CROI 2019 Abstract eBook

Abstract eBook

Oral Abstracts

Mozambique. We assessed in the Chokwe Health Demographic Surveillance System (CHDSS) trends in HIV incidence, and prevalence of viral load suppression (VLS, <1000 RNA copies/mL) and CBI including circumcision among men (MC), and HIV testing, diagnosis, and use of antiretroviral therapy (ART) among persons living with HIV (PLHIV). Located in Chokwe District, CHDSS includes ~95,000 residents. Methods: Since 2014, HIV testing services (HTS) including referral for MC and follow-up linkage-to-care for PLHIV has been offered annually at all ~20,515 CHDSS households. HIV incidence and prevalence of HIV, VLS, and CBI were assessed with annual surveys of residents aged 15-59 years in 10% (2014-2015) or 20% (2016-2017) of randomly selected households. Dried blood spots of participating PLHIV were tested at CDC for VLS and recent infection (mean <161 days). Annualized HIV incidence was calculated with a standard formula; participants on ART or with VLS were defined as having longstanding infection. Census-weighted CHDSS HIV incidence, incidence rate ratios (IRR), and prevalence of HIV, VLS, and CBI were estimated for the first three survey rounds (R1-R3, April 2014–March 2017). District health facilities offered ART for all PLHIV beginning in mid-2016, R3. Results: During R1-R3, 39,586 (72%) of 55,287 residents aged 15-59 years tested for HIV at home at least once, and 3,449 (886 men) were newly HIV diagnosed and provided linkage services. HIV prevalence decreased from 27.3% in R1 to 25.7% in R3 (p< 0.05) (Table). By R3, prevalence of MC, and prior HIV diagnosis, current ART use, and VLS among PLHIV increased 14.0%-21.6% (Table). Of 2,750 PLHIV, 30 (1.1%) had been recently infected (R1, 1.5%; R2, 1.2%; R3, 0.7%). HIV incidence decreased 53% overall (p<0.05), and 54% and 51% (p>0.05) among men and women, respectively (Table). Among persons aged 15-24 and 25-59 years, HIV incidence fell from 1.3% (0.0-2.5%) and 2.4% (0.6-4.3%) in R1 to 0.4% (0.0-1.0%) and 1.3% (0.1-2.4%) in R3, respectively. Conclusion: In a high HIV prevalence district in Mozambique, increasing population prevalence of HIV biomedical interventions was associated with increasing prevalence of VLS and an approximate 50% reduction in HIV incidence among adults. Annual home-based HTS with referral and linkage services can help achieve rapid scale up of CBI, increased VLS, and reduced HIV incidence. 99 A MODEL IMPACT ANALYSIS OF PrEP AND TasP IN FSW DEMONSTRATION PROJECT IN BENIN Lily Geidelberg 1 , Kate M. Mitchell 1 , Marlène Aza-Gnandji 2 , Luc Béhanzin 2 , Fernand A. Guédou 2 , Djimon M. Zannou 3 , Dissou Affolabi 3 , Rene Keke 4 , Flore Gangbo 3 , Moussa Bachabi 5 , Peter Vickerman 6 , Michel Alary 7 , Marie-Claude Boily 1 1 Imperial College London, London, UK, 2 Dispensaire des IST, Cotonou, Benin, 3 Centre National Hospitalier Universitaire Hubert Koutougou Maga de Cotonou, Cotonou, Benin, 4 Reference Laboratory of the National Center for the Treatment of HIV, Cotonou, Benin, 5 Programme Santé de Lutte contre le Sida, Cotonou, Benin, 6 University of Bristol, Bristol, UK, 7 CHU de Québec-Université Laval, Quebec, QC, Canada Background: Daily pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) can reduce HIV acquisition and transmission risk respectively. With a 2015 HIV prevalence of 19%, female sex workers (FSW) are a key group for HIV prevention in Cotonou, Benin. From 2014-2016, a demonstration project assessed the feasibility and utility of TasP and PrEP among FSW. We used mathematical modelling to project the population-level impact of the project and of extending the intervention for 20 years. Methods: A dynamic model of HIV transmission, PrEP and treatment among FSW, clients and the general population was parameterised using PrEP, TasP and condom use data from the demonstration project and other historical demographic, sexual behaviour, epidemiological and intervention data from Cotonou. The model was calibrated within a Bayesian framework to HIV prevalence and ART coverage data by risk group pre- and post-intervention,

PrEP and TasP initiations and PrEP use data from the study. The model assumed 256 PrEP initiations of HIV- FSW, 47% of whomwere retained after 2 yrs, over 250 person-yrs of follow-up with average 63% detectable (>0.3 ng/mL) tenofovir (PrEP). TasP was modelled by increased testing and ART initiation among HIV+ FSW giving 107 initiations over 2 yrs, 60% of whomwere retained after 2 years. We also modelled extending the intervention over 20 years reaching 21% of HIV- and 81% HIV+ FSW on PrEP and TasP respectively. We estimated the median (5th-95th percentile uncertainty range [UI]) fraction and number of incident HIV infections and DALYs averted (among FSW & whole population) over 20 yrs following the 2 or extended 20 yr interventions by comparing each PrEP and TasP intervention with its counterfactual (baseline scenario without modelled intervention). Results: Model results suggest that the 2 yr PrEP and TasP intervention prevented 1% [0.7–1.4] and 7% [4-11] of infections in FSW over 20 yrs respectively, compared to 0.3% [0.2–0.7] and 7% [4-11] in the whole population (Table). The extended 20 yr PrEP and TasP interventions could prevent 3% [1–5] and 12% [7-19] of all infections respectively over 20 yrs. Combining TasP and PrEP has a marginal incremental impact overall (infections and DALYs averted) over TasP alone. Conclusion: Due to suboptimal adherence to PrEP by FSW in the demonstration project, PrEP is expected to avert few HIV infections and DALYs among FSW and overall. TasP will have a greater impact and should be prioritised over PrEP to improve FSW HIV prevention in Cotonou.

Oral Abstracts

100 PROTECTION AGAINST PENILE OR INTRAVENOUS SHIV CHALLENGES BY bNAb 10-1074 OR 3BNC117 David A. Garber 1 , Debra R. Adams1, Patricia Guenthner 1 , James Mitchell 1 , Shanon Ellis 1 , Kristen Kelley 1 , Michael S. Seaman 2 , Janet McNicholl 1 , Michel Nussenzweig 3 , Walid Heneine 1 1 CDC, Atlanta, GA, USA, 2 Beth Israel Deaconess Medical Center, Boston, MA, USA, 3 The Rockefeller University, New York, NY, USA Background: Broadly neutralizing antibodies (bNAbs) 10-1074 and 3BNC117 are in clinical development for HIV prevention and treatment. In macaque models, passively administered 10-1074 or 3BNC117 protects against repeated rectal or vaginal SHIV challenges; however, their efficacy against other HIV acquisition routes relevant to men (penile) or persons who inject drugs (intravenous, IV) has not been discerned. Here, we evaluated the protective efficacy of a single subcutaneous (SC) injection of 10-1074 alone, or in combination with 3BNC117, against repeated penile or IV SHIV challenges, respectively. Methods: Macaques (6 rhesus, 5 cynomolgus) were injected SC once with 10-1074, or a combination of 10-1074+3BNC117, respectively (10mg each bNAb/kg). Beginning one week later, macaques were challenged repeatedly once weekly with SHIVsf162P3 (rhesus) or SHIVAD8-EO (cyno) via penile (200 TCID 50 into the prepuce pouch, 16 TCID 50 into the distal urethra) or IV (130 TCID 50 ) routes, respectively, until SHIV infection was confirmed via plasma viral load assay. Control macaques, which received no antibody, were challenged identically (10 penile, 2 IV). Longitudinal plasma samples were assayed via Tzmbl neutralization assay, using virions pseudotyped with 10-1074-sensitive (X2088_c9) or 3BNC117-sensitive (Q769.d22) HIV Envs to determine bNAb concentrations.

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CROI 2019