CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: This was a cluster randomized study with before and after population level cross sectional surveys in both intervention and control clusters administering structured questionnaires to randomly selected adolescents and youths. HIV testing kits were offered to all adolescents and youth who consented for testing. Proportions for HIVST uptake, positive rates and linkage were calculated. Results: Out of 6552 screened for HIV ST, 5353 (82%) consented for testing, with 62%male and mean age (SD) of 19 (2.1). Out of the 5353 tested, 68 (1.3%) were positive with more females (47/68) compared to males (21/68). Out of those positive 9/68 knew their HIV status with more females. Of the 56 new positive cases, 33 (59%) (Male 11, and Female 22) were successfully linked. Linkage was more likely with assisted HIV ST and same day treatment. Conclusion: While there a high uptake of testing HIVST among this age group, the yield and linkage was low low but high among female. Targeted testing among high risk adolescent and youth is recommended. Assisted HIVST and same day treatment has high probability of linkage to Care. Muhammad S. Jamil 1 , Garrett Prestage 2 , Kirsty Smith 2 , Rebecca J. Guy 2 , for the FORTH Investigator Group 1 WHO, Geneva, Switzerland, 2 Kirby Institute, Sydney, NSW, Australia Background: HIV self-testing (HIVST) increases testing frequency in men who have sex with men (MSM). HIVST kits are not currently available in Australia. A randomised controlled trial (FORTH) in Australia showed access to free HIVST doubled the frequency of testing in high-risk MSM over 12 months, with 4-fold increase in non-recent testers (tested >2 yr ago or never tested). We report FORTH trial results from an additional year of follow-up to assess the effect of HIVST on testing frequency in the second year. Methods: MSM who reported condomless anal intercourse or >5 male partners in the past 3 months were recruited at clinics and community sites between Dec 2013 and Feb 2015. Participants were randomly assigned (1:1) to the intervention (HIVST plus facility-based testing; n=182) or the standard care (SC; facility-based testing only; n=180) arms. After 12 months, all participants were offered HIVST for another year including SC arm (waiting-list [WL] arm in the second year). Participants completed a 3-monthly online survey to collect the number of HIV tests. The analysis population included MSM who completed the survey at 12 months, and of those who completed the end of study (24 month) survey. We calculated the mean number of tests per person and estimated the ratio of testing rates between groups using Poisson regression. Results: 296 MSM were included in the first (153 HIVST, 160 person-years [PY]; 143 SC, 148 PY) and 196 in the second year (97 HIVST, 99 PY; 99 WL, 102 PY). Compared to SC arm (2.1), mean HIV tests per person in the second year was: 3.4 in HIVST arm (RR:1.66, 95%CI:1.42-1.94, p<0.001); and 3.1 in WL arm (RR:1.50, 95%CI:1.28-1.76, p<0.001). Testing frequency also increased among non-recent testers (RR:2.71 and 2.50, respectively). There was no statistical difference in testing frequency between HIVST and WL arms in the second year (3.4 vs 3.1, RR:1.10, 95%CI:0.94-1.29, p=0.211), but the frequency was lower in HIVST arm in the second compared to first year (3.4 vs 4.2, RR:0.83, 95%CI:0.73-0.95, p=0.008). Conclusion: In this trial, compared to SC, HIV testing frequency was significantly higher in MSMwho continued to access HIVST in the second year as well as those who accessed HIVST in the second year only. The increase in frequency was greater among non-recent testers. MSM, especially those who have not tested recently, continue to have an interest in HIVST. Thus, efforts are needed to make HIVST accessible.

933 SUSTAINED INCREASES IN HIV TESTING IN MSMWITH HIVST: A RANDOMISED CONTROLLED TRIAL

934 EFFECTIVENESS OF DISTRIBUTING HIV SELF-TEST KITS THROUGH MSM PEER NETWORKS IN UGANDA Stephen Okoboi 1 , Lazarus Oucul 2 , Barbara Castelnuovo 1 , Collins Agaba 2 , Mastula Nanfuka 2 , Andrew Kambugu 1 , Rachel King 3 1 Infectious Disease Institute, Kampala, Uganda, 2 The AIDS Support Organization, Kampala, Uganda, 3 University of California San Francisco, San Francisco, CA, USA Background: Men who have sex with men (MSM) continue to be disproportionately impacted globally by the HIV epidemic and are also highly stigmatized in Uganda. Peer-driven HIV testing strategies can be effective in identifying undiagnosed infections. We examined peer HIV oral fluid self-test kits (HIVST) network distribution effectiveness in identifying undiagnosed HIV infection among MSM in The AIDS Support Organization (TASO). Methods: From June to August 2018, 15 MSM peers from TASO were identified and trained in HIVST and basic HIV counseling and asked to distribute 10 HIVST each through one wave to MSM who have never tested in the previous six months and link participants who test positive to care. We compared MSM peer HIVST distribution strategy to TASO MSM community and hotspot testing approaches in identifying undiagnosed HIV infection using Fisher exact test Results: Peers distributed HIVST to 150 MSM participants,143/150 (95%) completed HIVST (72 Entebbe-urban) and 71 Masaka-semi-urban). A total of 8 participants were newly diagnosed with HIV infection; 8/72 (8.3%) from Entebbe and 2/71 (2.8%) Masaka. This is higher than 4/147 (2.7%) observed in the TASO program Jan-March 2018 (P=0.02). All participants newly diagnosed with HIV infection, disclosed their test results to their peers, were confirmed HIV positive, and initiated on ART. Compared to TASO MSM testing programs, 77% of the MSM reached through the peer HIVST distribution had never tested or tested in the last 12 months. Conclusion: Our pilot findings suggest that distributing HIVST through MSM peer-network is effective and a promising strategy to increase uptake of HIV testing and reduce undiagnosed infections among MSM in Uganda 935 PREFERENCES FOR HIV SELF-TESTING IN SUBPOPULATIONS OF AUSTRALIAN GAY AND BISEXUAL MEN Jason Ong 1 , Richard De Abreu Lorenco 2 , Deborah Street 2 , Muhammad S. Jamil 3 , Kirsty Smith 4 , Fern Terris-Prestholt 1 , Rebecca J. Guy 4 , for the PUSH Study Group 1 London School of Hygiene & Tropical Medicine, London, UK, 2 University of Technology Sydney, Sydney, NSW, Australia, 3 University of New South Wales, Darlinghurst, NSW, Australia, 4 University of New South Wales, Sydney, NSW, Australia Background: In many high-income countries there are divergences in the HIV epidemic, with decreasing rates in locally born men who have sex with men but increasing or higher rates in recent migrants, ethnic populations and younger gay and bisexual men (GBM). Access to prevention services remains a challenge for these subpopulations, so innovative and discrete options for HIV testing are needed. We assessed the preferences among subpopulations of Australian GBM for HIV self-testing (HIVST) relative to other testing methods, and for how to access HIVST. Methods: We conducted a discrete choice experiment (DCE) among HIV- negative GBM age ≥18 years in January 2018 through Grindr advertisements. Men were randomized to one of two DCEs which included a series of 16 choices, each with two alternatives for HIV testing: DCE1 for HIVST kit attributes (price, accuracy, test type, collection method and who collects the specimen) and DCE2

Poster Abstracts

CROI 2019 365