CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: HIV testing may serve as an entry point for youth to engage with the HIV prevention and care cascade. Several barriers have been identified for youth attending for facility based HIV testing, thereby delaying knowledge of their HIV diagnosis and subsequent linkage to care. Here, we assess the uptake of a HIV oral mucosal transudate (OMT) self-testing amongst youth attending tertiary level colleges in Zimbabwe. Methods: Youth aged 16-24 years of age, of unknown HIV status and not having had a HIV test in the past 3 months were offered an OMT HIV self-test. Distribution points were chosen through social mapping involving students and staff at tertiary level campuses in Harare and Masvingo, Zimbabwe. Youth had the option to perform the self-test onsite, unassisted, in a private booth or offsite in a location of their choice. From 16th July 2019, blood based confirmatory testing was offered on site using SD Standard Q HIV ½ Ab 4-Line® and Chembio HIV ½ Stat-Pak® in parallel. Linkage to care (either confirmation of reactive test or attendance for ART initiation) was determined through phone call follow up. Results: Distribution took place over 57 days in a three-month period, 2,760 youth received a self-test kit, 1,310 (63%) female, median age 21 years (IQR 20-23). In total, 1792 (65%) said they previously had sex, median number of partners in past one year, 1 (IQR 1-2), 1140 (65%) reported condom use at last sex. Close to one third (30%) of males had been circumcised. In total, 917 (33%) were first-time testers. Of those who had previously tested, 422 (23%) had used a HIV self-test kit. Overall, 1206 (44%) of youth said they had heard of a HIV self-testing before. In total, 1592 (58%) opted to test themselves offsite. Of those who received a test kit, 1637 (59%) reported their results, 29 (1.8%) were reactive. Of these, 6 reported confirmatory testing off site, 5 had confirmatory testing on site (n=4 of positive, n=1 negative), 2 refused confirmatory testing on site, the remainder were unreachable through phone contact. Conclusion: Community based HIV self-test distribution in tertiary colleges is an opportunity to reach youth who may be at risk of HIV acquisition. Given the low HIV prevalence, linkage to prevention services is key for those testing negative. Further research needs to invest in ensuring seamless linkage to care for those testing reactive. 957 IS AN UNASSISTED PHARMACY-BASED HIV SELF-TESTING STRATEGY IN MOZAMBIQUE SUFFICIENT? Caroline De Schacht 1 , Carlota L. Fonseca 1 , Paula Paulo 1 , Noela Chicuecue 2 , Anibal Fernando 3 , Jalilo E. Chinai 3 , Wilson Da Silva 1 , Sofia Viegas 4 , Sara Van Rompaey 1 , Aleny Couto 2 , C. WilliamWester 5 1 Friends in Global Health, Maputo, Mozambique, 2 Ministry of Health, Maputo, Mozambique, 3 Provincial Health Directorate, Quelimane, Mozambique, 4 Instituto Nacional de Saúde, Maputo, Mozambique, 5 Vanderbilt University, Nashville, TN, USA Background: HIV self-testing (HIVST) is a strategy recommended by WHO to increase testing, especially among key populations, men and young people. In May 2019, an HIVST pilot began in Zambézia province involving 14 public/ private pharmacies (4 urban, 10 rural), allowing clients to purchase up to two oral HIV self-tests at a subsidized price of 50Mzn (~$US 0.80). The study assessed the acceptability and use of this strategy. Methods: Exit-surveys were conducted in a random sample of 20 clients per pharmacy, independently from test purchase. A survey was also done for a random sample of up to 10 clients per pharmacy who bought a test and accepted being contacted later. Structured questionnaires were used assessing perceptions on HIVST; clients contacted after test purchase were additionally asked about its use. Analysis (X2-test) was done for each variable comparing clients who purchased versus not. Sales were monitored using pharmacy-based registers. Results: During the first 3 months, 517 adults purchased 603 tests (70%male, 41%<30 years). A total of 351 pharmacy clients participated in the surveys: 259 who did not buy a test and 92 who bought one. Median age was 29 years [IQR 23-37], 65%male, 60%married and 63%with a ≥12th grade education level. The most frequently reported advantage of HIVST was confidentiality, while primary disadvantages were lack of counseling and fear of test result (Table 1). Eighty-five (24%) clients found the test expensive. From the 92 who bought a test, 73 participated in the additional survey, of whom 67 (93%) performed the test. Self-reported easiness of test instructions and test performance was 34% and 45%, respectively. Almost all (97%) were confident in the result, but 27 (40%) felt they needed additional information or counseling. Before doing the test, 49% felt very anxious, and 37% felt very anxious after the test awaiting results. Self-test result was revealed by 40 (60%)

(one HIV-positive), with 15% reporting linking to a health facility to confirm their result. Conclusion: HIVST at public/ private pharmacies was successfully employed, reaching male and young people. The cost, although small, might be a barrier. The perceived lack of counseling is concerning, suggesting a need for specific tools at pharmacies and/or offering assisted testing. Moreover, to attain the first 95 of the UNAIDS 95-95-95 goals, other strategies (e.g. index-case HIVST) should also be considered.

Poster Abstracts

958 HIV SELF-TESTING AMONG KEY POPULATIONS AND SEXUAL PARTNERS OF NEW MOTHERS IN UGANDA Esther M. Nasuuna 1 , Florence Namimbi 1 , James Wanyama 1 , Alice Namale 2 , Martin Ssuuna 1 , Alex Muganzi 1 , Joanita Kigozi 1 1 Infectious Diseases Institute, Kampala, Uganda, 2 CDC Uganda, Kampala, Uganda Background: HIV self-testing (HIVST) was adopted for hard to reach populations (key populations and partners of pregnant and lactating women) in Uganda in September 2018. We report the preliminary findings from this program in Kampala, Uganda. Methods: HIVST was rolled out to 38 facilities in Kampala in September 2018 using two distribution approaches. The facility-based approach targeted sexual partners of pregnant and lactating mothers with unknown HIV status. Before giving HIVST kits to female participants, we provided information about performing an HIV self-test through demonstration and videos in the local language. Women distributed the kits to their partners. The community-based approach targeted key populations (KPs), including female sex workers (FSWs) and men who have sex with men (MSMs) with unknown HIV status. Trained peers were given test kits at the facility to distribute to clients at KP hotspots. Clients who accepted were recorded in access-restricted distribution logs. Self-testers were asked to report results within 2 days; clients from the facility and the community who didnot report results received a follow-up phone call from a trained health worker. Those who reported HIV-positive results were offered confirmatory testing using the standard HIV testing algorithm. Data on kits distributed from October 2018 to June 2019, target population, testing yield, and linkage to care were summarized and analyzed in Excel. Results: We distributed 9378 HIVST kits. In the facility, mothers received 5212 (56%) kits for their sexual partners. In the community, KPs received 4166 (44%) kits (MSMs, 2192 [53%]; FSWs, 1974 [47%]). Of the 9378 kits distributed, 9126 (97%) were HIV negative and 252 (3%) clients reported HIV-positive results: 74 (29%) were partners of mothers, 126 (50%) were FSW, and 52 (21%) were MSM. There were 17 (7%) known positives among those who reported. Of the 170 (67%) clients that returned for confirmatory HIV testing: 36 (49%) partners of mothers, 99 (79%) FSW, and 35 (67%) MSM. Linkage to treatment (126 [74%]) was <95% of the program target: 22 (61%) partners of mothers, 78 (79%) FSW, and 26 (74%) MSM. Fig 1 Conclusion: HIVST can identify patients with HIV among hard-to-reach populations. However, confirmatory testing and linkage to care are challenging.

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