CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

767 POSTPARTUM DEPRESSIVE SYMPTOMS IN WOMEN LIVING WITH HIV IN BOTSWANA Keolebogile N. Mmasa 1 , Kathleen M. Powis 2 , Justine Legbedze 3 , Samuel W. Kgole 1 , Gosego Masasa 1 , Shan Sun 3 , Sikhulile Moyo 1 , Joseph Makhema 1 , Mompati O. Mmalane 1 , Patrick Zibochwa 4 , Lynn M. Yee 5 , Lisa B. Haddad 6 , Elaine J. Abrams 7 , Kathleen Malee 5 , Jennifer Jao 5 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Harvard University, Boston, MA, USA, 3 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA, 4 Ministry of Health, Gaborone, Botswana, 5 Northwestern University, Chicago, IL, USA, 6 Emory University, Atlanta, GA, USA, 7 ICAP at Columbia University, New York, NY, USA Background: Postpartum depression (PPD) is associated with poor maternal and child health outcomes. Few studies have evaluated PPD in women living with HIV (WLHIV) in Botswana, a high prevalence HIV setting. Methods: Using the Edinburgh Postnatal Depression Scale (EPDS), we evaluated PPD symptoms at 2, 6, and 12 months (mo) postpartum in WLHIV and HIV-uninfected (HIV-U) women enrolled in the Tshilo Dikotla cohort study in Botswana. Women scoring ≥10 on the EPDS or reporting thoughts of self- harmwere defined as at risk for ongoing PPD symptoms. Secondary outcomes included: EPDS score ≥10, EPDS score ≥13, and EPDS score ≥13 or reporting thoughts of self-harm. Generalized estimating equation models were fit to assess the association of maternal HIV infection with risk of PPD symptoms in the first year postpartum. Subgroup analyses in WLHIV were performed to assess factors associated with risk of PPD symptoms. Results: Of 321 women enrolled, 195 were WLHIV. WLHIV were older (28.9 vs 24.4 years, p<0.01) with higher gravidity, (3 vs 1, p<0.01) and were less likely to complete tertiary education (7% vs 31%, p<0.01) compared to HIV-U women. Among WLHIV, 45% had a CD4 count >500 cells/mm3 and 93% had an HIV RNA level <40 copies/mL at enrolment; median years since HIV diagnosis was 1.6. All WLHIV received a backbone of tenofovir + emtricitabine and either dolutegravir (DTG) or efavirenz (EFV). At 2, 6, and 12 mo postpartum, 301, 233, and 103 women, respectively, completed the EPDS. At 2 mo, 4 WLHIV and 6 HIV-U met the criteria for being at risk for PPD symptoms. At 6 mo and 12 mo, 6 and 4 WLHIV respectively met the criteria for being at risk for PPD symptoms, whereas no HIV-U women met the criteria. After adjusting for age, gravidity, education level, marital status, and employment, WLHIV were at increased risk for PPD symptoms compared to HIV-U women (adjusted Odds Ratio: 3.37, 95% Confidence Interval: 1.14-10.02). Findings were similar in models evaluating secondary outcomes. (Table 1) Among WLHIV, no associations were seen between age, gravidity, employment, CD4, years with HIV, timing of ART initiation, or ART regimen and PPD symptoms. Conclusion: Despite overall low rates of PPD symptoms in this small Botswana cohort, WLHIV may be at higher risk for experiencing PPD symptoms in their first year postpartum compared to HIV-U women. Screening WLHIV for PPD symptoms and providing support during the postpartum period are an important part of routine postpartum care for this vulnerable population.

1 University of California San Francisco, San Francisco, CA, USA, 2 University of California Berkeley, Berkeley, CA, USA, 3 Ministry of Health and Child Welfare, Harare, Zimbabwe, 4 Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA, 5 Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe Background: WHO revised treatment recommendations for pregnant women in 2013, and Zimbabwe began to place all pregnant women on HIV treatment for life (Option B+) in January 2013. We examined trends in the uptake of maternal PMTCT services and MTCT among women with a recent birth in Zimbabwe from 2012-18. Methods: We analyzed serial cross-sectional serosurvey data collected in 2012 (n=8800), 2014 (n=10,404), and 2018 (n=7361) from the evaluation of Zimbabwe’s Accelerated PMTCT Program. Using multi-stage cluster sampling, we randomly sampled mother-infant pairs each survey year from catchment areas (CAs) of 157 facilities. Eligible women were ≥16 years old and biological mothers of infants (alive or deceased) born 9 to 18 months before the interview. Participants were tested for HIV and interviewed about health service utilization during pregnancy and breastfeeding. Results: In 2018, of 7361 women surveyed, 6816 (92.6%) attended ≥1 antenatal care (ANC) visit, 5196 (70.6%) attended ≥4 ANC visits, 6872 (93.4%) were tested for HIV and received their results, and 6290 (85.5%) delivered in a health facility. The uptake of services targeted to all women was relatively stable from 2012-2018. In contrast, utilization of services targeted to HIV- infected women and their infants increased (Figure, maternal HIV prevalence in 2012: 12.4%, 2014: 13.4%, 2018: 10.6%). Uptake of both maternal antiretroviral therapy (2012: 59.4%, 2014: 64.7%, 2018: 73.2%; p<0.01) and infant ARV prophylaxis (2012: 62.6%, 2014: 66.5%, 2018: 73.3%; p<0.01) significantly increased from 2012-2018. Of infants born to HIV-infected mothers, 8.8%, 6.7%, and 3.6%were HIV infected in 2012, 2014, and 2018, respectively. In the 128 CAs with data on HIV exposed infants before and after implementation of Option B+, mean decrease in CA level MTCT was -6.4 percentage points (95% CI -9.3, -3.5) and the proportion of CAs with no transmissions increased from 55% in 2012 to 82% in 2018. CA level MTCT in 2018 varied by province between 1.3% and 9.5%. Conclusion: Zimbabwe has made remarkable progress increasing coverage of PMTCT services and reducing MTCT. Coverage of services for women living with HIV increased significantly, and an overall MTCT decreased to below the 5% threshold for virtual elimination. However, MTCT rates varied across provinces, and a minority of women living with HIV still did not receive PMTCT services. This highlights the need for continued efforts to simulate demand and overcome barriers to health services.

Poster Abstracts

768 TOWARDS EMTCT IN ZIMBABWE: SERVICE UPTAKE AND IMPACT OF OPTION B+ ON MTCT, 2012-2018 Mi-Suk Kang Dufour 1 , Sandra I. McCoy 2 , Aybuke Koyuncu 2 , Angela Mushavi 3 , Agnes Mahomva 4 , Nancy Padian 2 , Frances Cowan 5

769 HIV DRUG RESISTANCE AT PERINATAL TRANSMISSION AND ACCUMULATION DURING BREASTFEEDING

Ceejay Boyce 1 , Ingrid A. Beck 2 , Tatiana Sils 2 , Daisy Ko 2 , Annie Wong-On-Wing 2 , Sheila Styrchak 2 , Patricia DeMarrais 3 , Camlin Tierney 3 , Lynda Stranix-Chibanda 4 , Taha E. Taha 5 , Maxensia Owor 6 , Mary G. Fowler 5 , Lisa Frenkel 2 , for the Promoting Maternal and Infant Survival Everywhere trial (PROMISE) Study Team

CROI 2019 297