CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: Opt-out HIV/HCV testing was offered to individuals entering the Dallas County Jail between October 2015 and July 2016 at the time of a scheduled blood draw. Basic demographics were collected on all participants. For those who tested HIV positive, risk factors, prior engagement in care (seen by an HIV provider within 6 months previous to incarceration), and re-engagement in care (receipt of HIV care during incarceration) were assessed. Results: HIV opt-out testing Overall, 1.3% (41/3155) had a positive HIV screening test. Of these, 24%were false positives (positive 4th generation Ag/Ab test with negative HIV1/2 Ab differentiation test). Of those remaining, 16%were newly diagnosed, of whom 100%were linked to care. Among those previously known to be HIV-positive, one-third were not engaged in care before incarceration though 88%were linked back to HIV care in jail. HCV opt-out testing Overall, 16% (500/3042) had a positive HCV Ab screening test. Mean age was 49, 80%were men, and our cohort was racially diverse (43%White, 42% Black, and 15% Hispanic). One-third of inmates self-reported HCV positivity before being tested. Only 52% of the HCV-positive were baby boomers. Racial differences were observed within the baby boomer group, with 74% of blacks v. 35% of whites belonging to this cohort. Conclusion: Routine opt-out HIV/HCV testing in a jail setting identified multiple HIV and HCV infections. New HIV diagnoses were relatively rare, though linkage to care and re-engagement in HIV care was high. The rate of HCV Ab positivity was high and one-third was already aware of this diagnosis. Testing only those in the baby boomer cohort would have missed approximately half of HCV infections, predominantly among whites. Opt-out HIV/HCV screening in the criminal justice system is a unique opportunity to reach underserved individuals, who may otherwise not seek testing and are at high risk of transmitting these infections. 958 STRENGTHENING MALE-PARTNER TESTING IN ANTENATAL CARE: FINDINGS FROM SOUTH AFRICA Amy M. Medley 1 , Nienke van Schaik 2 , Carlos Toledo 1 , Makungureyi Mlambo 3 , Sello Moremi 2 , Kabelo Baloyi 2 , Nompumelelo Khanyile 3 , Sphindile Magwaza 3 , Cila Kabongo 4 , John Tumbo 4 1 CDC, Atlanta, GA, USA, 2 Hlth Systems Trust, Durban, South Africa, 3 US CDC, Pretoria, South Africa, 4 Rustenburg Sub-District Office, Rustenburg, South Africa Background: Knowing both partners’ HIV status during pregnancy is associated with improved maternal and infant outcomes and reduced risk of horizontal and vertical HIV transmission and acquisition. Despite high uptake of testing among women, male partner testing within antenatal clinics (ANC) remains low. This study aimed to increase the proportion of men and couples tested within ANC through promotion of facility and home-based HIV testing services. Methods: The study was conducted at four health facilities in the Bojanala District, South Africa from January 2015 - September 2016. All women, regardless of HIV status, attending their first ANC visit received education on the importance of partner HIV testing. Women were then offered letters inviting male partner(s) to the health facility for an HIV test or the option of home-based services. Information about partner testing and women’s clinical status were abstracted from patient medical charts and records post- partum. Numbers and proportions of male partner testing were assessed before and after the intervention. A multivariable logistic regression model, adjusted for clustering and study phase, was used to identify predictors of male partner testing. Results: In our preliminary analysis, a total of 1,342 women (600 in the pre-intervention, 742 in the post-intervention) had delivered (mean age: 26 years, 27% HIV-positive) of which 76%were single and 27%were primigravida. The proportion of women self-reporting partner testing for HIV increased from 14% to 33% (p<0.0001). Post-intervention, 59 couples tested at home, 110 tested at a study facility, and 64 tested elsewhere. Clinic records indicate that 690 couples tested at the four health facilities overall (14% concordant positive, 9% sero-discordant), while 181 couples tested in the home (8% concordant positive, 3% sero-discordant). In multivariable analysis, significant predictors of partner testing included being HIV-negative (OR: 1.4, 95% CI: 1.2, 1.6, p=0.002) and in the post-intervention cohort (OR: 3.2, 95% CI: 1.6, 6.5, p=0.001). Conclusion: Scaling-up HIV testing coverage among men is critical to achieving international goals aimed at ending the HIV epidemic. Our findings indicate that promotion of facility testing and targeted home-based HIV testing may be an effective strategy for increasing the number of male partners who receive an HIV test during the woman’s pregnancy. Additional efforts are also needed to increase HIV testing coverage among men. 959 HPTN 071 HOME-BASED TESTING IMPROVES UPTAKE OF HCT AMONG PREGNANT WOMEN IN ZAMBIA Stable Besa 1 , Ab Schaap 1 , Mwate J. Chaila 1 , S. Floyd 2 , Richard Hayes 2 , Sarah Fidler 3 , Kwame Shanaube 1 , H. Ayles 4 , for the Zambart Study Group 1 Zambart, Lusaka, Zambia, 2 London Sch of Hygiene and Trop Med, London, UK, 3 Imperial Coll London, London, UK, 4 London Sch of Hygiene and Trop Med, Lusaka, Zambia Background: The HPTN071 (PopART) trial is a 3-arm community randomized trial in 12 communities in Zambia and 9 communities in South Africa evaluating the impact of a combination HIV prevention package, including a universal test and treat intervention, on HIV incidence. In Zambia, almost 88% of ANC attendees receive HCT during any given pregnancy however, data are limited for pregnant women who have not attended ANC (non-ANC). Therefore, we assessed what contribution home based testing does to knowledge of HIV status among pregnant women in Zambia. Methods: All household members, including pregnant women, were offered a combination HIV prevention package by the Community HIV-care Providers (CHiPs) through a door- to-door approach. Uptake of different components of the PopART intervention, including HIV testing, were recorded electronically. We present data on the uptake of HCT among pregnant women in 4 Arm A communities in Zambia? During the first annual round of the intervention (November 2013 to June 2015). Results: A total of 55,703 women consented to participate in the intervention of whom 99.3% (55,291/55,703) had their health data recorded. 7.7% (4,261/55,291) of the women were pregnant with 7.8% (331/4,261) self-reporting as HIV positive (figure 1), while the remaining 92.2% (3,930/4,261) were offered HCT. Among the latter 60.5% (2,378/3,930) had attended ANC for their current pregnancy, with 96.6% (2,296/2,378) either agreeing to HIV testing by the CHiPs (n=1,376) or reporting to have been tested within the last 6 months (n=920). Of those who had not yet attended ANC, 91.9% (1,426/1,552) either agreed to HIV testing by CHiP’s (n=1,295) or reported to have been tested in the last 6 months (n=131). The HIV prevalence among those testing was nearly double for the non-ANC compared to ANC women [12.3% (159/1,295) versus 6.3% (86/1,376)]. Of the 576 pregnant women that knew their HIV-positive status following the intervention, 43%were tested HIV+ by CHiPs. Knowledge of HIV status defined as self-reported HIV-positive, tested by

Poster and Themed Discussion Abstracts

CHiPs or tested elsewhere within the past 6 months, increased from 60.0% before the intervention to 95.1% Conclusion: Community based HIV testing may enhance HIV case finding among women not yet in ANC.

CROI 2017 415