CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1094 WITHDRAWN Social Network Strategy for HIV Testing and Prevention in General Population, Nairobi County, Kenya Javies N Joel 1 , Rebecca Wangusi 1 , Jonathan Mwangi 2 , Patrick Awuor 1 , Emmah Momanyi 1 , Robert Mulwa 1 , Caroline Muthamia 1 , Bernard Odhiambo 1 , Joseph Mwangi 1 , Antony Kiplagat 3 , Sam Wafula 1 , Immaculate Mutisya 2 , Emily Koech 1 1 Centre for International Health, Education, and Biosecurity (CIHEB), Nairobi, Kenya, 2 US Centers for Disease Control and Prevention Nairobi, Nairobi, Kenya, 3 Nairobi City County, Nairobi, Kenya Background: Nairobi County has 5.9% HIV prevalence rate with 167,446 people living with HIV (PLHIV). Only 89% of PLHIV know their HIV status. To enhance HIV identification, Social Network Strategy (SNS) becomes key in in reaching individuals at elevated risk of HIV acquisition. It enlists newly diagnosed PLHIV or those at high-risk of HIV acquisition (seeds). These seeds are used to identify and refer individuals at risk in their social networks for HIV testing services (HTS). This study presents SNS results in general population beyond its past use among key populations. Methods: We implemented SNS for the general population in 42 facilities supported by CDC funded CIHEB CONNECT project in Nairobi County. The process included 4 phases; seed identification, seed instruction, recruitment of network members, and HTS for network members. Seed types included were newly diagnosed PLHIV, HIV negative clients at high risk of HIV acquisition, and peer educators. We conducted a retrospective descriptive analysis of programmatic patient-level data abstracted from HTS and SNS registers. Results: From January 2021 to December 2022, we enrolled 2777 (1735 females, 1042 Males) seeds with a mean age of 31.9 years (SD= 8.87). The seeds included 1259 (45%) HIV negative individuals at risk of HIV acquisition, 1258 (45%) newly diagnosed PLHIV, and 272 (10%) peer educators. Among network members, 4611 were recruited (2606 (57%) females and 2005 (43%) Males). A total of 197 (4.3%) of network members had a known positive HIV status while 4414 (95.7%) had a previous HIV negative or unknown status. Among the 4414 members with a previous negative or unknown HIV status, 3324 (75%) were tested (1906 females and 1418 males) yielding a HIV positivity rate of 5.9% (197 members positive150 females and 47 males). Females were more likely to test HIV positive as compared to males (7.9% versus 3.3%, p=0.007), and positivity was highest among those recruited by peer educators as compared to those recruited by individuals at high HIV risk acquisition and new HIV-positive clients (15.8%, 5.1% and 4.5% respectively, p=0.011). For those who tested HIV-positive, 184 (93%) were initiated on antiretroviral therapy and 657 (21%) of 3127 who tested HIV negative were initiated on pre-exposure prophylaxis (PrEP). Conclusion: SNS is effective in mobilizing individuals at high-risk of HIV acquisition for HTS with linkage to ART or PrEP. It provides an opportunity for scale up of HTS and prevention services in the general population. 1095 Community Network Driven COVID-19 Testing of Vulnerable Populations in the Central US: A RADx-UP RCT En-Ling Wu 1 , Xiaoquan Zhao 2 , Makenna Meyer 1 , Ellen Almirol 1 , Gjvar Payne 3 , Kavita Bhavan 4 , Nickolas Zaller 5 , Jerome Montgomery 6 , Anna Hotton 1 , Russell Brewer 1 , Michelle Johns 7 , Matthew Aalsma 8 , Amelia Knopf 8 , Faye Taxman 2 , John Schneider 1 , for the C3 Investigators 1 University of Chicago, Chicago, IL, USA, 2 George Mason University, Fairfax, VA, USA, 3 Capitol Area Reentry Program Inc, Baton Rouge, LA, USA, 4 University of Texas Southwestern, Dallas, TX, USA, 5 University of Arkansas for Medical Sciences, Little Rock, AR, USA, 6 Project VIDA, Chicago, IL, USA, 7 NORC at the University of Chicago, Chicago, IL, USA, 8 Indiana University, Bloomington, IN, USA Background: Community Network Driven COVID-19 Testing of Vulnerable Populations in the Central US (C3) is a multi-site Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP) study designed to evaluate an intervention combining Social Network Strategy (SNS) with COVID-19 prevention education messages to improve COVID-19 testing and vaccination among criminal legal involved and/or low-income Hispanic community members most impacted by COVID-19. Methods: C3 enrolled participants through peer referral across 8 study sites in the central United States – Texas, Louisiana, Arkansas, Indiana and Illinois – from April 2021 to December 2022. Participants were randomized 1:1 to the SNS arm, or to the SNS+messaging arm which included a staff-led activity to affirm participants' values and beliefs plus an educational video aiming to correct misinformation about testing and vaccination. Follow-up assessment for COVID-19 testing (primary outcome) and/or vaccination (secondary outcome among unvaccinated participants) was completed 3 weeks after baseline. Bivariate analyses were used to compare participant characteristics across

the proportion of a region's total HIV cases detected at Title X clinics. Regions were classified as high and low exposure to the Policy based on net loss of Title X clinics in 2019 (over 25% vs. under 25% of clinics). Multilevel linear regression modeling was used to examine interactions between Policy exposure and pre- and post-Policy implementation for HIV outcomes. Adjustment variables included demographic data on Title X clients and state-level metrics from 2018. Results: Title X clinics provided an annual average of 913,903 HIV tests and diagnosed 7.1% of the country's HIV cases (regional range 3.1% - 12.5%) from 2016-2021. High exposed regions provided 611,276 more HIV tests and diagnosed 1.3% more HIV cases than low exposed regions pre-Policy and provided 433,115 fewer HIV tests and diagnosed 2.3% fewer HIV cases than low exposed regions post-Policy. Interaction models showed HIV testing in high exposure regions declined significantly compared to low exposure regions from pre- to post- Policy (β -69,626 95% CI [-108,893, -30,359], p<.01) and Title X clinics in high exposure regions identified a significantly smaller proportion of the region's total HIV cases compared to low exposure regions from pre- to post-Policy (β -0.04, 95% CI [-0.07, 0.00], p=.05). Conclusion: The 2019 Policy had a notable negative effect on HIV testing and diagnoses in the Title X program. These results extend the known negative health consequences of the Policy to include HIV-related outcomes. Established sexual and reproductive health providers in the Title X program are a key provider of HIV services; anti-abortion policies that endanger the Title X network also threaten to weaken the U.S. HIV response. 1093 HIV Outcomes Among Partners Reached by Phone vs In-Person for Assisted Partner Services in Kenya Unmesha Roy Paladhi 1 , Edward Kariithi 2 , George Otieno 3 , James P. Hughes 1 , Harison Lagat 1 , Monisha Sharma 1 , Sarah Masyuko 1 , Paul Macharia 4 , Rose Bosire 5 , Mary Mugambi 6 , Carey Farquhar 1 , David Katz 1 1 University of Washington, Seattle, WA, USA, 2 PATH, Nairobi, Kenya, 3 PATH, Kisumu, Kenya, 4 Kenyatta National Hospital, Nairobi, Kenya, 5 Kenya Medical Research Institute, Nairobi, Kenya, 6 Ministry of Health, Nairobi, Kenya Background: Assisted partner services (APS) are an effective strategy for identifying and testing people with undiagnosed HIV and traditionally conducted primarily by phone with in-person contact for those unreachable by phone. However, less is known about the characteristics or HIV outcomes of those reached by different methods of contact. Methods: We analyzed data from 31 facilities in Kenya providing APS to female index clients newly diagnosed with HIV, their male partners, and female partners of those men testing newly HIV-positive. APS providers attempted to contact partners using phone first if a number was available and, if unsuccessful after three phone calls, traced partners in-person in the community. Using log-linear mixed models, we estimated relative risks (RR) between phone being the final (successful) contact method for notification and demographic characteristics (age, sex, income, education, key population membership, and clinic urbanicity) and HIV outcomes (testing, first-time testing, new diagnosis, and linkage to care, adjusting for age and sex). Results: From May 2018-March 2020, 2534 female index clients named 7614 male partners, of whom 772 (10.1%) tested positive and named an additional 4956 non-index female partners. Overall, we reached 11,912 (94.7%) partners, 5179 (43.5%) via phone and 6733 (56.5%) in-person. Among reached partners, being male (RR:1.25, 95% Confidence Interval [CI]:1.17-1.35) and completing secondary education or higher (RR:1.22, 95%CI:1.09-1.36) was associated with successful contact by phone. Of the 11,912 partners eligible for testing (reached by APS and no prior HIV diagnosis), 99.7% tested and 11.2% first-time tested. Of those tested, 13.1% received a new diagnosis, of whom 87.0% linked to care. Partners who received a new diagnosis were less likely to have been reached by phone vs. in-person (9.8% vs. 15.9%; adjusted RR:0.61, 95%CI:0.53-0.70). Being reached by phone was not significantly associated with testing, first-time testing, or linkage to care. Conclusion: In an APS program that reached 94% of elicited partners, fewer than half were successfully contacted by phone only. Men and those with higher education were more likely to be reached by phone, and partners receiving a new HIV diagnosis were more likely to be contacted in-person. Although phone-based tracing may reduce resources required for APS, a combined phone and in-person approach is likely essential to maintain a successful and equitable program.

Poster Abstracts

CROI 2024 354