CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

902 Migration, HIV Infection, and Combination HIV Prevention Access in Rakai, Uganda Mary K. Grabowski 1 ; Justin Lessler 1 ; Jeremiah M. Bazaale 2 ; LarryW. Chang 3 ; Dorean Nabukalu 2 ; Maria J.Wawer 4 ; Fred Nalugoda 5 ; Robert Sekubugu 5 ; Gertrude Nakigozi 6 ; Ronald H. Gray 4 1 Johns Hopkins Univ, Baltimore, MD, USA; 2 Rakai Hlth Scis Prog, Kalisizo, Uganda; 3 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 4 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 5 Rakai Hlth Scis Prog, Entebbe, Uganda; 6 Rakai Hlth Scis Prog, Baltimore, MD, USA Background: Migration has been historically associated with HIV spread in sub-Saharan Africa (SSA); however, the geography of local migration networks and the extent to which migrants contribute to total HIV burden and access HIV treatment and prevention services at the community- level are largely unknown. Methods: We surveyed 22,533 individuals aged 15-49 residing in 38 communities in the Rakai District, Uganda from August 2011 to January 2015 through the Rakai Community Cohort Study (RCCS). During the RCCS household census, persons who recently migrated into study communities since the prior survey (~1 year) were identified and their place of origin recorded and then geocoded to assess geographic flow of migrants. Consenting participants were HIV tested and interviewed to ascertain demographic, behavioral, and health data, including self-reported ART use and male circumcision status. The proportions of total HIV burden and newly detected cases attributable to in-migration were estimated and the predominant geographic sources of migrant-introduced HIV infections were identified. Results: We identified 5,533 individuals who recently migrated into RCCS study communities. These persons comprised 25% of the surveyed population and 23% of all persons living with HIV (ranging from 10-47% of total HIV burden across communities). Additionally, 49% (935/1918) of all newly identified HIV cases were introduced by migrants. Migrants were predominately female (n=3,603, 63%), and mostly came fromwithin the Rakai District (61%), the neighboring Masaka District (17%), or Kampala (6%); however, the overall migration network was geographically broad, spanning multiple districts and national boundaries (Fig1A). HIV prevalence did not vary between in-migrants and the resident population, though HIV-infected migrants tended to move to communities with higher prevalence (p<0.001; Fig1B). Male in-migrants were significantly less likely to be circumcised (RR=0.71, 95%CI: 0.66-0.77), and HIV-infected in-migrants were significantly less likely to use ART (RR=0.51, 95%CI: 0.45-0.58) compared to residents, irrespective of age or gender. Conclusions: Recent in-migrants account for a substantial proportion of total HIV burden in Ugandan communities. Large influxes of HIV-infected persons who are not linked to care and preferentially migrating to communities with higher HIV prevalence underscores the need for continuous HIV surveillance at the local level and novel, targeted interventions for mobile populations in SSA.

Poster Abstracts

A

B

HIV burGHQ LQ UHVLGHQWV YV LQíPLJUDQWV

DR CONGO

Identity Fitted, Coef=0.85, R 2 =0.618, p<0.001

Kampala

KENYA

Masaka

LakeVictoria

Kyotera

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Rakai District

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Bukoba

TANZANIA

RWANDA

HIV prevalence JO¢NJHrants

¢

0.0 0.1 0.2 0.3 0.4 0.5

0.0

0.1

0.2

0.3

0.4

0.5

HIV prevalence, residents

903 HIV Epidemiology and Service Uptake Among Fisherfolk in Asembo, Western Kenya, 2015 Fredrick S. Odongo 1 ; Emily Zielinski-Gutierrez 2 ; Kennedy Mutai 1 ; Paul Ogindo 1 ; George Olilo 1 ; Barbara Burmen; Daniel Kwaro 1 ; Kenneth Masamaro 1 ; Caroline Kambona 1 1 Kenya Med Rsr Inst, Kisumu, Kenya; 2 US CDC, Kenya, Nairobi, Kenya Background: In 2012, Nyanza region had the highest HIV prevalence in Kenya among persons aged 15-49 years of age (15.1% vs 5.6% nationwide). Fisherfolk, people who catch, sell, process fish and their spouses are a priority population in HIV transmission dynamics. We described HIV prevalence and HIV health service utilization among the fisherfolk in Asembo, of Nyanza region in rural western Kenya. Methods: A cross-sectional bio-behavioural census survey was conducted at Lake Victoria beaches and adjacent villages in Asembo between August 2014 and March 2015. Participants were interviewed on HIV risk behavior, service utilization and offered HIV testing. Self-reported HIV status was documented if testing was declined. Logistic regression was used to determine factors associated with a positive HIV status.

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CROI 2016