CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Methods: The study was conducted in 3 hospitals in Njombe (Tanzania’s highest HIV prevalence region) from June to September 2015. Newly HIV-diagnosed men and women, tested through PITC or VCT, were enrolled as index clients, and offered the choice of referring or bringing in their partner for HTC, or having a health provider anonymously contact their partner with the recommendation to come for HTC. Partners presenting to the facility were offered HTC and referred into HIV care and treatment if found HIV positive. Results: 4,832 individuals were tested for HIV. 765 (15.8%) tested positive; 643 consented to participate. Of these, 251 were ineligible for partner referral including for being underage (31); not having a sexual partner in the last 12 months (148); being mentally unstable (18); being at risk of intimate partner violence (8) or other (46). 387 (99.7%) eligible index clients participated in the listing and referral process. 392 partners were listed, of whom 242 (61.7%) came to the facility; 222 (91.7%) through index client referral and 20 (8.3%) after a health provider contacted them. Of the 228 (94.2%) partners who were tested for HIV, 144 (63.1%) tested positive, all newly diagnosed. HIV positivity rate did not differ significantly (p=0.5) among male (56.9%) and female partners (61.4%) (See Table 1) Conclusions: This study demonstrated feasibility, acceptability and effectiveness of partner notification/referral for HTC in facility-based HTC in Tanzania. Given the need for high yield of identifying previously undiagnosed HIV infected individuals in the context of reaching 90-90-90 goals, and noting that notification was primarily by index clients, the findings present strong evidence for integrating partner notification and testing into facility-based HTC services in Tanzania and similar settings in SSA.

Table1.OverviewofHTCPartnerTracingStudy findings (June– September2015) Facility

Makambako Kibena Ilembula Total

People tested forHIV in the facility

2092

1634

1106

4832

HIVpositive throughHTC (PITCandVCT)

351

322

92

765

Percent testingpositive throughPITCandVCT

16.7

19.7

8.3

15.8

Index clientseligibleand consenting toparticipate in thepartner listing for referral toHTC IndexClientpreference for sexualpartner referral approach (nof listedpartners): Client contacts / refersown sexualpartner

202

150

35

387

194

147

32

373

Provider contacts / refers sexualpartner

8

7

4

19

Partner comes to facilityby typeof referral: Client contacts / refersown sexualpartner

91

110

21

222

Provider contacts / refers sexualpartner

16

4

0

20

Partnersagreeing toHTC

98

109

21

228

Partners testingHIVpositive

49

81

14

144

HIVpositive rateamong testingpartners

50

74.3

66.6

63.1

979 94% Population HIV Testing CoverageWith Repeat Hybrid Mobile Testing in East Africa Gabriel Chamie 1 ; Jane Kabami 2 ; Emmanuel Ssemmondo 2 ;Tamara Clark 1 ; Elizabeth Bukusi 3 ; Maya Petersen 4 ; Moses R. Kamya 5 ; DianeV. Havlir 1 ; Edwin Charlebois 1 ; for the Sustainable East Africa Research for Community Health (SEARCH) team 1 Univ of California San Francisco, San Francisco, CA, USA; 2 Makerere Univ-Univ of California Rsr Collab, Kampala, Uganda; 3 Cntr for Microbiology Rsr, Kenya Med Rsr Inst, Kisumu, Kenya; 4 Univ of California Berkeley, Berkeley, CA, USA; 5 Makerere Univ Coll of Hlth Scis, Kampala, Uganda Background: In 2013-14, we reported 89% adult HIV testing coverage in 32 communities of 10,000 persons each in Uganda and Kenya using a hybrid mobile testing strategy (multi-disease community health campaigns [CHC], followed by home-based testing for CHC non-attendees [SEARCH:NCT01864603]). We repeated hybrid testing one year later and sought to determine: 1) adult testing coverage after two rounds of testing; 2) repeat testing rates; and 3) HIV prevalence, disease stage and testing coverage in year 2 among the 11% untested in year 1. Methods: In 2014-15 (year 2), we repeated population-wide HIV testing using our hybrid approach in 16/32 communities. We offered newmulti-disease services at CHCs, including urgent care and men’s health education, and in Kenya, worked with the Ministry of Health to offer on-site medical male circumcision, family planning and cervical cancer screening. We determined the proportion of stable adults (≥15 years; living in community for ≥6 months) that tested for HIV at least once during two rounds of hybrid testing, compared HIV prevalence and disease stage of adults who tested in year 2 but not year 1 vs. tested in year 1, and measured repeat testing in high-risk groups. Results: Overall, 73,284/77,778 (94%) baseline census-enumerated, stable adult residents tested for HIV at least once during two rounds of hybrid testing. In Year 2, we tested 59,382/75,362 (79%) eligible stable adults (alive and HIV-/unknown): 46,633 (79%) tested at CHCs vs. 12,749 (21%) at HBT. If 10,085 adults (13%) reported to have moved out of community by an informant are excluded, year 2 testing coverage was 91%. Of 62,004 baseline HIV- adults eligible for repeat testing, 51,099 (82%) re-tested in year 2. Of 8,742 (11%) adults who did not test in year 1, 4,337 (50%) tested in year 2 and had similar HIV prevalence to those who tested in Year 1 (Table). In year 1 HIV- key populations who had not died or moved away, 95% of bar workers, 85% of transport workers, and 89% of fishing industry workers tested in both years 1 and 2. In qualitative data, newmulti-disease services were a motivating factor for year 2 CHC participation. Conclusions: With a repeat hybrid mobile approach, we achieved near universal HIV testing coverage, (94% of stable adults) over 12-15 months in 16 rural communities in Kenya and Uganda. Offering newmulti-disease services in the repeat year contributed to ongoing high coverage (91%). This approach successfully reached transport, fishing and bar workers at high HIV risk for repeat test Table. Comparison of HIV prevalence, and CD4 and viral load metrics among adults who tested HIV+ in Year 1 vs. adults who did not test in Year 1 but tested HIV+ in year 2. Adults who tested HIV+ in Year 1 (N=6,682) p value

Poster Abstracts

Adults who did not test in year 1, but tested HIV+ in year 2 (N=421)

6,682/68,947 (9.7%) 515 (356-­‐698) 3.3 (1.3) 2.7 (2.7-­‐4.4)

421/4,337 (9.7%) 0.97 451 (292-­‐633) <0.001

HIV Prevalence

Median CD4+ cell count at diagnosis (IQR) Mean log HIV RNA (SD) Median HIV RNA (IQR)

3.0 (1.4) 2.7 (1.6-­‐4.3)

<0.001 <0.001

980 Does a Male CHiP Increase Uptake of HIV Testing by Men? Lessons FromHPTN 071 Study Mwelwa M. Phiri 1 ; Kwame Shanaube 1 ; Sian Floyd 2 ; Ephraim Sakala 1 ; Stable Besa 1 ; Sam Griffith 3 ; Helen Ayles 2 ; for the HPTN 071/PopARTTeam 1 ZAMBART, Lusaka, Zambia; 2 London Sch of Hygiene & Trop Med, London, UK; 3 FHI 360, Research Triangle Park, NC, USA

Background: Male involvement in HIV testing programs can be pivotal in changing the dynamics of the HIV and AIDs epidemic. Factors attributing to lowmale involvement in Sub-Saharan Africa include culture, patriarchy and general reluctance to engage in health services. HPTN 071 is a 3 arm community-randomized trial in 21 communities in Zambia and South Africa that aims to study the impact of a combination prevention package on HIV incidence. The intervention is delivered in annual rounds of home-based door-to-door visits and includes voluntary HIV counselling and Testing (HCT) by a pair of Community HIV care Providers (CHiPs). Our objective was to determine whether having a male CHiP as part of a pair improved male uptake of the intervention and HIV testing in our communities.

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CROI 2016