CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Longitudinal analyses were performed using generalized estimating equations to test for main and interaction effects of study group and time on sexual risk measures, adjusting for baseline differences. Results: Cohort groups differed at baseline on marital status, income and education, but not on sexual behavior. Study group was significant for only 3 measures: circumcised men were more likely to have had a partner in past 6 and 12 months, and less likely to drink alcohol before sex. Time was significant for 12 measures, with increases in: had a partner in the previous 6 months, 2+ partners in previous 6 and 12 months, had a partner of unknown HIV status, had concurrent partners, concurrent partners and did not use a condom at last sex, 2+ non-spouse partners, suspected partner had other partners, and being drunk in the past 30 days. There was a significant decrease in using a condom at last sex, consistent condom use with spouse, and having an STI Dx/Sx in the previous 6 months. Group by time interaction was significant only for drinking before sex. Conclusion: Lack of group by time interaction indicates no evidence for RC after VMMC. Of concern is the strong evidence for increased risk behavior among both groups over time. This study coincided with increased availability of ART in Zimbabwe. Possible emphasis on treatment at the expense of behavioral prevention may lead to viewing HIV as a chronic condition, so greater risk behavior. 985 WITHDRAWN 986 AGREEMENT OF SELF-REPORTED AND PHYSICALLY VERIFIED MALE CIRCUMCISION STATUS IN KENYA Elijah Odoyo-June 1 , Kawango Agot 2 , Edward Mboya 2 , Jonathan Grund 3 , Paul K. Musingila 1 , Donath Emusu 1 , Leonard Soo 1 , Boaz Otieno-Nyunya 1 1 US CDC, Nairobi, Kenya, 2 Impact Rsr and Development Org, Kisumu City, Kenya, 3 CDC, Atlanta, GA, USA Background: Self-reported male circumcision (MC) status is frequently used to estimate MC prevalence, although its accuracy varies by setting. Nevertheless, self-reported MC status remains essential because it is the most feasible method of collecting MC status data in community surveys; and its accuracy is an important determinant of data reliability. We assessed the accuracy of self-reported MC status among adult men during a household survey in non-circumcising communities within Nyanza region of Kenya where MC for HIV prevention is being rolled out. Methods: A total of 5,656 men aged 25-39 years from four counties were enrolled and a baseline questionnaire that captured information on self-reported MC status administered to 4,232 consenting men. Thereafter, a trained research assistant physically verified their MC status as fully circumcised (no foreskin), partially circumcised (foreskin is past coronal sulcus but covers less than half of the glans) or uncircumcised (foreskin covers half or more of the glans). The sensitivity and specificity of self-reported MC status were calculated using physically verified MC status as the gold standard. The data were pooled for analysis and did not account for the study design. Results: Out of 4,232 men, 2,197 (51.9%) reported being circumcised of whom 99.0% (2,176/2,197) were confirmed as fully circumcised on physical examination. Among the 2,035 men who reported being uncircumcised, 93.7% (1,907/2,035) were confirmed uncircumcised by physical examination. Kappa agreement between self-reported and physically verified MC status was high, К= 0.9858 (95% CI, 0.981-0.991), p<0.001. The sensitivity of self-reported MC status was 99.59% and specificity was 98.97%, and did not differ significantly by age group; the sensitivity range was 99.3% - 99.6%, and the specificity range was 98.7 % - 99.6%. Similarly, the Kappa agreement was high for all age groups: range 0.9805 - 0.9917. Conclusion: In this study population, the accuracy of self-reported MC status was high at 99.0%; therefore in this setting MC coverage estimates based on self-reported MC status are accurate and applicable for planning. We recommend similar studies to validate accuracy of self-reported MC status in other populations where MC is being rolled out. 987 VOLUNTARY MEDICAL MALE CIRCUMCISION FOR NONCOMMUNICABLE DISEASE CASE FINDING, NAMIBIA Nikki Soboil 1 , Shawn J. Rooinasie 2 , Catherine Laube 3 , Abubakari Mwinyi 1 , Amir Shaker 2 1 Jhpiego, Swakopmund, Republic of Namibia, 2 Ministry of Hlth and Social Services, Erongo Regional Directorate, Swakopmund, Republic of, 3 Jhpiego, Baltimore, MD, USA Background: The burden of non-communicable diseases (NCDs), including hypertension (HTN), is growing in sub-Saharan Africa (SSA), particularly in urban areas, with evidence of considerable under-diagnosis. An estimated 38% of urban Namibians are living with HTN. HTN is more prevalent in African males, and prevalence increases with age. A systematic review of HTN in SSA found less than 40% of people with HTN had been previously diagnosed. Males, whose health seeking is less common than females’, are particularly likely to suffer from undiagnosed HTN and other NCDs in Namibia. Voluntary medical male circumcision (VMMC) is one of few health services catering to males, and thus a rare opportunity for HTN screening. Jhpiego launched high volume nurse-led voluntary medical male circumcision VMMC services at Swakopmund State Hospital in Erongo Region, Namibia in May 2016, and more than 90% of the clients served to date have been aged 20 years and above, in contrast to VMMC clients across East and Southern Africa to date, the majority of whom have been aged between 10 to 19 years. Methods: Jhpiego abstracted data from client records for males registered for VMMC services between 13 May and 31 July 2016, including pre-operative physical screening data, to characterize the proportion of clients with blood pressure above 140/90 mm Hg. A random sample of 28 hypertensive clients were contacted post-hoc to determine whether they had been previously diagnosed. Results: Of the 1,266 males screened for VMMC between 13 May and 31 July 2016, 367 (29%) were hypertensive. Of hypertensive clients, 136 (37%) were Stage 1 (140-159/90-99 mm Hg), 89 (24%) were Stage 2 (160-179/100-109 mm Hg), and 142 (39%) were isolated systolic (>140/<90 mm Hg). Of the random sample of 28 hypertensive clients contacted post-hoc, 15 (53%) were newly diagnosed. Conclusion: VMMC can be a critical platform for HTN and other NCD screening, particularly in programs serving mature clients. VMMC programs seeking to attract a greater proportion of males aged 15-29 should prioritize careful pre-operative physical screening, as well as a systematic approach to deferrals and active referrals for clients diagnosed with HTN. Service delivery models integrated/co-located with primary care may help reduce loss to follow up for males newly diagnosed with HTN. Research is needed to better understand the full NCD disease burden in VMMC clients within and outside of Namibia. 988 WITHDRAWN 989 POPULATION-LEVEL VIRAL-LOAD MONITORING TO MEASURE PROGRESS TOWARDS THE “THIRD 90” Maia Lesosky 1 , Nei-Yuan M. Hsiao 1 , Wolfgang Preiser 2 , Jean Maritz 3 , Landon Myer 1 1 Univ of Cape Town, Cape Town, South Africa, 2 Stellenbosch Univ, Cape Town, South Africa, 3 NHLS, Cape Town, South Africa Background: Global targets for antiretroviral therapy (ART) programmes call for 90% of those on ART to achieve sustained viral suppression (VS) by the year 2020, but there are few programmatic data from viral load (VL) monitoring in sub-Saharan Africa to help measure progress towards this goal. Methods: Using routine laboratory data from the South African National Health Laboratory Service, we examined results of VL monitoring conducted in all adult patients on ART in the public health care system of the Western Cape province from 2009-2015. In this setting there have been major efforts to decentralise ART services during this period. Routine VL monitoring is conducted 6m and 12m after ART initiation and annually thereafter; repeated VL testing is done for those with suspected virologic failure. In this analysis we defined VS as any VL <1000 copies/mL and analysed the proportion of VS test results by patient age, calendar period (month/quarter) and health facility. Results: Data include 964,184 VLs from 217 facilities; the average number of VL tests/month increased from 7,291 in 2009 to 17,841 in 2015. The overall proportion of VS results <1000 copies/mL remained consistent between 80-86% during the period, with an increasing trend of 1% per year (p<0.001). There was marked heterogeneity in the proportion of VS tests between facilities (Figure 1a), with larger sites having higher proportions of VS tests (p<0.001): while only 12% of all facilities had an average of >90% VS during 2015,

Poster and Themed Discussion Abstracts

CROI 2017 427