CROI 2020 Abstract eBook
Methods: Working with the San Francisco Department of Public Health, we identified individuals with early HIV infection, many of whomwere on PrEP. The estimated date of detected infection (EDDI) was calculated; standard diagnostic and resistance testing was performed. Results: 58 participants (all men) with early HIV enrolled from 2015-2019. Most had sex with men (87%); median (IQR) age was 30 (25-37) years; pre-ART CD4 508 (355-680); log plasma HIV RNA 5.1 (4.1-5.7); time between EDDI and ART 29 (20-91) days. Among 24 with PrEP exposure, 13 (54%) reported prior use (>10 days pre-diagnosis), 6 (25%) active use (≤10 days pre-diagnosis), and 5 (21%) were found to have HIV on the day of PrEP initiation. The 6 reporting active PrEP at diagnosis had lower initial log plasma HIV RNA (2.8 vs 5.3, p=0.001) and higher CD4 (768 vs 488, p=0.03) than the 52 not on PrEP. The remaining analyses focus on those on active PrEP and those positive at PrEP initiation (n=11, Table). HIV Ab screening was positive in only 4/11 (36%). HIV RNA was detected in all cases, although <100 copies/mL in one and <20 copies/mL in two. Of these two, one had a newly positive Ab/Ag test, with cell-associated (CA)-DNA not detected and CA-RNA 117 copies/10 6 cells. The second had a negative Ab/Ag test and analysis of 25M PBMCs did not show CA-DNA or CA-RNA despite transiently detectable HIV RNA on clinical assays. Of the 8/11 who could have genotypic resistance testing, three had M184V/I mutations, with two transmitted and one emerging after 5 days on PrEP. Conclusion: Increasingly widespread PrEP use may result in distinct and challenging presentations of HIV infection. We present the largest case series of early (or pre-existing) HIV on PrEP, with resultant blunting of immune responses and viral loads. Those presenting with delayed evidence of infection may be continued on PrEP, resulting in suboptimal treatment and development of resistance. In some cases, diagnostic uncertainty will arise regarding whether infection was prevented or established with a more limited reservoir. Further characterization of infections during PrEP is needed.
median age was 25 years (IQR: 22-30), 44%were women, and median weekly income was US$13.60 (IQR: $8.16-21.76). Baseline characteristics were similar across arms. Among participants randomized to deposit contracts, 24 (14%) made a baseline deposit, and 2 (1%) made a 3-month deposit. In intent-to-treat analyses, the proportion of participants who retested for HIV at both 3 and 6 months was higher in the incentive arm (52%) than either the control arm (18%, p<0.001) or the deposit contract arm (16%, p<0.001; Figure). Among those in the deposit contract armwho made a baseline deposit, 83% retested at 3 months, and 46% retested at both 3 and 6 months. Those who made baseline deposits were significantly more likely to retest at 3 and 6 months than those who declined (46% vs. 11%, p<0.001). Seven participants seroconverted during the trial and were immediately referred for antiretroviral therapy Conclusion: Offering financial incentives to high-risk adults in Uganda resulted in significantly higher HIV retesting. Deposit contracts to help individuals follow through on a commitment to retesting had low uptake and overall did not increase retesting rates.
COMMUNITY-BASED HIV TESTING IN URBAN KENYA: A STRATEGY TO REACH MEN AND YOUTH Hong-Ha M. Truong 1 , A. Rain Mocello 1 , David Ouma 2 , Dena Bushman 1 , Kevin Kadede 2 , Eric Ating'A 2 , Dancun O. Obunge 2 , Elizabeth A. Bukusi 3 , Francesca Odhiambo 1 , Craig R. Cohen 1 1 University of California San Francisco, San Francisco, CA, USA, 2 KEMRI-UCSF, Kisumu, Kenya, 3 Kenya Medical Research Institute, Nairobi, Kenya Background: Some countries are struggling to reach the UNAIDS testing target, especially among men and youth. Randomized controlled trials and HIV testing services (HTS) have successfully conducted community-based hybrid HIV testing in rural settings in East Africa to identify persons unaware of their HIV-positive status and achieve testing saturation. We implemented a hybrid HIV testing approach in an urban slum setting in Kisumu, Kenya. Methods: The Community Health Initiative (CHI) conducted community mapping, household census, multi-disease community health campaigns (CHCs) and home-based tracking in Obunga in 2018. To encourage participation by men and youth, health and counseling services tailored for themwere provided. HTS eligibility (not previously diagnosed HIV-positive, aged >=15 years, sexually- active <15 years) and antiretroviral therapy (ART) initiation were based on 2018 national guidelines. We calculated the previously unidentified fraction (PUF), a newmetric, as the proportion of newly identified PLWH out of all previously identified and newly identified PLWH. Results: CHI reached a total of 23,584 persons: 21,364 enumerated residents and 2,220 nonresidents. There were 22,685 persons engaged through CHCs and tracking. Of 12,768 HTS-eligible persons, 12,407 (97%) accepted testing, of whom 3,917 (32%) were first-time testers. First-time testers were more likely to be men (AOR=1.1; p<0.03) and adolescents aged 15-19 years (AOR=2.8; p<0.01). There were 100 newly identified PLWH out of 1,247 total HIV-positive persons, representing an 8.0% PUF. The PUF was higher among men (9.8%) and youth aged 15-24 years (13.1%). Ninety-four percent of newly diagnosed persons initiated same-day ART. Conclusion: The community-based hybrid HIV testing approach was implemented successfully for the first time in an urban setting characterized by a high risk, impoverished and highly mobile population. CHI identified persons previously unaware of their HIV-positive status, thereby enabling linkage to care and same-day treatment and reducing onward transmission risk. Innovative approaches that make HIV testing more accessible and acceptable to the
141 A RANDOMIZED TRIAL OF INCENTIVES AND DEPOSIT CONTRACTS TO PROMOTE HIV RETESTING Dalsone Kwarisiima 1 , Alex Ndyabakira 1 , Kara Marson 2 , Carol S. Camlin 2 , Diane V. Havlir 2 , Moses R. Kamya 3 , Harsha Thirumurthy 4 , Gabriel Chamie 2 1 Infectious Diseases Research Collaboration, Kampala, Uganda, 2 University of California San Francisco, San Francisco, CA, USA, 3 Makerere University College of Health Sciences, Kampala, Uganda, 4 University of Pennsylvania, Philadelphia, PA, USA Background: Retesting for HIV in high-risk populations is critical for identifying newly infected persons and promoting prevention services. Whether standard financial standard incentives and less costly deposit contracts can increase retesting for HIV among at-risk adults is unknown. Methods: In a peri-urban Ugandan community, we recruited persons at-risk for HIV from selected venues (bars, sites of commercial sex work, and transport hubs) and referred them for clinic-based HIV testing. HIV-negative adults (18-59 years old) with self-reported risk (either >1 partner, HIV-infected partner, sexually transmitted infection, or payment/receipt of compensation for sex) were enrolled. Participants were randomized to either: (1) no incentive (control); (2) cash incentives (US$7) for retesting at 3 and 6 months (total $14); or (3) deposit contracts that leveraged loss aversion: participants could voluntarily deposit $5.50 at baseline and at 3 months that would be returned with interest (total US$7) upon retesting at 3 and 6 months respectively (total $14) or lost if participants failed to retest. The primary outcome was retesting for HIV at both 3 and 6 months. Results: A total of 524 participants were randomized to either no incentive (N=180), incentives (N=172), or deposit contracts (N=172). Participants’
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