CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1101 User-Friendly and Efficient Multiplex HIV, Syphilis, and Hepatitis B & C Self-Screening in Thailand Nicolas Salvadori 1 , Jullapong Achalapong 2 , Thitipan Akarasereenont 3 , Sawitree Nangola 4 , Chiraphat Kloypan 4 , Eakkapote Prompunt 4 , Naruepon Wongpluesin 5 , Surachet Arunothong 6 , Woottichai Khamduang 1 , Nicole Ngo Giang-Huong 7 , Sakorn Pornprasert 1 , Sumet Ongwandee 6 , Gonzague Jourdain 1 , for the Napneung Project Team 1 Chiang Mai University, Chiang Mai, Thailand, 2 Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, 3 STIs Clinic of the Office of Disease Prevention and Control Region 1 , Chiang Mai, Thailand, 4 University of Phayao, Phayao, Thailand, 5 Mae Lao Hospital, Mae Lao, Thailand, 6 Ministry of Public Health, Nonthaburi, Thailand, 7 Institut de Recherche pour le Développement, Chiang Mai, Thailand Background: Affordable and reliable rapid test kits pave the way for widespread screening. However, it is crucial that the process be user-friendly, quick, confidential, cost-effective and include medical support when needed. It should also save healthcare workers (HCW) time. The Napneung project is working towards efficient HIV screening methods. Methods: The Napneung project offers free and anonymous self-screening for HIV, syphilis and hepatitis B and C at five locations in northern Thailand to anyone aged ≥15 years. The medical team in collaboration with IT specialists developed an advanced web app, available in several languages, to automate most processes: online appointments to avoid queues and waiting times, instructions for user-guided self-screening, and standardized information provided on sexually transmitted infections while awaiting results. The app allows a HCW to assist multiple users at once. Only two drops of blood from a finger prick are needed to screen for the four infections. If a test is positive, confirmatory tests are performed, then post-test counseling and personalized referral for evaluation and treatment are provided. High-risk HIV-negative users are encouraged to start PrEP and re-test regularly. For demand creation, the service is promoted online through social media and search engines, and offline through posters and vouchers. No incentives are offered. Results: 16,753 screening sessions were provided to 12,175 users between Oct 19, 2015 and Jun 7, 2023. 49% of users were male at birth, 45% were aged 15-24 years, 17% reported being MSM or transgender women, and 63% had never tested for HIV. Median (interquartile) time from arrival to reading of test results was 36 (30-44) minutes. >99% reported being satisfied with the self-screening process. 222 (1.7%, excluding those already aware) were newly diagnosed with HIV (50% had never tested for HIV, and 62% were MSM or transgender women), 230 (1.9%) with syphilis, 193 (1.6%) with hepatitis B and 67 (0.5%) with hepatitis C. The relatively high median CD4 count at diagnosis (370 cells/ mm 3 , versus 200 nationwide) and recency assay testing showed that the service is used shortly after HIV acquisition. 95% of users newly diagnosed with HIV subsequently confirmed that they initiated treatment. Conclusion: This effective, well-received and affordable system saves time for HCW and users. Associating multiplex tests with IT resources enables the integration of efforts to fight these four chronic infections without additional burden. 1102 Effectiveness of Using HIV Self-Tests as an Incentive for Testing Within Assisted Partner Services Unmesha Roy Paladhi 1 , David Katz 1 , George Otieno 2 , James P. Hughes 1 , Harsha Thirumurthy 3 , Harison Lagat 1 , Sarah Masyuko 1 , Monisha Sharma 1 , Paul Macharia 4 , Rose Bosire 5 , Mary Mugambi 6 , Edward Kariithi 7 , Carey Farquhar 1 1 University of Washington, Seattle, WA, USA, 2 PATH, Kisumu, Kenya, 3 University of Pennsylvania, Philadelphia, PA, USA, 4 Kenyatta National Hospital, Nairobi, Kenya, 5 Kenya Medical Research Institute, Nairobi, Kenya, 6 Ministry of Health, Nairobi, Kenya, 7 PATH, Nairobi, Kenya Background: There is a need for interventions to increase the success of offering HIV self-testing (HIVST) within assisted partner services (APS) in low resource settings. Financial incentives have shown success in increasing HIV testing rates but results on non-monetary incentives remain mixed. We investigated the effectiveness of offering an additional HIV self-test as an incentive to increase HIV testing among partners receiving APS in Kenya. Methods: We conducted a single crossover study nested within a cluster randomized controlled trial at 24 facilities in western Kenya. 12 control sites offered only provider-delivered testing to partners of index clients with HIV for one year. 12 intervention sites, in addition to provider delivered testing, offered partners the opportunity to pick up a HIVST at a local pharmacy during the first six months (pre-implementation), then during the next six months (post-implementation) the sites switched to offering two HIVSTs. A difference in-differences approach using generalized linear mixed models, accounting

for clustering by facility and adjusting for age, sex, and income, was used to estimate the effect of the incentive of two HIVSTs on overall and first-time testing among APS partners who reported no prior HIV diagnosis. Results: From March 2021-June 2022, 1127 index clients received APS and named 8155 partners, of whom 2333 reported a prior HIV diagnosis and were excluded from analyses, resulting in 5822 remaining partners: pre implementation, 1489 (40.8%) and 2157 (59.2%) partners were in the control and intervention arms, and post-implementation, 815 (37.5%) and 1361 (62.5%) partners were in the control and intervention arms. Pre-implementation, 1422/1489 (95.5%) in the control arm tested for HIV versus 2111/2157 (97.9%) in the intervention arm; post-implementation the numbers were 699/815 (85.8%) and 1204/1361 (88.5%) in the control and intervention arms. Comparing partners offered one vs. two HIVSTs showed no difference in HIV testing (DID relative risk [RR]:1.01, 95%Confidence Interval [CI]:0.951-1.07) or first-time testing (DID RR:1.23, 95%CI:0.671-2.24). Of partners offered a second HIVST, 940/1204 (78.1%) opted for HIVST, 322/940 (34.3%) picked up two kits, and 231/322 (71.7%) reported that the second kit encouraged HIV testing. Conclusion: Offering a second HIVST to partners of index clients as an incentive within APS did not significantly impact HIV testing or first-time testing, likely since HIV testing rates were already high at baseline. 1103 Increased HIV RNA Testing of PrEP Users Following 2021 CDC Guidance: United States, 2019-2023 Weiming Zhu , Ya-Lin A. Huang, Kevin Delaney, Athena Kourtis, Karen W. Hoover Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Persons using PrEP can have ambiguous HIV test results for viral inhibition during use that might delay the diagnosis of HIV infection. In December 2021, CDC recommended HIV RNA nucleic acid testing (NAT) in addition to HIV antigen/antibody (Ag/Ab) testing at initiation of long-acting cabotegravir injections (CAB-LA), and for follow-up testing of users of all PrEP regimens. We estimated the impact of CDC guidance on combined HIV RNA-Ag/ Ab testing associated with PrEP use in the U.S. Methods: We analyzed data in the HealthVerity database of longitudinally linked prescriptions and HIV testing laboratory data from 2019 through June 2023. We identified persons prescribed oral or injectable PrEP and extracted their HIV testing records. A combined test is defined as Ag/Ab and RNA tests ordered within an interval of less than 7 days. We defined testing at PrEP initiation if it occurred ±7 days from the first prescription, and testing for follow-up if it occurred from 30 days after the first prescription to 14 days after the end of the last prescription. For oral PrEP users, we estimated the rate of combined testing among patients' follow-up testing pre- and post-2021 CDC guidelines. For CAB-LA users, we estimated the rate at PrEP initiation or follow up in the post-2021 guideline period. Results: We identified 10,856 oral PrEP users with follow-up testing during the pre-2021 guideline period; 552 (5%) received combined testing, 613 (6%) had NAT only, and 9,592 (88%) had Ag/Ab testing only. During the post- updated guideline period, among 10,972 oral PrEP users with follow-up tests, 3,109 (28%) received combined testing, 1,068 (10%) had NAT only, and 6,691 (61%) had Ag/Ab only. We found 691 CAB-LA users; only 130 (19%) received combined testing at PrEP initiation. Among 540 CAB-LA users with follow-up tests, 333 (62%) received combined testing, 118 (22%) had NAT only, and 78 (14%) had Ag/ Ab testing only. Conclusion: The rate of combined HIV RNA-Ag/Ab testing among oral PrEP users increased substantially after CDC published updated guidance in 2021 but the rates are sub-optimal, as is the rate of combined testing at CAB-LA initiation. However, the rate of combined testing during CAB-LA follow-up is higher. Further research is required to investigate the extent of long-acting early viral inhibition syndrome in individuals using PrEP, as well as to assess the cost-effectiveness of HIV RNA testing for PrEP users of different regimens.

Poster Abstracts

CROI 2024 357