CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1 Kenya Medical Research Institute, Kisumu, Kenya, 2 University of California San Francisco, San Francisco, CA, USA, 3 US CDC Nairobi, Nairobi, Kenya Background: Less than one third of children have ever been tested for HIV in the Nyanza region of western Kenya. Delayed HIV identification is associated with poor health outcomes and risk of virus transmission when older children begin sexual activity. This study examined whether targeted community outreach events (TCOE) increased HIV testing and identification of HIV-infected children in western Kenya. Methods: In Jul–Dec 2015, 493 TCOEs were implemented for children, ages 18 months – 14 years, and their caregivers within 148 health facility catchment areas supported by Family AIDS Care & Education Services (FACES). TCOEs were conducted in community venues and included HIV education, HIV testing, and linkage to care. This pre- and post-study compared HIV testing uptake (number tested) and yield (number HIV positive) in the 5 months before (Jan– Jun 2015) and during (Jul – Dec 2015) TCOE implementation among children (<15 years) eligible for testing at facilities or TCOE’s. Aggregated testing and yield data for both facility-based and TCOE testing, were captured in routine facility level tools. Negative binomial models clustered by facility were used to assess changes in uptake and yield after TCOE implementation overall and by sex, and to estimate monthly means. Results: Overall, TCOE implementation did not increase uptake (p=0.43) and average yield decreased (p<0.01). Pre-TCOE, the estimated mean number of children tested per facility was 34.4 (95% CI 29.1, 40.7) compared to post-TCOE, 36.4 (95% CI 30.8, 42.9). The estimated mean yield per facility pre- and post- TCOE was 0.48 (95% CI 0.40, 0.57) versus 0.26 (95% CI 0.21, 0.34), respectively. Findings by sex indicated that pre-TCOE more females than males per facility were tested, with estimated means of 37.4 (95% CI 31.8, 44.0) and 31.4 (95% CI 26.3, 37.5), respectively, (p<0.01). Adjusting for pre-TCOE levels, the change in number of males tested per facility from pre- to post-TCOE increased compared to females, 37.6 (95% CI 30.5, 46.3) and 35.0 (95% CI 30.1, 40.6) respectively, (p<0.01). There was no significant difference in yield by sex pre-TCOE (p=0.35) or when comparing yield overtime (p=0.68). Conclusion: TCOE’s did not increase HIV testing overall, and yield decreased when testing extended outside of facilities. TCOEs increased testing in males more so than females demonstrating the value of targeted testing for males. Additional approaches or redesign is required to improve strategies to reach children. 884 ENGAGEMENT IN CARE AND INFANT HIV TESTING AMONG LOST TO FOLLOW-UP OPTION B+ PATIENTS William J. Reidy 1 , Harriet Nuwagaba-Biribonwoha 2 , Siphesihle Shongwe 2 , Ruben Sahabo 2 , Kieran Hartsough 1 , Simangele Mthetwa 3 , Elaine J. Abrams 1 1 ICAP at Columbia University, New York, NY, USA, 2 ICAP at Columbia University– Swaziland, Mbabane, Swaziland, 3 Ministry of Health, Mbabane, Swaziland Background: Option B+ has been adopted across sub-Saharan Africa, resulting in increased ART uptake among HIV+ pregnant women. However, concerns of sub-optimal maternal and infant retention have emerged. High loss to follow-up (LTF) among mothers and HIV-exposed infants (HEI) has been reported, but limitations in accurately assessing retention in HIV care using health facility (HF) data have been documented. We collected additional information on engagement in care for women and HEI classified as LTF from Option B+ in Swaziland to provide updated outcomes. Methods: Women and HEI were classified as LTF (no visit within 3 months of expected visit) by 6 months postpartum using routine HF data. Additional information on engagement in HIV services was gathered by: 1) review of national ART patient database and paper records; 2) patient tracing via phone and community; and 3) patient interviews and abstraction from patient-held records. Data from these sources were combined with routine HF data to classify outcomes for LTF women and babies for whom sufficient information on clinic visits, vital status, and infant HIV testing, as applicable, was obtained. Self-reported information on care received as well as information documented by HF, as well as any reported evidence of maternal or infant death or pregnancy loss were included in the classification of outcomes. We conducted descriptive analyses to summarize frequencies of outcomes among LTF women and HEI. Results: Of 1,221 pregnant women initiating Option B+ at 10 HF from October 2014-September 2015, 434 (36%) women and 510 (42%) HEI were classified as LTF. Of 193 (44%) LTF mothers with outcome data, 119 (62%) were engaged in care, 60 (31%) disengaged from care, 11 (6%) had moved out of the country, and 3 (2%) had died. Among the 510 HEI classified as LTF, 48 (9%) were pregnancy

882 MICROBIAL TRANSLOCATION, IMMUNE ACTIVATION, AND GUT DYSBIOSIS IN HIV-EXPOSED INFANTS Charles D. Mitchell 1 , Sady Dominguez 1 , Varghese George 1 , Eddy Perez-Then 2 , Carlos V. Castillo 2 , Juan L. Santana-Guerrero 2 , Jeannette Baez 3 , Margaret Roach 1 , WilliamWalters 4 , Qiaojuan Shi 5 , Shao-Pei Chou 4 , Ruth Ley 4 , Savita Pahwa 1 1 University of Miami, Miami, FL, USA, 2 O&M School of Medicine, Santo Domingo, Dominican Republic, 3 Robert Reid Children’s Hospital, Santo Domingo, Dominican Republic, 4 Max Planck Institute for Developmental Biology, Tübingen, Germany, 5 Cornell University, Ithaca, NY, USA Background: The MITABS study (Microbial Translocation[MT], Immune Activation[IA], and Altered Bowel Flora Study[ABS]) is the first prospective, longitudinal study designed to simultaneously assess MT, IA, and alterations in the gut microbiome with clinical events in young (enrolled at < 6 months) HIV perinatally infected (HEI); and perinatally exposed, uninfected(HEU) infants in the Dominican Republic (DR) before and after starting antiretroviral therapy(ART). Methods: Cellular immune markers of IA (HLADR+CD38+ coexpression) in CD4 and CD8 T cells were determined by flow cytometry using the method of Hanekom et al, J Immune Meth, 2004. Plasma MT and IA (LPS, sCD14 and sCD163) were determined by standard assays. Metagenomic analysis was performed on both stool and plasma. Simultaneous assessments of MT, IA, ABS, and clinical events occurred at Entry, 6 weeks, 3,6, 12, and 18 months post entry. No HEI was on ART at entry. HIV-exposed infants in the DR are formula fed Results: Between 6/6/13 and 3/1/17, 78 infants (31 HEI; 47 HEU) were enrolled in the DR. Median ages at entry for all 78, the 31 HEI and the 47 HEU were 106, 145, and 89 days respectively. 19/31 HEI started ART. 10/31 developed AIDS (CDC criteria); 4 of whom died. No HEU has died. At entry, compared to HEU of the same age (<6 mo, n= 44), HEI not on ART (n= 15) had higher CD8 T cell Immune activation (HLADR+CD38+, 23.6% vs 4.3%, p=0.0005),CD8 (47% vs 24%, p=0.001), lower CD4 (49% vs 71%, p= 0.002) and lower CD4/CD8 ratio (1.04 vs 2.9). HEI also had higher plasma sCD14 (2523 vs 1473ng/ml, p=0.0001), and a trend for higher sCD163 (1212 vs 932 ng/ml, p=0.06) but surprisingly, the 2 groups had similarly elevated markers of MT (LPS, HEI 250 vs HEU 249pg/ml; iFABP, HIE 3293 vs HEU 2755 pg/ml). On prospective follow-up, MT markers (LPS, sCD163) in HEU normalized by 6-9 months. T cell IA were all within the normal range in HEU over time. In HEI, although IA and MT values decreased following ART, they were higher than in HEU. HEI gut microbiome was associated with lower diversity (richness, n=13) compared to HEU (n=38), and an unknown member of the Megaspheara genus was enriched in HEI on ART compared to HEI not on ART. Conclusion: HEU infants like HEI have high gut permeability during early infancy which gradually normalizes over time. Increased biomarkers of MT and IA in HEI are prevalent from early infancy and persist after starting ART. HEI have a less diverse microbiome than HEU, with enrichment of the genus Megaspheara in HEI on ART 883 WILL TARGETED COMMUNITY OUTREACH IMPROVE HIV TESTING UPTAKE AMONG CHILDREN IN KENYA? Samuel Ndolo 1 , Nicollate A. Okoko 1 , Mary A. Guzé 2 , George Nyanaro 1 , Lenah Nyabiage 3 , Elizabeth A. Bukusi 1 , Craig R. Cohen 2 , Jeremy Penner 1 , Jayne L. Kulzer 2

Poster Abstracts

CROI 2018 335