CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: This secondary analysis used data from a cohort study in Kenya to examine the association between recent intimate partner violence and the likelihood of partner and couples testing. From January-March 2015, 176 HIV-negative women were recruited from antenatal and postpartum care clinics and offered multiple oral fluid-based HIV test kits. Participants received instructions on how to use the self-tests and modest encouragement to offer them to their primary sexual partners. Using multinomial logistic regression, we assessed whether self-testing outcomes reported by participants at 3 months were associated with the history of physical or sexual violence in 12 months prior to study enrollment. The primary outcome had 3 categories indicating whether: the partner did not test; partner testing occurred but couples testing did not; or couples testing occurred. Logistic regression was used to further examine partner dynamics associated with couples testing. We estimated relative risk ratios (RRR) and odds ratios (OR), adjusting for key covariates. Results: Recent physical or sexual violence was reported by 20% of participants at enrollment. Compared to women who did not experience recent physical or sexual violence, women who experienced recent physical or sexual violence were less likely to report that partner testing occurred (0.10 aRRR, 95% CI: 0.02-0.47) or that couples testing occurred (0.13 aRRR, 95% CI: 0.03 - 0.54). Recent partner violence was not significantly associated with whether a male partner tested himself vs. as a couple. However, couples-testing was less likely to occur if the male partner had a neutral or negative reaction to the offer of a self-test (0.32 aOR, 95% CI: 0.12 - 0.87) or if it was not easy to persuade the partner to use a self-test (0.25 aOR, 95% CI: 0.09 - 0.76). Conclusion: Women are capable of deciding for themselves whether to offer self-tests to their partners. However, women who had experienced physical or sexual violence from their partner were less likely to achieve partner or couples testing with self-tests. This finding underscores the need to address intimate partner violence. 895 INFORMING HIV SELF-TESTING SERVICES IN MALAWI USING DISCRETE CHOICE EXPERIMENTS Pitchaya Indravudh 1 , Marc D’Elbee 2 , Moses Kumwenda 1 , Augustine Choko 3 , Doreen Sakala 1 , Thokozani Kalua 4 , Cheryl Johnson 5 , Karin Hatzold 6 , Liz Corbett 3 , Fern Terris-Prestholt 2 1 Malawi–Liverpool–Wellcome Trust Clinical Rsr Prog, Blantyre, Malawi, 2 London Sch of Hygiene & Trop Med, London, UK, 3 London Sch of Hygiene & Trop Med, Blantyre, Malawi, 4 Malawi Dept of HIV and AIDS, Lilongwe, Malawi, 5 WHO, Geneva, Switzerland, 6 Pop Services Intl, Harare, Zimbabwe Background: HIV self-testing (HIVST) has potential to improve equity in access to HIV testing and reach populations, including men and adolescents, underserved by standard-of- care services. This study examines relative preferences for HIVST services using Discrete Choice Experiments (DCE). Methods: Two DCEs were conducted with adults in four rural, high HIV prevalence districts in Malawi. The DCE was administered to randomly selected household members with disproportionate allocation to either a DCE on a) HIVST delivery (n=771) or b) linkage to a confirmatory test and ART initiation after a positive self-test (n=554). Choice bundles of HIVST service characteristics were offered to participants, including option of standard-of-care. Preference heterogeneity was examined by sex and age using multinomial logit and latent class models. Results: Respondents preferred home delivery of HIVST kits to distribution through health facilities or mobile clinics. Local lay distributors were stronger drivers of HIVST uptake compared to alternative providers, including intimate partners and health workers. Oral HIVST kits were preferred to provider-delivered HIV testing or finger-prick HIVST. Small user fees (US$0.07 to 0.21) were strong disincentives, especially among women. Delivery options relating to pre-test support did not affect choice, though there was negative preference for the HIVST instruction leaflet as the sole means of post-test guidance. Following a positive self-test, respondents preferred receiving information on confirmatory testing or HIV care by telephone compared to a leaflet, SMS reminder, or in-person support. Regarding location, respondents had negative preference for linking to mobile clinics over health facilities and their homes. For facility-based HIV care, service fees (US$0.14) and long waiting times (3 hours) were disincentives. HIV-specific service areas at clinics were significant drivers of linkage to care. Sex and age significantly affected willingness to be tested. Men and younger people were more likely to choose to test for HIV, potentially due to outstanding demand. Similar age trends were observed for linkage to care, with older respondents less likely to access services. Conclusion: Preferences elicited in the DCEs support proactive and low-cost distribution by lay providers and minimal support linking to facility-based care services. Sex and age- differentiated responses suggest that some aspects of HIVST services could be configured to reach more men and adolescents. 896 PROVIDING USER SUPPORT FOR HIV SELF-TESTING BEYOND INSTRUCTIONS-FOR-USE IN MALAWI Pitchaya Indravudh 1 , Moses Kumwenda 1 , Melissa Neuman 2 , Blessings Chisunkha 1 , Karin Hatzold 3 , Chiwawa Nkhoma 4 , Thokozani Kalua 5 , Cheryl Johnson 6 , Miriam Taegtmeyer 7 , Liz Corbett 8 1 Malawi–Liverpool–Wellcome Trust Clinical Rsr Prog, Blantyre, Malawi, 2 London Sch of Hygiene & Trop Med, London, UK, 3 Pop Services Intl, Harare, Zimbabwe, 4 Pop Services Intl, Blantyre, Malawi, 5 Malawi Dept of HIV and AIDS, Lilongwe, Malawi, 6 WHO, Geneva, Switzerland, 7 Liverpool Sch of Trop Med, Liverpool, UK, 8 London Sch of Hygiene & Trop Med, Blantyre, Malawi Background: HIV self-testing (HIVST) devices provide a convenient option for home-based testing, but comprehension of standard manufacturer instructions-for-use can be highly variable. Methods: Commercial OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test Kits packaged for HIVST were procured with pictorial IFUs accompanied by text in both English and ChiChewa. Ease-of-use was assessed through cognitive interview with literate adults (age ≥16 years) attending HIV testing services in rural and urban Blantyre. Participants were provided with the packaged kits containing IFUs but no other assistance. A standardised questionnaire and observation record was administered during self-testing. Feasibility was then evaluated in two rural villages, with 342 participants from randomly-selected households and community peer groups (age ≥16 years and not on antiretrovirals). Respondents were offered the options of self-testing, receiving standard HIV testing, or not testing and were administered baseline and exit questionnaires. Respondents opting to self-test received a brief demonstration on kit content and usage. HIVST results were compared to a reference standard (2 parallel rapid blood-based kits by a trained professional). Results: Numerous problems occurred in 20 cognitive interviews, including difficulty in package opening and misinterpretation of translated phrases (“two pouches”; “test stand”) and imagery. Abstract symbolisation (e.g. knife and fork for eating; traffic crosses for ‘do not’) was poorly recognised. Although 18/20 completed HIVST, these difficulties greatly affected timeliness and confidence in validity. In contrast, all 291 feasibility participants (80.0% literate) who opted to self-test completed the test following standardised demonstration. Self-read results agreed with reference for 12/13 HIV-positive participants (sensitivity 92.9%, 95%CI 66.1%-99.8%) and 276/277 HIV-negative participants (specificity 99.60%, 95%CI 98%-100%). Uptake was high, with 85.1% of participants opting to self-test. Respondents also reported high levels of ease and satisfaction, with 100% recommending HIVST to friends and family. Conclusion: In settings where commercially packaged self-assembly products are rarely encountered, literacy may not guarantee ability to follow HIVST IFUs unless accompanied by demonstration of use. Cognitive interviewing provides a rapid and convenient way to alert self-testing implementers of this need in their communities. 897 ACCEPTABILITY OF SELF-COLLECTED RECTAL SWABS FOR HIV EXPOSURE TESTING AMONG MSM/TGW Hong Van Tieu 1 , Maria Lemos 2 , Michele Andrasik 2 , Ira Fleming 2 , Vijay Nandi 1 , Geneva Ortiz 1 , Debbie Lucy 1 , Martin Musuruana 3 , Julie McElrath 2 , Beryl A. Koblin 1 1 New York Blood Cntr, New York, NY, USA, 2 Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA, 3 Univ of Illinois, Peoria, IL, USA Background: HIV biomedical prevention trials lack a reliable, sensitive method to measure HIV exposure and condomless sex. A pilot, prospective cohort study assessed the acceptability of self-collected rectal swabs and feasibility of testing for HIV-1 RNA and Y chromosome short tandem repeats (STRs) as biomarkers for HIV exposure and condomless receptive anal sex among MSM and transgender women (TGW) in NYC. Data on acceptability of and adherence to self-administered rectal swab collections for detection of HIV exposure biomarkers are presented here.

Poster and Themed Discussion Abstracts

CROI 2017 389