CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Results: Of 584 GBT mobilised for self-testing and 188 for AHI symptoms, 453 GBT (76.2%, 445/584 self-tests, and 4.3%, 8/188 AHI referrals) completed HTC (Figure 1). Median age was 26 (IQR: 22-30) years. Of these, 5.3% (24/453) were newly diagnosed with HIV, including 2 with positive HIV-RNA and negative (n=1) or discordant (n=1) rapid tests. 91.7% (22/24) initiated ART following a median of 2 (IQR: 1-7) days. In addition to the 24 newly diagnosed GBT, 9 partners and 4 GBT diagnosed through routine HTC were offered APNS and 70.3% (26/37) accepted. Of 41 enrolled partners, 26.8% (11/41) were newly diagnosed and 39.0% (16/41) were known positive. Of these, 90.9% (10/11) initiated ART, while all 16 known positive partners were on ART. Among 17 index participants, no social harm (100%, 17/17) was reported. PrEP initiation among HIV-negative participants was 25.4% (109/429) for mobilised GBT and 21.4% (3/14) for partners. Conclusion: A targeted peer mobilisation approach offering self-tests, screening for AHI symptoms, and APNS for newly diagnosed GBT appears feasible and safe. These strategies can effectively penetrate hidden epidemics among GBT and link newly diagnosed GBT to care.

strains among MSM in the UK. These data suggest an evolving MSM epidemic and transmission dynamics. 937 ASSISTED PARTNER NOTIFICATION SERVICES IN KAMPALA, UGANDA Florence Namimbi 1 , Faridah Akuju 1 , Martin Ssuuna 1 , Esther Nasuuna 1 , Rhoda Mwondha 1 , Stella Alamo 2 , Madina Apolot 2 , Nelson Kalema 1 , Alice Namale 2 , Joanita Kigozi 1 1 Infectious Disease Institute, Kampala, Uganda, 2 CDC Uganda, Kampala, Uganda Background: Of the estimated 1.2 million people living with HIV (PLHIV) in Uganda, 77% knew their status as of 2017, falling short of the UNAIDS 95% target of PLHIV who know their status. To address this gap, we implemented World Health Organization-recommended assisted partner notification (APN) in routine clinical services. Methods: Health workers were trained to implement APN at 69 health facilities in two urban Ugandan districts (October 2017–September 2018). Health workers identified eligible HIV-positive clients aged ≥15 years who had sexually transmitted infections, or a non-suppressed viral load and notifiable sexual partners with unknown HIV status. Eligible index clients provided written consent for an interview to elicit partner information and eventual notification. Health workers contacted partners through a phone call or home visit and notified them of their possible exposure and offered HIV testing. All those tested were linked to treatment and prevention services. We followed up with index clients to determine whether they experienced gender-based violence (GBV) after partner notification. We also determined APN acceptability and completion of the HIV cascade. Results: Of 55,312 index clients eligible for APN, 37,289 (67.4%) participated. Of these, 20,732 (55.6%) were men aged ≥25 years. APN teams identified 49,314 sexual partners, and 40,177 (81.5%) were notified of their exposure. Of those notified, 6925 (17.2%) knew they were HIV positive and were on treatment. Of those with previously negative or unknown status, 20,284 (61.0%) were tested at the notifying facility, and 6028 (29.7%) were HIV positive. APN identified more HIV-positive women across all age groups than men. Following testing, 5803 (96.3%) of all newly identified HIV-positive partners initiated ART. 368 (0.9%) of index clients (women, 258 [70.1%]) reported experiencing post- notification GBV. Conclusion: We found moderate APN acceptability and high linkage to care for HIV-positive partners. However, we need to understand why fewer partners were elicited than suggested in the literature and why 40% of notified partners declined testing at notifying facilities. A follow-up of those who declined facility testing is needed to ascertain if they tested elsewhere and were linked to care. Also, although <1% of index clients reported GBV, our findings suggest that monitoring and strengthening linkage to GBV services could help improve APN programs. 938 TARGETED PEER MOBILISATION AND ASSISTED PARTNER NOTIFICATION SERVICES IN KENYA Maartje Dijkstra 1 , Khamisi Mohamed 2 , Alex Kigoro 2 , Mahmoud Shally 2 , Abdalla Wesonga 2 , Teresia Mumba 2 , Nana Mukuria 2 , Margaret Juma 2 , Evans Gichuru 2 , Shaun Palmer 2 , Susan M. Graham 3 , Elisabeth M. van der Elst 2 , Eduard Sanders 2 1 Public Health Service Amsterdam, Amsterdam, Netherlands, 2 Kenya Medical Research Institute, Kilifi, Kenya, 3 University of Washington, Seattle, WA, USA Background: Peer mobilisation, HIV self-testing, acute HIV infection (AHI) screening, and assisted partner notification services (APNS) among gay, bisexual, other men who have sex with men and transgender women (GBT) may have great potential in penetrating hidden epidemics, and identifying GBT and their sexual partners with undiagnosed HIV. We operationalised these strategies in coastal Kenya and assessed safety, feasibility and linkage to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services after testing. Methods: Twenty-seven lay GBT mobilisers offered OraQuick HIV self-tests to at-risk peers and immediate clinic referral for peers with AHI symptoms in April-August 2019. Regardless of the self-test result, mobilised GBT received HIV testing and counselling (HTC) with two HIV antibody rapid tests in series, according to Kenyan guidelines. GBT with negative or discordant rapid tests received GeneXpert point-of-care HIV-RNA testing. GBT newly diagnosed with HIV were offered immediate ART and APNS. HIV-negative GBT were offered PrEP. A subgroup of index participants returned to the study clinic one month after initiating APNS to assess potential social harms.

Poster Abstracts

939 SCALE-UP OF ASSISTED PARTNER SERVICES (APS) IN BOTSWANA Matthew R. Golden 1 , Matias Grande 2 , Shreshth Mawandia 2 , Odirile Bakae 2 , Lenna Tau 2 , Goabaone Mogomotsi 3 , Esther Mmatli 3 , Modise Ngombo 3 , Jenny Ledikwe 2 1 University of Washington, Seattle, WA, USA, 2 International Training and Education Center for Health - Botswana, Gaborone, Botswana, 3 Botswana Ministry of Health, Gaborone, Botswana Background: Controlled studies have shown that APS is efficacious, and World Health Organization guidelines recommend that all persons diagnosed with HIV be offered APS. We evaluated APS implementation in the PEPFAR supported districts of Botswana to define program coverage and outcomes. Methods: Starting in October 2018, the Government of Botswana Ministry of Health and Wellness and the International Training and Education Center for Health implemented a new APS program in 52 clinical sites. Guidelines during the evaluation period recommended that all persons with newly diagnosed HIV infection be offered APS; APS recipients (index cases [IPs]) chose to notify partners themselves or to notify partners in collaboration with counselors. Counselors used structured paper registers to record information about each named partner, including if the partner HIV tested and their test result. Aggregate outcomes from registers were entered into a database. We analyzed data collected between October 2018 and June 2019 to define conventional partner notification indices. These indices measure the number of partners named, tested and testing HIV positive per IP (i.e. contact index, testing index and case-finding index, respectively). Results: Staff at 52 clinics performed 130,889 HIV tests during the evaluation period, of which 7015 (5.4%) were positive. A total of 6959 (99%) persons who tested HIV positive were offered APS, of whom 6508 (94%) were eligible for the intervention and 6097 (88% of HIV positive persons) received APS and were defined as IPs. IPs named 5182 sex partners (contact index=0.85, range across sites 0.68-0.93), electing to notify 3760 (73%) themselves and requesting counselor assistance to notify 1425 (27%). A total of 3403 (66%) partners tested for HIV (testing index=0.56, range 0.2-0.68) of whom 751 (22%) were HIV positive. The case-finding index was 0.12 (range 0-0.17). Conclusion: Botswana clinics have successfully implemented APS, with high levels of program coverage and high HIV positivity among tested partners. However, fewer than one partner is named and tested per index case, suggesting areas for program improvement. The case-finding index

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