CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

is highest in urban areas; thus, HIV prevention is largely focused on urban YMSM and less is known about sexual health of rural YMSM in relationships. Rural YMSM are less likely to be tested for HIV/STIs than urban YMSM, and inconsistent condom use is common. The present study used baseline data from a randomized controlled trial of a relationship education and HIV prevention program for male couples to test associations of rurality with HIV risk and prevention behaviors among YMSM. We hypothesized that higher rurality would be associated with fewer HIV risk and prevention behaviors. Methods: Participants were 430 YMSM in relationships. Participants’ average age was 28.70 years (SD = 7.34). Participants’ HIV status was negative (75.3%), positive (10.7%), or unknown (14.0%). Couples were eligible based HIV risk criteria (i.e., at least one member reports having condomless anal sex with a known serodiscordant serious partner or with any casual sexual partner). Participants completed measures of HIV/STI testing history, PrEP use, number of sex partners outside of their main relationship, and condomless anal sex (CAS) acts with those partners. Rurality was measured using the Index of Relative Rurality, a continuous and threshold-free measure of rurality. Data were analyzed using multilevel mixed models. Analyses controlled for age and race. Results: Results are summarized in Table 1. YMSM in more rural areas (i.e., higher rurality) were less likely to have been tested for HIV/STIs, and to have used PrEP, compared to urban YMSM. Higher rurality was also associated with fewer outside partners and fewer CAS acts; however, rates of CAS in the past three months were high for YMSM in both the top (i.e., most rural; M= 4.05, SD = 4.26) and bottom (M= 4.72, SD = 4.96) quartiles of rurality. Conclusion: Rural YMSM lack access to sexual health-related services and face stigma associated with same-sex sexual behavior and HIV, which may act as barriers to HIV/STI testing and PrEP use. Although rural YMSM had fewer sex partners outside their relationship and fewer CAS acts than urban YMSM, CAS was not infrequent, highlighting the need for increased HIV prevention geared toward young male couples living in more rural, less resourced areas. 860 BURDEN OF HIV AMONG MEN ATTENDING EMERGENCY DEPARTMENTS IN SOUTH AFRICA George Mwinnyaa 1 , Elizabeth Hahn 1 , Aditi Rao 1 , Steven J. Reynolds 2 , Andrew D. Redd 3 , Reinaldo Fernandez 4 , Jernelle Miller 4 , Morgan P. Keruly 3 , Roshen Maharaj 5 , Pamela Mda 5 , David Stead 5 , John Black 5 , Thomas C. Quinn 2 , Oliver Laeyendecker 2 , Bhakti Hansoti 4 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 NIAID, Baltimore, MD, USA, 3 NIAID, Bethesda, MD, USA, 4 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 5 Walter Sisulu University, Mthatha, South Africa Background: We sought to identify factors associated with HIV infection, HIV diagnosis, and lack of antiretroviral treatment (ART) among men attending emergency departments (EDs) in the Eastern Cape region of South Africa. Methods: Men aged ≥18 years were approached in three EDs, between June 2017 and July 2018. Study staff offered HIV testing, completed testing and collected demographic data on participants. HIV positive patients were consented for a blood sample, which was tested for the presence of antiretrovirals (ARVs) and quantification of HIV viral load. Log-binomial models were used to characterize male’s engagement in ART and care cascade and to determine factors associated with HIV prevalence. Results: Overall, 21% (302/1458) of men tested positive for HIV, of which 41% (124/302) were unaware of their status. Of the HIV positive males that underwent further testing only 47% (104/222) tested positive for the presence of ARVs, and 43% (101/236) were virally suppressed (defined as a viral load <1000 copies/ml). HIV prevalence increased with age, with 4% of men aged <20 years testing positive to a peak of 35% of those aged between 36-45 years. Factors significantly associated with being HIV+ include presenting with generalized weakness (adjusted prevalence ratio [adjPR] 1.49, 95% CI 1.16,1.92), signs of tuberculosis (adjPR 1.95, 95% CI 1.55,2.44), and being admitted to the hospital (adjPR 1.26, 95% CI 1.03,1.54) relative to males with no weakness,

tuberculosis or admissions, respectively. Men diagnosed with HIV in the ED were more likely to be younger (>50%were less than <35 years of age), trauma patients (vs. medical) (adjPR 1.69, 95% CI 1.11,2.57), or presenting with fever (vs. no fever) (adjPR 1.90, 95% CI 1.18,3.08). Less than 30% of men under the age of 35 years had evidence of ART and none of the 19 HIV+men <25 years of age were virally suppressed. Furthermore, those with concurrent alcohol problems had lower frequency of being virally suppressed (38%, 36/96). Conclusion: There is a high burden of HIV among men visiting EDs in the Eastern Cape, with almost half unaware of their HIV status. Furthermore, none of the youngest men were virally suppressed. The ED is a critical venue to identify HIV infected men not on treatment. HIV service providers, program implementers and policy makers, should consider how to leverage the ED as a venue to provide HIV services to young men in order to meet the 90-90-90 targets particularly in South Africa. Mukandavire 1 , Amrita Rao 3 , Sheree Schwartz 3 , Ubald Tamoufe 4 , Serge Billong 5 , Peter Vickerman 6 , Stefan Baral 3 , Marie-Claude Boily 1 1 Imperial College London, London, UK, 2 University of Toronto, Toronto, ON, Canada, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Metabiota, Yaoundé, Cameroon, 5 University of Yaoundé, Yaoundé, Cameroon, 6 University of Bristol, Bristol, UK Background: Key populations (KP) such as men who have sex with men (MSM), female sex workers (FSW) and their clients are at high risk of HIV. We estimated the impact of past interventions and the contribution of risks stemming from unmet HIV prevention/treatment needs of KP and lower-risk groups to HIV transmission in Yaoundé, Cameroon. Methods: We developed and calibrated a deterministic model of HIV transmission within a Bayesian framework to reproduce the HIV epidemic in Yaoundé over time, based on a comprehensive review of site-specific demographic, behavioural, HIV and intervention coverage data. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all transmitted infections over 10-year periods attributable to sex within different partnerships. Results: Condoms and ART together averted 33% (95% uncertainty interval: 21-47) of infections over 1980-2018. Rising condom use among FSW had the largest historical impact (18% (9-37) of infections averted from 1980-2018); recent ART scale-up averted 36% (31-41) over 2009-2018. With increasing condom use during paid sex, the contribution of sex between FSW and their partners fell from 37% (17-61) of all transmitted infections over 1989-1998 to 22% (8-36) over 2009-2018 (Table). In the last decade, sex between clients (7% of all people living with HIV (PLHIV)) and their partners; MSM (8% of PLHIV) and their male and female partners; and between lower-risk individuals (82% of PLHIV) contributed to 39% (26-56), 42% (17-52), and 43% (31-60) respectively. By 2018, ART coverage was estimated to be highest among FSW (86% (79-91)), followed by lower-risk groups (51% (46-56)), MSM (47% (40-52)), and clients (44% (34-48)). Consequences of unmet HIV prevention/treatment needs of MSM are predicted to contribute to 44% (17-57) of new transmissions occurring in the coming decade (Table). Conclusion: Increases in condom use among FSW, and recent ART scale-up have had a large transmission impact in Yaoundé and changed the relative contribution of different partnerships to onward transmission over time. Findings highlight the need to prioritize HIV prevention and treatment interventions to MSM and clients of FSWwhose unmet needs are now contributing the most to onward transmission, while maintaining achievements in reducing HIV transmission in the context of sex work.

861 ROLE OF KEY POPULATIONS AND PAST INTERVENTIONS ON HIV TRANSMISSION IN CAMEROON Romain Silhol 1 , Sharmistha Mishra 2 , Anna L.Bowring 3 , Christinah

Poster Abstracts

CROI 2020 321