CROI 2016 Abstract eBook

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Poster Abstracts

Results: Of 4,050 participants interviewed, 940 (23%) were fisherfolk. The median age of fisherfolk was 32 years, 30%were aged 30-39 years;62%were female. Among fisherfolk 71%were married, almost one-third (31%) of fisherfolk were fishmongers, 28% fishermen, 21% spouses offishermen, 9% fish processors,2% boat managers, with 9% in other cadres. Only 12% of fisherfolk reported having migrated out of Asembo for ≥ 1month. Of the 911 fisherfolk with HIV status available, 23.4% (95% CI 21-26) were HIV positive (74% self-reported and 26% tested). HIV prevalence was 26.8% among females and 17.8% among males, 35% among 30-39 year olds, 33.3% among boat managers and 32.1% among fish processors. Fisherfolk who were currently or previously married were significantly more likely to be HIV positive compared to those who were single (AOR 2.3, 95% CI 1.1-4.9; AOR 6.7, 95% CI 2.9-15.7 respectively). Compared to fisherfolk aged 30-39 years, those aged 13-19, 20-29, and ≥ 50 years were significantly less likely to be HIV positive (AOR 0.1, 95% CI 0.0-0.4; AOR 0.5, 95% CI 0.3-0.7; AOR 0.2, 95% CI 0.1-0.4, respectively). Migration was not associated with HIV positivity. Circumcision was reported by 52% (95% CI 46-57) of male fisherfolk. Among the 183 HIV positive fisherfolk, 53 %( 95% CI 45-60) reported being currently in HIV care. Conclusions: HIV prevalence among the Asembo fisherfolk was high among women;persons currently or previously married and those in their thirties were more likely to be infected compared with others. Given that only about half of HIV infected persons reported being in care, targeting and adapting treatment and prevention interventions to the needs of this key population is critical. 904 Young HIV+ Adults in Botswana Less Likely to Seek Treatment or Be Virally Suppressed Vladimir Novitsky 1 ;Tendani Gaolathe 2 ; Mompati Mmalane 2 ; Sikhulile Moyo 2 ; Molly Pretorius Holme 1 ; Kathleen Powis 3 ; KathleenWirth 1 ; EricTchetgenTchetgen 1 ; Shahin Lockman 4 ; M. Essex 1 1 Harvard Sch of PH, Boston, MA, USA; 2 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana; 3 Massachusetts General Hosp, Boston, MA, USA; 4 Brigham and Women’s Hosp, Harvard Med Sch, Boston, MA, USA Background: The scale-up of ART programs has been successful in Botswana. However the nature and role of populations with detectable plasma HIV-1 RNA remain unclear. Methods: As part of the Botswana Combination Prevention Project (an ongoing cluster-randomized HIV combination prevention trial in Botswana), a baseline household survey was performed in 24 rural communities November 2013–August 2015. Residents 16–64 years old were targeted in a random sample of 20% of households in each community. For this analysis, detectable HIV-1 RNA was defined as >400 cps/mL. Women under 30 y.o. and men under 35 y.o. were defined as young adults. Results: 2,727 HIV-infected residents enrolled; 1,915 (70%) were currently on ART. A high proportion of all HIV-infected individuals (72%), including 96% of individuals on ART, were virologically suppressed. Twenty eight percent (95% CI: 25%–30%) of individuals had detectable HIV-1 RNA. Younger age was associated with having detectable HIV-1 RNA (p=0.0001, Fig. A) and with not being on ART (p<0.0001, Fig. B). Young HIV-infected men and women were approximately 23% less likely to be on ART (RR: 0.77; 95% CI: 0.70-0.85; p<0.0001). Among the 495 HIV-positive young men and women, 252 (51%) had a detectable HIV-1 RNA. The median HIV-1 RNA level in all individuals with detectable HIV-1 RNA was 4.2 (IQR 3.6–4.8) log 10 cps/mL and was higher in men than in women (p<0.0001), but did not differ by age group (p=0.19). Seventeen percent of all HIV-infected individuals and 61% of persons who were not virologically suppressed had HIV-1 RNA >10,000 cps/mL. Eight percent of all individuals infected with HIV for over 12 months and 55% of persons not virologically suppressed had HIV-1 RNA >10,000 cps/mL. A relatively high proportion of ART-naive individuals (15%) had HIV-1 RNA <400 cps/mL. We cannot exclude that at least some of these individuals were taking ARV. Conclusions: In rural communities in Botswana, a high proportion (72%) of all HIV-infected individuals had HIV-1 RNA ≤400 cps/mL. However, young HIV-infected adults were less likely to be on ART and the majority of them had detectable HIV-1 RNA. Targeted interventions should be tailored to improving HIV care-seeking behavior among young adults in Botswana. Young adults in Botswana may be contributing disproportionately more to HIV-transmission networks. Research on dynamics of HIV transmission networks among young adults may inform prevention programs.

Poster Abstracts

905

High Risk of HIV Transmission and Acquisition Among Older South Africans Molly S. Rosenberg 1 ; Xavier Gomez-Olive 2 ; Julia K. Rohr 3 ; Brian Houle 4 ; StephenTollman 5 ; Kathleen Kahn 2 ;Till Bärnighausen 1 1 Harvard Sch of PH, Boston, MA, USA; 2 Med Rsr Council/Wits Rural PH and Health Transition Unit, Johannesburg, South Africa; 3 Harvard Univ Sch of PH, Boston, MA, USA; 4 Australian Natl Univ, Canberra, Australia; 5 Univ of the Witwatersrand, Johannesburg, South Africa Background: HIV risk in older adults in sub-Saharan Africa is understudied. Sexual behavior and HIV status are likely associated in this population because risky sexual behaviors increase the risk of acquiring HIV, and because HIV testing and counseling services could prompt safer sexual behaviors to avoid subsequent transmission. Exploring these associations will help to understand the potential drivers of sexual transmission of HIV in older adults, and will provide preliminary insight into the importance of HIV testing and counseling for secondary prevention in this understudied population. Methods: Using baseline data from the Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities, we examined the relationship between HIV status, status awareness, and sexual behavior in older adults in a population-based sample of 4714 men and women over age 40 in the rural Agincourt sub-district of South Africa. We classified participants into one of five HIV status categories based on laboratory-confirmed HIV status, and whether self-reported HIV status (positive, negative, or unknown) was concordant with the laboratory-confirmed status. We compared prevalence of recent sexual activity, condom use, casual sex, and multiple partnerships across each HIV status category using log-linear regression models, adjusting for key socio-demographic characteristics (age, education, and marital status). Results: HIV prevalence was very high in this population (22.2%; 95% CI: 20.7, 23.7) and nearly half of the laboratory-confirmed HIV cases were not aware of their status (44%). Recent sexual activity was common and represented in similar proportions across all HIV- and HIV+ categories. Those who tested HIV+ were more likely to report condom use with their most recent partner, compared to those who tested HIV-; however, the magnitude of effect was much stronger among those who were aware of their positive status (aPR: 4.23; 95% CI: 3.47, 5.15). Importantly, those who tested HIV+ were also more likely to report recent casual sex and multiple partnerships, compared to those who tested HIV-.

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