CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

their partner, 92% reported their partner used the self-test and 96% used a self-test with their partner; 6 (2%) male partners with previously unknown HIV status tested positive using self-tests. Conclusion: Within routine ANC, acceptance of at-home male partner HIVST was high and frequently led to couples’ HIV, enhancing mutual knowledge of HIV status. IPV was a barrier to acceptance and offering of self-tests. Given low male attendance at clinics, distributed HIVST is an attractive strategy to improve male partner HIV testing. 927 MALE PARTNER LINKAGE TO CLINIC STI-HIV SERVICES AFTER COUPLE EDUCATION & HIV TESTING Jennifer Mark 1 , Alison C. Roxby 1 , John Kinuthia 2 , Alfred Osoti 3 , Daisy Krakowiak 1 , Monisha Sharma 1 , Quy Ton 1 , Barbra Richardson 1 , Carey Farquhar 1 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya, 3 University of Nairobi, Nairobi, Kenya Background: Home-based HIV testing and education has potential for increasing HIV testing and access to health information and services among men. However, the extent to which men follow-up to clinic based STI and HIV services is yet to be defined. We aim to understand how a home-based antenatal couple education and HIV testing intervention influences male partner follow-up to clinic-based HIV and STI services including STI treatment, HIV care and treatment, and medical male circumcision. Methods: We conducted a randomized controlled trial of 601 unaccompanied pregnant women attending a first antenatal visit in Kenya from September 2013 to June 2014. Women and their male partners received either the intervention of home-based couple education and HIV-syphilis testing during pregnancy or an invitation letter for standard clinic-based couple HIV testing. Education included identification of STI symptoms and the importance of clinic treatment, in addition HIV treatment for PMTCT and circumcision for HIV-negative men. Male self-reported outcomes were compared between arms at 6 months postpartum. Results: Among 525 women who completed the study to 6 months postpartum with their infants, we reached 487 men (93%), resulting in 247 and 240 men in the intervention and control arm, respectively. Men of the intervention arm were more likely to report seeking an STI consultation for symptoms [RR=1.59; 95%CI=1.33-1.89]. Syphilis testing at the intervention identified 4 couples requiring treatment and all 4 of these men reported later seeking treatment. Sixty-one men were HIV-infected at study exit, among whom 17 (42%) of 40 intervention men and 5 (24%) of 21 control men were newly diagnosed during the period of the study. Four of 17 men and 3 of 5 men with newly diagnosed HIV in the intervention and control arms, respectively, reported linking to HIV care services [RR=0.69; CI:0.50-0.96]. Few eligible men sought medical circumcision for HIV prevention (4 of 72 intervention and 2 of 88 control). Conclusion: One-time home-based couple education encouraged male partners to seek clinic STI treatment, however, this was not the case for men with newly diagnosed HIV infection who would likely benefit from additional follow-up to link to care and treatment. Newly diagnosed men identified in home-based testing should be targeted to follow-up linkage to HIV care, which could result in equivalent or better access than clinic-based services alone.

1 CDC, Atlanta, GA, USA, 2 US CDC Pretoria, Pretoria, South Africa, 3 Health Systems Trust, Durban, South Africa, 4 Rustenburg Subdistrict Office, Rustenburg, South Africa Background: Despite high uptake of HIV testing among pregnant women, male partner testing within antenatal clinics (ANC) remains low. This study aimed to increase the proportion of men tested within ANC through promotion of facility and home-based HIV testing and distribution of HIV self-test kits. Methods: This study was conducted at a large health center in the Bojanala District of South Africa from January 2017 – October 2017. All pregnant women, whose partner was HIV-negative or of unknown status, were offered three options for partner testing: (1) a partner invitation letter for facility testing; (2) home testing; or (3) up to 2 Ora-Quick self-test kits to take to their male partners. Instructions included with the self-test kit asked men to send a free “call me back” text to a counsellor after completing the test. Counsellors returned men’s calls, collected their results, and provided post-test counseling over the phone. Men could receive up to two R25 (~US$2) airtime vouchers: one for receiving post-test counseling and one for returning the self-test kit via text or physically to the facility. Cost information was collected for all three testing options and is presented in 2017 US dollars. Results: We enrolled 1,166 women (mean age: 28 years, 72% single, 37% primigravida). HIV prevalence was 21% (12% newly diagnosed, 9% documented known positive). Figure 1 illustrates the uptake of facility, home, and HIV self- testing during the study. Records indicated that 223 men tested at the facility (6% concordant positive, 3% sero-discordant), while 28 men tested in the home (7% concordant positive). HIV self-test kits were distributed to 668 men. Of the 313 (47%) test kits returned either physically or via text, no discrepancies were noted between men’s interpretation of the test result and the result obtained by the counselor. The cost per partner tested was $77 for facility, $125 for home, and $83 for self-testing, while the cost per partner testing positive was $403, $1,483, and $2,742 respectively. Conclusion: HIV self-testing was extremely popular among pregnant women as a method for partner testing, but even with incentives, only 60% of men received post-test counseling. The costs of HIV self-testing were similar to facility testing. Further operational research will be needed to ensure linkage to confirmatory testing and HIV treatment in the event of a positive HIV self-test, which will further reduce the cost per positive diagnosis associated with HIV self-testing.

Poster Abstracts

929 INDEX CASE FINDING A STRATEGY FOR CLOSING THE GAP FOR HIV DIAGNOSIS IN TANZANIA Peris L. Urasa 1 , Angela Ramhadani 1 , Neema Makyao 1 , Leonard Subi 2 1 National AIDS Control Program, Dar es Salaam, Tanzania, United Republic of, 2 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of Background: Tanzania adopted the 90-90-90 strategy as part of the National HIV Strategic Plan to end HIV by 2030. To achieve the first 90, the identification of PLHIV through HIV testing is key to the strategy’s success, and the whole cascade. In Tanzania, only 52% of PLHIV ages 15 to 64 years know their HIV status of which 55.9% are females and 45.3% are HIV positive males. To increase

928 OUTCOME AND COST OF 3 METHODS FOR INCREASING MALE PARTNER TESTING IN SOUTH AFRICA Amy M. Medley 1 , Arielle Lasry 1 , Nompumelelo Khanyile 2 , Tonicca Maphanga 3 , Mothoemang Tlotleng 3 , Carlos Toledo 1 , Cila Kabongo 4 , John Tumbo 4

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