CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

PEPFAR/USAID-funded HIV combination prevention project providing outreach services to high-risk individuals in 14 regions of Tanzania. Biomedical services provided to men include HIV testing, linkage to care and treatment, screening for STIs and TB, alcohol and drug screening and provision of condoms. Male Sauti beneficiaries are male partners of female sex workers (PFSW), other men (OM) who visit hotspots for HIV such as bars and brothels, and men having sex with men (MSM). Methods: Sauti project collect data through clinical intake forms, de-identifies and uses for project analysis. We conducted multi-variable regression analysis to identify factors associated with testing HIV-positive on men, with categories PFSW, OM and MSM. Data analyzed was from October 2017 to June 2018. Results: 268,842 men were tested for HIV (n=183,936 PFSW; n=81,274 OM and n=3,632 MSM) with 3.1% testing positive (5.2% among 35+ years and 2.1% below 35). HIV infection rates were higher among men age 35 + (3.4% among men who thought they were HIV negative or didn’t know their status and 5.6% newly HIV infected), compared to 1.4% and 2.1% respectively, among men <35. PFSWwere 1.56, (1.48-1.64) times more likely to test positive compared to OM, and MSM were over twice as likely [2.20, (1.84-2.63)]. Behavioral and biomedical factors increasing likelihood of testing HIV positive: inconsistent condom use [1.70, (1.58-1.82), and self-reported uncircumcised [1.62, (1.54-1.69). Conclusion: While the majority of men reached with HTS were < 35 years, a much higher proportion of men 35+ tested positive. Presumably testing the same number of older compared to younger men could have resulted in 4,526 more HIV positive men being identified and linked to treatment. Our findings support a targeted approach to creating demand among older men for HTS, and providing targeted services to men promoting condom use and circumcision. Findings were also consistent with other studies showing MSM to be at highest risk of HIV infection, and thus in need of targeted test and treat services

1 University of Washington, Seattle, WA, USA, 2 Asociacion Civil Impacta Salud y Educacion, Lima, Peru, 3 Fred Hutchinson Cancer Research Center, Seattle, WA, USA Background: Transgender women (TW) are at extremely high risk of HIV, even compared to men who have sex with men (MSM). MSM and TW and their sexual networks are often conflated in research. While studies of MSM show transmission in ‘closed’ networks comprised almost exclusively of MSM, sexual networks of TW have not been characterized. Understanding TW sexual networks, including identity and behavior of sexual partners of TW (PTW), is important to better explain the high HIV incidence in TW. Methods: We used modified respondent-driven sampling to collect cross- sectional data from TW and their sex partners in Lima, Peru (February – July 2018). TW seed participants completed a survey and invited up to 3 sex partners using a WhatsApp referral system. In each wave of forward partner referral, invited partners could complete the survey and were provided referral coupons. The questionnaire assessed gender and sexual identity, sexual behavior, and self-reported HIV status. We constructed a sexual network map and characterized sociodemographics and behavior of PTW. Results: In total, 470 eligible respondents completed the survey, including 203 PTW, defined as reporting a TW partner within 3 months. The network diagram (Figure) shows that almost all partners invited by TWwere cisgender (cis-) men, who almost always invited only TW sexual partners in the next wave. In the survey, 41% of PTW reported exclusively TW partners in the previous 3 months and 52% reported both cis-women and TW partners; only 7% reported cis-male partners. TW primarily reported cis-male partners, with only 2% reporting other gendered partners. PTW reported attraction to TW (83%) and cis-women (68%), with only 9% reporting attraction to cis-men. Most PTW reported being the insertive partner in anal sex (88%); most also reported ever purchasing (78%) or selling (56%) anal sex. Condomless anal intercourse in the past 3 months was reported by 60% of PTW and 65% of TW. Over half of PTW did not know their HIV status (54%), compared to 42% of TW and 20% of other network members (primarily MSM). Conclusion: We found almost no overlap between MSM and TW sexual networks. Nearly all PTWwere bi-/hetero-sexual cis-men who partner with trans- or cis-women. Most reported HIV-risk behaviors and did not know their HIV status. Our results do not fully explain the high HIV rates in TW, but highlight the need for HIV prevention interventions specifically designed for TW and PTW, particularly in settings where interventions focus mostly on MSM.

Poster Abstracts

843 HIV EPIDEMIC POTENTIAL IN SEXUAL NETWORKS OF MSM IN SAN FRANCISCO AND ATLANTA Emeli J. Anderson , Kevin M. Weiss, Pragati Prasad, Samuel Jenness Emory University, Atlanta, GA, USA Background: Population-level HIV transmission dynamics depend on the potential speed through which HIV may circulate, which is a function of the connectivity of sexual partnership networks. Sexual network features are often characterized by cross-sectional measures such as concurrency or demographic mixing patterns, but these do not quantify the epidemic potential of HIV through a network over time. Temporal measures of connectivity in high-risk populations are needed to estimate the potential for future HIV outbreaks and optimize control efforts. Methods: We compared the forward reachable path (FRP) of men who have sex with men (MSM) in San Francisco (SF) and Atlanta (ATL). The FRP measures the maximum number of men each MSM can reach directly, though his own partners, and indirectly, through partners of partners. Empirical data were from ART-Net, a cross-sectional study of 2176 MSM in the US, aged 15–65. Recent partnerships were categorized as main, casual (ongoing, but shorter than main), and one-time. We fit temporal exponential random graph models for each partnership type from these data. Complete MSM networks predicted from

842 FACTORS ASSOCIATED WITH HIV SEROPOSITIVITY AMONG HIGH-RISK MEN IN TANZANIA Maneno Luponya 1 , Caterina Casalini 1 , Ankita Mehta 1 , Peter Nyanda 1 , Yeronimo Mlawa 1 , Neema Makyao 2 , Angela Ramhadani 2 , Erick Mlanga 3 , Jason Reed 4 , Maligo Katebalila 1 , Marya Plotkin 4 , Albert Komba 1 , Jeremie Zoungrana 1 , Kelly Curran 4 1 Jhpiego, Dar es Salaam, Tanzania, United Republic of, 2 National AIDS Control Program, Dar es Salaam, Tanzania, United Republic of, 3 USAID Tanzania, Dar es treatment, WHO identified men as highly important to reach with HIV testing services (HTS) and enrollment into treatment. Globally, only one third of all HIV tests performed are on men and 40% of men living with HIV are on ART. In Tanzania, 19% fewer men living with HIV know their status, 7% fewer use ART and 6% fewer are virally suppressed compared to women. The Sauti project is a Salaam, Tanzania, United Republic of, 4 Jhpiego, Baltimore, MD, USA Background: Due to dramatically lower enrollment into HIV care and

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