CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

CI 1.1-1.9, p=0.03). Among individuals with ART information (3,505), those who tested HIV-positive in EDs less frequently initiated same-day ART compared to VCT/other PITC (71% vs 82%, PR=0.9, 95% CI 0.8-1.0, p=0.003). Conclusion: HIV testing was successful within EDs in Botswana and yielded higher frequency of detecting undiagnosed HIV infections than VCT or other PITC; however, immediate ART initiation was less frequent. ED HIV testing programs should strengthen linkage to care for those who test positive.

1127 COMMUNITY HIV-PREVENTION SERVICES IMPROVE THE HIV TREATMENT CASCADE IN 5 COUNTRIES Mansoor S. Farahani 1 , Andrea Low 1 , Karampreet K. Sachathep 1 , Neena M. Philip 1 , Wolfgang Hladik 2 , Andrew Voetsch 2 , Godfrey Musuka 3 , Andrew F. Auld 4 , Shirish Balachandra 5 , Jackson Okuku 6 , Amee M. Schwitters 7 , Bharat S. Parekh 2 , Hetal Patel 2 , David Hoos 1 , Jessica E. Justman 1 1 ICAP at Columbia University, New York, NY, USA, 2 CDC, Atlanta, GA, USA, 3 ICAP at Columbia Universtiy, Email institution information to CROIabstracts@iasusa.org, 4 CDC Malawi, Lilongwe, Malawi, 5 US Centers for Disease Control and Prevention, Atlanta, GA, USA, 6 CDC Zambia, Lusaka, Zambia, 7 CDC Nigeria, Abuja, Nigeria Background: The effect of using HIV prevention services on using HIV treatment services has not been well documented in southern Africa. Using nationally representative data from household surveys conducted in Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe (2015–2017), we examined the correlation of self-reported voluntary medical male circumcision (VMMC) and condom use among HIV-negative adults with use of treatment services by people living with HIV (PLHIV), represented by the UNAIDS 90-90-90 targets, at the community level. Methods: Among HIV-negative adults in the surveys, we estimated the prevalence of self-reported VMMC status and condom use (during last sexual act in the prior 12 months) at the smallest geographic sampling unit (enumeration area [EA]). We used multilevel mixed-effects logistic regression, adjusted for demographic and risk behavior variables at individual level to estimate the correlation between VMMC and condom use at the EA level with the likelihood of PLHIV being aware of their status, currently on ART, or virologically suppressed (VS). Results: Among 10,861 PLHIV aged 15–64 years (62%women) residing in 1,734 EAs across surveys, 76% had a previous HIV diagnosis, 68%were receiving ART, and 60%were VS. Median EA-level prevalence of HIV infection, VMMC, and condom use was 16% (interquartile range [IQR], 10%–24%), 16% (IQR, 6%–32%), and 72% (IQR, 55%–88%), respectively. On multilevel analysis, the odds of knowing HIV-positive status, receiving ART, or being VS were significantly higher for PLHIV residing in an EA where ≥75% of the adults reported condom use (adjusted odds ratio [AOR], 1.3 [95% confidence interval (CI), 1.2–1.5]; 1.3 [95% CI, 1.1–1.4]; 1.2 [95% CI, 1.1–1.3], respectively). The odds of knowing HIV-positive status, receiving ART, or being VS were significantly higher for PLHIV residing in an EA where ≥15% of men reported VMMC (AOR, 1.2 [95% CI, 1.1–1.3]; 1.1 [95% CI, 1.0–1.3]; and 1.1 [95% CI, 1.0–1.2], respectively). Conclusion: In these five countries, community utilization of prevention services was positively correlated with the individual use of treatment services, suggesting that combination prevention services can play a synergistic role in epidemic control.

Poster Abstracts

1126 COMBINATION HIV PREVENTION STRATEGIES TO MEET THE 2030 ENDING THE HIV EPIDEMIC GOALS Samuel Jenness 1 , Jordan Johnson 1 , Karen W. Hoover 2 , Dawn K. Smith 2 , Kevin P. Delaney 2 1 Emory University, Atlanta, GA, USA, 2CDC, 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 prevention and care activities in high-burden areas like the Southeast US. It is unknown what interventions, alone or in combination, will have the greatest impact towards meeting the EHE 2030 targets. Methods: We developed a stochastic network-based HIV transmission model for men who have sex with men (MSM) stratified by race. Our model was calibrated to current surveillance-based estimates of HIV prevalence, PrEP utilization, and HIV care continuum levels in the Atlanta area. Counterfactual model scenarios varied HIV screening rates relative to empirical levels, under assumptions that HIV-negative screens are linked to PrEP initiation versus no PrEP linkage, and also relative improvements to HIV care linkage and care retention for those testing HIV-positive. Results: Compared to current HIV screening rates, a ten-fold relative increase (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 41.2% of infections averted under the assumption of PrEP linkage, with prevention through both increased PrEP coverage (from 14.9% to 67.0%) and increased HIV viral suppression (from 48.9% to 55.8% of all infected). At the same relative increase in screening but under the assumption of no PrEP linkage, 9.9% of infections would be averted, with prevention only through increased viral suppression. HIV care linkage, even if immediate upon screening HIV-positive, would have a negligible effect on infections averted (0.2%). Improvements to HIV care retention could avert 33.5% of infections if retention rates were improved 10-fold, through increased viral suppression (from 48.9% to 79.6% of all infected). If both screening and retention were jointly improved up to 10-fold (Figure), 66.6% and 47.9% of infections would be averted under assumptions of PrEP linkage and no-linkage, respectively. Conclusion: Interventions to improve HIV screening linked with PrEP for those screening negative and HIV care retention would have the largest impact on HIV incidence. Additional interventions beyond these improvements to HIV screening, PrEP coverage, and HIV care retention will be necessary to reach the EHE targets.

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