CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

892

ASSISTED PARTNER SERVICES AMONG PEOPLE WHO INJECT DRUGS IN NAIROBI, KENYA Aliza Monroe-Wise 1 , Brandon Guthrie 1 , Loice Mbogo 2 , Bill Sinkele 3 , David Bukusi 2 , Matthew Dunbar 1 , Paul Macharia 4 , Esther Gitau 3 , Betsy Sambai 2 , Helgar Musyoki 4 , Sarah Masyuko 4 , Joshua T. Herbeck 1 , Carey Farquhar 1 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya, 3 Support for Addictions Prevention and Treatment in Africa, Nairobi, Kenya, 4 National AIDS and STD Control Programme, Nairobi, Kenya Background: Testing key populations (KPs) for HIV is essential to achieving the first of the UNAIDS 90-90-90 goals. Identifying and testing partners of HIV-infected individuals, or assisted partner services (aPS), is an efficient tool for case-finding. aPS has not been used among people who inject drugs (PWID), one of the highest risk KPs. We determined whether aPS could find, test, and link to care the injecting and sexual partners of HIV-infected PWID in Nairobi, Kenya. Methods: Recruitment of index participants (indexes) occurs at 3 needle and syringe exchanges in Nairobi. Indexes provide contact information for injection and sexual partners in the past 3 years. Blinded to the index’s identity, community-embedded peer educators (CEPEs) attempt to contact all named partners, first by phone, then community tracing. When partners are contacted, they are notified of their possible HIV exposure and are offered HIV counseling and testing. Participants also complete questionnaires and are offered rapid hepatitis C (HCV) testing. To examine aPS effectiveness, we determined the number of indexes needed to be interviewed (NNTI) to find a 1) first-time tester; 2) new HIV case; 3) known HIV-positive person not on treatment. Results: To date, 149 indexes have enrolled who have named 440 partners (Figure 1). Of named partners 332 (76%) have been traced and enrolled. Because partners could enroll multiple times if named by multiple indexes, the 332 enrolled partners represented 274 unique individuals, of whom 194 (71%) were injection partners (IPs), 35 (13%) sexual partners (SPs), and 45 (16%) injection and sexual partners (ISPs). Among partners 63 (22%) were HIV-infected, of whom 7 (11%) were unaware of their status and 8 (13%) were aware but not on ART. HIV prevalence was highest among IPs and ISPs (24%) and lower among SPs (11%). NNTI was 19 per first-time tester, 21 per new HIV case, and 10 per HIV-infected person not on ART. HCV Ab was found in 50 (33%) indexes and 57 (20%) partners. Confirmatory RNA tests are pending. Almost all partners required in-person tracing, as they could not be reached by phone. No adverse events have been reported related to aPS. Conclusion: aPS using CEPEs is an effective tool for finding and testing high- risk partners of PWID. Nearly one quarter of partners reached were HIV-infected. Among these, one quarter did not know his/her status or was not on ART. We conclude that aPS is a novel testing strategy that may reduce HIV transmission and promote engagement in care among PWID.

Poster Abstracts

891 AN OUTBREAK OF HIV IN HOMELESS HETEROSEXUALS WHO INJECT DRUGS IN NORTH SEATTLE, WA Matthew R. Golden 1 , Richard Lechtenberg 2 , Sara N. Glick 1 , Julia C. Dombrowski 1 , Jeff Duchin 2 , Jenifer R. Reuer 3 , Shireesha Dhanireddy 1 , Santiago Neme 1 , Susan E. Buskin 2 1 University of Washington, Seattle, WA, USA, 2 Public Health–Seattle & King County, Seattle, WA, USA, 3 Washington State Department of Health, Tumwater, WA, USA Background: King County, WA, was the first urban area in the US to achieve the WHO 90-90-90 objective and new HIV diagnoses in the county have declined almost 50% in the last decade. HIV infection among non-men who have sex with men (non-MSM) persons who inject drugs (PWID) has traditionally been rare, with an average of 9 diagnoses annually 2008-2017 and 7 diagnoses in 2017. However, the number of heroin overdoses in King County increased 264% 2007-2018, the number of persons living homeless (PLH) increased 129% 2010- 2017, and >60% of PWID are PLH. The area has a growing, highly vulnerable PWID population. Methods: We analyzed public health HIV surveillance, partner services (PS), and molecular HIV surveillance (MHS) data to characterize a cluster of HIV diagnoses among non-MSM PWID and their sex and injection partners. Cluster cases met ≥1 of the following criteria: 1) non-MSM diagnosed with HIV in 2018 with PS data indicating sex or injection drug equipment sharing with a cluster case; 2) HIV diagnosis in 2018 among non-MSM PLH in the outbreak area; 3) MHS showing HIV infection with a strain related to cases meeting criteria 1 or 2 (HIV-TRACE distance ≥1.5%). We excluded cases if MHS indicated infection unrelated to the cluster. Results: From 1/1/18 to 9/15/18, 19 non-MSM PWID were diagnosed with HIV, a 171% increase compared to the 12 months of 2017. Eleven of the 19 cases, as well as 9 cases diagnosed 2008-2017, were part of a cluster. All 11 cluster cases diagnosed in 2018 were PLH in an area of approximately 3 square miles; 8 were cis-women, 2 of whom exchanged sex, and 8 were PWID, 7 of whom injected heroin. Public Health-Seattle & King County (PHSKC) initially identified the cluster through PS, with additional cases added using MHS data that were not available in real time. Ten cluster cases were diagnosed in the 20 months before disease investigators first identified links between cases. PHSKC has responded to the cluster by alerting medical and social service providers and the public; expanding outreach testing and condom distribution; promoting testing in emergency departments and jails; increasing syringe services; promoting PrEP in PWID; and working to build new clinical capacity in the area of the outbreak. Conclusion: In the face of growing homelessness and heroin use, even areas with well-developed HIV care and prevention programs are vulnerable to outbreaks of HIV among the most disadvantaged persons. MHS procedures need to be improved to more quickly identify growing clusters.

CROI 2019 347