CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

tetanus are used as proxy indicators of non-compliance as most are preventable by following program guidelines. Results: Of 661,653 MCs performed in Kenya from August 2014 to August 2017, a total of 25 NAEs were reported. The spectrum of NAEs recognized and reported is growing and includes 4 infant deaths (3-due to non MC conditions); 1 adolescent death (15yrs due to tetanus); 3 non-fatal tetanus (1 related to PrePex); 5 penile glans injuries during forceps guided MC in boys 10-12 yrs; 1 penile glans injury during Mogen clamp infant MC; 3 urethral fistulae in boys 10-12 years; and 8 conditions (including 2 severe bleeding, 1 necrotizing fasciitis, and 5 previously undiagnosed medical conditions) leading to hospitalization for ≥3 days. Cases associated with non-compliance (24%) were 5 penile glans injuries and 1 case of tetanus following MC through PrePex device where the second requisite dose of tetanus toxoid was not given. Conclusion: NAE reporting system has enhanced understanding of AEs and revealed cases of serious AEs associated with non-compliance or undiagnosed underlying medical conditions. MC programs should implement enhanced NAE reporting systems to monitor lapses in compliance with program safety standards and for learning purposes. Programs introducing newmethods of MC should expand their scope of NAEs to include previously undescribed AEs. 1067 SAFETY AND ACCEPTABILITY OF PREPEX CIRCUMCISION AMONG ADOLESCENTS IN KISUMU, KENYA Kawango Agot, Julie Ambia , Risper Bosire, David Muhuaya, Joshua Juma, Background: Non-surgical methods of male circumcision (MC) that are simpler to use are required to accelerate uptake of voluntary medical male circumcision in sub-Sahara Africa. We aimed to assess safety and acceptability of PrePex device, a non-surgical MC method, among adolescent boys aged between 10 and 12 years in Kisumu, Kenya. Methods: We implemented two PrePex procedures: day 0 foreskin removal procedure (FRP) and standard PrePex where the foreskin is left to self-detach. Questionnaires were administered to study participants and parents/legal guardians by clinicians after device placement. All study participants are being followed for 56 days; however, we report until day 42 for which follow-up is complete. Percentages were used to summarise acceptability and safety of the PrePex device. Chi-square test was used to assess the association between the PrePex procedure and safety. Results: Between April and August 2017, 214 adolescent males were enrolled; 41% (88/214) underwent the standard PrePex procedure. Of those enrolled, 44% had contraindications to PrePex circumcision; 65 had preputial adhesions and 30 had a narrow foreskin, with 21 having both conditions. Overall, 59% (56/95) of those with contraindications underwent day 0 FRP procedure. By day seven, 96% (192/201) kept penile hygiene as instructed, 79% (156/198) reported no pain and 96% (191/200) reported no difficulties in passing urine. However, these attributes were not associated with the type of PrePex procedure. Four of those who underwent day 0 FRP and five of those who underwent standard procedure reported missing school due to pain. Poor hygiene was associated with reporting pain (p<0.001). By day 21, 79% (151/193) had experienced epithelialization and 77% (148/193) granular tissue formation. Adolescents who underwent standard procedure were more likely to experience epithelialization and granular tissue formation (p<0.001) compared to those who underwent day 0 FRP. By day 42, all participants had experienced epithelialization and granular tissue formation. Only one moderate adverse event occurred during device placement. All participants found the procedure to be quite safe or very safe and were willing to recommend it to their peers. Conclusion: Non-surgical circumcision using the PrePex device was safe and acceptable among adolescent males ages 10-12 years. Most participants reported no pain post device placement. Only one moderate intra-operative adverse event occurred. 1068 INTEGRATION OF FAMILY PLANNING INTO HIV CARE AND TREATMENT PROGRAM IN KENYA Wangui Muthigani 1 , Emily R. Begnel 2 , Dunstan Achwoka 3 , Tai Ho Chen 3 , John Kinuthia 4 , Christine J. McGrath 2 , Alison L. Drake 2 1 Ministry of Health, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 US CDC Nairobi, Nairobi, Kenya, 4 Kenyatta National Hospital, Nairobi, Kenya Background: Integration of family planning (FP) services in HIV care can improve uptake of FP and prevent mother-to-child HIV transmission. We Abraham Bitok, Spala Ohaga, Benard Ayieko, Maurice Onyango Impact Research and Development Organization, Kisumu, Kenya

characterized FP use and integration of FP services in HIV care by county-level HIV prevalence. Methods: We conducted a cross-sectional survey of sexually active, HIV- infected women aged 15-49 years from 109 HIV care and treatment facilities with ≥1000 patients on antiretroviral therapy (ART) in Kenya. Facilities were classified as integrated if HIV and FP care were delivered in the same building, and as high or low HIV burden (average county prevalence 12% and 4%, respectively). Modern FP included tubal ligation, vasectomy, intrauterine devices (IUDs), implants, injectables, oral contraceptives (OCs), vaginal rings, condoms, and emergency contraception. Women who did not desire pregnancy within 2 years and were not using modern FP were defined as having unmet FP need. Analyses were adjusted to account for facility-level clustering. Results: Overall, 4805 HIV-infected women were enrolled; 3746 from 85 facilities in high burden counties and 1059 from 24 facilities in low burden counties. Median age was 34 years (IQR 28-39), 60%were married, and 89% were on ART. Integrated services were offered at 74% of facilities; 90% of unintegrated facilities provided FP referrals. FP consultations during HIV care were uncommon (8%), and more likely in low (16%) than high (6%) burden counties (p<0.01). Among 4014 (84%) women who did not receive FP services during their most recent HIV care visit, 56%were already using a non-barrier modern method. Of the 791 (16%) women who received FP services, 69% only received consultation and 1% planned to initiate FP following consultation. The majority (85%) of women used modern FP; 70% used condoms with (37%) or without (32%) another modern FP method. Other modern method use included injectables (32%), implants (25%), OCs (5%), and IUDs (5%). Method mix was similar by HIV burden (p>0.05). Desire for pregnancy prevention during the next 2 years was slightly higher (85%) in low than high (82%) burden counties (p=0.04); however, unmet need was similar (13% for low vs. 10% for high burden, p=0.3). Conclusion: Despite low FP counseling rates at HIV care visits, integrated FP services and contraceptive use were high among HIV-infected women, largely driven by high rates of condom use. Offering FP counseling at each HIV care visit may improve dual method use, reduce unmet need, and prevent unintended pregnancies among HIV-infected women. 1 INSERM, Bordeaux, France, 2 Centre Africain de Recherche en Épidémiologie et en Santé Publique, Lomé, Togo, 3 Conseil National de Lutte contre le SIDA, Lomé, Togo Background: Increased access to prevention of mother-to-child transmission services with expanded antiretroviral eligibility have led to dramatic reduction in HIV vertical transmission, but evidence on women’s childbearing desire in relation to antiretroviral treatment (ART) is sparse, showing increased likelihood in some settings but not in others. Previous assessment often lacked comparative group of uninfected women and concerns remain over high prevalence of unplanned pregnancy among HIV+ women. We investigated whether HIV infection in the era of universal ART influences childbearing desire and behavior of HIV+/- women in order to inform programmatic priorities. Methods: A cross-sectional survey was conducted in three rural and urban health facilities in Togo in 2016. Eligible HIV+ women were non-pregnant, aged 18-49 years and on ART regardless of timing of initiation. HIV- women were recruited from those accompanying patient at a non-HIV service in the same health facilities. Non-infection to HIV was self-declared. The outcomes were childbearing desire and unmet need for family planning. Health-seeking behaviors were analyzed in respect to women’s childbearing desires. Logistic regression models were used to assess the associations between the outcomes and women’s HIV status with adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: Of 1,189 women included in the study (706 HIV+, 483 HIV-), 60.5% declared having childbearing desire. Adjusted for age, study site, presence of a male partner and the number of living children, women’s HIV status was not associated with the likelihood of reporting childbearing desire (aOR: 0.8, 95%CI: 0.5-1.1). Of those having immediate desire (N=276), only one in three reported having fertility-related dialogue with health providers, with no difference by HIV status (p=0.4). Overall, use of modern contraceptives was 21.1%, and 25.3% in HIV+ and HIV- women respectively (p=0.1). Among sexually active women wanting to avoid or delay pregnancy, unmet need for family planning Shino Arikawa 1 , Cécile Cazes 1 , Anne Thomas 2 , Thierry Tiendrebeogo 1 , Benjamin G. Kariyiare 2 , Vincent Pitche 3 , Didier K. Ekouevi 1 , Renaud Becquet 1

Poster Abstracts

1069 MISSED OPPORTUNITY FOR FAMILY PLANNING IN HIV-INFECTED WOMEN ON ART IN TOGO

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