CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

950 RISK COMPENSATION FOLLOWING PrEP DISCONTINUATION AMONG HIV- SERODISCORDANT COUPLES Randy Stalter 1 , Kenneth K. Mugwanya 1 , Jared Baeten 1 , Katherine Thomas 1 , Lara Kidoguchi 1 , Connie L. Celum 1 , Andrew Mujugira 1 , Kenneth Ngure 2 , Elizabeth A. Bukusi 1 , Renee Heffron 1 , for the Partners Demonstration Project Team 1 University of Washington, Seattle, WA, USA, 2 Partners in Health Research and Development, Thika, Kenya Background: Time-limited PrEP use by HIV-negative members of HIV serodiscordant couples until the HIV-positive partner achieves and sustains viral suppression with antiretroviral treatment (ART) is a highly effective HIV prevention strategy. Whether transitioning from self-controlled PrEP protection by the uninfected partner to relying on effective ART use by the HIV-positive partner results in a reduction in condomless sex has not been assessed. Methods: Data are from the Partners Demonstration Project, a prospective open-label PrEP demonstration study in Kenya and Uganda. HIV-negative partners in serodiscordant couples were provided with PrEP and encouraged to discontinue PrEP when their HIV-positive partner used ART for >6 months (unless there were additional partners, ART adherence concerns, or immediate fertility desires). We included all couples with an HIV-negative partner that discontinued PrEP due to the HIV-positive partner being on ART for ≥6 months. Self-reported numbers of sex acts and condomless sex acts in the past month were collected quarterly. We used segmented regression with zero-inflated negative binomial models to compare the levels and rates of change of sexual behaviors before and after the HIV-negative partner discontinued PrEP. Multivariable models adjusted for demographics, baseline sexual behavior, pregnancy and couple relationship status. Results: We included 567 couples who were followed for 622 person-years while the HIV-negative partner was on PrEP and for 506 person-years after PrEP discontinuation. HIV-negative partners had a median age of 30 years and were female in 33% of couples. In multivariable analyses, there was a 40% decrease in condomless sex acts reported after PrEP discontinuation (rate ratio [RR]=0.60, 95% CI: 0.41-0.87) where the HIV-negative partner was female. There was no change among couples where the HIV-negative partner was male (RR=1.03, 95% CI: 0.84-1.28), ≤30 years of age (RR=1.06, 95% CI 0.83-1.38), or >30 years of age (RR=0.77, 95% CI: 0.58-1.02). We found no difference in the rate of change in sexual risk behaviors after PrEP discontinuation regardless of HIV-negative partner gender or age. Conclusion: Discontinuation of PrEP by HIV-negative partners due to sustained ART use by their HIV-positive partners did not result in an increase in sexual frequency or condomless sex. However, couples with female HIV-negative partners engaged in fewer condomless sex acts immediately after PrEP discontinuation. 951 VOLUNTARY MEDICAL MALE CIRCUMCISION IN SWAZILAND: ACHIEVEMENTS AND GAPS Zandile Mnisi 1 , Chiara Draghi 2 , Chunhui Wang 3 , Trong T. Ao 4 , Suzue Saito 3 , Neena M. Philip 3 , Choice Ginindza 5 , Sabelo Dlamini 6 , Kristin Brown 4 , Fortune T. Mhlanga 5 , Caroline Ryan 4 , Jessica E. Justman 3 , Harriet Nuwagaba-Biribonwoha 3 1 Ministry of Health, Mbabane, Swaziland, 2 CDC, Mbabane, Swaziland, 3 ICAP at Columbia University, New York, NY, USA, 4 CDC, Atlanta, GA, USA, 5 Central Statistical Office, Mbabane, Swaziland, 6 University of Swaziland, Mbabane, Swaziland Background: Medical male circumcision (MMC) lowers the risk of heterosexually acquired HIV infection in men by approximately 60%. In Swaziland, self-reported MMC prevalence among adult males (18+years) was 8% in the 2007 Demographic and Health Survey, and 17% in the 2011 Swaziland HIV Incidence Measurement Survey (SHIMS), SHIMS1. The global target for MMC coverage is 80% in high HIV prevalence countries, and the Swazi national target is 70% by 2018. We assessed self-reported MMC prevalence in the 2016/7 SHIMS (SHIMS2). Methods: SHIMS2 was a nationally representative, two-stage cluster questionnaire. We calculated the MMC prevalence by sociodemographic characteristics and HIV status. The Rao-Scott chi-square test was used to test group differences. Multivariate logistic models evaluated the associations between MMC status and sociodemographic characteristics: age, education, wealth quintile, location, marital and HIV status. All analyses were adjusted for survey design, non-coverage, and non-response. randomized, cross-sectional household survey. From August 2016 to March 2017, male participants 15+ years self-reported MMC status through an individual

Results: Among the 4,815 men (median age 29.2 years, Interquartile range [IQR]: 19.9, 42.8), overall MMC prevalence was 27.1% (95% Confidence Interval [95% CI]: 25.3-29.0%) peaking in the age group 15-19 years 38.7% (95% CI: 35.1-42.3%) and lowest in the age group 65+ years 7.9% (95% CI: 4.8-11.1%), p<0.0001. In the multivariate analysis, the odds of self-reporting MMC were significantly lower among men aged 25+ (aOR=0.69, 95 CI%: 0.57-0.85) versus 15-24 yrs men; HIV positive men (aOR=0.55, 95% CI: (0.44-0.69); married men (aOR=0.72, 95%CI: 0.58-0.89) versus never married men; men with no education (aOR=0.52, 95%CI: 0.34-0.81) versus those with primary schooling. Compared to men in the middle wealth quintile, men in the highest quintile were more likely to self-report MMC (aOR=1.47, 95% CI: 1.09-1.97). Among males 18-49 years, MMC prevalence increased from 17% (95% CI: 16.2-18.4) in SHIMS1 to 28% (95% CI: 26.0-30.4) in SHIMS2. Conclusion: Although a modest increase in MMC prevalence has been observed since 2011, the national and international targets will likely not be met. Innovative MMC approaches are needed to increase MMC prevalence, particularly among uneducated, low wealth and older men.

Poster Abstracts

952 SHIKAMANA INTERVENTION SIGNIFICANTLY REDUCES HIV INCIDENCE AMONG FSW IN TANZANIA Deanna Kerrigan 1 , Jessie Mbwambo 2 , Samuel Likindikoki 2 , Wendy Davis 1 , S.W. Beckham 3 , Andrea Mantsios 3 , Anna M. Leddy 4 , Noya Galai 3 1 American University, Washington, DC, USA, 2 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of, 3 Johns Hopkins University, Baltimore, MD, USA, 4 University of California San Francisco, San Francisco, CA, USA Background: Female sex workers (FSW) are at dramatically heightened risk for HIV compared to women overall, with 13.5 greater odds of being HIV-infected globally. In Tanzania, modeling has shown FSW and their clients represent 23% of incident HIV infections. A prior systematic review and meta-analysis found that community-driven combination prevention models have been found to reduce the risk for HIV infection by 32% among FSW in Latin America and South Asia, but no proven models exist for FSW in sub-Saharan Africa. Methods: We conducted a two-community randomized controlled trial of a community-driven combination HIV prevention model among 496 FSW (203 HIV+ and 293 HIV-) enrolled in a longitudinal cohort in Iringa, Tanzania. The multi-level intervention model was developed based on extensive formative research and anchored on FSW needs and priorities. The intervention included: community drop-in-center and mobilization activities, peer education and navigation services, mobile HIV testing, clinical care provider and police sensitivity trainings, and SMS reminders to promote care engagement and ART adherence. At baseline and 18-month follow-up, study participants were surveyed and screened for HIV infection, the presence of ART in the blood, and viral load. Poisson robust regression and propensity score matching was utilized to compare HIV incidence and viral load at follow-up between the intervention and control communities. Results: Participants in the intervention community were significantly (62%) less likely to become infected with HIV at follow-up (OR 0.38; p=0.047), with an HIV incidence of 5.0% in the intervention vs. 10.4% in the control arm. We also observed a significant difference in reductions in inconsistent condom use from baseline to follow-up between the intervention (72.0% to 43.6%) vs. control (68.8% to 54.0%) community (p=0.042). As shown in Table 1,

CROI 2019 372