CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

941 PARTNER TESTING SERVICES TO ACHIEVE HIV EPIDEMIC CONTROL IN 9 PEPFAR COUNTRIES, 2019 Bakary Drammeh 1 , Shahul Ebrahim 1 , Andrew L.Baughman 1 , Arielle Lasry 1 , Randy Yee 1 , Wayne A Duffus 1 , Jacqueline Rurangirwa 1 , Shane T. Diekman 1 , Amy M. Medley 1 , Tiffiany Michelle Aholou 1 , G. Laissa Ouedraogo 1 , Isabelle Tondoh- Koui 2 , Ismelda Pietersen 3 , Stephanie Behel 1 , for the HIV Testing Services 1 CDC, Atlanta, GA, USA, 2 Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire, 3 US CDC Windhoek, Windhoek, Namibia Background: The US President’s Emergency Plan for AIDS Relief (PEPFAR) supports HIV prevention in most HIV endemic countries. Programs provide partner notification services (PNS) or index testing as an HIV case finding strategy.Data is collected on PNS, contacts of index cases and HIV indicators as Monitoring, Evaluation and Reporting (MER) data.These data measures progress towards HIV epidemic control by reaching the first UNAIDS 90. Methods: To evaluate progress towards reaching the 1st 90, we performed a descriptive analysis of MER data reported by 9 countries during October 2018-March 2019 through a Data for Accountability, Transparency and Impact Monitoring database. The 9 countries were prioritized based on HIV prevalence and the need to scale up HIV prevention activities. The five variables selected represent key elements of the HIV testing cascade indicators. Results: Three countries that were within 6% of achieving the 1St 90 (Namibia 4%, South Africa 5%, Rwanda 6%) had the lowest proportion of HIV-positive cases who accepted partner notification services (Namibia 66%, South Africa 52%, Rwanda 28%). In contrast, countries that had a larger gap to the 1st 90 target (Mozambique 18%, Nigeria 23%, Cote d’Ivoire 40%) showed a higher index case acceptance (Mozambique 87%, Nigeria 74%, Cote d’Ivoire 94%). Three countries met the PEPFAR benchmark of 1.5 contacts per index (Namibia 1.6, Uganda 1.7, Mozambique 1.5) but only two countries showed a high percentage of HIV positives as a result of the index exposure to contacts (Namibia 98%, Mozambique 94%). Despite being high HIV prevalence countries (Eswatini 27.4%), (Namibia 12.1%), (South Africa 18.8%) and closest to the 1st 90, these countries reported low HIV pos per 100 index (Eswatini 14, Namibia 19, South Africa 3). Conclusion: These findings suggest that select countries closer to achieving the 1st 90 target with high HIV burden (Namibia, Southern Africa and Rwanda) tend to have a lower rate of index case acceptance. However, index testing is an important modality for countries that have a large gap to achieving the 1st 90s. Non-aggregated data within these countries should be evaluated to fully understand the most effective modality in each country.

is substantially below that reported in most published evaluations, likely reflecting a combination suboptimal program implementation and the high proportion of HIV infected persons in Botswana who already know their HIV status.

940 OPTIMIZING TESTING INCREASES YIELD IN HIV CASE FINDING IN 24 COUNTRIES, 2018–2019 Shahul Hameed Ebrahim 1 , Arielle Lasry 1 , Randy Yee 1 , Wayne A Duffus 1 , John Abellera 1 , Shane T Diekman 1 , Jacqueline Rurangirwa 1 , Bakary Drammeh 1 , Tiffany Ahoulou 1 , Michael Grillo 2 , Vincent Wong 3 , Stephanie Behel 1 1 CDC, Atlanta, GA, USA, 2 Defense Health Agency, San Diego, CA, USA, 3 United States Agency for International Development, Washington, DC, USA Background: In 2019, the U.S. President’s Emergency Plan for AIDS Relief prioritized the scale-up of testing contacts of HIV-positive index patients (contact testing) and optimizing provider-initiated testing and counseling services (PITC) to boost the first 90 goal (90% of people living with HIV know their HIV status) of the UNAIDS strategy. We assessed the impact of changes in HIV-testing modalities on the first 90 goal. Methods: We used PEPFAR data from 24 countries that reported at least 2,000 HIV-positive test results per quarter. We compared second quarter (Q2) HIV testing data from 2018 and Q2 2019 and calculated the number of HIV tests and the yield (percentage of HIV-positive tests) by testing modality. Results: Overall, HIV test volume decreased by 12%, and the number of HIV-positive results decreased by 4%, whereas overall yield increased by 9% (3.6% to 3.9%). In 2019, the 5 modalities that contributed to most (85%) of the HIV test volume were routine PITC in outpatient departments (OPDs; excluding emergency rooms, in-patient services, and tuberculosis and sexually transmitted infection clinics; 50%), voluntary counseling services (11%), mobile clinics (6%), contact testing (4%), and prenatal clinics (14%). Between 2018 and 2019, test volume increased in contact testing but decreased in others (Table). PITC in OPDs remained the leading contributor to the number of HIV-positive results, but the contribution of this modality to overall HIV-positive results decreased from 54% in 2018 to 45% in 2019. By modality, contact testing had the highest yield (8.9%, 2018; 14.3%, 2019) and was the second largest contributor to overall HIV-positive results (112,433/709,544 [15.8%]) in 2019. Increased test volume in other modalities (emergency wards, pediatrics, and TB and malnutrition clinics; 15% of all tests in 2019) did not increase yield (2018, 3.5%; 2019, 3.2%). Conclusion: Overall, contact testing and optimization of other testing modalities increased HIV testing yield between 2018 and 2019. Increased yield and scale from contact testing was, however, insufficient to compensate for the decrease in HIV-positive results. Both yield and absolute number of cases should be considered in assessing the impact of scale-up of contact testing and optimization of case-finding approaches.

Poster Abstracts

942 COMPARISON OF INDEX TESTING APPROACHES TO IMPROVE HIV- TESTING EFFICIENCY IN RWANDA Eric Remera 1 , Elyse Tuyishime 2 , Suthar Amithab 3 , Mugwaneza Placidie 1 1 Rwanda Biomedical Centre, Kigali, Rwanda, 2 CDC Rwanda, Kigali, Rwanda, 3 CDC, Atlanta, GA, USA Background: In 2016, WHO released guidelines on partner notification services / index testing. In these guidelines several approaches were recommended. In order to gain experience and understand the relative contribution of each approach towards epidemic control, Rwanda implemented client referral, provider testing, and contract referral. We report our findings here of their relative performance in reach, testing uptake, yield, and linkage to care. Methods: Index testing is implemented in all 23 health facilities in Kigali city. Three index testing strategies are used to actively find new cases of PLHIV: client referral, provider testing, and contract referral. The cases identified are linked

CROI 2020 353