CROI 2024 Abstract eBook

Abstract eBook

Oral Abstracts

200

Together TakeMeHome: Launch of a National HIV Self-Test Distribution Program, March-December 2023 Kevin P Delaney 1 , Travis H. Sanchez 2 , Robin Macgowan 1 , Ruth Dana 2 , Lucinda Ackah-Toffey 2 , Jen Hecht 3 , Emily Lilo 1 , Avery Smithson 4 , Revae S. Downey 1 , Jessica Keralis 1 , Emily Pingel 1 , Natalie O. Cramer 5 , Patrick S. Sullivan 2 , Athena Kourtis 1 , for the Together TakeMeHome Program Team 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Emory University, Atlanta, GA, USA, 3 Building Healthy Online Communities, San Francisco, CA, USA, 4 DLH Corporation, Newberry, MI, USA, 5 National Alliance of State and Territorial AIDS Directors, Washington, DC, USA Background: HIV testing is the first step to accessing both HIV treatment and prevention services. HIV self- testing is a key strategy for overcoming barriers to HIV testing. Methods: The Together TakeMeHome (TTMH) program is a CDC-sponsored, direct-to-consumer, HIV self- test distribution program. CDC's Let's Stop HIV Together campaign implemented marketing on platforms including social media, dating apps, and search and display advertising. Marketing was primarily to men who have sex with men (MSM), especially Black and Hispanic MSM, Black women, and transgender women. Building Healthy Online Communities developed messages and in-app buttons in partnership with dating apps including Grindr and BLK. Persons ages 17+ in the US and Puerto Rico were eligible to order 1-2 HIV self-tests every 90 days. Ordering wasn't restricted by prior HIV diagnosis or PrEP usage, but persons reporting ARV use were encouraged to give ordered HIV self-tests to others. A short survey was offered post-order with an opt-in for follow-up surveys. Ten- and 60-day follow-up surveys on their HIV self-test experience were conducted. Results: In March 2023, TTMH launched, with 181,558 orders placed in the first 9 months. Most orders (86%) were for two tests, with 337,812 total tests distributed. Most participants (109,956, 62%) came from the Grindr app. Sixty percent (108,715) of all orders contained enough information to describe participants in terms of the priority populations. Of these 61% were from men reporting male partners in the past 12 months (18% from Black MSM and 33% from Hispanic MSM), 10.7% from gender diverse persons, and 10% from Black women. Most orders (26%) were placed by persons who had never tested for HIV, or who had last tested >12 months ago (27%). Over half of participants, 86,143 (56.5%) opted into follow-up communications and as of December 11, 2023, 5,294 (6.1%) completed the 10-day survey. Among them, 109 (2.1%) reported a positive result with the HIV self-test, 6.5% sought additional STI testing, and 4.5% self-reported starting PrEP after receiving the self- test. Conclusion: Overall, the TTMH program has very high demand, with many persons from priority populations accessing HIV testing for the first time. Many sought additional clinical services after HIV self-testing. It is important for clinicians to be aware of the demand for HIV self-testing and how it may fit into their patient care, including preparing for discussions about HIV follow-up testing, pre-exposure prophylaxis and treatment. Incidence of Health Facility Switching and HIV Viral Rebound in Uganda: A Population- Based Study Joseph G Rosen 1 , Anthony Ndyanabo 2 , Ronald M. Galiwango 2 , Robert Ssekubugu 2 , Katherine Rucinski 1 , Gertrude Nakigozi 2 , Fred Nalugoda 2 , Godfrey Kigozi 2 , Thomas C. Quinn 3 , Larry W. Chang 3 , Caitlin E. Kennedy 1 , Steven J. Reynolds 4 , Joseph Kagaayi 2 , Mary Kate Grabowski 3 , for the Rakai Health Sciences Program 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA Background: Prior studies have shown that a sizeable fraction of persons on antiretroviral therapy (ART) in Africa, once believed to be care-disengaged, have actually transferred to other healthcare facilities for continued HIV treatment. However, the relationship between facility switching and virologic outcomes, specifically HIV viral rebound, among persons on ART is poorly understood. Methods: We used population-level data collected between 2015 and 2020 from 40 continuously surveilled communities, including four hyperendemic Lake Victoria fish landing sites, in the Rakai Community Cohort Study. Persons aged 15-49 years with serologically confirmed HIV infection self-reporting current ART use and contributing ≥1 follow-up visits were included in the study. Facility switching and virologic outcomes were assessed between two consecutive study visits (i.e., index and follow-up visits, ~18-month visit interval). Persons attending different HIV treatment facilities between index and follow-up visits were classified as having switched facilities. The primary

outcome was laboratory-confirmed viral rebound, defined as ≥200 HIV RNA copies/mL at follow-up visit among individuals exhibiting viral load suppression (<200 copies/mL) initially. Multivariable Poisson regression with generalized estimating equations and robust standard errors was used to model associations between facility switching and viral rebound, reported as adjusted incidence rate ratios (adjIRR) with 95% confidence intervals (95%CI). Results: Overall, 2,257 persons self-reporting current ART use (median age: 35 years, 65% women, 92% virally suppressed at index visit) contributed 3,335 visit-pairs and 5,959 person-years (py) to the analysis. Facility switching was common (4.8 switches per 100 py, 95%CI: 4.2-5.5) and highest in persons aged 15-29 years (7.3 switches per 100 py, 95%CI: 5.9-9.1), fishing community residents (7.4 switches per 100 py, 95%CI: 6.3-8.6), and in-migrants (10.4 switches per 100 py, 95%CI: 8.3-13.1). Among initially suppressed persons (n=2,076), the incidence of viral rebound was over twice as high in persons switching facilities relative to those attending the same clinic over the visit interval (adjIRR 2.27, 95%CI: 1.16-4.45). Conclusion: Facility switching was common and associated with viral rebound among initially suppressed persons. Investments in more agile, person-centered HIV care models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV treatment continuity.

Oral Abstracts

202

Lakeside Combined HIV and Schistosomiasis Services in Malawian Fishermen: A Cluster Randomized Trial Augustine T Choko 1 , Kathryn L. Dovel 2 , Sekeleghe A. Kayuni 1 , Donaldson Conserve 3 , Anthony Butterworth 1 , Amaya Bustinduy 4 , J. Russel Stothard 5 , Wala Kamchedzera 1 , Madalo Mukoka-Thindwa 1 , James Jafali 1 , Peter MacPherson 6 , Katherine Fielding 7 , Nicola Desmond 5 , Elizabeth L. Corbett 4 1 Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 George Washington University, Washington, DC, USA, 4 London School of Hygiene & Tropical Medicine, London, United Kingdom, 5 Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 6 University of Glasgow, Glasgow, United Kingdom, 7 London School of Hygiene & Tropical Medicine, Blantyre, Malawi Background: Undiagnosed HIV and Schistosomiasis are highly prevalent among fishermen in the Great Lakes region of Africa. Combined interventions to address barriers to diagnosis, treatment and prevention for both infections are urgently needed. Methods: Between March 2022-January 2023, we conducted a cluster randomized trial with 45 lakeside "boat-team" (clusters) in Lake Malawi. Clusters were randomly allocated (1:1:1) to: 1) enhanced standard of care (SOC), with beach clinics offering HIV testing and referral, and schistosomiasis presumptive treatment (praziquantel) advertised by leafleting; 2) peer educator (PE), with a peer-nominated boat crew member trained to promote beach clinic services; or 3) peer-distributor-educator (PDE), where PEs distributed oral HIV self-test (HIVST) kits in addition to promoting beach clinic services. The co-primary outcomes (measured at 28 days) were: composite self-reported ART initiation, or booked for voluntary male medical circumcision (VMMC); and 1 S. haematobium egg seen on light microscopy of the filtrate from 10mls urine ("egg-positive"). Secondary outcomes included self-reported HIV testing in the PDE arm, and observed HIV testing in eSOC and PE arms as well as perceived acceptability of HIV pre-exposure prophylaxis (PrEP). Analyses were by intention-to-treat with multiple imputation while accounting for clustering and any baseline imbalance. Results: Of 6036 fishermen screened, 5207 (86.3%) were eligible: (SOC: 1745 [87.6%]; PE: 1687 [81.9%]; PDE: 1775 [89.5%]). Participant characteristics were balanced across arms. Mean age was 33y (sd: 12.3), 3032 (58.3%) were literate, 5.9% (308) reported taking ART, and 44% were egg-positive for S. haematobium

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CROI 2024