CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: A VMMC service programwas highly effective in preventing HIV acquisition. The effectiveness of VMMC in this observational study is consistent with efficacy in clinical trials and support current recommendations that VMMC is a key component of combination HIV interventions and central to efforts to reduce HIV incidence.

84 (62%) participants were retained and 62 (74%) remained on PrEP. Over one-third (12/31) of those on study but off PrEP discontinued TDF/FTC due to self-reported side effects; one led to study discontinuation. Of 120 participants with drug concentrations measured, 67 (56%) had at least one protective concentration; 22 (18%) had consistently protective drug concentrations across all available study visits attended. For all visits, women with protective TFV-DP were more likely to have a higher proportion of positive iTAB responses compared to those with TFV-DP<1050 fmol/punch (p<0.05 at all visits except week 24). There were no incident HIV infections and 4 incident bacterial STIs. Conclusion: Cisgender women in a PrEP demonstration project had mixed adherence and retention; many had non-protective TFV-DP concentrations and over 25%were lost to follow up. US PrEP programs may need to consider offering prevention alternatives for women who discontinue or struggle with PrEP adherence. In particular, integrating PrEP delivery within other valued medical or social services may promote and augment HIV prevention efforts.

1038 “STYLISH MAN” CLUSTER RCT TO INCREASE MALE CIRCUMCISION FOR ADULT MEN ≥19, UGANDA Maria Wawer 1 , Godfrey Kigozi 2 , Stephen Mugamba 3 , Amos Zikusooka 2 , Joseph Kagaayi 2 , David Serwadda 2 , Anthony Ndyanabo 2 , Joseph Ssekasanvu 4 , Larry W. Chang 5 , Ronald H. Gray 1 1 Johns Hopkins Bloomberg School of Public Health; Rakai Health Sciences Program, Baltimore, MD, USA, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 Makerere University, Kampala, Uganda, 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5 Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: There is need to increase acceptance of voluntary medical male circumcision (VMMC) among men ≥19 years who are at highest risk of incident HIV, but who are under-represented in VMMC programs in sub-Saharan Africa. Methods: Between 2015-2018, we conducted a community cluster randomized trial (5 clusters per arm) to assess community promotion of voluntary medical male circumcision mobilization using a de-medicalized messaging intervention (the “Stylish Man”.) In the intervention arm, VMMC was provided via mobile camps alongside a 3-4 day “Stylish Man Event” (infotainment, games, testimonials by satisfied adopters and their partners, “red carpet” VMMC services for men >19 years, messages stressing VMMC as an adult lifestyle choice rather than just a health service), compared to control arm services provided via standard mobile VMMC camps of the same duration. The primary endpoint was the number and proportion of men aged >19 accepting VMMC services, and the population prevalence/incidence of VMMC among non-Muslim men ≥ 19 in three population-based Rakai Community Cohort Study surveys during the trial. Differentials between intervention and control arms were estimated using rate ratios (RR) and 95% confidence intervals (CI). Results: The number of men accepting VMMC in the intervention arm (5,992) was higher than in the control arm (4,394); also, the numbers and proportions of acceptors aged >19 was higher in the intervention (n=2,083, 34.8%, than the control arm (n=752, 17.1%, RR= 1.96, 95%CI 1.82-2.11); and the differential was statistically significant in all cluster pairs. The population prevalence of VMMC in men >19 increased over time in both arms and was significantly higher in the intervention compared to the control arm during the first follow up (RR=1.11, 95%CI 1.05-1.18.) The incidence of VMMC was also higher in the intervention arm during the first inter-survey interval (RR=1.71, 95%CI 1.43- 2.06), but not at later time points. Conclusion: Community mobilization/de-medicalized promotion increased VMMC uptake in men aged >19, as reflected in service statistics. Population- level VMMC prevalence in men >19 was initially higher in the intervention arm, but VMMC rates increased in both arms over time and the differential between arms was not sustained. Programs should consider demedicalized approaches to increase VMMC among older men. 1039 SEX AND THE PENILE MICROBIOME: POTENTIAL SHARING OF HIV RISK– ASSOCIATED ANAEROBES Cindy M. Liu 1 , Jessica L. Prodger 2 , Ronald M. Galiwango 3 , Godfrey Kigozi 3 , Aggrey Anok 3 , James Nnamutete 3 , Mathias Agaba 3 , Deo Male 3 , Yahaya Isabirye 3 ,

Poster Abstracts

1037 LONG-TERM EFFECTIVENESS OF VOLUNTARY MEDICAL MALE CIRCUMCISION FOR HIV PREVENTION

Gideon Loevinsohn 1 , Godfrey Kigozi 2 , Joseph Kagaayi 2 , Fred Nalugoda 2 , Larry W. Chang 1 , David Serwadda 2 , Steven J. Reynolds 3 , Gertrude Nakigozi 2 , Robert Ssekubugu 2 , Maria Wawer 2 , Aaron Tobian 1 , Ronald H. Gray 4 , Mary K. Grabowski 1 , for the Rakai Health Sciences Program 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 NIAID, Baltimore, MD, USA, 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: While the efficacy of male circumcision for HIV prevention was demonstrated in clinical trials, evidence on the long-term effectiveness of post- childhood circumcision through voluntary medical male circumcision (VMMC) programs in sub-Saharan Africa is limited. We assessed effectiveness of VMMC in preventing HIV acquisition in a President’s Emergency Plan for AIDS Relief (PEFAR) funded program in the Rakai region of Uganda using longitudinal data from the Rakai Community Cohort study (RCCS). Methods: A cohort of initially uncircumcised HIV-uninfected men in the RCCS were followed between 2009 and 2016 in 30 communities during scale-up of VMMC programs. Self-reported data on circumcision status was collected and rapid HIV tests were done at five surveys conducted every 18 months. Incident HIV infection was estimated to occur at the midpoint of the inter- survey interval. Multivariable Poisson regression with generalized estimating equations was used to estimate adjusted incident rate ratios (IRR) and 95% confidence intervals (CI) of HIV acquisition in circumcised versus uncircumcised men adjusting for sociodemographic characteristics and sexual behaviors. Results: 3,916 non-Muslimmen were followed for 17,088 person-years over 9,469 study visits. There were 1,338 newly reported VMMCs (10.79/100py) and 138 incident HIV infections (0.81/100py) observed. At baseline, men adopting circumcision were significantly younger and more likely to have never initiated sex, consistently use condoms, and to be unmarried compared to uncircumcised men. Over the study period, the median age of men adopting circumcision declined from 28 years (interquartile range [IQR]:21-35) to 22 years (IQR:18- 29; p-trend < 0.001). Overall, HIV incidence was 0.40/100 person-years (py) among circumcised men compared to 0.98/100 py among uncircumcised men (unadjusted IRR=0.4; 95% CI 0.25-0.66; adjusted IRR=0.47; 95% CI: 0.28-0.78). The effectiveness of circumcision for HIV prevention was sustained with increasing time from surgery (Figure) and was similar across age groups and calendar time.

CROI 2020 390