CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

clusters of recent infection and estimate incidence among newly diagnosed adolescent girls and young women (AGYW) seeking antenatal care (ANC) in Malawi. Methods: Pregnant AGYW aged 15–24, newly diagnosed with HIV at their first ANC visit in Lilongwe, Blantyre, Machinga, and Zomba districts were consecutively enrolled, completed behavioral questionnaires and provided blood samples for recency testing. Recent infection was defined as normalized optical density value of ≤1.5 or ≤2.0 on the Limiting Antigen Avidity Enzyme Immunoassay (Maxim or Sedia, respectively) and VL ≥1,000 copies/mL. We calculated the prevalence of recent infection and annualized incidence using data abstracted from ANC registers on the number and serostatus of all AGYW attending ANC. We assumed mean duration of recent infection of 161 days (95% confidence interval [CI], 145–177 days), 1% false recency rate and that previously diagnosed AGYW had long-term infections. Results: From November 2017 to July 2018, we enrolled 610 AGYW. Over half [63.6%, (367/577)] were unaware of their partners’ HIV status, 30.6% (185/605) had never been tested, 31.6% 188/595) reported sexually transmitted infection symptoms in the past year, and 25.1% (151/602) reported ever being abused by a sexual partner. HIV prevalence among pregnant AGYW in all districts was 4.3%. Of 590 AGYWwith test results, 68 (11.5%) had recent infection; median VL among recently infected AGYWwas 27,548 copies/mL (IQR 8,060 - 88,785 copies/mL). Overall incidence was 0.31/100 person years (py; CI 0.14-0.44): 0.25/100 py (CI, 0.12-0.38) among AGYW aged 15-19 years and 0.34/100 py (CI, 0.19-0.49) among AGYW aged 20-24 years. Incidence was significantly higher in Blantyre [0.55/100 py (CI, 0.24–0.86), P <0.001] and Lilongwe [0.37/100 py (CI, 0.21–0.53), P <0.001] relative to Machinga and Zomba [0.12/100 py (CI, 0.00–0.24)]. Conclusion: One in ten newly diagnosed pregnant AGYWwas recently infected, with incidence estimates indicating ongoing transmission among AGYW in these districts. The majority had been infected >1 year ago, which may represent delayed diagnosis. Recent infection testing in ANC settings can help identify unmet needs for HIV prevention, testing, and treatment. 832 HIV SEROSTATUS CONVERSION AMONG REPEAT-TESTING FEMALE SEX WORKERS IN TANZANIA Amasha H. Mwanamsangu 1 , Gaspar Mbita 1 , Kelly Curran 2 , Amani Shao 3 , Raymond Bandio 1 , Nelson Jonas 1 , Friedrich Conrad 4 , Peris Urasa 5 , Erick Mlanga 6 , Jeremie Zoungrana 1 , Maligo Katebalila 1 , Marya Plotkin 2 , Albert Komba 1 , Caterina Casalini 1 1 Jhpiego, Dar es Salaam, Tanzania, United Republic of, 2 Jhpiego, Baltimore, MD, USA, 3 National Institute for Medical Research, Kisesa HDSS, Mwanza, Tanzania, United Republic of, 4 Elton John AIDS Foundation, Dar es Salaam, Tanzania, United Republic of, 5 National AIDS Control Program, Dar es Salaam, Tanzania, United Republic of, 6 USAID Tanzania, Dar es Salaam, Tanzania, United Republic of Background: The risk of HIV acquisition among female sex workers (FSW) across Sub-Saharan Africa is estimated to be 13x higher than other women: understanding population-specific risk factors can provide important information to guide HIV prevention interventions. Sauti is a PEPFAR/USAID- funded combination prevention project working in 14 regions in Tanzania, serving key and vulnerable populations with biomedical and structural prevention, care and treatment interventions including HIV testing. FSW are primary recipients of Sauti services, provided at brothels and other hot spots for HIV transmission. This analysis describes factors associated with HIV serostatus conversion among a cohort of FSW originally testing HIV negative and subsequently testing HIV positive during the course of attending Sauti services. Methods: Sauti project data comprise clinical intake forms which Sauti program collects, de-identifies, enters into a database and uses for program analysis. From October 2016 to December 2017, 261,566 FSW tested for HIV. 6,892 returned for repeat testing testing for 3 months or more from the original test: these are the repeat testers cohort. All repeat tester data was analyzed to examine when re-testing occurred and understand factors which may have influenced seroconversion. We conducted multivariable logistic regression analysis to estimate odds ratios for risk factors associated with HIV seroconversion. Results: 6,128 FSW repeat tested, testing negative for HIV at initial test. Of these 235 (3.8%) tested HIV positive upon repeat test. Having a syndromic STI (3.21, 95% CI: 2.53-8.12) and non-use of STI periodic presumptive treatment ( 1.34, 95% CI: 1.07-1.94) were highly predictive of HIV sero-conversion. Other predictors for included: older age 35+ years (3.10, 95%: CI: 1.97-4.85), never

used condom in last three sexual intercourse (1.58, 95% CI: 1.16-3.05) and practicing anal sex (2.45, 95% CI: 1.81-3.31) Conclusion: Our findings highlighted higher risk of sero-conversion among FSWwho had a syndromic STI and/or did not have presumptive periodic treatment of STIs, as well as behavioral factors such as reporting anal sex and/or inconsistent condom use. The findings underscore the importance of provision of both biomedical and behavioral services to FSW tailored to fit their risk profile. Consistent condom use and STI/HIV prevention are important service delivery components to stress in light of these findings.

Poster Abstracts

833 QUANTIFYING TRANSMISSIONS FROM AGE GROUPS IN SIMULATIONS OF HPTN071 (POPART) TRIAL William Probert 1 , Rafael Sauter 1 , Michael Pickles 2 , Anne Cori 3 , Justin Bwalya 4 , Sian Floyd 5 , Nomtha Mandla 6 , Kwame Shanaube 4 , Blia Yang 6 , Helen Ayles 4 , Peter Bock 6 , Deborah J. Donnell 7 , Sarah Fidler 3 , Richard Hayes 5 , Christophe Fraser 1 1 University of Oxford, Oxford, UK, 2 University of Manitoba, Winnipeg, MB, Canada, 3 Imperial College London, London, UK, 4 Zambart, Lusaka, Zambia, 5 London School of Hygiene & Tropical Medicine, London, UK, 6 Desmond Tutu TB Centre, Western Cape, South Africa, 7 Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA, USA Background: The HIV epidemic in sub-Saharan Africa (SSA) is known to be heterogeneous, contributing to the perception that preventative efforts need to be targeted to those at most risk of transmitting or acquiring the virus. The HPTN071 (PopART) trial has been testing the impact of a universally delivered combination prevention package in 21 communities in Zambia and South Africa. An individual-based simulation model (IBM) has been developed as part of the trial. Using the IBM we quantify the proportion of new infections that arise frommen and women of different age groups, and the potential impact of suppressing transmissions from each of these groups. Methods: The IBM is calibrated to trial data in each intervention community (arm A of the trial; one community shown here). Using the best-fitting parameter set, projections of the epidemics are made up to 2030, with 40 replicates. Projections beyond the end of the trial assume continuation of the PopART intervention at a national scale. We estimate the population attributable fraction (PAF), the proportion of new infections that arise frommen and women of different ages over defined time-periods. PAF can be defined either as the proportion of infections where a certain group is directly the source of the infection (PAF direct ), or can include both direct and indirect effects by modelling the total number of HIV infections averted if a certain group were not able to transmit HIV (PAF total ). Results: In all simulations, for individuals less than 25 years old (y.o.), PAF direct of women was higher than men whereas, for ages greater than 25 y.o., this relationship was reversed. When considering indirect transmissions, PAF total was similar in men and women across all age groups but higher in the 20-34 y.o. age group. In the first 20 years of the epidemic, the PAF direct was highest in 25-29

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