CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Results: We found modest but significant differences in engagement in HIV care and ART uptake by sexual risk behaviors. ART initiation was lower in persons reporting 3+ sexual partners (adjPRR 0.84, 95% CI 0.71–0.98) and among women aged 15-29 with 2 sexual partners (PRR 0.74, 95% CI 0.57–0.95). ART initiation was also lower in persons with non- marital sexual partners (adjPRR 0.90, 95% CI 0.82–0.98); particularly among men aged 15-29 (PRR 0.62, 95% CI 0.44–0.89). Persons with sexual partners outside the community were less likely to be enrolled in care (adjPRR 0.90, 95% CI 0.82–0.98) or to be on ART (adjPRR 0.87, 95% CI 0.78–0.96). ART initiation was lower in persons who used alcohol before sex (adjPRR 0.91, 95%CI 0.83-0.99). Conclusion: In this population-based cohort, there was evidence of lower rates of adoption of HIV care and ART among persons reporting higher sexual risk behaviors. These factors likely reduce the population-level effectiveness of treatment as prevention programs. Tailored strategies are needed to engage HIV-positive persons at highest risk for onward transmission in HIV care. 997 HIV TESTING, LINKAGE TO CARE, AND VIRAL SUPPRESSION AMONG GAY MEN IN NIGERIA Habib R. Omari 1 , Uchenna Ononaku 2 , Rebecca G. Nowak 1 , Ifeanyi Orazulike 3 , Trevor Crowell 4 , Nicaise Ndembi 2 , Hongjie Liu 5 , Stefan Baral 6 , Man Charurat 1 1 Univ of Maryland, Baltimore, MD, USA, 2 Inst of Human Virology Nigeria, Abuja, Nigeria, 3 Intl Cntr on Advocacy and Rights to Hlth, Abuja, Nigeria, 4 US Military HIV Rsr Prog, Bethesda, MD, USA, 5 Univ of Maryland Coll Park, Coll Park, MD, USA, 6 The Johns Hopkins Univ, Baltimore, MD, USA Background: The UNAIDS 90-90-90 targets challenge healthcare systems to diagnose people living with HIV (PLHIV), link them to care, and support them to achieve viral suppression. In particular for key populations such as men who have sex with men (MSM), characterizing individual, network, and structural barriers to care is essential in order to inform interventions to achieve these goals. We characterize the HIV treatment cascade within the context of “test-and-treat” among MSM in Nigeria. Methods: FromMarch 2013-June 2016, TRUST/RV368 study used respondent-driven-sampling to recruit MSM into a “one-stop” clinic. Participants completed a structured survey and HIV testing. Those initiated antiretroviral therapy (ART) were considered linked into care and underwent HIV RNA testing every three months (Abuja) or six months (Lagos). Those with HIV RNA <1000 copies/ml at the latest follow-up visit were considered virally suppressed. Multivariate logistic regression models were used to calculate adjusted odds ratios (aOR) for factors associated with HIV testing, linking in care, and viral suppression. Results: A total of 1604 MSM were recruited and 628 (39.1%) PLHIV were included in these analyses of treatment cascade (Figure 1). Higher education was associated with increased HIV testing while having no place to socialize was associated with decreased HIV testing. Factors associated with increased odds of being linked in care included education, senior secondary school vs < senior secondary school (aOR 2.4, 95%CI: 1.0–5.5), participation in HIV prevention meetings (aOR 1.9, 95% CI: 1.2–3.0), having an older partner 20-29 vs ≤19 years (aOR 2.6, 95%CI: 1.6–4.2), and having HIV-infected partners (aOR 1.9, 95%CI: 1.3–2.9). Ever being blackmailed (aOR 0.6, 95%CI: 0.3–1.0) and those recruited at later waves (aOR 0.4, 95%CI: 0.3–0.6) were less likely to be linked in care. Viral suppression at six months was associated with having a partner with higher education senior secondary school (aOR 1.9, 95% CI: 1.0–3.6) and increased education (aOR 2.2, 95% CI: 1.2–4.1). Conclusion: Social determinants of health potentiated engagement in HIV care whereas structural determinants including blackmail mitigated this engagement for MSM in Nigeria. Given the high HIV prevalence and incidence among these men, comprehensive programs and policies combined with implementation research to study optimal implementation is needed to support effective linkage and sustained retention in the HIV treatment cascade.

Poster and Themed Discussion Abstracts

998 ART INITIATION AND RETENTION IN AFTER-HOUR VERSUS DAILY MALE HEALTH CLINICS Tali Cassidy 1 , Amir Shroufi 1 , Sarah Jane Steele 1 , Morna Cornell 2 , Virginia de Azevedo 3 , David Binza 4 , Rodd Gerstenhaber 1 1 Médecins Sans Frontières, Cape Town, South Africa, 2 Univ of Cape Town, Cape Town, South Africa, 3 City of Cape Town Dept of Hlth, Cape Town, South Africa, 4 Western Cape Provincial Dept of Hlth, Cape Town, South Africa Background: In large African antiretroviral therapy (ART) programs, disproportionately fewer men initiate ART, and at more advanced age and disease stage than women. Identifying and overcoming gender-specific barriers, at the individual and service delivery level, are critical to improving HIV/STI services for men. Previous research in Khayelitsha, a large, high HIV-prevalence township near Cape Town, found that despite increased male access to HIV counseling and testing (HCT), the proportion of men accessing treatment did not increase. MSF, the City of Cape Town and the Western Cape Provincial Department of Health, piloted two male services in Site B, Khayelitsha: Site B Male Clinic (SBMC) and a male after-hours clinic (MAC). Both facilities have all-male staff and offer HIV/STI services, including testing and treatment. SBMC is open daily 8:00-16:00 and MAC is open on Wednesdays 16:00-19:30. We compare the characteristics and outcomes of these two clinics. Methods: Those on ART who initiated at another clinic are referred to as transfers-in (TFI) while known HIV-positives tested positive at another service before presenting. Summary statistics of patient characteristics and outcomes are presented, contrasting the two clinics where relevant. Results: Between June 2014 and June 2016, 14193 visits took place; median: 588/month (IQR: 509-659). Most (88%) of these visits took place at SBMC. Compared to MAC, patients at SBMC were more likely to seek STI treatment(45% vs 21%). Over half of the HCT occurred at an STI-related visit and HCT yielded a 6.2% positivity rate. The median CD4 counts were 376 (IQR:260-505) cells/µL at testing. Of those found eligible for ART, 91% (42/46) ever initiated at MAC compared to 69% at SBMC (203/295). Compared with SBMC, a far

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