CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Technology-based condom distribution solutions are crucial in addressing barriers to condom access in KVPs. 1251 Cost-Effectiveness of an Agricultural Intervention Among Adults With HIV and Their Children in Kenya Assurah W Elly 1 , Elly Weke 1 , Pauline Wekesa 1 , Rachel Burger 2 , Lila Sheira 2 , Mocello Adrienne 2 , Edward Frongillo 2 , Lisa Butler 2 , Sheri Weiser 2 , Craig Cohen 2 , Jim Kahn 2 , Elizabeth Bukusi 1 , Starley Shade 2 1 Kenya Medical Research Institute-UCSF Infectious Disease Research Training Program, Kisumu, Kenya, 2 University of California San Francisco, San Francisco, CA, USA Background: Agricultural interventions to address food insecurity have been shown to improve HIV health outcomes through nutritional, mental health, and health behavior pathways, but little is known about their costs and cost effectiveness Methods: We estimated costs and incremental cost-effectiveness of implementing a multisectoral agricultural intervention (Shamba Maisha) compared to control within a cluster-randomized trial in 8 matched health facilities during 2016-2019. Shamba Maisha included loans to purchase a human-powered irrigation pump, fertilizer, seeds and pesticides, and provision of training in sustainable agriculture and financial literacy. Participants were adults in HIV care at participating clinics who were followed for 24 months. We estimated cost per person using site visits, conversations with study coordinators, micro-costing techniques, a time-and-motion personnel study, and administrative record review. Costs were categorized into capital goods, personnel costs, and recurrent goods and services. We observed effects of the intervention on food insecurity, depression, and social support among participants and length/height for age among their young children (aged 6-23.9 months). Results from the study were translated into disability-adjusted life years (DALYs) averted. We estimated the incremental cost per DALY averted among participants and their young children in the intervention compared to those in the control arm. Results: Participants included 720 adults with HIV (366 intervention, 354 control). Results were also assessed among 207 young children (95 intervention, 112 control). Overall, the incremental cost of implementation of Shamba Maisha compared to control was $642 per person ($841 intervention, $199 control). This included an added cost per person of $209 for capital goods, $387 for personnel salaries and benefits, $22 for recurring goods, and $24 for recurring services. The intervention averted an estimated 0.158 DALYs per person, including 0.027 DALYs for decreased food insecurity, 0.053 for decreased depression, 0.044 for increased social support, and 0.034 for greater length/height for age among young children. The overall incremental cost-effectiveness ratio was $4027 per DALY averted Conclusion: The Shamba Maisha multisectoral agricultural intervention was cost-effective based on the WHO threshold of three times the annual GDP per capita ($6020 USD in 2021). Future analyses will account for reduced health care costs associated with improved health outcomes. 1252 Integrated HIV+NCD Care in Community Microfinance Groups: Harambee Cluster Randomized Trial Results Becky Genberg 1 , Jon Steingrimsson 2 , Juddy Wachira 3 , Catherine Kafu 4 , Marta Wilson-Barthes 2 , Sonak Pastakia 5 , Dan N. Tran 6 , Jamil A. Said 3 , Rajesh Vedanthan 7 , Suzanne Goodrich 8 , Paula Braitstein 9 , Youjin Lee 2 , Joseph Hogan 2 , Omar Galárraga 2 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Brown University, Providence, RI, USA, 3 Moi University, Eldoret, Kenya, 4 Academic Model Providing Access to Healthcare, Eldoret, Kenya, 5 Purdue University, West Lafayette, IN, USA, 6 Temple University, Philadelphia, PA, USA, 7 New York University Langone Medical Center, New York, NY, USA, 8 Indiana University, Indianapolis, IN, USA, 9 University of Toronto, Toronto, Canada Background: In Sub-Saharan Africa, distance to health facilities, vertical care delivery, increased burden of non-communicable diseases (NCDs), and limited socioeconomic resources are barriers to patients maintaining HIV viral suppression. The Harambee cluster randomized trial tested a differentiated care model delivering HIV+NCD care within microfinance (MF) groups of people living with HIV in western Kenya. Methods: Fifty-seven MF groups (n=855 participants) were randomized in a 1:1 ratio to receive integrated community-based (ICB) care or standard facility-based care (SOC). The ICB intervention included: (1) clinical care visits during MF group meetings inclusive of clinical consultations, NCD management, distribution of antiretroviral therapy (ART) and NCD medications; (2) support for ART adherence; and (3) facility referrals as needed. Primary outcome was viral

Poster Abstracts

1250 Automated Condom Distribution for HIV Prevention: Mwanza, Tanzania, 2021-2023 Aafke Kinemo 1 , Julie Franks 2 , Emmanuel Mihayo 3 , Macdonald Mahiti 1 , Joyce Thomas 1 , Oresto Munishi 1 , Omari Msumi 1 , John Kahemele 1 , Kokuhumbya Kazaura 4 , Nyagonde Nyagonde 5 , Mbaraka Amuri 5 , Haruka Maruyama 1 1 ICAP at Columbia University, Dar es Salaam, United Republic of Tanzania, 2 ICAP at Columbia University, New York, NY, USA, 3 Ministry of Health, Mbabane, Eswatini, 4 Centers for Disease Control and Prevention, Atlanta, GA, USA, 5 Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania Background: In Tanzania, factors such as fear of stigma associated with getting condoms, concerns about cost, stock outs, and limited outlets beyond the health facility make it hard for people to access condoms. Barriers to access limit condom use among key and vulnerable populations (KVPs) highly impacted by HIV, including adolescent girls and young women (AGYW), female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID). Automated dispensing technology is a standalone unit consisting of simple electro-mechanical systems to automate the entire distribution process. The unit's interactive digital display, aesthetically pleasing and ergonomically designed, improves the user experience, and increases access to condoms. We describe the use of automated digital dispensing machines in community settings to increase access to condoms. Methods: We installed six machines at hotspots in Mwanza City frequented by KVPs. Peer outreach workers from the KVP communities were trained on use of the machines and sensitized peers in surrounding communities. Machines dispensed free condoms to people with access codes. Peers distributed unique personal identification numbers to KVP for up to 15 free condoms per day. Non-KVP clients received single-use access for up to three condoms per day. Machines captured user demographics and number of condoms dispensed through a self-guided questionnaire using the machine's touch screen. All data was stored in a secured server to ensure information security and confidentiality. Results: Between October 2021 and June 2023, a total of 545,581 condoms were distributed to 6,572 KVP; users had a mean age of 29 (range: 25-29) years. Among users, 68% were female, and 77% (n=418,512) of condoms were collected by females. In addition, 57% of condoms were retrieved by FSWs; 15% by AGYW; 14% by MSM; and 14% by PWID. A mean of 93 (range: 62–210) condoms were accessed per female user compared to 61 condoms (range: 4–112) per male user. Machines were accessible 24 hours, 7 days a week. Machine peak access days were over weekends with peak access times between 4 p.m. to 8 p.m. Conclusion: The proportion of female clients that accessed condoms is generally high. Machines installed in key locations and incorporated with community-based, peer-led approaches can expand condom access beyond health facilities and to times when most health facilities were closed.

CROI 2024 411