CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

free condoms as part of prevention service in the last 12 month. 23.5% of couples were serodiscordant, in 16.9% of cases partner-PWID was HIV-positive. Only quarter of them had the HIV test in the last 12 month and knew the result. None of HIV-negative partners received PrEP. Conclusion: The HIV epidemic in Ukraine is still in progress and it’s involving people outside of KP through unprotected sex. With the understanding that the sexual behavior is hard to correct and people won’t start use condoms with their regular partners if they have not done so yet - better prevention strategy is needed. In this view sexual partners of PWID should be considered as one of the priority groups for PrEP 836 LOW CROSS-SECTIONAL HIV-1 INCIDENCE AT END OF BOTSWANA “YA TSIE” PREVENTION STUDY Sikhulile Moyo 1 , Simani Gaseitsiwe 1 , Corretah Boleo 1 , Julia Huesa 2 , Kenanao P. Kotokwe 1 , Molly Pretorius Holme 2 , Tendani Gaolathe 1 , Kara Bennett 3 , Jean Leidner 4 , Kathleen Wirth 2 , Janet Moore 5 , Shahin Lockman 2 , Joseph Makhema 1 , Max Essex 2 , Vlad Novitsky 2 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Harvard University, Boston, MA, USA, 3 Bennett Statistical Consulting, Inc, New York, NY, USA, 4 Goodtables Data Consulting, Norman, OK, USA, 5 CDC, Atlanta, GA, USA Background: Botswana has one the highest HIV-1 prevalence estimates and high antiretroviral treatment (ART) coverage. We sought to measure HIV incidence cross-sectionally in the 6 Botswana communities participating in a community-wide End-of Study Survey (ESS) of the Botswana Combination Prevention Project (BCPP), “Ya Tsie.” Methods: All consenting adult residents aged 16–64 years in 6 rural and peri-urban communities were enrolled in the BCPP ESS. Data and samples from ESS were used to estimate cross-sectional HIV incidence by an algorithm that included Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing for ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5 and HIV-1 RNA cut-off at 400 copies/mL. The Mean Duration of Recent Infection was estimated to be 130 days and the False Recent Rate (FRR) was 0%. Results: Among 14,125 individuals participating in the ESS, HIV status was available for 13,985 participants, 3,614 of whomwere HIV positive and 3,248 were on ART. Among 366 ART-naïve participants, LAg-Avidity EIA data was generated for 345 (94%) participants with 37(11%) having ODn<1.5 and initially classified as recent infections. Among these 37, 21(57%) had an HIV-1 RNA load ≤400 copies/mL and were excluded, as potential elite/viremic controllers or undisclosed ART use. Thus, 16 LAg-Avidity-EIA-recent, ARV-naïve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16–64 year old adults was estimated at 0.44% (95% CI 0.22–0.65%). Conclusion: Using a cross-sectional algorithm, HIV incidence in the 6 BCPP ESS communities was less than 0.5%. The rate at ESS is lower than the BCPP baseline incidence of ~1%, which might reflect the successful scale-up of the ART program in Botswana. 837 BEHAVIORAL AND SEROLOGICAL FINDINGS OF THE KADUNA STATE AIDS INDICATOR SURVEY, 2017 Adebobola T. Bashorun 1 , Aishat B. Usman 1 , Mark Anthony 2 , Taiwo Ibinaiye 1 , Abisola Oladimeji 1 , Titi Olugbade 3 , Mustapha Jamda 4 , Patrick Nguku 1 1 African Field Epidemiology Network, Abuja, Nigeria, 2 Kaduna State Agency for AIDS Control, Kaduna, Nigeria, 3 Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria, 4 University of Abuja, Abuja, Nigeria Background: Nigeria has one of the highest rates of new HIV infections in sub- Saharan Africa. Approximately three million Nigerians are living with HIV with a current adult prevalence of 3.0%. Thirty-one percent of positive adults and 21% of positive children are on Antiretroviral treatment (ART). In Kaduna state, ART coverage is estimated to be 27% for adults and 6% for children. We conducted this study to determine the prevalence of HIV and describe the demographic, socio-economic, and behavioral risk factors associated with the HIV epidemic and programmatic gaps in Kaduna State, Nigeria. Methods: We conducted a population based, cross-sectional, two staged survey of households across the 23 Local Government Areas in the state between January to April 2017. Twenty-two thousand one hundred and ninety-four (22,194) individuals aged 0-64 years were sampled through strata allocation from 3,383 urban and rural households. Open data kits (ODK) electronics questionnaires were used to collect information about HIV,

awareness of HIV status and behaviors that drives the HIV epidemic across age- groups. Blood samples were collected to determine to HIV status, CD4 count and viral load. Data was analyzed using STATA 12 software Results: A total 22,194 individuals were interviewed with a response rate of 93.9%, 20,406 (97.9%) tested for HIV and given result. One hundred and thirty individuals tested positive. Overall HIV prevalence was 0.6%.Of the 20,406 respondents, 3,115 (15.3%) were previously tested with result and 47 (36%) self-reported being HIV positive. Ninety-six percent of those who self-reported HIV positive were positive when retested. Among all the positives, 17.6% had CD4 count ≤ 500µ/ml and 39.7% had viral load < 1000 copies/ml. Behavioral drivers of HIV were hesitation to take a HIV test 68.3% (OR 1.7 95%CI 0.9-3.2) and fear of loss of respect from others if found positive 66.4%(OR 1.0 95% CI 0.5-1.9),inconsistent condom use in the last 12 months 3.1%,(OR 0.3 95% CI 0.2- 0.6), widowed 5.3%(OR 11.795% CI 4.2-32.5), unmarried but living with partner 4.9%(OR 11.195%CI 1.9-65.7) Conclusion: Fear of stigmatization and co-habitation were found to be behavioral drivers of HIV in Kaduna state, and indicates potential for HIV transmission and spread. We recommend to the State targeted campaigns about HIV Counselling and testing services (HTS), health promotion of non- discriminatory attitudes about HIV, and health education about safer practices to reach different sectors of the population. Samuel S. Malamba 1 , David S. Zamar 2 , D. Martin Ogwang 3 , Anton Friedman 2 , Kate Jongbloed 2 , Herbert Muyinda 1 , ACHILLES KATAMBA 1 , Nelson Sewankambo 1 , Martin T. Schechter 2 , Patricia M. Spittal 2 1 Makerere University College of Health Sciences, Kampala, Uganda, 2 University of British Columbia, Vancouver, BC, Canada, 3 St. Mary’s Hospital Lacor, Gulu, United Arab Emirates Background: Conflict in Northern Uganda in the 2000s resulted in widespread atrocities, human rights violations and death, and sawmillions flee to internally displaced people (IDP) camps. War related traumas combined with difficulties in accessing prevention and health services has led to extreme HIV vulnerability among conflict-affected people who have survived the war. Methods: The Cango Lyec (Healing the Elephant) Project is a prospective cohort involving conflict-affected people in Nwoya, Amuru, and Gulu districts, Northern Uganda. Participants aged 13–49 at baseline were followed over 2 years and longitudinal data were collected on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were collected and tested for HIV at baseline and at each 12-month follow-up. Cox proportional hazard models determined factors associated with HIV incidence. Results: In total, 1918 participants (1021 female, 897 male) who were HIV negative at baseline and had at least one follow-up, contributed a total of 3899 person years for analysis. In this study, 39 (23 female, 16 male) participants contracted HIV during follow-up. This corresponds to a combined cumulative incidence of 10.0 per 1000 person years (95%CI: 7.1-13.7). Stratified by sex, cumulative incidence was 11.0 (95%CI: 7.0-16.6) among women and 8.8 (95%CI: 5.0-14.3) among men. Adjusting for potential confounders (age, sex, marital status, district of residence, displacement status, and religion), factors associated with an increased risk of contracting HIV included: having ever been abducted (HR: 3.6; 95%CI: 1.8-7.3), experiencing war-related traumatic events (HR: 2.5; 95%CI: 1.2-5.3), suicide ideation (HR: 3.2; 95%CI: 1.1-9.2), having 2 or more sexual partners (HR: 4.0; 95%CI: 1.2-13.4), inconsistent condom use (HR: 5.6; 95%CI: 1.18-25.0), and genital ulcers (HR: 2.8; 95%CI: 1.1-7.5). Conclusion: Conflict-affected participants who had experienced abduction and traumatic events during the war were disproportionately impacted by HIV infection in this study. Trauma-informed HIV prevention and treatment services, as well as culturally safe mental health initiatives are urgently required. 839 HIV, COINFECTIONS, AND RISK BURDEN AMONG PRISONERS AND STAFF: UGANDA NATIONAL SURVEY Lisa A. Mills 1 , Samuel Sendagala 1 , James Kisambu 2 , Rose N. Bosa 1 , Patrick Omiel Okecho 1 , Bruce J. Kirenga 3 , Samuel Wasike 1 , Robert Downing 4 , Brad Bartholow 1 , Mary N. Kaddu 5 , Lisa J. Nelson 1 , Shona Dalal 1 838 CANGO LYEC (HEALING THE ELEPHANT): HIV INCIDENCE IN POSTCONFLICT NORTHERN UGANDA

Poster Abstracts

CROI 2019 326