CROI 2020 Abstract eBook

Abstract eBook

Oral Abstracts

42 INDEX FACTORS INCREASE PARTNER NOTIFICATION YIELD FOR KENYAN PEOPLE WHO INJECT DRUGS Brandon Guthrie 1 , Aliza Monroe-Wise 1 , Loice Mbogo 2 , Natasha Ludwig- Barron 1 , John D. Scott 1 , Bill Sinkele 3 , David Bukusi 4 , Matthew Dunbar 1 , Paul Macharia 5 , Esther Gitau 3 , Betsy Sambai 4 , Helgar Musyoki 5 , Sarah Masyuko 1 , Joshua T. Herbeck 1 , Carey Farquhar 1 1 University of Washington, Seattle, WA, USA, 2 University of Washington in Kenya, Nairobi, Kenya, 3 Support for Addictions Prevention and Treatment in Africa Foundation, Nairobi, Kenya, 4 Kenyatta National Hospital, Nairobi, Kenya, 5 National AIDS and STD Control Programme, Nairobi, Kenya Background: Assisted partner notification services (aPNS) to find, test, and link to care partners of HIV+ individuals may aid in achieving HIV care cascade goals in key populations. Our ongoing evaluation of aPNS for people who inject drugs (PWID) in Kenya identifies characteristics of indexes associated with highest yield for this community. Methods: Indexes were recruited from needle/syringe programs and methadone clinics in Nairobi and Kilifi County and offered enrollment if HIV+. Indexes provided contact information for injection and sexual partners (past 3 years). Community-embedded peer educators traced partners and referred them to study sites for HIV testing. aPNS efficiency was assessed by number of indexes needed to interview (NNTI) to find one additional HIV+ partner not on ART. Results: 441 enrolled indexes named 1821 partners (70% injection partners, 18% sexual, and 11% sexual and injection). Indexes named a median of 4 partners (interquartile range [IQR] 3-5). aPNS was provided to 1565 (86%) partners, with a median of 4 partners (IQR 2-5) tested among female indexes and 3 (IQR 2-4) among males (p=0.002). aPNS yielded 470 HIV+ partners, of whom 116 (25%) were not on ART and 50 (11%) were unaware of their HIV status. One or more HIV+ partners were identified for 262 (59%) indexes, with a single HIV+ partner identified for 34% of indexes and ≥2 HIV+ identified for 25% of indexes. Overall, NNTI was 3.8 to identify one partner not on ART; aPNS in Nairobi was more likely than Kilifi Country to yield HIV+ partners not on ART (NNTI=3.3 vs 9.1; p<0.001). NNTI to identify partners not on ART was 2.5 for female indexes versus 7.1 for males (p<0.001). Adjusted for sex of the index, aPNS was more efficient for finding HIV+ not on ART among indexes not in a methadone program (NNTI=2.5 vs 4.1 for females; NNTI=4.9 vs 19.2 for males; p=0.003). After 6-months, 71% of partners not initially on ART had started treatment. Conclusion: aPNS can improve the HIV care cascade for partners of PWID in Kenya, finding 1 HIV+ partner not on ART per 3.8 indexes. While most HIV+ partners were aware of their HIV status, 25%were not currently on ART, highlighting a need for improved care engagement. Focusing on index PWID most likely to yield HIV+ partners not fully engaged in care will maximize aPNS to achieve viral suppression. We found females, those not in methadone programs, and in Nairobi yielded the most partners not on ART. 43 COMMUNITY-BASED MULTIMONTH DISPENSING OF ART: A CLUSTER RANDOMISED TRIAL IN LESOTHO Betty B. Tukei 1 , Geoffrey Fatti 2 , Appolinaire Tiam 3 , Vincent Tukei 3 , Thapelo Maotoe 1 , Ian Sanne 1 , Thembisile Xulu 1 , Nicky Mabhena 4 , Francis Akpan 1 , Ian Membe 5 , Iyiola Faturiyele 5 , Justine Mirembe 5 , Kgotso Maile 1 , Makatleho Sejana 1 , Charles Chasela 1 1 Right to Care, Johannesburg, South Africa, 2 Kheth’Impilo AIDS Free Living, Cape Town, South Africa, 3 Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA, 4 Kheth'Impilo, Cape Town, South Africa, 5 United States Agency for International Development, Washington, DC, USA Background: Lesotho adopted the test and start strategy for HIV services in June 2016 with anticipated increase in patient load. Our study evaluated community-based differentiated models of multi-month dispensing (MMD) of ART among stable HIV-infected adults in Lesotho. We report 12 month outcomes of the study. Methods: The cluster-randomised trial was conducted in 30 selected clusters, stratified into rural and urban geo-locations. The clusters were randomised to three differentiated model of care arms: (i) 3 monthly ART supply at facilities (3MF) as control, (ii) 3 monthly ART supply through community ART groups (3MC) as intervention; (iii) 6 monthly ART supply through community ART distribution points (6MCD) as intervention. The primary outcome was retention in care with virologic suppression as secondary outcome. Outcome analysis were by intention-to-treat. We compared risk differences between arms with binomial population and used Cox’s proportional hazards regression to compare

potentially due to an augmented antiviral immune response. Trials evaluating the efficacy of VES in combination with other agents such as CD8-inducing vaccines and monoclonal antibodies are warranted.

Oral Abstracts

41LB DURABLE HIV-1 ANTIBODY PRODUCTION IN HUMANS AFTER AAV8- MEDIATED GENE TRANSFER Joseph P. Casazza 1 , Sandeep Narpala 1 , Laura Novik 1 , Galina Yamshchikov 1 , Evan Cale 1 , Nicole Doria-Rose 1 , Bob C. Lin 1 , Adrian B. McDermott 1 , Mario Roederer 1 , Alejandro B. Balazs 2 , David Baltimore 3 , Richard A. Koup 1 , Julie Ledgerwood 1 , John R. Mascola 1 , for the VRC603 Team 1 Vaccine Research Center, NIAID, Bethesda, MD, USA, 2 Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA, 3 California Institute of Technology, Pasadena, CA, USA Background: Gene transfer protocols offer an alternative to repeated injections of HIV broadly neutralizing antibodies (bNAb) as a means of maintaining effective immunoprophylaxis. VRC07 is a bNAb targeting the CD4 binding site of the HIV-1 envelope glycoprotein. Methods: Seven HIV-infected volunteers on effective ARV therapy were enrolled in a phase I, open-label dose escalation trial of an AAV8 vector encoding the HIV bNAb VRC07 at doses of 5x1010 (N=3), 5x1011 (N=2), and 2.5x1012 (N=2) viral genomes per kilogram (vg/kg) by IM injection. Volunteers were between 30 to 60 yr. All volunteers in the 5x1010 and 5x1011 vg/kg doses were followed for 1yr or longer. Two volunteers in the 2.5x1012 dose group have been followed for between 7-9 mo. Results: Product administration was well tolerated. Local reactogenicity was observed only in the 2.5x1012 vg/kg dose group where both volunteers reported mild pain and tenderness at the injection sites. One person in the intermediate dose group reported mild myalgia. All reactogenicities resolved within 1 week of product administration. No serious adverse events were attributed to product. Vector-based VRC07 production was found in all volunteers following injection. Peak VRC07 concentrations were 0.17-0.43 μg/ml in the 5x1010 dose group, 0.23-0.74 μg/ml in the 5x1011 dose group and 1.1-1.2 μg/ ml in the 2.5x1012 dose group (Figure). The data suggest a pattern of antibody production defined by an early peak in VRC07 concentration 4-6 wks after product administration, a decrease in concentration 7-14 weeks after product administration and then a slow increase in concentration after 16 wks resulting in stable or continually increasing antibody concentration over the next 36 wks. In 3 of 5 individuals followed for one year or longer, antibody concentrations at 1 yr were higher than at the 4-6 wk peak. In the other 2 volunteers, one in the 5x1010, the other in the 5x1011 vg/kg dose group, anti-VRC07 antibodies were identified starting 6 and 14 wks after product administration. Anti-VRC07 antibodies were not detected in the other 5 volunteers. Conclusion: These data suggest that adeno-associated viral vectors can safely be used to stably produce HIV-1 specific bNAbs in humans for over a 1-year period following a single administration of vector. AAV8 mediated gene transfer may offer a means to generate effective vectored immunoprophylaxis in humans.

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CROI 2020