CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: SAMBA’s high concordance in this population suggests a role for POC NATs when starting and monitoring PrEP, detecting acute infection, and for monitoring potential virologic failure among PWH on ART.

was most sensitive to costs of HIV care and ART, and time spent misdiagnosed. In Scenarios A and B, for the entire tested population, LE and costs were very similar between all 3 strategies. In Scenario C, with field-based RDT characteristics and attrition, NAT-Resolve averted more misdiagnoses and was cost-saving compared to RDT-WHO and RDT-CI. Conclusion: With HIV Rapid Diagnostic Testing-based strategies, the impacts of misdiagnoses may be substantial. In combination with RDTs, in practice in a low HIV prevalence setting, POC NAT-based testing strategies will minimize misdiagnoses, improve attrition, and be cost-saving.

955 COMMUNITY-LED HIV SELF-TESTING INCREASES TESTING AND LINKAGE TO CARE OF MEN IN UGANDA Joanita Nangendo 1 , Joan Kalyango 1 , Gloria O. Odei 1 , Jane Kabami 1 , Fred Semitala 1 , Anne Katahoire 1 , Charles Karamagi 1 , Rhoda Wanyenze 1 , Moses R. Kamya 1 1 Makerere University College of Health Sciences, Kampala, Uganda Background: Targeted strategies are needed to increase knowledge of HIV sero-status and improve the HIV care cascade among men. We implemented a community-led oral HIV self-testing (HIVST) intervention among men in a peri-urban district in Uganda and assessed uptake of HIV testing, identification of HIV+ persons and linkage to care. Methods: We conducted an implementation study from October 2018 to June 2019 among 1628 men in 30 villages of Mpigi district in Uganda. Community health workers distributed one HIVST-kit and a tailored linkage-to-care insert to each consenting male aged 15+years and living in a sampled household. We allowed up-to 10 days to use the kit, 30 days to seek confirmatory testing at a health facility (HF) and up to 60 days to start care if confirmed HIV+. We collected baseline data including demographics, testing history and HIV risk behavior. At follow up, we measured HIVST-uptake (by proof of used kit) and linkage-to-care as HF-confirmation of HIV sero-positive status (by proof of HIV test result slip) and ART initiation. We summarized categorical data as proportions and used Poisson regression to determine predictors of HF- confirmation of HIV sero-status among men using HIVST. Results: At baseline, 19.8% (322/1628) of participants had never tested for HIV and only 37.2% (606/1628) had tested in the last 12 months. HIVST-uptake was 95.3% (1551/1628) with 3.9% (63/1628) testing HIV+. Of those who used HIVST, 81.0% (1257/1551) sought HF-confirmation of HIV sero- status, 76.2% (48/63) of positives by HIVST were confirmed HIV+ at a HF. 79.2% (38/48) of confirmed HIV+ were newly diagnosed and 20.8%were previously diagnosed but untreated with ART or had fallen out of care, and 96% (46/48) of the confirmed HIV+ initiated ART. Participants seeking HF confirmation of HIV sero-status were more likely to be older aged 25+ years (9.52, 95%CI: 3.22-28.18), unaware of their partner’s status (2.73, 95%CI: 1.46-5.11) and not to have used the HIVST-kits (14.94, 95%CI: 5.47-40.77). Conclusion: Community-led HIVST may be an efficient way to increase male HIV testing and linkage to care of newly diagnosed HIV+ and known HIV+ who had fallen out of care. Further research is needed to assess cost-effectiveness and scalability of this intervention in resource-limited settings. 956 UPTAKE OF HIV SELF-TESTING AMONGST YOUTH IN TERTIARY EDUCATION COLLEGES IN ZIMBABWE Grace McHugh 1 , Andrea L. Koris 2 , Tsitsi Bandason 1 , Katharina Kranzer 3 , Rashida A. Ferrand 3 1 Biomedical Research and Training Institute, Harare, Zimbabwe, 2 Duke Global Health Institute, Durham, NC, USA, 3 London School of Hygiene & Tropical Medicine, London, UK

Poster Abstracts

954 EVALUATION OF QUALITATIVE AND SEMIQUANTITATIVE HIV POINT-OF- CARE NUCLEIC ACID TESTS Lauren R. Violette 1 , Andy M. Cornelius-Hudson 1 , Madison A. Snidarich 1 , Sonny Michael Assennato 2 , Allyson Ritchie 2 , Neha Goel 2 , Pollyanna R. Chavez 3 , Steven Ethridge 3 , Helen Lee 2 , Kevin P. Delaney 3 , Joanne Stekler 1 1 University of Washington, Seattle, WA, USA, 2 Cambridge University, Cambridge, UK, 3 CDC, Atlanta, GA, USA Background: Point-of-care (POC) nucleic acid tests (NAT) could detect acute HIV infection, resolve discordant screening results, monitor patients taking pre- exposure prophylaxis (PrEP), and identify virologic failure among persons with HIV infection (PWH) on antiretroviral treatment (ART). Real-time communication of POC NAT results can improve HIV prevention and care. While the SAMBA II POC NAT is used in Europe and Africa, it has not been evaluated in the US. Methods: From June 2018 to August 2019, PWH and persons testing for HIV participated in Project DETECT, a study evaluating POC HIV tests in real-time. From June 2018 to March 2019, the SAMBA II Whole Blood Qual test [limit of detection (LOD) 400 copies/mL] was used for all participants. From April to August 2019, the Qual test was used on participants who had never been on ART and the SAMBA II Leukodepleted Whole Blood Semi-Q (LOD 1000 [range 500- 2000] copies/mL) test was used for PWH who had started ART. Both whole blood (WB) tests were performed on unprocessed venipuncture (VP) and finger-stick (FS) WB. Results fromWB tests and the SAMBA II Plasma Semi-Q test performed on frozen plasma from PWH were compared to Abbott RealTime HIV-1 PCR results (PCR) on plasma. Sensitivity, specificity, and concordance between tests were calculated. Results: SAMBA was used in 292 visits among 249 participants; 180 (62%) visits were from PWH, and 112 (38%) from persons testing HIV-negative. 58 PWH had undetectable RNA levels by PCR, 27 had detectable but unquantifiable levels, and 95 had quantifiable RNA levels with a median 7487 (IQR 576-89630) copies/ mL. The Qual test was used at 224 visits. Sensitivity of the Qual test among PWH with plasma RNA >400 copies/mL was 92% in VP and 97% in FS WB [Table]. Sensitivity of the Semi-Q test among ART-treated participants with RNA >1000 copies/mL was 100% in VP and FS WB. Specificity of the Qual test in ART-naive participants with RNA <400 copies/mL and persons testing HIV-negative was 100% in VP (n=111) and FS (n=9) WB. Four (8%) of 52 persons on ART with plasma RNA <1000 copies/mL (<20, 469, 608, and 949 copies/mL) had VP WB Semi-Q test results reported as >1000 copies/mL. Among PWH, the plasma Semi-Q had 96% and 95% concordance to WB and PCR results, respectively.

CROI 2020 358