CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

779 HIV SEROCONVERSION DURING PREGNANCY AT ROUTINE ANTENATAL CARE CLINICS IN BOTSWANA Katrina F. Ortblad 1 , Shreshth Mawandia 2 , Odirile Bakae 2 , Lenna Tau 2 , Matias Grande 2 , Goabaone Mogomotsi 3 , Esther Mmatli 4 , Modise Ngombo 3 , Laura Seckel 5 , Renee Heffron 1 , Jillian Pintye 1 , Jenny Ledikwe 1 1 University of Washington, Seattle, WA, USA, 2 International Training and Education Center for Health, Gaborone, Botswana, 3 Botswana Ministry of Health, Gaborone, Botswana, 4 Ministry of Health and Wellness, Gaborone, Botswana, 5 International Training and Education Center for Health, Seattle, WA, USA Background: Risk of HIV acquisition during pregnancy and postpartum is high in sub-Saharan Africa. While current prevention of mother-to-child HIV transmission (PMTCT) programs are designed to detect and treat women with chronic HIV infections, women who are newly infected or acquire HIV after initial antenatal testing may have infections that go undetected. Botswana was the first African country to routinize HIV testing for pregnant women attending antenatal care (ANC) and ANC attendance in Botswana is high at 97%. Repeat HIV testing during ANC is both time and cost intensive. We evaluated the frequency of detecting previously undiagnosed HIV infections among routine ANC attendees in Botswana. Methods: From January 2018 to September 2019, a national HIV testing programwas implemented at 139 ANC clinics in 15 districts in Botswana. Electronic data captured information on demographics (age, sex, citizenship), HIV testing (date, location, result) and linkage to antiretroviral treatment (ART). For this analysis, individuals who previously tested HIV-positive prior to their first identified ANC visit were excluded, enabling an evaluation of frequency of detecting previously undiagnosed HIV. Among HIV-negative individuals who had a repeat HIV test at a subsequent ANC visit, we measured time to re-testing and frequency of HIV seroconversion during ANC follow-up. Results: In total, 29,583 women (median age 26 years, IQR 22-31) were tested for HIV at ANC clinics and 97% tested HIV-negative (28,735). Of those, 28% (8,005) had a repeat HIV test at a subsequent ANC visit; median time to HIV re-testing was 92 days (IQR 70-112) and frequency of HIV seroconversion was 0.3% (23). ART initiation among all women who tested HIV-positive at ANC (854) was 88% (686/782). Women who tested HIV-negative were similar in age, citizenship, and urban testing location to those who tested HIV-positive; women who initiated ART were similar in age and urban testing location, but not citizenship status (99% citizens vs 52% non-citizens, p<0.001), to those that did not initiate ART, Fig. 1. Conclusion: In this large evaluation, we detected previously undiagnosed HIV infection and seroconversion among ANC attendees in Botswana, despite high ANC testing and PMTCT coverage. To reach elimination of MTCT, repeat HIV testing and primary prevention during ANC remain key components of PMTCT programs.

778 RISK OF VERTICAL TRANSMISSION FROM MOTHERS WITH PERINATAL HIV INFECTION IN ZIMBABWE Tafadzwa Sibanda 1 , Tsitsi G. Monera-Penduka 1 , Enerst Chikwati 1 , Jan Van Den Hombergh 1 , Juan Gonzalez Perez 1 1 AHF Zimbabwe Background: Data from all PHIV women 18 years and above active in care by April 2019 in Mpilo ART Clinic (Zimbabwe) with at least one pregnancy in the last five years were included in the study and compared with a sample of HIV+ women not perinatally infected meeting the same criteria. Demographic and clinical data was extracted from databases and complemented with individual interviews to get information on pregnancy outcomes and HIV status of exposed infants. For data analysis, proportions were compared using Chi square. Logistic regression was used to identify predictors of MTCT. Methods: Data from all PHIV women 18 years and above active in care by April 2019 in Mpilo ART Clinic (Zimbabwe) with at least one pregnancy in the last five years were included in the study and compared with a sample of HIV+ women not perinatally infected meeting the same criteria. Demographic and clinical data was extracted from databases and complemented with individual interviews to get information on pregnancy outcomes and HIV status of exposed infants. For data analysis, proportions were compared using Chi square. Logistic regression was used to identify predictors of MTCT. Results: Out of 564 PHIV women in the ART clinic database, 148 accepted to be interviewed and provided complete information on 166 pregnancies. Similarly, 152 non-Perinatally infected HIV positive (non-PHIV) women were interviewed yielding 174 pregnancies. Women in the PHIV group were younger (median age 20 years old versus 34 in non-PHIV) and have been longer in HIV care at the time of pregnancy (median 9 years versus 6 in non-PHIV). 81% of all participants have a VL test in the previous 12 months, with 66.4 % of PHIV women and 87.2% of non-PHIV women achieving a VL < 1,000 copies/ml. On pregnancy outcomes, risk of abortion/stillbirth was double in the PHIV group (24.1% [40/166] vs (13.8% [24/174], OR: 2.0 p: 0.01). MTCT rate was slightly higher in PHIV women (8.7% [11/126] vs 7.3%% [11/150]) but the difference was not statistically significant. When adjusting for age, education, last VL and time in HIV care at the time of pregnancy, mode of acquisition of HIV of the mother was not independently associated with the risk of MTCT. Conclusion: Our results from a large ART clinic in Zimbabwe do not confirm findings from a US-based cohort where MTCT rate was more than double in PHIV mothers compared with those with horizontally acquired HIV. We identified, however, an increased risk of abortion/stillbirth in PHIV women, as well as, a high prevalence of unsuppressed VL what highlights the importance of intensive VL monitoring to optimize ART in that group.

Poster Abstracts

780 TRENDS IN MARIJUANA, ALCOHOL, AND OPIOID USE IN PREGNANT AND POSTPARTUM HIV+WOMEN Lynn M. Yee 1 , Deborah Kacanek 2 , Chase Brightwell 2 , Lisa B. Haddad 3 , Jennifer Jao 4 , Kathleen M. Powis 5 , Tzy-Jyun Yao 2 , George R. Seage 2 , Ellen G. Chadwick 4 1 Northwestern University, Chicago, IL, USA, 2 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 3 Emory University, Atlanta, GA, USA, 4 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 5 Massachusetts General Hospital, Boston, MA, USA Background: Concurrent with the opioid epidemic in the United States (US), rates of marijuana use have risen among pregnant and non-pregnant women of reproductive age. Amid evolving legal and social changes, little is known about substance use among pregnant and postpartumwomen living with HIV (WLHIV).

CROI 2020 288