CROI 2019 Abstract eBook

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Oral Abstracts

duration (p<0.005 for all targets). HBV transcription (pgRNA) did not correspond with cccDNA levels in the same cells (p>0.05). Additionally, we identified cells that contained cccDNA but not pgRNA, defined here as transcriptionally silent, that accumulated with longer DAART from 0% (HB1) to 46.1% (HB5) of infected hepatocytes (Table). Conclusion: Our results indicate that the HBV viral landscape is highly dynamic, and that there is heterogeneity in transcription of cccDNA including complete silencing. Understanding transcriptional silencing in HBV-infected hepatocytes may be critical to emerging immunotherapy and could be exploited to develop a functional cure.

Community-based HIV testing and linkage is a key component of combination prevention in efforts to achieve effective HIV control.

Oral Abstracts

92LB IMPACT OF UNIVERSAL TESTING AND TREATMENT IN ZAMBIA AND SOUTH AFRICA: HPTN071(POPART) Richard J. Hayes 1 , Deborah J. Donnell 2 , Sian Floyd 1 , Nomtha Mandla 3 , Justin Bwalya 4 , Kwame Shanaube 4 , Ayana Moore 5 , Susan H. Eshleman 6 , Christophe Fraser 7 , Wafaa M. El-Sadr 8 , Peter Bock 3 , Nulda Beyers 3 , Helen Ayles 4 , Sarah Fidler 9 , for the HPTN 071 (PopART) Study Team 1 London School of Hygiene & Tropical Medicine, London, UK, 2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 3 Desmond Tutu TB Centre, Western Cape, South Africa, 4 Zambart, Lusaka, Zambia, 5 FHI 360, Durham, NC, USA, 6 Johns Hopkins University, Baltimore, MD, USA, 7 University of Oxford, Oxford, UK, 8 Columbia University, New York, NY, USA, 9 Imperial College London, London, UK Background: Universal testing and treatment was proposed as a strategy to achieve steep reductions in HIV incidence in generalized epidemics, yet prior trials showed inconsistent results. We report the results of HPTN071(PopART), the largest HIV prevention trial ever conducted. Methods: In this community-randomized trial (2013-18), 21 urban communities in Zambia and South Africa were arranged in 7 matched triplets and randomized within triplets to: Arm A (full PopART intervention including universal ART), B (PopART intervention with ART per local guidelines) and C (standard of care). Local guidelines adopted universal ART in 2016. The PopART combination prevention intervention comprised annual rounds of home- based HIV testing by Community HIV-care Providers (CHiPs) who supported linkage to care, ART adherence and other HIV services. Impact was measured in a Population Cohort (PC) comprising one randomly selected adult (aged 18-44y) from a random sample of ~2,000 households per community, surveyed at baseline, 12m, 24m and 36m. Viral load (VL) was measured in all HIV+ PC participants at 24m. The primary outcome was HIV incidence between 12-36m compared between arms. Intervention data on HIV testing and ART uptake were collected by CHiPs in Arm A and B communities. Results: A total of 48,301 adults were enrolled in the PC. Baseline HIV prevalence was similar across arms (A:21.2%; B:21.1%; C:22.4%). Between 12-36m, 553 incident HIV infections were observed in 39,733 person-years (1.4/100py). The adjusted HIV incidence rate ratio for Arm A compared with C was 0.93 (95%CI:0.74-1.18, p=0.51, Table) and for Arm B compared with C was 0.70 (95%CI:0.55-0.88, p=0.006). Intervention data indicated that the first two 90s were achieved in Arms A and B after three annual rounds. Viral suppression (VS: VL<400 copies/mL) at 24mwas 72.1% in Arm A, 67.9% in Arm B and 62.5% in Arm C, with lower rates in men and younger adults (<25y). Conclusion: The PopART intervention achieved the 90-90-90 targets and high rates of VS (~70%). The intervention, with ART delivered according to local guidelines (Arm B), reduced HIV incidence by 30%. The lack of effect in the full intervention arm (Arm A), where universal treatment was delivered prior to change in guidelines, was surprising and not explained by observed rates of VS. Phylogenetic and qualitative analyses may shed light on this dissonant finding.

93 A RANDOMIZED TRIAL ON INDEX HIV SELF-TESTING FOR PARTNERS OF ART CLIENTS IN MALAWI Kathryn Dovel 1 , Kelvin Balakasi 2 , Frackson Shaba 2 , Khumbo Phiri 2 , Ogechukwu Offorjebe 3 , Sundeep Gupta 1 , Vincent Wong 4 , Eric Lungu 2 , Mike Nyirenda 2 , Brooke E. Nichols 5 , Khumbo Ngona 6 , Risa M. Hoffman 1 , for the EQUIP Innovations for Health 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Partners in Hope, Lilongwe, Malawi, 3 Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA, 4 United States Agency for International Development, Washington, DC, USA, 5 Boston University, Boston, MA, USA, 6 Government of Malawi Ministry of Health, Lilongwe, Malawi Background: HIV testing of sexual partners of HIV-positive clients (index testing) is critical for case identifications and reducing transmission. Current index testing strategies have limited reach – only 20% of partners in Malawi are tested using standard partner referral slips (PRS) – a paper version of passive facility referrals for partners. Delivery of HIVST to partners at their home may address barriers to index testing. We evaluated an index HIVST intervention among partners of ART clients in Malawi. Methods: A randomized trial was conducted at 3 district hospitals in Malawi between March28-June13, 2018. ART clients were screened during routine services. Inclusion criteria were: >15 years of age; sexual partner with unknown HIV status; no history of interpersonal violence with that partner; and partner lives in facility catchment area. Clients were randomized 1:2: (1) standard PRS or (2) HIVST (Oraquick HIV Self-Test(c) demonstration and distribution and referral for confirmation by blood-based testing). Baseline and follow-up surveys were conducted with ART clients and a subset of sexual partners willing to present at facilities for a survey. Primary outcomes (partner tested, test result, confirmatory testing) were reported by ART clients. Uni- and multivariate logistic regressions were conducted. Results: 365 ART clients enrolled in the study, with median age 37 years and 22%male. Only 3 clients refused HIVST. 91% and 92% of clients in HIVST and PRS arms respectively reported distributing the intervention to their partners (p-value=0.70; Table). However, 81% of partners in HIVST tested compared to only 29% of partners in PRS (AOR:9.6; p-value<0.001). Positivity rates did not differ by arm (19% in HIVST versus 16% in PRS; p=0.74). Among newly diagnosed HIV-positive partners in HIVST, only 20% received a confirmatory, blood-based test within 4-weeks. 99% and 97% of ART clients reported being comfortable providing HIVST and demonstrating use to partners, respectively. Among partners who used HIVST and completed a survey (n=126; median age


CROI 2019

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