CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

p<.0001. ART initiation rates were also lower among the 16-24 (69%) age group compared to those 25 and older (80%), χ2 (1, N= 3,554) = 43.2, p<.0001 (see Table 1). Conclusion: BCPP achieved high rates of linkage to care and ART initiation through a combination of community- and clinic-based interventions. In the context of a highly successful national program, BCPP was able to substantially increase uptake and coverage of treatment. Despite targeted efforts, young people 16-24 (particularly men) were less likely to link to care and initiate ART, compared to older persons. Interventions are needed that encourage and support young people to start and remain on treatment.

Poster Abstracts

1084 DISTRIBUTION OF ADVANCED HIV IN 3 HIGH HIV PREVALENCE COUNTRIES IN AFRICA

Menard L. Chihana 1 , Helena Huerga 2 , Gilles van Cutsem 3 , Stephen Wanjala 4 , Charles Masiku 5 , Elisabeth Szumilin 6 , Jean F. Etard 7 , Mary-Ann Davies 8 , David Maman 1 1 Epicentre, Cape Town, South Africa, 2 Epicentre, Paris, France, 3 MSF, Johannesburg, South Africa, 4 MSF, Nairobi, Kenya, 5 MSF, Lilongwe, Malawi, 6 MSF, Paris, France, 7 IRD, Montpellier, France, 8 University of Cape Town, Cape Town, South Africa Background: Despite substantial increases in antiretroviral therapy (ART) access, a number of HIV-infected patients continue to experience advanced disease, contributing to ongoing HIV-related morbidity and mortality. To help reduce mortality, the WHO recently released guidelines for managing individuals with advanced HIV disease and their rapid initiation on ART. We quantified population level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa. Methods: Three HIV cross-sectional surveys were conducted in Ndhiwa (Kenya); September-November 2012, Chiradzulu (Malawi); February-May 2013 and KwaZulu-Natal (South Africa); July-October 2013. Individuals aged 15-59 years were eligible for inclusion. Consenting individuals were interviewed at households using a structured questionnaire followed by rapid HIV testing and, among those who tested positive, home based CD4 testing for Kenya and Malawi and laboratory tested for South African and viral load testing were conducted. Advanced HIV was defined as CD4 count of <200 cells/µl. Results: Among 18991(39.2%male) individuals, 4113(21.7%) tested HIV- positive; 385/3957 (9.7%; 95% Confidence Interval [CI]:8.8-10.7) had advanced HIV, ranging from 8.1%(6.6-9.9) in Malawi to 11.6%(9.9-13.5) in Kenya. Only 158/385 (41.0%) reported ever being on ART, with 32.0% on ART for at least 6 months; the rest were ART naive (figure). The proportion of ART naive individuals among those with advanced HIV was lower in Malawi and South Africa where criteria for ART initiation at the time were less restrictive than Kenya (63.3% vs 74.8%; p=0.04). Overall, 68.7% of ART naive had not previously been diagnosed with HIV, and this was similar across countries. Among those on ART for at least 6 months, 46.3% had viral load ≥1000 copies/µL; 60.2%were male and 65%were 35-59 years old. Conclusion: Our estimates of advanced HIV in the population were lower than most clinical studies. More than half of patients with advanced HIV were ART naive, the majority not previously diagnosed as HIV-infected, suggesting the need for different testing strategies to identify and link these patients to care.

1085 CASCADE OF CARE AMONG SERODISCORDANT COUPLES IN 4 HIGH PREVALENCE SETTINGS IN AFRICA

Menard L. Chihana 1 , Nolwenn Conan 1 , Erica Simons 2 , Cyrus Paye 2 , Daniela B. Garone 3 , Reinaldo Ortuno 4 , Helena Huerga 2 , Gilles van Cutsem 5 , Stephen Wanjala 6 , Charles Masiku 7 , Elisabeth Szumilin 8 , Jean F. Etard 9 , Mary-Ann Davies 10 , David Maman 1 1 Epicentre, Cape Town, South Africa, 2 Epicentre, Paris, France, 3 MSF, Harare, Zimbabwe, 4 MSF, Blantyre, Malawi, 5 MSF, Johannesburg, South Africa, 6 MSF, Nairobi, Kenya, 7 MSF, Lilongwe, Malawi, 8 MSF, Paris, France, 9 IRD, Montpellier, France, 10 University of Cape Town, Cape Town, South Africa Background: Discordant couples are at high risk of HIV transmission. We quantified the prevalence of HIV discordant couples and evaluated each step of the cascade of care among HIV infected partners in four high prevalence settings in sub-Saharan Africa. Methods: We used data from four HIV prevalence surveys conducted in Ndhiwa (Kenya); September-November 2012, Chiradzulu (Malawi); February- May 2013, Gutu (Zimbabwe) and Nsanje (Malawi); September-December 2016. Individuals aged 15+ years were eligible for inclusion. Consenting individuals were interviewed at home using a structured questionnaire and were asked to participate in voluntary rapid HIV testing. For participants who tested HIV- positive, viral load tests were done for all sites while CD4 tests were done for everyone in Ndhiwa and Chiradzulu and for only those not on ART in Gutu and were not done in Nsanje. Couples were people who themselves reported being married or living together with the partner in the same household at the time of the survey. Results: Of eligible 25,861 individuals, 23,415 (90.5%) were included and of these 22,854 (97.6%) tested for HIV. Among 4,918 identified couples, HIV discordancy was found in 15.9% (95%CI 14.0-18.0) in Ndhiwa, 10.0% (8.6-11.5) in Chiradzulu, 5.6% (4.7-7.5) in Nsanje and 7.6% (6.0-9.6) in Gutu. Among couples with at least one HIV-infected partner, the proportion of HIV-discordancy was 44.8% in Ndhiwa, 40.9% in Chiradzulu 39.4% in Nsanje and 41.8% in Zimbabwe. Men were more likely to be the HIV-positive partner in

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