CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

39 years; 67%men), 16% reported challenges understanding HIVST instructions and 8%were unable to interpret HIVST results. Reported adverse events (psychological IPV/end of relationship) did not vary by arm (~8%). Conclusion: Index HIVST greatly increased HIV testing without increased risk of adverse social events. Inadequate interpretation and test confirmation limits the impact of index HIVST and requires further study.

Oral Abstracts

95 HIV TESTING, TREATMENT, AND VIRAL SUPPRESSION COVERAGE IN A CLUSTER-RANDOMIZED TRIAL Kathleen Wirth 1 , Tendani Gaolathe 2 , Molly Pretorius Holme 1 , Mompati O. Mmalane 2 , Etienne Kadima 2 , Kutlo Manyake 2 , Sikhulile Moyo 2 , Kara Bennett 3 , Jean Leidner 4 , Refeletswe Lebelonyane 5 , Pamela J. Bachanas 6 , Joseph Makhema 2 , Max Essex 1 , Shahin Lockman 7 , Eric Tchetgen Tchetgen 8 1 Harvard University, Boston, MA, USA, 2 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 3 Bennett Statistical Consulting, Inc., Ballston Lake, NY, USA, 4 Goodtables Data Consulting, Norman, OK, USA, 5 Botswana Ministry of Health, Gaborone, Botswana, 6 CDC, Atlanta, GA, USA, 7 Brigham and Women’s Hospital, Boston, MA, USA, 8 University of Pennsylvania, Philadelphia, PA, USA Background: In settings like Botswana with high HIV prevalence and treatment coverage, it is unknown whether uptake of HIV-prevention and treatment interventions can be further increased. Methods: The Botswana Combination Prevention Project, a pair-matched cluster-randomized trial, compared uptake of an intervention package of intensive HIV testing/counseling(HTC) campaigns, linkage to care, expanded antiretroviral treatment(ART), and male circumcision(MC) versus standard- of-care in Botswana from 2013-2018. In mid-2016 universal ART became standard-of-care. We longitudinally followed residents aged 16-64 years of a random~20% sample of households in 30 communities (15 intervention, 15 standard-of-care) for ~30 months to assess uptake of ART, viral suppression, and MC. HIV testing was conducted annually. To assess change in HTC coverage (documented HIV-negative test within 12 months or knowledge of HIV-positive status) by arm, we recruited an additional sample of residents not enrolled in the longitudinal cohort from six communities/three pairs at study end. For HTC, ART, and viral suppression, we estimated risk ratios(RR) and 95% confidence intervals(CI) (accounting for clustering) using log-linear Poisson regression adjusted for potential baseline coverage imbalances, stratified by time and pair. MC uptake among HIV-uninfected uncircumcised men aged 16-49 years was evaluated using pair-stratified interval-censored Cox proportional hazards. Results: We enrolled 8,974 HIV-negative and 3,596 HIV-positive residents in the longitudinal cohort. An additional 11,767 residents were assessed for HTC uptake at study end. After accounting for baseline differences, HTC coverage was significantly higher in the intervention arm at study end (P<0.0001; Fig.1A). ART coverage and viral suppression increased in both arms, with greater increases in the intervention arm (ART P<0.0001; viral suppression P=0.004; Fig.1B-C). At study end, 98% (95%CI: 93%-100%) of HIV-positive cohort participants in intervention communities were on ART; 96% (95%CI: 92%-100%) were virally suppressed. A small number (348) of 1,873 HIV-negative uncircumcised men reported becoming circumcised, with higher uptake in the intervention arm (P<0.0001). Conclusion: Population levels of HTC, ART, viral suppression, and MC increased in both arms over time, with significantly greater increases in the intervention arm. Remarkably, at study end, nearly all HIV-positive cohort participants in intervention communities were on ART and virally suppressed.

94 VIRAL LOAD SUPPRESSION AND YIELD OF HIV TESTS ARE SPATIALLY CORRELATED, KENYA 2015-17 Anthony Waruru 1 , Joyce Wamicwe 2 , Thomas Achia 1 , Lucy Ng’ang’a 1 , Kenneth Masamaro 1 , Jacques Muthusi 1 , Emily C. Zielinski-Gutierrez 1 , James Tobias 3 , Stella Njuguna 1 , Catherine Mbaire 4 , Kevin M. De Cock 1 , Thorkild Tylleskär 5 1 US CDC Nairobi, Nairobi, Kenya, 2 Ministry of Health, Nairobi, Kenya, 3 CDC, Atlanta, GA, USA, 4 US Department of State Nairobi, Nairobi, Kenya, 5 University of Bergen, Bergen, Norway Background: High antiretroviral therapy (ART) coverage and high rates of viral load suppression (VLS) should reduce transmission of HIV, and ultimately, HIV incidence and the number of new HIV diagnoses. We used 3 years of HIV program data in Kenya to assess whether trends in the number of new HIV diagnoses were associated to ART coverage and VLS rates and spatial-temporally auto correlated at county-level [sub-National unit (SNU)]. Methods: We analyzed routine program SNU-level aggregate ART coverage and VLS (proportion of persons on ART with VL<1000 copies/mL) data for 3 years (2015-2017). We examined the association between ART coverage and VLS rates to new HIV diagnoses by fitting spatial and spatial-temporal semi-parametric Poisson regression models using R-Integrated Nested Laplace Approximation (INLA) package. We used the extended Cochran-Mantel-Haenszel stratified test of association to test for trend across years for fitted rates of new HIV diagnosis and a structural equation model to assess direct effects between the two exogenous covariates to fitted newly HIV-diagnosed as the endogenous variable adjusting for clustering by 47 SNUs. Finally, we mapped fitted HIV positivity using QGIS version 3.2. Results: A spatial-temporal model with covariates was better in explaining geographical variation in HIV positivity (deviance information criterion (DIC) 381.2) than either a non-temporal spatial model (DIC 418.6) or temporal model without covariates (DIC 449.2). Overall, the fitted HIV positivity decreased over 3 years frommedian of 2.9% in 2015, [interquartile range (IQR): 1.9-3.4] to 1.5% in 2017, IQR(1.3-2.0), (Figure), stratified test of association p=0.032. VLS had a direct effect on HIV positivity rates p=0.014, but ART coverage did not, p=0.502. Conclusion: In 3 years of widespread availability of ART, we have observed a general decline of rates of new HIV diagnoses associated with improved VLS rates. To assess the trends and impact of implementation of scaled-up care and treatment, spatial-temporal analyses help to identify geographic areas that need focused interventions.

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CROI 2019