CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Malawi has nearly reached the target of 90% viral suppression in those on ART among this nationally representative cohort of women in Option B+. A relevant proportion of women with unsuppressed VL are at strongly increased risk of vertical transmission. Further characterization of this group of women and providing tailored support measures will be important to achieve elimination of MTCT. 822 INFANT HIV-FREE SURVIVAL IN THE ERA OF “OPTION B+” SERVICES IN RURAL ZAMBIA Benjamin H. Chi 1 , Wilbroad Mutale 2 , Jennifer Winston 1 , Winifreda Phiri 1 , Joan T. Price 1 , Charles Y. Msiska 3 , Helen Ayles 4 , Jeffrey S. Stringer 1 1 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 2 University of Zambia, Lusaka, Zambia, 3 Government of Zambia Ministry of Health, Lusaka, Zambia, 4 Zambart, Lusaka, Zambia Background: Lifelong antiretroviral therapy (ART) is now recommended for all HIV-infected pregnant and breastfeeding women (i.e., “Option B+”); however, few have described overall infant outcomes in this new era of prevention of mother-to-child HIV transmission (PMTCT). This is a particular gap in rural Africa, where disease burden is high and access to health services often limited. Methods: As part of a broader assessment of PMTCT program impact, we enrolled a prospective cohort study in four predominantly rural districts in Zambia’s Lusaka Province. The study coincided with the nationwide scale-up of Option B+ for PMTCT. HIV-infected mothers and their HIV-exposed newborns (≤30 days old) were recruited and followed at 6 weeks, 6 months, and 12 months of life. Information was collected about infant health status and maternal ART use; infant specimens were tested via HIV DNA PCR. In Kaplan-Meier analyses, we estimated the overall infant HIV-free survival at 12 months and stratified by district, community, and maternal ART use. We also investigated the relationship between community-level 12-month maternal ART use and infant HIV-free survival via linear regression. Results: From Jun-2014 to Nov-2015, we enrolled 827 mother-infant pairs in 33 communities. At 12 months, 23 (2.8%) participating infants had died and 22 (3.0%) were HIV-infected. 36 (4.3%) were lost to follow-up. Overall, infant HIV-free survival was 99.0% (95%CI: 98.0–99.5%) at 6 weeks, 97.5% (95%CI: 96.1–98.4%) at 6 months, and 96.3% (95%CI: 94.8–97.4%) at 12 months. Women reporting ART use at enrollment had higher infant HIV-free survival than those who did not (97.4% vs. 89.0%, p=0.01). Differences were noted at the district (p=0.01) and site levels (p=0.01; figure, left panel). At 12 months, 80.5% (95%CI: 77.7–83.2%) of mothers reported ART use, but this proportion varied widely by community (55.6-100%, p=0.001; figure, right panel). In community-level analysis, no relationship was observed between 12-month infant HIV-free survival and maternal ART use (p=0.65). Conclusion: Estimates for infant HIV-free survival were relatively similar across all communities, despite a range of reported maternal ART use at the community level. These findings are encouraging, but highlight the need for rigorous monitoring and evaluation of PMTCT services at the population level.

Poster Abstracts

823 HIV-POSITIVITY AMONG HIV-EXPOSED INFANTS IN LESOTHO IN THE ERA OF OPTION B+ Tsigereda G. Belachew , Kieran Hartsough, Andrea Schaaf, Mahlompho Ntholeng, Tiffany G. Harris Columbia University Medical Center, New York, NY, USA Background: Lesotho’s HIV prevalence among pregnant women is 28%. In 2013, Lesotho’s Prevention of Mother to Child Transmission (PMTCT) program adopted Option B+ and revitalized the village health worker (VHW) program to strengthen community level PMTCT. The national goal was to test 95% of HIV-exposed infants (HEI) at 2 and 18 months and reduce transmission rates to <5% by 2016. Methods: We reviewed routinely collected PMTCT data of infants aged <18 months registered for Under 5 services from July 2013-July 2014 in 111 facilities in 4 high HIV burden districts prioritized for the Accelerating Children on Treatment (ACT) initiative. Two districts (Berea, Leribe) used an Enhanced VHW Model in which women and HEI were accompanied to care visits and 2 districts (Maseru, Mafeteng) used a Standard VHWModel (no accompaniment). This analysis examined HEI positivity, 18-month retention, VHW Care Models effects, and progress to PMTCT targets. Statistical analyses utilized generalized linear mixed models with a random effect to account for facility clustering. Results: A total of 4,354 HEI registered for care were included. Of 3,612 HEI registered by 2 months of age, 77% (2,748) received 2-month DNA PCR testing on time; of these, 2.5% (70) tested HIV(+), 88% (2,408) tested HIV(-) and 10% (270) had no recorded result. By 18 months of age, overall 2.9% (128/4,354) were HIV(+) [including those who tested HIV(+) prior to 18 months], 27% (1,158) were discharged as HIV(-), while 70% (3,068) did not have a final HIV status, of whom 76% had at least 1 prior HIV(-) test. At both 2 and 18 months, males were less likely to test HIV(+) compared to females (1.9% vs 3.2%, 2.4% vs 3.7%; both p=0.04). HEI in the Enhanced VHWModel were less likely to have an HIV(+) (2.2% vs 3.5%) and missing status (66% vs 74%) at 18 months compared to those in the Standard VHWModel (both p=0.001). HIV(+) infants in the Enhanced VHWModel were less likely to be retained on treatment at 18 months than those in the Standard VHWModel (26% vs 48%, p=0.05). Conclusion: Overall, HIV positivity among HEI was <5%; however, most HEI were missing a final HIV status at 18 months. Opportunities were missed to provide HIV testing, retain HEI until final status was confirmed at 18 months, and retain HIV(+) infants on treatment. Strengthening interventions, including the Enhanced VHWModel, to identify, link and retain HEI in care are critical to achieve elimination of mother to child transmission.

CROI 2018 310