CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1 US CDC, Nairobi, Kenya, 2 Impact Rsr and Development Org, Kisumu, Kenya, 3 CDC, Atlanta, GA, USA 4 US CDC, Kisumu, Kenya, 5 Seattle Children’s Rsr Inst, Seattle, WA, USA Background: Uptake of voluntary medical male circumcision (VMMC) as an intervention for the prevention of HIV is low among men aged ≥25 years in Nyanza region, Kenya. We evaluated the baseline prevalence and cofactors of VMMC among men 25-39 years who were targets of interventions to improve VMMC uptake. Methods: As part of a cluster randomized controlled trial (cRCT) to evaluate tailored interventions to improve uptake of VMMC, we conducted a survey of men from the Luo, traditionally non-circumcising ethnic community who were aged 25-39 years and residing in non-contiguous administrative locations selected as cRCT sites. We determined their circumcision status, estimated VMMC prevalence and assessed predictors of being circumcised using univariate and multivariate Generalized Estimating Equations logistic regression to account for study design. Results: While 9,711 men were screened, 5,639 (58.1%) consented and were enrolled into cRCT. Of these 5,639 used for this analysis, 2,851 (50.6%) self-reported being circumcised. Uncircumcised men aged 25-39 years residing or planning to continue living in the study village for the next 9 months were included in the study. Circumcised men aged 39 years who were non-resident or planning to move away from the study village within 9 months after enrolment were excluded. Three-quarters of enrolled men consented to visual verification of circumcision status of whom 2,195 (52.0%) were confirmed fully or partially circumcised. The odds of being circumcised, as self-reported, were significantly higher for men with secondary school education (adjusted Odds Ratio (aOR)=2.15; 95% CI: 1.11-4.13, p =0.023), college (aOR=2.12; 95% CI: 1.12-4.00, p=0.021), and university (aOR=2.86; 95% CI: 1.53-5. 34, p=0.001) education compared to no education; for non-Christians (aOR=2.03; 95% CI: 1.28-3.21, p=0.003) compared to Christians; and for the employed (aOR=1.32; 95% CI: 1.09-1.59, p=0.004). The odds were lower for men with history of being divorced/separated/widowed (aOR=0.59; 95% CI: 0.41-0.85, p=0.005) compared to being single; and for men aged 35-39 years (aOR 0.83; 95% CI: 0.41-0.85, p=0.003) compared to men aged 25-29 years. Conclusion: Among the Luo community in Nyanza region of Kenya, men aged 35-39 years with post-primary education, non-Christians and employed are more likely to be circumcised. VMMC providers seeking to improve uptake among men aged 25-34 years should target men who are or were married, the less educated and the unemployed. 983 MALE CIRCUMCISION AND RISK COMPENSATION IN KWAZULU-NATAL, SOUTH AFRICA Katrina F. Ortblad 1 , Guy Harling 1 , Joshua A. Salomon 1 , Frank Tanser 2 , Deenan Pillay 3 , Tinofa Mutevedzi 3 , Till Baernighausen 4 1 Harvard Univ, Boston, MA, USA, 2 Africa Cntr for Pop Hlth, Mtubatuba, South Africa, 3 Africa Hlth Rsr Inst, Mtubatuba, South Africa, 4 Heidelberg Univ, Heidelberg, Germany Background: Voluntary medical male circumcision (VMMC) has been proven in a number of randomized clinical trials (RCTs) to reduce HIV transmission by 60%. However, the benefits of circumcision might be negated by risk compensation, i.e., increases in risky sexual behaviors because of the biological HIV risk reduction following circumcision. To date, data on risk compensation in sub-Saharan Africa has been largely limited to RCTs. We test the risk compensation hypothesis for the first time using data from a population-based cohort study in sub-Saharan Africa. Methods: A population-based cohort in KwaZulu-Natal, South Africa was followed longitudinally from 2003 to 2014. Self-reported circumcision status and sexual behavior was collected for all individuals annually, 2009-2014. Four variables were used to measure sexual behavior: (1) condom use at last sex, (2) regular condom used, (3) number of partners in the last 12 months, and (4) number of concurrent partners. Multivariable models with individual fixed effects were used to determine the impact of circumcision uptake on the self-reported sexual behavior variables. Results: From 2009 to 2014 14,997 unique men reported their circumcision status (median age 25 years, IQR: 19-41 years). During this time circumcision prevalence rose dramatically (2% in 2009 to 12% in 2014) and 954 individuals partook in circumcision interventions (as indicated by changes in their circumcision status over time). No significant changes in sexual behaviors were observed before and after circumcision uptake. The odds of condom use at last sex were 1.1 (95% CI: 0.4 – 3.0) for individuals post-circumcision compared to pre-circumcision and individuals post-circumcision had 0.9 times (95% CI: 0.7 – 1.2) the reported number of sexual partners in the past 12 months compared to number of partners reported pre-circumcision. Conclusion: We find no evidence for risk compensation following circumcision in a community in rural KwaZulu-Natal. The often-hypothesized risk compensation phenomenon is unlikely to reduce the impact of VMMC campaigns on population HIV incidence in this and similar real-world settings. Circumcision should continue to be vigorously scale-up as a key HIV prevention strategy and newly circumcised males should continue to be counseled on the importance of condom use post-circumcision.

Poster and Themed Discussion Abstracts

984 RISK COMPENSATION OVER 2 YEARS AMONG MEN IN A NATIONAL VMMC ROLL-OUT IN ZIMBABWE

Daniel E. Montano 1 , Danuta Kasprzyk 1 , Deven T. Hamilton 1 , Mufuta Tshimanga 2 1 Univ of Washington, Seattle, WA, USA, 2 Univ of Zimbabwe, Harare, Zimbabwe

Background: Three randomized control trials (RCTs) demonstrated at least 60% protection of voluntary medical male circumcision (VMMC) against HIV acquisition, and protection against acquisition of ulcerative STIs and HPV. This protection may be offset by risk compensation (RC). Prior RC studies involved men who were part of or follow-on to the RCTs, with men exposed to safe sex messages each time they were seen. This is the first study of RC among men circumcised in a national VMMC program, who were not exposed to safe sex messages each time they were surveyed. Methods: We assessed change in sexual risk behavior over 2 years among circumcised versus uncircumcised men. We enrolled a cohort of 2,379 HIV-negative men aged 18-40 in 2 urban areas in Zimbabwe: 1,196 circumcised near recruitment, 1,183 eligible for VMMC but declined it. Men were surveyed at baseline, 6, 12, and 24-months with extensive sexual behavior measures including number of partners in last 6-, 12-months, and lifetime, sex with sex workers, condom use, concurrent partnerships, and alcohol and drug use.

CROI 2017 426