CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

975 Home-Based HIV Testing and New HIV Diagnoses in Chókwè District, Mozambique

Isabelle Casavant 1 ; Duncan MacKellar 2 ; RicardoThompson 3 ; Robert Nelson 2 ; Juvencio Bonzela 4 ; Bertur Alface 5 ; StanleyWei 1 ; Daniel Shodell 6 ; Judite Cardoso 7 ; Nely Honwana 1 1 CDC, Maputo, Mozambique; 2 CDC, Atlanta, GA, USA; 3 Natl Inst of Hlth Mozambique, Maputo, Mozambique; 4 CITSC, Chókwè, Mozambique; 5 Provincial Directorate of PH, Xaixai, Mozambique; 6 Colorado Dept of PH and Environment, Denver, CO, USA; 7 JHpiego, Maputo, Mozambique Background: Home-based HIV testing and counseling (HTC) has not been widely adopted because of high costs and low yield in new HIV diagnoses. As part of the Chókwè Mozambique Health Demographic Surveillance System (CHDSS), we report on the uptake of HTC offered at home, prevalence of HIV, and percentage of new diagnoses in a southern district of Mozambique. Methods: CHDSS conducts an annual census of approximately 95,000 residents. As part of the first round of a multi-year combination-prevention project, in 2014-15, staff visited each CHDSS household and offered HTC to all residents. Consenting residents were screened for prior HIV diagnosis. Rapid HIV testing was conducted at home for residents without prior diagnosis, otherwise testing was conducted at the CHDSS laboratory using whole blood collected at home. Analyses are restricted to residents 15-59 years of age. Reported HIV prevalence is not adjusted to the CHDSS population. Results: Of 53,227 residents 15-59 years of age, 25,344 (47.6%) tested for HIV. Proportionally more females than males (52% vs 41%), older (25-59) than younger adults (15-24) (50% vs 45%), and residents in rural than urban areas (50% vs 45%) tested for HIV. Of residents encountered, an estimated 82% of males and 88% of females accepted HTC. Of residents tested, 5119 (20.2%) were HIV-infected and 1945 (7.7%) were newly diagnosed. HIV prevalence increased markedly by age-group through 40-44 years, exceeding 30% for females and males in this age group, and steadily declined in older age groups (Figure). HIV prevalence was higher among females than males for each age group, particularly from 15 through 39 years. Percentage of new HIV diagnoses approached or exceeded 10% for females in age groups 20 through 44 years, and for males in age groups 25 through 44 years (Figure). For age groups 25 through 39 years, although HIV prevalence was substantially higher among females than males, percentage of new diagnoses (~10%) was similar in both groups. Conclusions: In the first year of the combination-prevention project, nearly half of the estimated population 15-59 years of age were HIV tested, resulting in the new HIV diagnosis and referral to care of nearly 2,000 persons. Although testing rates were high among persons encountered, home-based HTC reached fewer men, younger persons, and persons who lived in urban areas. In high-prevalence populations, home-based HTC may be an important part of a comprehensive approach to achieve UNAIDS targets to diagnose 90% of HIV-infected persons.

Poster Abstracts

976 Increased Linkage to HIV Care After Clinic vs Community Testing in Rural Mozambique

Elisa López Varela 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: Improvements in testing services are needed if the global target of 90-90-90 is to be achieved. Client or provider -initiated and home-based HIV counseling and testing (VCT, PICT and HBT, respectively) are all complementary testing modalities to be considered when selecting local appropriate interventions. Linkage to HIV care throughout the cascade is a crucial indicator and yet there is little data on linkage across testing modalities. We aimed to compare the linkage rates between VCT, PICT and HBT in Southern Mozambique. Methods: Between 2014 and 2015, we prospectively enrolled 341, 432 and 396 new adult HIV diagnoses through VCT, PICT and HBT respectively in a semi-rural area served by the Manhiça District Hospital (MDH). Passive follow-up information was obtained through the MDH electronic HIV patient tracking and demographic surveillance system. Loss to Follow up (LTF) at each step of the care cascade was defined within 3 months of testing. Logistic regression was used to estimate the impact of testing modality on LTF at each step of the cascade. Results: Among the 1169 enrolled patients, 56%were female with a median age of 34, 35 and 38.4 years in VCT, PICT and HBT respectively (p<0.0001). Linkage differed according to testing modality and cascade step. Of those tested at VCT, PICT and HBT, 99% (n=336), 92% (n=397) and 29% (n=113) respectively enrolled in care (p=0, 0001) while 51%, 42% and 53% of those enrolled attended the 1 st clinic visit. PICT was significantly associated with a higher risk of LTF both at enrollment and 1 st clinical visit (p=0.0001 and 0.0215 respectively). Women, older participants and those reporting work absenteeismwere less likely to be LTF for the 1 st visit. Significant predictors of LTF at the staging step included being male (p=0.04) and having individual testing (p=0.05). Among those individuals eligible for ART, there was no significant difference in ART initiation between HIV testing cohorts (67, 63 and 68% for VCT, PICT and HBT respectively). Conclusions: HBT participants were more likely not to enroll in care as compared to VCT and PICT, but there was no difference in LTF for initiating ART among those eligible. Areas relying on HBT should implement additional measures to ensure linkage to care after testing. Regardless of testing modality, there is a considerable block in the cascade of care before the 1 st clinic visit leading to very low rates of ART initiation.

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CROI 2016