CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1096 HOW SHOULD WE PRIORITIZE AND MONITOR INTERVENTIONS TO END HIV EPIDEMIC IN AMERICA? Kevin P. Delaney 1 , Samuel Jenness 2 , Jordan A. Johnson 2 , Dawn K. Smith 1 , Karen W. Hoover 1 , Norma Harris 1 , Elizabeth DiNenno 1 1 CDC, Atlanta, GA, USA, 2Emory University, Atlanta, GA, USA Background: The goal of the US Ending the HIV Epidemic (EHE) plan is to reduce HIV incidence by 90% over the next decade. This initiative will direct a major scale-up of many prevention and care activities in high-burden areas. An important aspect for local jurisdictions will be the ability to monitor changes in their local HIV epidemic to ensure progress. Models can help informwhat changes in potential indicators to expect as prevention interventions are implemented. Methods: We developed a stochastic network-based HIV transmission model for men who have sex with men (MSM)‚ calibrated to current surveillance-based estimates of HIV prevalence‚ PrEP use‚ and HIV care continuum levels in the Atlanta area (Baseline). Two counterfactual scenarios increased HIV screening rates to annual and quarterly. Additional scenarios included increases of 10x for ART retention relative to empirical rates‚ with and without increases in screening. Changes in HIV incidence and indicators readily available to local HIV surveillance programs – new HIV diagnoses and the proportion of those that were acute infections – were assessed for 10 years following implementation. Results: Compared to current HIV screening rates‚ increasing HIV screening to annual or quarterly for all MSM would lead to approximately 97% and 99% of all extant HIV infections (among this risk group) being diagnosed. By year 5 of the intervention new diagnoses (dashed lines) would correspond directly with the unobserved true HIV incidence (solid lines) in all scenarios (Figure). The more rapid the build-up of HIV testing‚ the more quickly new diagnoses approximate HIV incidence‚ with an increase to quarterly testing leading to new diagnoses matching true incidence by year 3. The proportion of all new HIV diagnoses identified while acute increased with testing frequency from approximately 2% at baseline‚ to approximately 8% and 26% of all diagnoses with annual and quarterly rescreening. However‚ reductions in incidence through other mechanisms such as improved retention on ART do not increase the proportion identified while acutely infected. Conclusion: These results suggest one strategy for jurisdictions seeking to simultaneously reduce HIV incidence and improve their ability to track their epidemic would be to dramatically increase HIV screening in the earliest stages of elimination efforts. This should lead to an initial dramatic increase in new diagnoses, after which new HIV diagnoses would accurately measure incident HIV infections

1097 HIV CARE CASCADE: MEN WHO HAVE SEX WITH MEN & TRANSGENDER WOMEN/GENDERQUEER, ZIMBABWE Tiffany Harris 1 , Lauren Parmley 1 , Munyaradzi Mapingure 1 , Owen Mugurungi 2 , John H. Rogers 3 , Tsitsi Apollo 2 , Getrude Ncube 2 , Elizabeth Gonese 3 , Brian K. Moyo 2 , Perpetua Gozhora 1 , Godfrey Musuka 1 , Sophia Miller 1 , Yingfeng Wu 1 , Avi Hakim 4 , Innocent Chingombe 1 1 ICAP at Columbia University, New York, NY, USA, 2 Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe, 3 CDC, Harare, Zimbabwe, 4 CDC, Atlanta, GA, USA Background: Men who have sex with men (MSM) and transgender women/ genderqueer individuals (TGW/GQ) are at greater risk for HIV than the general population and face stigma and other barriers to receiving HIV services. However, little HIV data is available among these groups in Zimbabwe. We examined progress toward the 90-90-90 treatment targets (90% of HIV-positive persons know their status; of these, 90% are on antiretroviral treatment [ART]; and of these, 90% have viral load suppression [VLS]) among a sample of MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe. Methods: We used respondent-driven sampling to identify MSM and TGW/GQ individuals aged 18+ to participate in a biobehavioral survey in 2019. Consenting participants completed a questionnaire that obtained sociodemographic and HIV-related data and underwent HIV and viral load testing. VLS was defined as HIV RNA <1000 copies/mL. Univariate analyses were used to calculate sample estimates, as data did not reach convergence. Results: In Harare, 416 MSM and 279 TGW/GQ received HIV testing (97% of participants). Median age was 24 years. HIV prevalence was 21.4% (MSM, 17.1%; TGW/GQ, 28.0%); of those testing positive, 61.7% (MSM, 69.0%; TGW/GQ, 55.1%) had VLS. Among those testing HIV-positive, 34.9% (MSM, 33.8%; TGW/GQ, 35.9%) reported knowing their status; of these, 90.4% (MSM, 91.7%; TGW/GQ, 89.3%) reported using ART; and of these, 83.0% (MSM, 81.8%; TGW/GQ, 84.0%) had VLS. In Bulawayo, 760 MSM and 56 TGW/GQ received HIV testing (>99% of participants). Median age was 26 years. HIV prevalence was 23.4% (MSM, 23.3%; TGW/GQ, 25.0%); of those testing positive, 61.3% (MSM, 61.6%; TGW/GQ, 57.1%) had VLS. Among those testing HIV-positive, 52.9% (MSM, 53.7%; TGW/ GQ, 42.9%) reported knowing their status; of these, 95.1% (MSM, 94.7%; TGW/ GQ, 100.0%) reported using ART; and of these, 80.2% (MSM, 78.9%; TGW/GQ, 100.0%) had VLS. Conclusion: HIV prevalence was higher in sampled MSM and TGW/GQ than that in the general male population aged 15-64 years in both Harare (11.1%) and Bulawayo (16.1%). Self-reported awareness of HIV status was lower among MSM and TGW/GQ than among the general adult male population (68.3%) in Zimbabwe. HIV-positive participants who knew their status had high ART coverage and high VLS, indicating strong linkage to care and retention on treatment in this subgroup. Improvements in testing are needed among MSM and TGW/GQ, and programs could consider innovative approaches to optimize case finding among these populations.

Poster Abstracts

CROI 2020 413