CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

892 ETEST: A “SMART” HOME HIV TESTING SYSTEM ENABLING REAL-TIME FOLLOW-UP AFTER TESTING

Tyler B. Wray 1 , Philip A. Chan 2 , Don Operario 1 , Erik Simpanen 1 1 Brown Univ, Providence, RI, USA, 2 The Miriam Hosp, Providence, RI, USA

Background: Men who have sex with men (MSM) are at high risk for HIV, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV could encourage more regular testing and potentially detect some new infections earlier, but providing sufficient follow-up after testing is a challenge. A more active approach to post- test follow-up with HBST may be needed, so that those who receive reactive (preliminary positive) results can be efficiently linked with care, and those who test negative can be connected with other key prevention services (e.g., safe sex supplies, sexually transmitted infection [STI] testing, pre-exposure prophylaxis [PrEP] consultation). Methods: We developed the “eTEST” system, which uses Bluetooth low energy beacons (BLE) and a smartphone app to remotely monitor when HBST kits have been opened (see Fig. 1), allowing Qualified HIV Test Counselors (QHTCs) to actively follow up with users over the phone after testing. In this 7 month study, we recruited 60 high-risk MSM who had not tested in the last year fromMSM-oriented “hookup” apps and randomly assigned them to receive one of the following in the mail at baseline, 3-months, and 6-months: either (1) “eTEST” HBST kits, (2) standard HBST kits, or (3) reminders to seek clinic-based testing. Those in the “smart” HBST condition received follow-up calls from QHTCs within 24 hours, while those in the “standard” group had no follow-up. Results: Between-groups comparisons suggested that more participants in the HBST conditions reported having tested for HIV (98% vs. 40%, t=0.93, p<.05) and other STIs compared with the control condition (45% vs. 10%, t=1.98, p<.05), but these rates did not differ between the “smart” and standard HBST groups. However, compared with control and standard HBST conditions, more in the “smart” HBST group received HIV risk reduction counseling (65% vs. 25%, t=2.98, p<.05), safe sex supplies (55% vs. 17%, t=2.45, p<.05), and were referred for PrEP consultation (55% vs. 0%, t=3.61, p<.05). More “smart” HBST participants also began PrEP (15% vs. 0%), but this difference was not significant. Conclusion: Initial results suggest that HBST may encourage more regular HIV and STI testing among high-risk MSM, and that the eTEST system in particular may be useful for engaging individuals with other critical services. Further research is needed to determine whether eTEST facilitates earlier detection of new infections and linkage to care. 893 PEER-LED ORAL HIV-SELF TESTING FINDS UNDIAGNOSED HIV AMONG MSM IN MALINDI, KENYA Elisabeth M. van der Elst 1 , Mahmoud Shally 1 , Clifford Oduor 1 , Oscar Chirro 1 , Fauz Ibrahim 2 , Bernadette Kombo 1 , Susan M. Graham 3 , Eduard Sanders 4 1 KEMRI Wellcome Trust Rsr Prog, Kilifi, Kenya, 2 Kilifi County Dept of Hlth, Kilifi, Kenya, 3 Univ of Washington, Seattle, WA, USA, 4 Kenya Med Rsr Inst, Kilifi, Kenya Background: Men who have sex with men (MSM) in Kenya experience structural and social barriers to HIV-testing, and have a high burden of undiagnosed HIV. We assessed whether oral HIV self-testing (OST) extended by MSM lay counsellors would be acceptable and feasible compared to clinic-based HIV testing and counseling (HTC) of mobilised MSM in an area known for sex work. Methods: We compared HIV-prevalence and time to immediate ART initiation among newly diagnosed MSM who were mobilised either for clinic-based HTC or for OST, using trained lay counsellors. For HTC, 5 MSM recruiters mobilised between 20 and 30 MSM per week during 6 months. Clinic-based HTC followed national testing guidelines (i.e., two positive rapid tests needed to confirm HIV positive status). OST was facilitated by six MSM lay counsellors who each extended 5 OST kits to their peers per week. Irrespective of the OST result, all MSM who did OST were asked to report for confirmatory HTC per national guidelines at the clinic. All newly HIV-diagnosed MSM were offered immediate ART at a Government hospital serving key populations. Results: During July-December 2015, 690 MSM with median age 27.0 years (interquartile range (IQR): 22-33) underwent HCT, and 24 (3.5%) were newly diagnosed. Of these, 20 (83.3%) MSM initiated ART at the hospital after a median 5 days (IQR: 3-14). During March-June 2016, 337 MSM were provided with OST, and 333 (99.1%) MSM with median age 26.0 years (IQR:23-32) reported for confirmatory testing. A total of 29 MSM (8.7%, p<0.001) were newly diagnosed. Of these, 24 (82.8%, p=1.0) started ART on the day of HIV- confirmation. MSMwere highly motivated to participate in OST, which they considered an activity they owned. Conclusion: In Malindi, peer-led OST followed by confirmatory testing was feasible and identified a higher prevalence of undiagnosed HIV-infection in MSM compared to HCT. Men who underwent OST had high rates of retesting, and tended to accept immediate ART treatment. OST appeared a feasible strategy to engage MSM for HIV testing and care. 894 ROLE OF PARTNER VIOLENCE IN WOMEN’S ABILITY TO DISTRIBUTE SELF-TESTS TO MALE PARTNERS Elisabeth Schaffer 1 , Kawango Agot 2 , Harsha Thirumurthy 1 1 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 Impact Rsr and Development Org, Kisumu City, Kenya Background: Offering multiple HIV self-tests to women in sub-Saharan Africa is a promising way to increase male partner testing and couples testing. Recent findings indicate that women are willing and able to safely distribute self-tests to their partners, yet the extent to which prior history of intimate partner violence limits the potential of this approach is unknown.

Poster and Themed Discussion Abstracts

CROI 2017 388