no past year migration, odds of infection were 35% higher in migrant men (OR 1.36 [95%CI 1.17,1.59]) and women (OR 1.35 [95%CI 1.12,1.63]). Relative to those who spent few or no nights in household in past month, men who spent every night had lower odds of HIV infection (OR 0.79 [95% CI 0.72, 0.88), as did women who spent most nights (OR 0.88 [95%CI 0.78,0.99) or every night (OR 0.79 [95%CI 0.71,0.89]). In addition, the number of months living outside household in past year was associated with HIV prevalence in men only. The adjusted odds of infection were 20% higher in men who had spent 6 or more months away from the household in past year, relative to men who were more residentially stable (OR 1.21 [95%CI 1.04,1.4]). Conclusion: Gender-specific patterns of mobility were associated with HIV prevalence, controlling for important confounders. Absence from households in past year was a stronger predictor in men, but residence change (migrated in past year) had similar effects in men and women. Even very recent mobility (nights away in past month) was associated with higher HIV prevalence. Causal pathways may be complex and bidirectional, and require further investigation with longitudinal data. 861 HIGH RISK BEHAVIOR IN MARRIED PEOPLE LIVING WITH HIV: IMPLICATIONS FOR PREVENTION Zachary A. Kwena 1 , Catherine K. Makokha 1 , David O. Ang’awa 1 , Elizabeth A. Bukusi 2 1 Kenya Med Rsr Inst, Kisumu, Kenya, 2 Kenya Med Rsr Inst, Nairobi, Kenya Background: Global efforts to end HIV by 2030 focus on reducing and eventually eliminating new infections in priority populations. Preventing high risk sexual behaviors among people living with HIV/AIDS is a cornerstone for such efforts. We sought to establish HIV high risk behavior among married people living with HIV/AIDS in the fishing communities on Lake Victoria within Kenya. Methods: In 2015, we conducted a resurvey of 545 couples who had previously been enrolled in a cross-sectional survey conducted between September 2011 and June 2012. Although the target was to trace and re-interview all couples, we only contacted 903 individuals of whom 89.5%were couples. Among those contacted were 175 individuals who had tested HIV positive during the first survey and referred to care. On contact, the participants were asked to return to the study clinic to participate in a resurvey. Returning participants were consented and invited for face-to-face interviews in private rooms. We asked themwhether or not they had enrolled in care and time to enrolment. In addition, we asked them about their sexual behavior including extramarital partnerships and condom use in marriage and extramarital partnerships. We defined high risk sexual behavior as reporting (1) extramarital sex in the preceding 12 months and, (2) inconsistent marital and extramarital condom use regardless of partners HIV status. Results: Overall, 61% of the participants were involved in high risk sexual behavior. Marital condom use was low with 46% reporting inconsistent condom use in their marriages. This did not improve even among those in serodiscordant relationships where 38% reported inconsistent condom use. One third (33%) reported extramarital sex in the preceding 12 months; 35% reporting unprotected sex in their most recent extramarital sexual encounter. Half (53%) of those who reporting unprotected extramarital sex also reported unprotected marital sex. Enrolment in HIV care was associated with reduced odds of engaging in high risk sexual behavior (aOR 0.14; 95%CI: 0.03-0.66) after controlling for age, spouse HIV status, education level and wealth index. Conclusion: Married people living with HIV/AIDS in these fishing communities on Lake Victoria engage in high risk sexual behavior that can result in new infections within their marriages and sexual networks. Rigorous process of ensuring linkage to care after people test HIV positive and ensuring enrolment into care could prevent involvement in high risk behavior and new infections. 862 HIV AND SYPHILIS COINFECTION IN MEN WHO HAVE SEX WITH MEN, BANGKOK, 2005–2016 Chaiwat Ungsedhapand 1 , Kanokpan Panchroen 1 , Anuwat Sriporn 1 , Wichuda Sukwicha 1 , Wipas Wimonsate 1 , Nutthawoot Promda 1 , Santi Winaitham 1 , Anupong Chitwarakorn 2 , Eileen F. Dunne 3 , Michael Thigpen 3 1 Thailand MOPH–US CDC Collab, Nonthaburi, Thailand, 2 Thailand MOPH, Nonthaburi, Thailand, 3 US CDC, Nonthaburi, Thailand Background: We evaluated HIV and syphilis infection among men attending Silom Community Clinic for HIV voluntary counseling and testing (VCT) services in Bangkok, Thailand over 10 years. Methods: We tested VCT clients for HIV and syphilis, and collected basic demographic information. Serological testing for syphilis used a 2-step algorithmwith rapid plasma reagin and if reactive, treponemal specific testing (Immunochromatography assay). Serological testing for HIV infection followed the Thailand national 3-step algorithm using rapid tests. We used multivariable logistic regression to evaluate factors associated with coinfection at the first visit. We also described HIV only, syphilis only, or both HIV and syphilis (dual) seroconversion. We used Wilcoxon Signed Ranks Test to compare the time to seroconversion between HIV and syphilis. Results: From September 2005-June 2016, there were 10,014 unique clients. Among these, 786 (7.8%) had prevalent HIV and syphilis coinfection, 1,953 (19.5%) had HIV infection only, 458 (4.6%) had syphilis only, and 6,817 (68.1%) had neither infection. Prevalent coinfection increased with each calendar year from 1.3% in 2006 to 9.5% in 2015 (p<0.05). Coinfection was more common among those ≥ 22 years (aOR 1.8, 95% CI 1.4-2.2), clients not born in Bangkok (aOR 1.3, 95% CI 1.1-1.6), and Thai clients (aOR 2.0, 95% CI 1.5-2.7).

Poster and Themed Discussion Abstracts

CROI 2017 372