CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

984 MALE AND ADOLESCENT FIRST-TIME HIV TESTERS REACHED BY COMMUNITY HEALTH INITIATIVE Hong-Ha M. Truong 1 , Dancun O. Obunge 2 , Mary A. Guzé 1 , Esther Wandera 2 , Placide Ntawali 1 , Eliud Akama 2 , Frankline Otieno 2 , Elizabeth A. Bukusi 2 , Patrick Oyaro 2 , Craig R. Cohen 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Kenya Medical Research Institute, Kisumu, Kenya Background: Knowledge of HIV status is the entry point for linkage to prevention, and care and treatment, and the first step towards achieving the UNAIDS 90-90-90 target. In Kenya, HIV testing coverage is lower among men than women and lower among adolescents than older adults, a pattern observed in other sub-Saharan African countries. We characterized persons presenting for first-time HIV testing through a community health initiative facilitating testing and linkage. Methods: HIV testing and linkage to same-day antiretroviral therapy (ART) initiation were offered at multi-disease community health campaigns (CHCs) conducted in western Kenya. Home-based HIV testing was offered to residents not attending the CHCs. Persons age ≥15 years and sexually-active youth <15 years who had not been previously-diagnosed with HIV were eligible. Differences by first-time and repeat testers were assessed by Fisher’s exact test and bivariate logistic regression. Results: The initiative reached 1,230 first-time testers, representing 13% of 9,465 persons accepting HIV testing and 4.3% of 28,460 persons reached overall. Of first-time testers, 634 (52%) were male and 480 (39%) were adolescents aged 10-19 years, including 272 adolescent males. First-time testers were more likely to be male (p<0.01) and younger (p<0.01) than repeat testers. Overall, 0.98% of first-time testers (12 cases) were newly-diagnosed with HIV compared to 1.25% of repeat testers (103 cases). HIV+ proportion was 1.1% among male first-time testers and 0.9% among male repeat testers. Among testers aged 25-34, HIV+ proportion was higher among first-time [6 of 48 (12.5%)] than repeat [(34 of 1,312 (2.4%)] testers (OR=5.36, p<0.01) and male first-time [4 of 30 (13%)] than repeat [(9 of 533 (2%)] testers (OR=8.96, p<0.01). No adolescent first-time testers were newly-diagnosed. Of 10 new cases identified at CHCs, 7 initiated ART the same day as part of the campaign. Conclusion: The hybrid approach offering HIV testing at CHCs in combination with follow-up home visits is an effective strategy for reaching first-time testers, particularly adolescent males. The yield of newly-diagnosed HIV cases among males and persons aged 25-34 was higher among first-time testers than repeat testers. Innovative approaches that make HIV testing more accessible and acceptable to the community, such as HIV testing as part of a package of health services, may be critical for reaching populations that might otherwise be reticent to take up standard facility-based testing services. 985 DOOR-TO-DOOR HIV TESTING TO INCREASE ANTIRETROVIRAL THERAPY UPTAKE‚ WESTERN KENYA Fredrick Miruka 1 , Kawango Agot 2 , Spala Ohaga 2 , Rose Oyoo 2 , Rachel Joseph 1 , Jonathan Mwangi 3 , Jesee N. Nakhumwa 2 , Isaac Ngere 4 , Paul K. Musingila 1 , Hellen Muttai 1 1 US CDC Kisumu, Kisumu, Kenya, 2 Impact Research and Development Organization, Kisumu, Kenya, 3 US CDC Nairobi, Nairobi, Kenya, 4 Ministry of Health, Nairobi, Kenya Background: Identifying and initiating persons with HIV infection on antiretroviral therapy (ART) to achieve viral suppression is critical for epidemic control and improved patient outcomes. A national survey in Kenya in 2012 found that 53% of persons with HIV infection were unaware of their HIV status and 16% had never been tested for HIV. Home-based HIV testing services (HTS) aim to increase access to HIV testing and enable linkage to ART. We describe the demographic characteristics and HIV testing uptake among persons reached by door-to-door HTS conducted in Siaya County, Kenya where estimated HIV prevalence was 25%. Methods: We conducted a retrospective analysis of routine program data collected from home-based HTS in Siaya County in May 2016–April 2017. HTS was offered to residents aged >15 years according to Kenya guidelines. Those with known HIV status (HIV positive or tested negative ≤3 months prior) were ineligible for testing. SAS v.9.3 was used for exploratory analysis and to test for associations between variables using bivariate and multivariable logistic regression. Results: In total, 206,435 (90%) of 229,143 residents enumerated were found at home. Of these, 23,220 (11%) had known HIV status. The remaining 183,564 (89%) were eligible for HIV testing; 177,559 (97%) were tested, among whom

7% (12,884) had never been tested, 23% (41,186) were tested >12 months prior, and 69% (123,172) were tested <12 months prior. Of the 22,359 residents away from home, 65% (14,502) were males of whom 65% (9,483) were aged >25 years. Among those tested, the median age was 27 (IQR 19-44) years, and 56%were female. Overall, 1,937 (1.1%) of those tested-1.2% of females and 0.9% of males (p-value 0.063)-were newly HIV-positive. The majority (57%) of HIV infections were detected among persons last tested <12 months ago and among those >35 years of age (43%). However, persons whose last test was >12 months vs. ≤12 months prior (aOR 1.54, 95% CI 1.34-1.77) and those aged 25-34 years vs. >35 years (aOR 1.96, 95% CI 1.67–2.30) were more likely to have a positive test. Overall, 76% (1,480/1,937) of newly HIV-positive residents were linked to ART. Conclusion: Door-to-door testing increased knowledge of HIV status and identification of new HIV positives although positivity was low in spite of high coverage. Strategies for reaching those missed, at highest risk of acquiring HIV, specifically males aged ≥25 years, and linkage of HIV positive individuals to ART are needed. 986 BARRIERS TO HIV TESTING IN SWAZILAND: EFFECT OF FAMILY SUPPORT AND TRAVEL TIME Harriet Nuwagaba-Biribonwoha 1 , Yingfeng Wu 2 , Averie B. Gachuhi 2 , Margaret McNairy 2 , Matthew R. Lamb 2 , Sikhathele Mazibuko 3 , Zandile Mnisi 4 , Veli M. Madau 1 , Sean Burke 1 , Neena M. Philip 2 , Wafaa M. El-Sadr 2 1 ICAP at Columbia University–Swaziland, Mbabane, Swaziland, 2 ICAP at Columbia University, New York, NY, USA, 3 Ministry of Health–Swaziland National AIDS Programme, Mbabane, Swaziland, 4 Ministry of Health, Mbabane, Swaziland Background: HIV testing and awareness of HIV positive (HIV+) status are the gateway to HIV prevention and treatment. We assessed factors associated with HIV testing among participants in Link4Health, a cluster-randomized study evaluating the effect of a combination strategy on linkage to- and retention in- care after an HIV+ test in Swaziland. Methods: Adults ≥18 years (y), newly tested HIV+ were recruited into the study from Aug-2013 to Nov-2014. We analysed baseline study data for 1) history of prior HIV testing and 2) self-report of awareness of HIV+ status prior to the study baseline HIV+ test. We assessed demographic and structural factors associated with testing e.g. age, sex, family support received, and travel time to clinic. Hierarchical logistic regression models with study sites as random effects were used to generate raw and adjusted odds ratios [AOR, 95% Confidence Intervals] for covariates of HIV testing. Results: Of 2,196 HIV+ adults [59% female, median age 31y, IQR 26-39], 1183 [53.8%] reported no prior HIV test. The odds of no prior HIV testing were higher among men [AOR 1.7, 1.4-2.0], and among adults who needed more family support [AOR 1.5, 1.2-1.8], versus those who reported needing the same or less family support. Among the 2,196 HIV+ adults, the most common reasons for HIV testing at the study baseline visit were being sick [58%], worry about HIV [34%], and health provider recommendation [15%]. Reasons did not differ by prior HIV testing. Only 248 of 2,196 HIV+ participants [11.3%] were aware of their HIV+ status prior to the study baseline HIV+ test. Men were less likely to be aware of their HIV+ status [AOR 0.7, 0.5-0.9)]. Compared to adults 40-49y, HIV+ youth 18-25y [AOR 0.6, 0.4- 0.95] and older adults 50+y [AOR 0.5, 0.3-0.9] were less likely to be aware of their HIV+ status. Adults who reported needing more family support were less likely to be aware of their HIV+ status [AOR 0.6, 0.5- 0.8]. HIV+ participants who lived ≥45 minutes from the clinic were less likely to be aware of their HIV+ status [AOR 0.5, 0.4-0.8], compared to those who lived <45 minutes of the clinic. Conclusion: About half the HIV+ adults in this study had no history of prior HIV testing and only 1/10 were aware of their HIV+ status. Men, youth, older adults, those needing more family support and those living further from clinics were less likely to be aware of their HIV+ status. Tailored strategies are needed to effectively engage such groups in testing and enable access to relevant services. 987 HIV TESTING IN PRIMARY CARE CLINICS IN SOUTH AFRICA: A MISSED OPPORTUNITY Bhakti Hansoti 1 , Tonderai Mabuto 2 , Griffiths Kubeka 2 , Salome Charalambous 2 , Deanne Kerrigan 1 , Chris Hoffmann 1 1 Johns Hopkins Hospital, Baltimore, MD, USA, 2 The Aurum Institute, Johannesburg, South Africa Background: South Africa (SA) has the world’s highest burden of HIV infection (approximately 7 million), with the burden of undiagnosed HIV infection

Poster Abstracts

CROI 2018 377