CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

was 62.4% and 68.9% in HIV+ and HIV- women respectively (aOR:1.3, 95%CI: 0.9-1.9). Conclusion: Childbearing desire in HIV+ women on ART was as high as that of HIV- women. Despite regular contacts with health personnel, contraceptive needs and fertility concerns of HIV+ women remained unaddressed. HIV care should better integrate reproductive health services with appropriate counselling and provision of a full-range of contraceptive methods to allow safe conception in HIV+ women. 1070 CONTRACEPTION AND PrEP IN SOUTH AFRICAN HAIR SALONS: OWNER, STYLIST, AND CLIENT VIEWS Ingrid V. Bassett 1 , Ai Xu 1 , Sabina Govere 2 , Hilary Thulare 2 , Simone C. Frank 1 , Christina Psaros 1 , Robert A. Parker 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 AIDS Healthcare Foundation, Durban, South Africa Background: Nearly half of unintended births in sub-Saharan Africa occur among women ages 15-24, who also have high HIV incidence. Women congregate regularly without partners in community hair salons; these may be useful venues for family planning and HIV prevention services. We assessed the acceptability and feasibility of offering contraception and PrEP for HIV in hair salons in South Africa. Methods: We surveyed hair salon owners, stylists, and female clients (≥18y) at hair salons in and around Umlazi Township about comfort with a nurse offering health services, including contraception, HIV testing, and PrEP. To assess feasibility of offering services, we asked clients about frequency and time spent at salons. We assessed the relationship between salon features and clients’ attitudes towards receiving health services at the salon using Fisher’s exact test. Results: We visited 12 township and 5 Durban salons, with a median of 235 unique monthly clients (IQR 110, 425). 9 salons (53%) had a private room useable for health services. Most owners (11/17, 65%) were female and comfortable (94%) with a nurse offering health services in their salon. Most stylists (75/92, 82%) were women and 98% reported that if trained they would be willing to talk to clients about health topics and refer to a nurse for services. Among 326 female clients, median age was 28 (IQR 24-33) and 73% currently use contraception; the majority (97%) visit the salon at least every 2 months, attend the same salon for most visits (80%) and spend >1 hour (83%). 91% reported willingness to receive injectable contraception, 93% oral contraceptive pills, 74% HIV testing and 77% PrEP at the salon. Clients from salons in townships compared to in Durban were more likely to be willing to get contraception (p<0.001) and PrEP (p=0.001) in the salon. Access to a private salon roomwas also significantly related to client willingness to receive health services (p=0.005). Women already on contraception were more likely to agree to contraception in the salon (p=0.028); contraceptive use was not related to willingness to receive PrEP (p=0.82). Conclusion: Most owners, stylists and clients were willing to receive contraception and PrEP from a nurse in hair salons in South Africa. Clients regularly attend salons in intervals compatible with injectable contraception and PrEP use. Hair salons represent an innovative venue for reaching young women at high risk for unintended pregnancy and HIV infection. 1071 PREGNANCY INTENTION AND CONTRACEPTIVE USE IN MALAWI’S PMTCT PROGRAM Deus Thindwa 1 , Megan Landes 2 , Monique van Lettow 2 , Annie Kanyemba 3 , Ernest Nkhoma 3 , Thokozani Kalua 4 , Happy Phiri 3 , Joep J. van Oosterhout 5 1 Imperial College London, London, UK, 2 University of Toronto, Toronto, ON, Canada, 3 Management Sciences for Health, Lilongwe, Malawi, 4 Malawi Department of HIV and AIDS, Lilongwe, Malawi, 5 Dignitas International, Zomba, Malawi Background: Avoiding unintended pregnancies through family planning is a WHO strategy in preventing mother to child transmission of HIV (PMTCT) and maternal morbidity/mortality. We investigated factors associated with recent unintended pregnancy, unmet contraceptive need, future pregnancy intention and current contraceptive use among Malawian women living with HIV in the Option B+ era. Methods: Women living with HIV were enrolled at 4-26 weeks postpartum into a cohort study at the Under-5 clinics of three high-volume government hospitals. Structured baseline interviews included questions on socio- demographics, HIV knowledge, partner’s HIV status/disclosure, ART use,

pregnancy intention and contraceptive use. Logistic regression was used to determine factors associated with pregnancy intention and contraceptive use. Results: We enrolled 578 HIV-positive women between May 2015 – May 2016; median maternal age was 28 years (IQR: 23-32), median parity was 3 deliveries (IQR: 2-4) and median infant age was 7 weeks (IQR: 6-12). Overall, 41.8%women had a recent unintended pregnancy, of whom 35.0% had unmet contraceptive need and 65.0% had contraceptive failure, from ineffective, or incorrect use, prior to conception. In multivariable analysis, recent unintended pregnancy was higher in women ≥35 years vs. 14-24 years (aOR: 2.1, 95%CI: 1.0-4.2) and in women with parity >3 vs. primiparous (aOR: 2.9, 95%CI: 1.5-5.6). Unmet contraceptive need was higher in women 14-24 years vs. ≥35 years (aOR: 4.2, 95%CI: 1.8-9.9), primiparous vs. parity >3 (aOR: 8.3, 95%CI: 1.8-39.5), and women whose partner’s HIV-status was unknown (aOR: 2.2, 95%CI: 1.2-4.0). Current contraceptive use was associated with being on ART during index pregnancy (aOR: 2.5, 95%CI: 1.5-3.9). Finally, future pregnancy intention was higher among women non-affiliated to a Christian religion (aOR: 2.8, 95%CI: 1.1-6.8). Conclusion: High rates of recent unintended pregnancy and unmet need for contraceptives among women living with HIV highlight the need for improved access to contraceptive services. To help achieving elimination of MTCT of HIV in Malawi family planning programs should also address contraceptive failure, from ineffective and incorrect use. 1072 HIV-1 RESERVOIR DYNAMICS IN MENOPAUSAL WOMEN DURING HORMONE THERAPY Stephanie Banning 1 , Olivia Roberts-Sano 1 , Emanuele Mazzola 2 , Qianjing He 1 , Stacey Chapman 3 , Rebecca Gelman 2 , Susan Cu-Uvin 3 , Athe Tsibris 1 1 Brigham and Women’s Hospital, Boston, MA, USA, 2 Dana–Farber Cancer Institute, Boston, MA, USA, 3 The Miriam Hospital, Providence, RI, USA Background: Recently presented data suggested that estrogen might block HIV reactivation in cells isolated from premenopausal women. We tested the effects that systemic hormone therapy (HT) had on reservoir dynamics in menopausal women living with HIV. The scientific premise of our study was that estradiol limits HIV-1 latency reversal. Methods: We conducted a non-randomized, open label pilot study in 12 treated HIV-infected, virologically suppressed (>1 year) menopausal women who were experiencing vasomotor symptoms. Three women without a uterus received transdermal estrogen patch (patch HT), 6 women with a uterus received conjugated estrogens and medroxyprogesterone acetate (oral HT), and 3 women received no treatment (no HT). HT was given for 4 weeks. HIV-1 total DNA and cell-associated RNA (caRNA) levels in PBMC, along with latency reversal agents (LRA)-induced virus reactivation in resting CD4+ T cells (rCD4), was assessed using blood samples obtained at entry and weeks 1, 4, and 8. Plasma levels of estradiol (E2) and estrone (E1) were measured by mass spectrometry. The primary endpoint was the change in HIV-1 caRNA levels between weeks 0 and 4. Results: Mean log 10 levels of HIV-1 DNA and caRNA at week 0 were 2.5 and 3.0 copies/106 PBMC, respectively, in the patch HT group, 2.3 and 3.2 in the oral HT group, and 2.4 and 3.1 in the no HT group. In the oral HT group, E2 and E1 levels increased from entry (8.9 pg/mL and 30.2 pg/mL, respectively) to week 4 (17.9 and 110). A statistically significant difference in the differences of HIV-1 log 10 caRNA was observed between the oral and no HT groups when comparing weeks 0 and 4 (p=0.024); caRNA levels in the HT group were higher. No other statistically significant differences were observed between weeks 0 and 4 when comparing the patch, oral and no HT groups. HIV-1 differences of log 10 DNA levels were similarly unchanged. Greater magnitudes of HIV-1 caRNA increases were observed in rCD4 treated with RMD when compared to either PHA/IL-2 or bryostatin in all HT groups, an effect that was not inhibited by fulvestrant. No association of LRA response with HT group or duration of HT was observed. Conclusion: In this pilot study, HT did not decrease HIV levels in PBMC or ex vivo LRA-induced virus reactivation in rCD4. Increases in estradiol concentrations were modest. RMD was a more potent LRA than PHA/IL-2 or bryostatin in the samples we tested. A larger study is required to more definitively address the association between HT and HIV-1 reservoir dynamics.

Poster Abstracts

CROI 2018 410