CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

973 Effect of Secondary Distribution of HIV Self-Tests onWomens Sexual Decision-Making Harsha Thirumurthy 1 ; Samuel H. Masters 1 ; Sue N. Mavedzenge 2 ; Eunice Omanga 3 ; Kawango Agot 3 1 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2 RTI, San Francisco, CA, USA; 3 Impact Rsr and Develop Org, Kisumu, Kenya

Background: Providing multiple HIV self-tests to individuals for distribution to their sexual partners, i.e. ‘secondary distribution’, is a novel strategy that has the potential to increase knowledge of partner HIV status and enable safer sexual decision-making. By facilitating HIV testing at the time of high-risk sexual behaviors, self-testing might promote condom use and other HIV prevention behaviors. However, there is limited evidence on the feasibility of ‘secondary distribution’ of self-tests or the ability of individuals to make more informed sexual decisions with self-tests. We explored whether providing multiple self-tests to high-risk HIV-uninfected women influences their sexual decisions. Methods: Antenatal and postpartumwomen and female sex workers (FSWs) who were HIV-uninfected and aged 18-39 years were recruited at 2 sites in Kisumu, Kenya. Following informed consent and instructions on using the OraQuick Rapid HIV 1/2 Test, women received 3-5 self-tests for own use or distribution to others. Structured interviews were conducted with the index participants (IPs) at enrollment and multiple times over 3 months to determine how self-tests were used. We examined IPs reported sexual behavior when their partners self-tested HIV-positive or HIV-negative. Results: A total of 277 IPs (176 antenatal and postpartum, 101 FSWs) were enrolled. Most IPs distributed a self-test to at least one sexual partner (88% antenatal and postpartum, 96% FSWs), with FSWs giving self-tests to an average of 2.9 sexual partners. In total, 4% (4/144) of antenatal and postpartumwomen’s partners and 14% (41/298) of FSWs’ partners were reported to obtain an HIV-positive result from the self-test. Sexual intercourse was significantly less likely when a sexual partner tested HIV-positive versus HIV-negative (18% vs. 62%, p<0.01). Condom use among those who reported sexual intercourse was also significantly higher after a sexual partner tested HIV-positive versus HIV-negative (100% vs. 44%, p<0.01). Conclusions: The results suggest that women who received multiple HIV self-tests were able to distribute tests to current or potential sexual partners and make positive sexual behavior decisions accordingly. Providing multiple self-tests for secondary distribution to high-risk women such as FSWs can lead to increased partner testing, results disclosure, and enable women to make safer HIV prevention decisions. The potential for secondary distribution as an HIV prevention strategy warrants further evaluation and consideration.

974

Awareness of HIV Status: the Disclosure Gap in Rural Africa Elisa LópezVarela 1 ; Laura de la Fuente Soro 1 ; Orvalho J. Augusto 2 ; Charfudin Sacoor 2 ; Ariel Nhacolo 2 ; Esmeralda Karajeanes 3 ; Paula M.Vaz 3 ; Denise Naniche 1 1 Barcelona Inst for Global Hlth, Barcelona, Spain; 2 Centro de Investigação da Manhiça (CISM), Maputo, Mozambique; 3 Fundação Ariel Glaser, Maputo, Mozambique Background: Awareness of HIV infection is the first critical step in the continuum of HIV care. However, previous HIV status is not always disclosed to counselors and health personnel and little is known about the extent and causes of non-disclosure. The objective of this study was to measure the extent of non-disclosure of HIV status at a clinical and community setting in the Manhiça District, Southern Mozambique. Methods: This study was nested in a larger prospective observational study of linkage to care conducted between May 2014 and June 2015 in the Manhiça demographic surveillance system (DSS). Randomly selected adults from the DSS were visited at home and offered HIV voluntary counseling and testing (HBT). Provider initiated (PICT) and voluntary testing (VCT) were offered at the Manhiça district Hospital. All participants who did not know their HIV status and who tested positive at HBT, VCT or PICT were enrolled in the study. A history of previous HIV diagnosis was verified through the hospital electronic patient tracking system (ePTS). Results: Among the 1401 adults screened in HBT, 323 (23.1%) disclosed their positive HIV status to the community counselor prior to testing. Of those tested, 108 were positive with an estimated prevalence of new HIV diagnoses of 10.0% (95%CI 8.4-12). However, 37 of the 108 positive (34.2%) were later identified through the ePTS as registered HIV-infected patients. The adjusted community prevalence of new HIV diagnoses was thus 6.8% (95%CI 5.5-8.5). The additional prevalence of new HIV diagnoses attributed to non-disclosure was higher in females (3.7%) than in males (2.4%) and highest among adults aged 35-44 years (5.3%). The overall HIV community prevalence of new and previous diagnoses was estimated at 30.8% (95% CI 28.4-33.2). The proportion of non-disclosures among participants testing positive at clinic-based testing sites and later identified through the EPTS was also high (12% at VCT and 29% at PICT p<0.001). Conclusions: Non-disclosure of a previous HIV diagnosis among individuals testing positive is a frequent challenge encountered in all testing modalities. It can impact epidemiological population-based indicators relying on HIV self-disclosure. Inaccuracies in these indicators have implications on HIV programmonitoring including estimating new diagnoses, real needs, coverage of ART and patient attrition.

Poster Abstracts

414

CROI 2016