CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1179 Estimating Need for Annual HIV Testing Met by a Nationwide Mailed HIV Self-Testing Program Jessica M. Keralis 1 , Kevin Delaney 1 , Travis Sanchez 2 , Patrick S. Sullivan 2 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Emory University, Atlanta, GA, USA Background: The Together TakeMeHome program (TTMH) provides free HIV self-test kits (HIVSTs) by mail, allowing people at least 17 years old who may experience barriers to accessing other HIV testing services to test privately on their own time. Users can order one or two HIVSTs. Our goal was to use nationally representative survey data to estimate the need for annual HIV testing in each state and what percentage of that need is being met by TTMH. Methods: TTMH order data from March 2023 to July 2024 were used to calculate the number of orders and test kits mailed to each state. Among US adults who self-reported behaviors that increase the chances of getting or transmitting HIV and, we estimated the proportion that have (1) never tested for HIV and (2) not been tested in the past year (including never testers) with 2016-2022 data from the Behavioral Risk Factor Surveillance System, a nationally representative telephone survey of adults in the US. An estimated range of met need percentage for the two estimates was generated, assuming that the tests were used by people with behaviors similar to those reported in BRFSS. The lower bound was calculated by dividing the number of orders by the estimates for each state, assuming the individual used both test kits. The upper bound, calculated by dividing the number of test kits by each state estimate, assumes that all ordered tests were used and by different individuals, allowing for possible diffusion of kits to others in the user’s social network. Results: As of July 2024, TTMH distributed 586,099 HIVSTs through 315,710 orders across all 50 states, the District of Columbia, and Puerto Rico. Overall, 5.4% of US adults engaged in behaviors with elevated HIV risk in the past year. Among those, 50.0% had never been tested for HIV (range: 26.6% in DC to 61.8% in UT), and 67.8% had not tested in the past year or ever (range: 43.4% in DC to 77.9% in SD). For those who have never been tested for HIV, likely met need estimates ranged from a low of 2.2%-4.0% (WY) to a high of 21.0%-39.6% (DC). For those who have not been tested in the past year, met need estimates ranged from a low of 1.2%-2.1% (WY) to a high of 7.1%-13.8% (PR). Conclusions: Many in the US who could benefit from annual HIV testing are not being served by existing services. TTMH is meeting some of this need, with percentage of met need varying widely by state. 1180 Engaging Male Partners of HIV-Negative Pregnant Women in HIV Testing Using Oral HIV Self-Test Maganizo B. Chagomerana 1 , Annie Thom 1 , Nora E. Rosenberg 2 , William C. Miller 2 , Irving F. Hoffman 2 , Agatha Bula 1 , Mitch M. Matoga 1 , Mina Hosseinipour 1 1 University of North Carolina Project–Malawi, Lilongwe, Malawi, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Women are at risk of acquiring HIV throughout the perinatal period. HIV testing uptake among the male partners remains low thus the couple are often unaware of the male partner’s HIV status. The antenatal setting, with nearly universal uptake of HIV testing for women, can also serve as a way of reaching male partners. However, the optimal way to engage the male partners is unknown. We sought to evaluate the effect of providing partner notification (PN) + oral HIV self-test (HIVST) kits to pregnant women for their male partner. Methods: We conducted a two-arm un-blinded randomized trial of HIV negative pregnant women who were attending antenatal care for the first time at Bwaila Hospital in Lilongwe, Malawi from October 2019 to August 2021. Women were randomized 1:1 to receive PN only inviting their partners for HIV testing (standard of care [SOC]) or PN + 1 HIVST kit for partner testing at home (intervention). Due to changes in the national HIV guidelines, from April 2021, women in the SOC arm received PN + 1 HIVST kit and women in the intervention received PN + 2 HIVST kits for couple testing at home. Two-sample test of proportions was used to compare differences in proportions of male partners who reported to clinic within 30 days post randomization. We used log-rank test and Log-binomial regression to compare time to return to clinic and assess factors associated with male partners’ return to clinic, respectively. Results: We enrolled 200 pregnant women (100 each arm); 191 (96%) were married. All 70 male partners who reported to clinic tested negative at home. The proportions of males who reported to clinic were similar between intervention and SOC arms; 1) overall: 32% vs 38% (probability difference [pd] = -0.06; 95% CI:-0.07–0.19), 2) pre-guidelines change: 45% [10/21] vs 48% [9/20], pd=-0.03; 95% CI: -0.28–0.33), and post-guideline change: 28%

[22/79] vs 36% [29/80], pd=-0.08; 95% CI:-0.23–0.06). Time to return to clinic did not differ between the two arms (Figure 1). Male partners for women with at least secondary education were more likely to report to clinic (adjusted risk ratio=2.25; 95% CI:1.09–4.64) than those for women with no formal or primary education only. Conclusions: The inclusion of HIVST kit as part of passive partner notification did not improve clinic-based HIV testing among male partners of pregnant women. To ensure that men know their HIV status, innovative approaches are needed to reach and engage them in HIV testing.

1181 Moderators of a Home-Based Couple Intervention on Couple HIV Testing and Counselling Uptake in Kenya Zachary A. Kwena 1 , Kevin Owuor 2 , Lynae Darbes 3 , Anna Helova 2 , Evelyne Owengah 1 , Elizabeth A. Bukusi 4 , Abigail Hatcher 5 , Moses Okombo 6 , Janet M. Turan 2 1 Kenya Medical Research Institute-UCSF Infectious Disease Research Training Program, Kisumu, Kenya, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of Michigan, Ann Arbor, MI, USA, 4 Kenya Medical Research Institute, Kilifi, Kenya, 5 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 6 KEMRI Kenya, Nairobi, Kenya Background: Identifying individuals who require particular strategies or possess characteristics for which the interventions are most effective is critical for achieving personalized care and optimal impact. We sought to identify and assess moderators of a home-based couples intervention on uptake of couple HIV testing and counselling (CHTC) in southwestern Kenya. Methods: In a randomized control trial, we enrolled 800 stable couples (2/3 of the women living with HIV, WLWH) between 2019-2023. Consenting couples were randomized to a home-based couples intervention (HV, n=267), HIV self-test kits for couples (HIVST, n=266), or standard care (SC, n=267). In the HV arm, pairs of lay health workers (one female, one male) conducted two home visits during pregnancy and up to 3 visits postpartum, providing health education, couple communication skills building, and offering CHTC. Surveys with both partners occurred at baseline, 3- and 12-months postpartum, and brief phone assessments at 6- and 18-months postpartum, collecting data on socio-demographics, healthcare utilization, couple dynamics, and HIV testing outcomes. A log-binomial generalized estimating equation model was used to assess the potential moderating effect of baseline measures; including previous couple testing, education, wealth, couple age disparity, stigma perceptions, couple communication, relationship satisfaction, woman’s HIV status, parity, and length of the relationship; on the effect of the intervention on CHTC uptake. Marginal probabilities and effects with plots were reported. Results: Significant moderators of the intervention effect on CHTC were the HIV status of a woman at baseline (interaction p-value=0.041) and parity (p values=0.018). The overall probability of CHTC was higher among HIV-negative women compared to WLWH, with marginal effects of 11% in HIVST, 27% in HV, and 12% in the SC arm (Figure 1). Results also showed a significantly lower CHTC probability among women with numerous prior live births, as compared to those with few live births (Figure 2). Conclusions: The home-based intervention appeared to have a more beneficial impact on CHTC uptake in couples where the woman was HIV-negative at baseline, compared to couples where the woman was HIV-positive. In addition, the intervention had more impact on CHTC uptake in couples with lower parity. Future intervention roll-out aiming for higher CHTC might target HIV-negative women with lower parity.

Poster Abstracts

The figure, table, or graphic for this abstract has been removed.

CROI 2025 387