CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

983 COMMUNITY-BASED SERVICES REACH LARGE VOLUMES OF HIGH RISK MEN IN TANZANIA Caterina Casalini 1 , Dorica Boyee 1 , Amasha Mwanamsangu 1 , Magnus Ndolichimpa 1 , Yeronimo Mlawa 2 , Peris Urasa 3 , Neema Makyao 3 , Erick Mlanga 4 , Nelson Rutabanzibwa 1 , Benjamin Myovela 1 , Anike Akridge 4 , Albert Komba 1 , Jason Reed 1 , Kelly Curran 1 1 Jhpiego, Dar es Salaam, Tanzania, United Republic of, 2 EngenderHealth, Dar es Salaam, Tanzania, United Republic of, 3 National AIDS Control Program, Dar es Salaam, Tanzania, United Republic of, 4 USAID Tanzania, Dar es Salaam, Tanzania, United Republic of Background: Population-based HIV Impact Assessments in African countries show that men are under-represented in the 90-90-90 cascade. In Tanzania, UNAIDS estimates that as of 2016, 70% of PLHIV had been diagnosed, with a smaller proportion of men knowing their HIV status as compared to women (PEPFAR, 2017), increasing the likelihood of transmitting HIV to uninfected women. USAID-funded Tanzania’s Sauti Project provides community-based combination HIV prevention, testing and linkage services to key and vulnerable populations including partners of female sex workers (PFSW) and other men at Hotspots (OMHS). Methods: We analyzed routine program data from Sauti services between August 2015 and July 2017 to determine the volume of tests provided to men and characterize males testing for HIV. Male PFSWwere defined as having paid for sex within past 12 months. OMHS were defined as men reached in areas of high HIV transmission risk. Men reporting sex with men were excluded. Binomial logistic regression was used for the analysis. Results: Nearly half of the 1,026,358 individuals tested for HIV (482,925 or 47.1%) were men: 30.4%were PFSW; 53.4%were ages 20-35 years; 54.6% were married; 37.3% never used condom in the past three vaginal sex acts, 21% reported anal sex, among whom 40.7% never used condom in the last three anal sex acts; 50.7% did not know the HIV status of the current partner(s). Among 477,890 males receiving an HIV test, 219,046 (45.8%) tested for the first time ever. Among first-time testers, 6,095 (2.8%) tested HIV positive, compared to 6,255 (2.5%) testing positive who had been previously tested for HIV or had an unknown HIV testing history. First time HIV testing was associated with age <20 years (RR: 1.66; 95% CI: 1.25-2.21; p<0.001), being single (RR: 1.27; 95% CI: 1.13-1.43; p<0.001), testing HIV positive (RR: 1.31; 95% CI: 1.07-1.60; p=0.009), and reporting inconsistent condom use with regular/permanent partners (RR: 1.24; 95% CI: 1.01-1.52; p=0.041). Conclusion: Through community based testing platforms that target PFSW and other males congregating in areas of high HIV incidence, it is possible to reach large volumes of high risk behaviors adult men with HIV testing, including first time testing and diagnosis of new cases of HIV, which is imperative to achieving the first 90 of the 90-90-90 goals. Additional innovations such as HIV self-testing and partner notification services may further expand the number of men reached with testing.

with new HIV infection. However, reporting being married showed to be protective [HR=0.6: 95% CI 0.4-0.9] Conclusion: HIV incidence rate is high in this population in southern Malawi and special intervention efforts are needed to stem the epidemic in Malawi 982 GAPS ALONG THE PrEP CONTINUUM AMONG STD CLINIC ATTENDING MSMWITH HIGH RISK BEHAVIORS Farah Mouhanna 1 , Amanda D. Castel 1 , Kerri Dorsey 1 , Meredith Haddix 1 , Anya Agopian 1 , Hannah Yellin 1 , Hibo Abdi 1 , Michael Kharfen 2 , Irene Kuo 1 1 George Washington University, Washington, DC, USA, 2 District of Columbia Department of Health, Washington, DC, USA Background: The Pre-exposure Prophylaxis (PrEP) care continuum is a measurement tool developed to monitor PrEP implementation and identify areas in need of additional scale up. We sought to compare differences in knowledge, attitudes, and use of PrEP among MSM and transgender male-to- females (TG) compared to females and heterosexual males (HET) and trends over time. Methods: A convenience sample of 460 STD clinic attendees in Washington DC were surveyed in 2012 (n=174) and 2016 (n=286). Demographics, self-reported risk behaviors, and self-perceived risk were measured. Stages of the PrEP continuumwere assessed ranging from ‘self-perceived HIV risk’ to ‘have taken PrEP’. Uni-, and bivariate analyses were conducted to assess for differences in populations, risk behaviors, and PrEP continuum outcomes. Multivariate analyses were done adjusting for survey year, race, insurance, income, number of casual partners, HIV tests in the last year, and having heard of and used post- exposure prophylaxis (PEP). Results: Among 460 participants, 53 (12%) were MSM/TG, 81%were Black, 21% had private insurance, 49% had some college education, and 60% had a regular healthcare provider. Comparing MSM/TG participants to HET, significant differences were observed by race, insurance, and income (all p<0.05). MSM/ TG participants had more casual sex partners (OR 1.12; 95%CI:1.06-1.18), and were more likely to be at the STD clinic due to symptoms (OR 2.15; 95%CI:1.01- 4.58), or having a partner with an STD (OR 5.07; 95%CI:1.86-13.83), had heard of PEP (OR 5.05; 95%CI:2.79-9.14) and used PEP (OR 11.08; 95%CI:3.33-36.84) compared to HET. In terms of the PrEP continuum, while MSM/TG participants had higher self-perceived risk for HIV (43% vs. 18%, aOR 3.79; 95%CI:1.47-9.82), there were no significant differences in having heard of PrEP (38% vs. 12%, aOR 2.41; 95%CI:1.00-5.83), likelihood of taking PrEP if it were free (68% vs. 54%, aOR 1.84; 95%CI:0.76-4.46), having health insurance (78% vs. 77%, aOR 0.68; 95%CI: 0.24-1.89), having discussed PrEP with a provider (11% vs. 3%, aOR 1.37; 95%CI:0.31-6.16), and having used PrEP (8% vs. 0.7%, aOR 3.06; 95%CI: 0.40- 23.32) compared to HET (Figure). PrEP awareness (18% vs. 29%; p=0.0138) and use (0.6% vs. 2.5%; p<0.0001) increased from 2012 to 2016. Conclusion: PrEP awareness and use was low among both groups, with minor increases over time. PrEP education and risk-reduction programs should be implemented in STD clinics to facilitate high-risk groups’ advancement along the PrEP continuum.

Poster Abstracts

CROI 2018 376