CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

to baseline. Significant HIV neutralization was observed for Visit 3 CVLs (24 hrs after film insertion) for all 3 HIV strains and for HSV-2. Neutralizing activity in Visit 4 CVLs (6-10 days post film use) was not significantly different from Visit 1 (baseline) CVLs. Conclusion: Single dose vaginal application of MB66 filmwas safe and well- tolerated. Significant HIV-1 and HSV-2 neutralization (ex vivo) was observed at 24 hours post-film insertion.

Tanzania, United Republic of, 9 South African National Department of Health, Pretoria, South Africa Background: The WHO and UNAIDS have set a Fast-Track goal to achieve 90% coverage of voluntary medical male circumcision (VMMC) among males aged 10-29 years in priority settings by 2021. Little is known about age-specific facilitators of VMMC uptake among adolescents. Methods: Younger (10-14 years; n=967) and older (15-19 years; n=559) adolescent males completed structured interviews prior to receiving VMMC counseling at 14 service provision sites across South Africa (4 sites; n=446), Tanzania (4 sites; n=540), and Zimbabwe (6 sites; n=540) about perceptions of and motivations for VMMC. Adjusted prevalence ratios (aPR) were estimated by multivariable modified Poisson regression with generalized estimating equations and robust standard errors to account for site-level clustering. Results: The majority of adolescents in both age groups reported a strong desire for VMMC. Compared to older adolescents, younger adolescents were less likely to cite HIV/STI protection (aPR=0.77 [95%CI=0.66-0.91]) and hygienic reasons (aPR=0.77 [95%CI=0.66-0.91]) as their motivation to undergo VMMC, but were more likely to report being motivated by advice from others (aPR=1.88 [95%CI=1.54-2.29]). While most adolescents believed that undergoing VMMC was a normative behavior, younger adolescents were less likely than older adolescents to perceive that the majority of their peers were already circumcised (i.e., higher descriptive norms; aPR=0.79 [95%CI=0.71-0.89]), higher injunctive norms (aPR=0.86 [95%CI=0.73-1.00]), and higher anticipated stigma from peers/girls for being uncircumcised (aPR=0.79 [95%CI=0.68-0.90]). Younger adolescents were also less likely than older adolescents to correctly cite that VMMC offers males partial HIV protection (aPR=0.73 [95%CI=0.65-0.82]). Irrespective of age, adolescents’ main concern about undergoing VMMC was pain (aPR=0.95 [95%CI=0.87-1.04]). Among younger adolescents, fear of pain was negatively associated with desire for VMMC (aPR=0.89 [95%CI=0.83- 0.96]). Conclusion: Age-specific strategies are important to consider for sustainable VMMC demand generation. Programmatic efforts to create and sustain VMMC demand should consider building on the social norms surrounding VMMC and aim to alleviate fears about pain. There is also a need to correct the misperceptions surrounding the level of HIV protection VMMC offers. 1066 NOTIFIABLE ADVERSE EVENTS ASSOCIATED WITH MEDICAL MALE CIRCUMCISION IN KENYA Elijah Odoyo-June 1 , Kawango Agot 2 , Nandi Owuor 3 , Cristine Kisia 4 , Boaz Otieno-Nyunya 5 , Paul K. Musingila 5 , Vincent Ojiambo 6 , Norah Talam 7 , Hellen Muttai 5 , Kennedy Serrem 8 , Martin Sirengo 8 1 US CDC Nairobi, Kisumu, Kenya, 2 Impact Research and Development Organization, Kisumu, Kenya, 3 Jhpiego–Kenya, Kisumu, Kenya, 4 WHO Kenya Office, Nairobi, Kenya, 5 US CDC Kisumu, Kisumu, Kenya, 6 USAID/Kenya and East Africa, Nairobi, Kenya, 7 KEMRI/Walter Reed Proj, Kericho, Kenya, 8 Ministry of Health, Nairobi, Kenya Background: Since 2008, Kenya has implemented medical male circumcision for HIV prevention, with passive reporting of moderate and severe adverse events (AE) to monitor program safety. With PEPFAR support, an additional reporting systemwas introduced in 2014 in which an AE is classified as notifiable if it occurs within 30 days of medical circumcision (MC) and is tetanus or leads to death, complete or partial amputation of the penis, hospitalization for >3 days or probable permanent disability or deformity. We report Kenya’s experiences with reporting notifiable AEs. Methods: Building on PEPFAR’s notifiable AE (NAE) reporting protocol, Kenya has implemented a robust NAE investigation and follow-up system that is reported through standardized forms. The system incorporates taking photographs of AE lesions to monitor healing and evaluate effectiveness of management; these also serve as records of the final outcomes and as case studies for learning. Incidence of penile glans injuries in boys 10-14 years and

1064 ACCEPTABILITY OF TETANUS TOXOID VACCINE PRIOR TO SAFE MALE CIRCUMCISION Anna Lawino , Richard A. Mangwi, Christopher G. Orach Makerere University College of Health Sciences, Kampala, Uganda Background: Uganda has experienced cases of tetanus in the safe male circumcision (SMC) program for HIV prevention. Gulu district begun implementation of tetanus toxoid (TT) vaccination of men prior to SMC in 2015. However, there is concern that the introduction of the vaccine in SMC may lead to reduced uptake of circumcision. This study aimed to assess the level and factors associated with acceptability of TT vaccine by adult men prior to SMC in Gulu district, Uganda. Methods: This was a cross sectional study conducted fromMay to June 2017. A total of 685 uncircumcised men aged 18 years and above were interviewed using semi-structured questionnaires. Key informant interviews were conducted with 10 health workers and 2 district focal persons for immunization and HIV. Quantitative data analysis was done using STATA version 13. Qualitative data were analyzed using thematic content analysis. Results: Two thirds (66.1%) and 52.1% of respondents accepted TT vaccine for SMC and expressed willingness to get circumcised respectively. Good overall knowledge of tetanus and TT vaccination stood at 80.2%while only 11.3% knew the recommended vaccine doses. Factors significantly associated with acceptability of TT vaccine were: good overall knowledge of tetanus and TT vaccination (AOR: 2.05, 95% CI: 1.29-2.94), positive vaccine perception (AOR: 0.45, 95% CI: 0.24-0.82), TT vaccination community outreaches (AOR: 1.78, 95% CI: 1.05-2.99), ever received TT vaccination (AOR: 2.64, 95% CI: 1.76-3.97) and rural residence (AOR: 1.93, 95% CI: 1.14-3.29). Implementation challenges were: losses to follow up, limited funds, vaccine stock outs, lack of awareness on benefits of TT vaccination among community members and health workers. Conclusion: Acceptability of TT vaccine prior to SMC was moderately high and willingness to get circumcised was 52.1%. The factors significantly associated with acceptability of TT vaccine before circumcision included good knowledge about tetanus and TT vaccine, positive vaccine perception, TT vaccination community outreaches, rural residence and ever received TT vaccine. The district health office and key implementing partners of SMC need to (1) Develop strategies for community sensitization on TT vaccination of men, (2) Conduct in service training and supervision of health workers on new policy changes, (3) Scale up SMC and strengthen community education on it’s benefits, and (4) Target use of community based approaches of vaccine delivery to improve accessibility and uptake. 1065 PERCEPTIONS OF AND MOTIVATIONS FOR VMMC AMONG ADOLESCENTS: A MULTICOUNTRY STUDY Eshan U. Patel 1 , Michelle R. Kaufman 1 , Kim H. Dam 1 , Lynn M. Van Lith 1 , Karin Hatzold 2 , Arik V. Marcell 1 , Webster Mavhu 3 , Catherine Kahabuka 4 , Lusanda Mahlasela 5 , Emmanuel Njeuhmeli 6 , Kim S. Ahanda 6 , Getrude Ncube 7 , Gissenge J. Lija 8 , Collen Bonnecwe 9 , Aaron Tobian 1 1 The Johns Hopkins University, Baltimore, MD, USA, 2 Population Services International, Harare, Zimbabwe, 3 Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe, 4 CSK Research Solutions, Ltd, Dar es Salaam, Tanzania, United Republic of, 5 Centre for Communication Impact, Pretoria, South Africa, 6 United States Agency for International Development, Washington, DC, USA, 7 Ministry of Health and Child Welfare, Harare, Zimbabwe, 8 Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam,

Poster Abstracts

CROI 2018 408