CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

primary school due to the SEARCH intervention (p<0.001). Outcomes such as assets, non-food expenditures, and survival expectations improved significantly over time, but there were no significant differences between intervention and control communities. Conclusion: Universal antiretroviral therapy provision led to significant economic benefits for HIV-positive adults, particularly those with high CD4 counts. Improvements in socio-economic outcomes and survival expectations were observed in all communities following multi-disease testing at baseline. 1074 CONDOM USE AND PRICES IN TRANSACTIONAL SEX ENCOUNTERS AMONG HIGH-RISK WOMEN IN KENYA Harsha Thirumurthy 1 , Yan He 1 , Perez Ochwal 2 , Noora Marcus 1 , Sue Napierala 3 , Suzanne Maman 4 , Kawango Agot 2 1 University of Pennsylvania, Philadelphia, PA, USA, 2 Impact Research and Development Organization, Kisumu, Kenya, 3 RTI International, San Francisco, CA, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: The exchange of money, goods, or services in sexual relationships is a key driving factor for HIV risk in areas where incidence is above elimination rates. We assessed factors that influence condom use and the monetary value of transactional sex encounters among high-risk women in a high prevalence setting in Kenya. Methods: Baseline data were obtained for an ongoing cluster randomized trial of an HIV self-testing intervention among women in 66 community clusters in Siaya County, Kenya (NCT03135067). Clusters included fishing communities along Lake Victoria and market centers with hotspots for female sex workers. Eligibility criteria for for women in clusters included: age ≥18 years, HIV- negative status, and self-report of ≥2 sexual partners in the past month. Data were collected on participants’ most recent transactional sex encounters, including sexual partner characteristics, condom use, and the “price” of each encounter as indicated by the total value of money, goods, and services received. Regression analyses with participant fixed effects were used to assess participant and partner factors that predicted condom use and the price of each encounter. Results: Among 2,087 participants, 1,396 (67%) reported sex work as one of their income sources and 1,983 (95%) reported on 4,474 transactional sex encounters. Participants had an average age of 27.1 years (IQR 22-31) and for 62.2% the highest education level completed was primary or below. Condom use was reported in 51% of encounters and was significantly more likely with first-time male partners rather than with repeat partners (65% vs. 49%, p<0.001). The median price per encounter was $9.9 (interquartile range $5-$19.8). Prices were $1.8 higher with partners aged >30 years vs. ≤30 years (p<0.05). Higher prices were also reported partners who were wealthier ($5.4 higher, p<0.01) and rated as being handsome ($1.9 higher, p<0.01). Encounters in which either the participant or partner were intoxicated had significantly lower prices. Unprotected sex was associated with a 15% higher price among women with some secondary or higher education (p=0.05) but there was no significant difference among women with primary education or less. Conclusion: Among high-risk women in Kenya, there is high prevalence of transactional sex and suboptimal condom use. The large monetary value of transactional sex encounters and lower condom use with repeat partners suggests a need for economic and behavioral interventions that facilitate reduced sexual risk-taking. 1075 SABES: A COST-EFFECTIVE TasP INTERVENTION TO IDENTIFY AND TREAT RECENT HIV INFECTIONS Angela K. Ulrich 1 , Blythe J. Adamson 2 , Dobromir Dimitrov 1 , Robert De la Grecca 1 , Daniel Wood 1 , Enrique M. Saldarriaga 2 , Rikita Bansal 1 , Joseph Babigumira 2 , Robinson Cabello 1 , Hugo Sanchez 3 , Jorge Sanchez 4 , Javier R. Lama 5 , Ann Duerr 1 1 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 2 University of Washington, Seattle, WA, USA, 3 Epicentro, Lima, Peru, 4 Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru, 5 Asociacion Civil Impacta Salud y Educacion, Lima, Peru Background: Sabes , a treatment-as-prevention (TasP) intervention in Lima, Peru, was implemented to test the hypothesis that frequent HIV testing and initiation of ART during early (acute and recent [<3 months]) HIV infection will markedly reduce onward HIV transmission among men who have sex with men (MSM) and transgender women (TW). HIV-negative, high-risk individuals were

identified, underwent monthly HIV testing, and were rapidly initiated on ART if they became HIV infected. Methods: We evaluated the cost-effectiveness of the Sabes TasP intervention compared to the standard of care using a government health care perspective, 20-year time horizon, and 3% annual discounting. The epidemic model was adapted from a compartmental model of HIV transmission in Peru; cost estimates were based on those incurred during the implementation of the Sabes study, the Peru Ministry of Health HIV program, and the published literature. We estimated the cumulative number and fraction of HIV infections prevented, reduction in HIV incidence and prevalence, the incremental cost- effectiveness ratio (ICER), and net monetary benefit. Results: Implementation of Sabes among MSM and TW in Lima, Peru, is projected to identify an additional 7,751 early HIV infections over 20 years, beyond the standard of care. By 2038, we estimate that the fraction of undiagnosed early HIV cases would decrease to less than half of what is expected with no intervention. We estimate that each additional diagnosis of early infection cost $6,412. Sabes improved health, resulting in greater total discounted QALYs per person than the standard of care (16.70 vs. 16.39) over the 20-year time horizon. Sabes had an ICER of $578 per QALY compared to the standard of care and was considered cost-effective using a threshold of the GDP per capita in Peru ($6,572 per QALY gained). Upfront costs to deliver the intervention were off-set by longer-term healthcare savings. Conclusion: Our analysis suggests that the TasP intervention, Sabes , is a cost-effective approach to reducing the burden of HIV. Our study supports the implementation of such programs in vulnerable and high-risk MSM and TW in urban, epidemic hot-spots such as Lima, Peru. Given the public health crisis of the HIV epidemic, it is essential to capitalize on interventions with known efficacy, such as Sabes , for scale-up to reduce onward HIV transmission in a cost-effective manner. 1076 COST-EFFECTIVENESS OF LONG-ACTING ART FOR ADOLESCENTS AND YOUNG ADULTS IN KENYA Jessica Culhane 1 , Monisha Sharma 1 , Katherine Wilson 1 , Allen Roberts 1 , Cyrus Mugo 2 , Dalton Wamalwa 2 , Irene Inwani 3 , Ruanne V. Barnabas 1 , Pamela K. Kohler 1 1 University of Washington, Seattle, WA, USA, 2 University of Nairobi, Nairobi, Kenya, 3 Kenyatta National Hospital, Nairobi, Kenya Background: Despite the high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Without the need for daily adherence to oral ART, long-acting injectable ART (LA-ART) may simplify adherence and, consequently, decrease transmission, morbidity, and mortality in this priority population. However, LA-ART may cost more than oral ART and its threshold for cost-effectiveness has not been evaluated in SSA. Methods: We adapted a mathematical model of HIV transmission and progression in Kenya to capture HIV acquisition and viral suppression among AYA (age 10-24). We projected the health and economic impact of LA-ART, assuming 75% of AYA on oral ART would switch to LA-ART with a two-month duration of viral suppression per injection. We evaluated two scenarios for LA ART adherence: the first similar to current oral adherence rates (75% viral suppression across AYA) and the second, higher adherence assuming 94% of AYA on LA-ART are virally suppressed (based on LATTE-2 Phase 2b trial results). In the first scenario, we assume AYA who are not adherent to oral ART receive only one two-month injection of LA-ART per year and are virally suppressed by LA-ART for 17% of the year, increasing overall (oral and long-acting) AYA viral suppression to 78%. The higher LA-ART adherence scenario increases overall AYA viral suppression to 89%. We assessed population-level effects of LA-ART over a 10-year time horizon. We calculated the maximum incremental cost of

Poster Abstracts

CROI 2019 423