CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

961 RESTART OF THE HIV EPIDEMIC AMONG PWID IN OCCUPIED CRIMEA AND IN THE EAST OF UKRAINE

Marina Kornilova , Yana Sazonova Alliance for Public Health, Kyiv, Ukraine

Background: Russian military intervention in Eastern Ukraine and occupation of Crimea in March 2014 have caused significant public health consequences. The conflict jeopardized the HIV/AIDS programs and undermined several years of Ukrainian public health efforts aimed at reversing the HIV epidemic in key population. Since 2011 HIV prevalence among people who inject drugs (PWID) in Ukraine has stabilized at approximately 20% (21.9% in the 2015 bio-behavioral survey). The ban on opioid substitution treatment, which was deemed to be illegal in occupied Crimea and self-proclaimed Luhansk and Donetsk People’s Republics in the Donbass region, along with limited access to clean needles had affected this population. We analyzed data of two cross-sectional surveys conducted in the occupied Crimea and two biggest cities on the armed intervention zone 1 year before and after the onset of the conflict to measure to what extend the key population was affected. Methods: We performed the secondary analysis of data obtained through the integrated bio-behavioral surveys among PWID recruited through RDS in 3 main conflict territories in 2013 ad 2015: Simpheropol (Crimea), Donetsk and Luhansk (armed conflict zones). Data analysis was performed in RDS-Analyst taking into account the size of the participants network, with prior adjustments for outliers (imputed visibility procedure) and calculation of 95% CI. Results: The HIV prevalence among PWID has grown in all three cities from 22.5% (CI 17.6-28.1) in 2013 to 32.2% (CI 26.8-37.9) in 2015 in Simpheropol; from 26.5% (CI 19-35) to 33.5% (28.1 – 38.8) in Donetsk; and from 3.2% (CI 1.7 – 5.4) to 7.5% (2.5 – 13.0) in Luhansk. The coverage with OST decreased from 33.5% in Simpheropol and 23.6% in Luhansk to 0% and from 13.6% to 8.0% in Donetsk. The proportion of PWID who received cleaned needles as part of HIV prevention package in the last 12 month decreased from 79.1% in 2013 to 54.1% in 2015 in Simpheropol, from 49.4% to 31.4% in Donetsk and from 43.7 to 12.0% in Luhansk. The same trend was observed in access to free condoms: from 66.8% in 2013 to 53.8% in 2015 in Simpherolpol, from 49.2% to 30% in Donetsk and from 43.3% to 10.6% in Luhansk. Conclusion: Russian military intervention in Eastern Ukraine and annexation of Crimea have caused significant public health consequences, the ban on OST and major reduction of HIV prevention programs in the affected territories have re-started the HIV epidemic among PWID. Current behavior trends suggest further desease spread. 962 HIV TESTING AND PREVENTION SERVICES AMONG PERSONS WHO INJECT DRUGS–INDIANA, 2016 Mary Tanner 1 , Sharoda Dasgupta 1 , Monita Patel 1 , Julie O’Donnell 1 , Brandon Halleck 2 , Joseph Amlung 2 , Caitlin Conrad 2 , Cameron McAlister 3 , Erika Chapman 2 , Ayriane Bailey 2 , Michael Spiller 1 , Dita Broz 1 , Philip J. Peters 1 , Paul J. Weidle 1 , Joan Duwve 3 1 CDC, Atlanta, GA, USA, 2 Indiana State Health Department, Indianapolis, IN, USA, 3 Indiana University, Indianapolis, IN, USA Background: The emergency response to the 2015 HIV outbreak among persons who inject drugs (PWID) in rural Indiana included increased HIV testing, establishment of a syringe services program (SSP), and HIV care services in this underserved area. We assessed uptake of HIV testing and prevention services among PWID one year after outbreak identification. Methods: PWID in the outbreak area were recruited using respondent- driven sampling between January and February 2016 and interviewed using a structured questionnaire about demographics, HIV testing and diagnosis, and awareness of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV. We report percentages and medians with interquartile ranges (IQR) for categorical and continuous variables respectively. We used Fisher’s exact test to assess differences in PrEP knowledge based on last HIV test location. Results: Of 200 participants, 58%were male, 92%were non-Hispanic white, and 92%were heterosexual. Median age was 35 years (IQR: 28, 43). Fifty-nine (30%) persons reported being HIV-positive and 81% of them received the diagnosis in the last year. Only 15 (8%) reported never testing for HIV; most common reasons for not testing were perceived low risk of infection, fear of diagnosis, and other reasons; stigma was not cited as a reason for not testing. Of the 185 persons who ever tested for HIV, 52% had not tested before the outbreak but were tested during/after the outbreak response. Of 182 persons

960 AGE DISPARITIES IN EUROPEAN HIV TRANSMISSION PAIRS UNCOVERED WITH VIRAL SEQUENCE DATA Matthew D. Hall 1 , Chris Wymant 1 , Oliver Ratmann 2 , Jan Albert 3 , Norbert Bannert 4 , Anne-Marte Bakken Kren 5 , Marion Cornelissen 6 , Kate Grabowski 7 , Huldrych F. Günthard 8 , Laurence Meyer 9 , Kholoud Porter 10 , Matti Ristola 11 , Guido Vanham 12 , Christophe Fraser 1 1 University of Oxford, Oxford, UK, 2 Imperial College London, London, UK, 3 Karolinska Institute, Stockholm, Sweden, 4 Robert Koch Institute, Berlin, Germany, 5 Oslo University Hospital, Oslo, Norway, 6 University of Amsterdam, Amsterdam, Netherlands, 7 Johns Hopkins University, Baltimore, MD, USA, 8 University Hospital Zurich, Zurich, Switzerland, 9 INSERM, Le Kremlin-Bicetre, France, 10 University College London, London, UK, 11 Helsinki University Central Hospital, Helsinki, Finland, 12 Institute of Tropical Medicine, Antwerp, Belgium Background: Viral sequence data provide a powerful tool for investigating closely-related HIV infections, but previous approaches have usually used only one sequence per patient, and have been unable to reconstruct the likely direction of transmission between individuals. With larger within-host genetic datasets now available, methods can be refined to incorporate inference of directionality. We have implemented such an approach in our tool phyloscanner. Here, we use phyloscanner to explore the age disparity between sources and recipients of infection amongst European men who have sex with men (MSM). Methods: Phyloscanner was used to analyse Illumina short-read sequence data from the BEEHIVE study, sampled from 2892 Europeans living with HIV diagnosed between 1985 and 2015. The results allowed us to assign a measure of confidence to which individuals were involved in transmission pairs and in which direction transmission occurred. We selected a confidence threshold to define probable pairs and examined the distribution of transmitter and recipient ages at the time of recipient seroconversion. We also performed a regression analysis on a richer dataset where no threshold was applied but pairs were weighted by confidence level, and modelled transmitter age as a function of recipient age. Results: 57 MSM transmission pairs were identified. In 38 (67%), the recipient was older than the transmitter, with a mean age difference of 2.16 years. However, there was marked variation in age disparity with respect to recipient age. In pairs where the recipient was under 30, the transmitter was a mean 6.11 years older. From ages 30 to 39, the mean disparity was not significantly different from zero (0.35 years). In older recipients, the transmitter was a mean 8.41 years younger. The regression model predicts that transmitter age grows by 0.28 years for every increased year of recipient age, with the cross-over to transmitters tending to be younger than recipients occurring at an age of 35.3. Conclusion: Our results suggest that MSM in their thirties were more likely to be the source of infections in others of all ages. This suggests a trade-off, with MSM under 30 and above 40 both less likely to act as transmitters. In the young, this is likely due to a shorter period of potential exposure, while in the old, it could be due to reduced sexual activity or reduced unsafe sexual activity. This study demonstrates the power brought by large genetic datasets to the investigation of demographic correlates of transmission.

Poster Abstracts

CROI 2018 367