CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

of $1500 or less, and 36.0% completed high school. Women had a median of 1 (IQR 1-2) male sexual partners in past year, 44.1% reported condomless vaginal sex in the past year, and 49% reported a prior STI: 35.2% reported a lifetime history of chlamydia, 26.0% gonorrhea, and 30.6% trichomoniasis. Current STI detected by NAAT did not differ by HIV status (22.0% HIV+ vs. 20.5% HIV-; p=0.946): vaginal chlamydia (2.1% HIV+ vs. 1.5% HIV-; p=0.915), rectal chlamydia (2.7% HIV+ vs. 3.1% HIV-; p=0.968), pharyngeal chlamydia (1.3% HIV+ vs. 0.0% HIV-; p=0.42), vaginal gonorrhea (3.8% HIV+ vs. 2.3% HIV-; p=0.727), rectal gonorrhea (0.9% HIV+ vs. 1.6% HIV-; p=0.843), pharyngeal gonorrhea (1.3% HIV+ vs. 0.8% HIV-; p=0.892), and trichomoniasis (14.3% HIV+ vs. 13.0% HIV-; p=0.937). Conclusion: Prevalence of genital and extragenital chlamydia and gonorrhea, and genital trichomoniasis are high among WRA with and without HIV infection. The implications for women's reproductive health and HIV transmission highlight the importance of extragenital STI testing for women with HIV or vulnerable to HIV infection. 1165 Prevalence and Risk Factors Associated With HPV Infections Among Women with HIV Women in Meru, Kenya Celestine K Nyamari 1 , Anthony Kebira 2 , Frank Onyambu 3 1 Centre for Molecular Biosciences and Genomics, Nairobi, Kenya, 2 Kenyatta University, Nairobi, Kenya, 3 Meru University of Science and Technology, Meru, Kenya Background:Cervical cancer, caused by, Human Papilloma Virus (HPV) is the leading cause of preventable deaths among women. High incidence and high mortality for cervical cancer are reported in low- and middle-income countries where immunocompromised HIV-infected women exhibit an increased risk. We determined circulating high-risk HPV genotypes in HIV-infected women in Meru, Kenya and identified risk factors associated with HPV infections in a cross sectional study of 273 women aged 25 to 64 years. Methods: Sociodemographic and clinical details were collected using a questionnaire. Cervical specimens were obtained using a self-sampling technique, followed by HPV DNA extraction and real time PCR targeting 24 high risk genotypes with differentiation of HPV 16, 18, and 45. Descriptive statistics were used to summarize baseline characteristics, while logistic regression analysis was utilized to determine the risk factors associated with HPV infection. Results: Out of the 273 tested samples, 60.81% (N=166) tested positive for high risk HPV broken down as HPV 18 (37.73 %), HPV 45 (32.23 %), other high-risk HPV types (14.29 %), and HPV 16 (12.45 %) .The prevalence of multiple infections with HPV 16 and 18 was 8.42% (N=23). We further found 54.82% (N= 90) had undergone Pap smear and 45.18% (n=75) had undergone VIA/ VILI within the last six months with 4 individuals reporting abnormal results. Notably, among the 161 participants who reported normal results in their Pap smear/VIA tests, HPV positivity was detected. In our tentative analysis we used logistic regression to show the risk factors for high risk HPV were age of 35 to 44 years (OR: 0.45, 95% CI [0.206-0.981], P=0.045), and contraceptive use (OR: 0.496, 95% CI [0.247-0.996], p=0.047). Conclusion: Our study reveals a concerning high prevalence of high-risk HPV in Kenya and identifies two significant risk factors among HIV-infected women in Meru. Women aged 35-44 years exhibit an increased risk for HPV, while contraceptive use is another risk factor. This underscores the urgent need for tailored interventions and enhanced screening strategies among HIV-infected women in Meru, Kenya. The identified risk factors highlight areas where proactive measures can make a significant impact on reducing cervical cancer risk. Our findings contribute to the growing evidence on HPV burden in Kenya, reinforcing the call for effective public health measures to prevent cervical cancer. 1166 One-Dose HPV Vaccine Durability in a Moderate HIV Prevalence Setting: Mathematical Modeling Analyses Christine L. Hathaway 1 , Grace Umutesi 2 , Jesse A Heitner 1 , Rachel Jackson 3 , Christine Wangeci 4 , Wesley Mugambi 4 , Lydiah Khalayi 4 , Valerian Mwenda 5 , Lynda M. Oluoch 6 , Mary Nyangasi 5 , Rose E. Jalang’o 4 , Nelly R. Mugo 6 , Ruanne V. Barnabas 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 University of Washington, Seattle, WA, USA, 3 State University of New York Upstate Medical University, Syracuse, NY, USA, 4 National Vaccination and Immunization Program, Nairobi, Kenya, 5 National Cancer Control Program, Nairobi, Kenya, 6 Kenya Medical Research Institute, Nairobi, Kenya Background: The World Health Organization recommends a 1-dose human papillomavirus (HPV) vaccination strategy to increase coverage and accelerate cervical cancer elimination. However, the duration of efficacy of 1-dose is

uncertain among women living with HIV (WLHIV); immune dysregulation may limit vaccine durability. We modelled the potential impact of a 1-dose HPV vaccination strategy on cervical cancer outcomes for WLHIV in Kenya. Methods: Using a validated dynamic compartment transmission model for Kenya simulating bidirectional interactions between HIV and HPV, we modelled the impact of a) expanded HIV interventions on cervical cancer outcomes, b) going from a multi-dose to 1-dose HPV vaccine strategy assuming 90% coverage of 9-year-old girls and lifelong efficacy, c) reduced durability scenarios with an efficacy period (EP) of 15-30 years and waning period (WP) of 10-20 years, and d) leveraging 5-year cost savings from a potential switch to a 1-dose strategy on a catch-up vaccination program. Multi-dose vaccine efficacy was assumed to be 100%, and 1-dose efficacy for WLHIV assumed to be aligned with women without HIV at 97.5% (95% CI, 90.0-99.4%). We evaluated the percent reduction in cervical cancer incidence and mortality. Results: If Kenya achieves UNAIDS targets by 2030 without additional HPV vaccination, we expect a 1.7% cervical cancer incidence reduction amongst WLHIV compared to a baseline of no vaccination and current ART coverage. Achieving UNAIDS targets as well as 90% coverage of a 3-dose HPV vaccine for WLHIV would further reduce incidence to 85.1%. A 1-dose scenario with lifelong efficacy would have similar reductions in incidence and mortality. The worst case waning scenario of 15-year EP/10-year WP would weaken the incidence reduction by a difference of 17% compared to the 1-dose lifelong efficacy scenario, while the best-case waning scenario of 30-year EP/20-year WP would limit the reduction by 0.1%. Catch-up vaccination has the potential to avert some of the impact of HPV vaccine waning. Conclusion: Assuming 1-dose efficacy results are consistent for women living with and without HIV, durability differences between dosing strategies will not significantly impact cervical cancer outcomes for WLHIV. While waning vaccine efficacy for 1-dose could increase cervical cancer cases compared to multi-dose strategies, general population vaccination could mitigate some of this change. Empiric data on single-dose HPV vaccine efficacy and duration for women living with HIV are needed.

Poster Abstracts

1167 Integrated Antenatal HIV, Hepatitis B, & Curable STI Testing: A Pragmatic Study in Harare, Zimbabwe

Kevin Martin 1 , Chido Dziva Chikwari 1 , Ethel Dauya 2 , Constance R. Mackworth Young 1 , Joseph D. Tucker 1 , Victoria Simms 1 , Tsitsi Bandason 2 , Francis Ndowa 3 , Leolin Katsidzira 4 , Owen Mugurungi 5 , Anna Machiha 5 , Michael Marks 1 , Katharina Kranzer 1 , Rashida A. Ferrand 1 1 London School of Hygiene & Tropical Medicine, London, United Kingdom, 2 Biomedical Research and Training Institute, Harare, Zimbabwe, 3 Skin & Genito-Urinary Medicine Clinic, Harare, Zimbabwe, 4 University of Zimbabwe, Harare, Zimbabwe, 5 Ministry of Health and Child Care, Harare, Zimbabwe Background: Many STIs are known to cause neonatal death and other adverse outcomes among pregnant women, but most antenatal clinics in the Global South do not routinely screen for STIs outside of HIV and syphilis. Building on existing HIV and syphilis testing in antenatal care (ANC) may provide a platform for integrating testing for other STIs. We aimed to evaluate the feasibility of integrated ANC STI testing and determine the prevalence of chlamydia (CT), gonorrhoea (NG), trichomoniasis (TV), hepatitis B (HBV), HIV and syphilis in ANC in Zimbabwe. Methods: A prospective pragmatic study was conducted in two ANC clinics in Harare, Zimbabwe, over a nine month period in 2023. Clients were screened for CT, NG, TV, HBV, HIV, and syphilis, using point-of-care tests. Treatment, partner notification, and onward referral were provided as per national guidelines. The primary outcome was composite prevalence of CT, NG, TV, syphilis and HBV. Using a MRC complex evaluation framework, we assessed the number of people who received same-day results, treatment, and referrals. Results: Of 11921 clients attending ANC, 953 (8.0%) were approached for participation, and 881 (92.4%) were enrolled (figure 1). Prevalence of HIV was

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