CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Methods: CHiPs were paired up at the start of the intervention based on availability, gender balance, location of residence of the CHiP in relation to work area and personal characteristics. Every CHiP pair was assigned to a geographical zone consisting of 350-450 households. Process data of household visits was collected real time using hand-held electronic devices. Outcome was defined as the proportion of males accepting the intervention and male uptake of HIV testing among those eligible. Primary exposure was the presence or absence of a male CHiP in the pair. Only pairs that worked together for the full duration of the study period were included. Crude proportions were calculated using cross-tabulation and crude OR’s were calculated using logistic regression taking clustering on community level into account. Results: Of the 206 pairs of CHiPs, 166 worked together since the start of the study: 53 female-female (FF) pairs, 107 male-female (MF) pairs and 6 male-male (MM) pairs. 25,206 out of 27,262 males (92.5%) accepted to take part in the intervention when counseled by MF or MM pairs compared to 49,581 out of 54,192 males (91.5%) with FF pairs (OR 0.88, 95% CI 0.55-1.40). Uptake of HIV-testing by eligible male participants (never tested or self-reported negative) was 29,348 out of 43,136 (68.0%) in pairs with minimally one male CHiP versus 17,857 out of 28,074 (63.6%) in FF pairs (OR 1.22, 95% CI 0.97–1.53). Conclusions: We did not find convincing evidence that the presence of a male CHiP improves the uptake of the intervention or HIV-testing by male participants. Other factors such as the interaction between age of the CHiP and participants need to be considered. 981 Uptake of HIV Testing in the HPTN 071 (PopART) Trial in Zambia Background: The HPTN071 (PopART) trial is a 3-arm community randomized trial in 12 communities in Zambia and 9 communities in South Africa evaluating the impact of a combination HIV prevention package, including a universal test and treat intervention, on HIV incidence. Arm A of the study provides the “full” combination HIV prevention package including home-based HIV voluntary counselling and testing, promotion of VMMC, and offer of immediate ART for those testing HIV-positive. The intervention in Zambia is offered in 8 of the 12 communities and is delivered in annual rounds by Community HIV Care Providers (CHiPs). We present data from the first annual round across the 4 Arm A communities in Zambia, which have an adult population of about 100,000. Methods: Individuals who are contacted are offered participation in the study intervention, with verbal consent. Uptake of different components of the intervention, including HIV testing, was recorded electronically by the CHiPs during household visits. Data were analysed for the first annual round of the intervention, December 2013 to June 2015. Results: 48,790 households (~100%) were visited by CHiPs during the first round, enumeration of individual household members was completed for 96% (46,899/48,790), and 83% (101,578/121,698) of adults (≥ 18 years) consented to participate. Refusal rate was 6.5% (7958/121,698) and 9% (10,962/121,698) were not contacted. Of those that consented to participate 45% (45,610/101,578) were men and the median age was 29. Prior to the CHiP visit, 47% (48,006/101,578) “knew their HIV status”, using a definition that they either reported they were HIV-positive (n=7,732), or that they had tested for HIV in the previous 12 months and were HIV-negative (n=40,274). Among those who did not self-report they were HIV-positive, 71% (66,829/93,846) accepted the offer of HIV counselling and testing from CHiPs, and 7.6% (5,108/66,829) tested HIV-positive. Among those consenting, 90% of women (50,619/55,968) and 87% (39,551/45,610) of men knew their HIV status by the end of Round 1; 16% (8,701/55,968) of women and 9% of men (4,139/45,610) self-reported or tested HIV-positive. Conclusions: Through a home-based approach of offering a combination HIV prevention package the percentage of adults who knew their HIV status increased from~50% to ~90%, among those who were contacted and consented to participate. Kwame Shanaube 1 ; Joseph M. Chaila 1 ; Sian Floyd 2 ; Ab Schaap 1 ; Sam Griffith 3 ; Richard Hayes 2 ; Sarah J. Fidler 4 ; Helen Ayles 2 ; for the HPTN 071/PopART 1 ZAMBART, Lusaka, Zambia; 2 London Sch of Hygiene & Trop Med, London, UK; 3 FHI 360, Research Triangle Park, NC, USA; 4 Imperial Coll London, London, UK

Poster Abstracts

982 HIV Testing and ART Coverage Before a UTT Intervention: Findings in HPTN 071(PopART) Helen Ayles 1 ; Sian Floyd 1 ; Nomtha Mandla 2 ; AliciaYoung 3 ; Deborah Donnell 4 ; Nkatya Kasese 5 ; Ayana Moore 6 ; Nulda Beyers 7 ; Sarah J. Fidler 8 ; Richard Hayes 1 1 London Sch of Hygiene & Trop Med, London, UK; 2 Univ of Stellenbosch, Cape Town, South Africa; 3 SCHARP, Seattle, WA, USA; 4 SCHARP, Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 5 ZAMBART, Lusaka, Zambia; 6 Family Hlth Intl, Durham, NC, USA; 7 Univ of Stellenbosch, Tygerberg, South Africa; 8 Imperial Coll London, London, UK Background: In 2014 UNAIDS set aspirational “90-90-90” global targets for knowledge of HIV status and ART coverage among people living with HIV. HPTN071 (PopART) is a 3-arm community randomised trial in 12 communities in Zambia and 9 communities in South Africa (SA), which tests the impact on HIV incidence of a combination HIV prevention approach compared with standard-of-care. Household-based interventions are provided in 2 trial arms, and include a universal offer of HIV testing and support for linkage to HIV care. ART is delivered through routine health care services; in one intervention trial arm, it is offered to all HIV-positive (HIV+) adults irrespective of CD4 count. We analysed baseline data on community-wide uptake of HIV testing and ART, to quantify the level of service expansion required to reach the 90-90-90 targets. Methods: A randomly-selected cohort (PC) of adults aged 18-44 years was recruited from November 2013 to March 2015 to measure primary and secondary trial outcomes. Consenting participants provided a blood sample for laboratory HIV testing, and the research questionnaire included questions on previous HIV testing, knowledge of HIV status, and uptake of ART. Results: 38,383 adults were enrolled in the PC, ~2000 in each trial community. A total of 23,362 were enrolled before they were offered the household-based interventions, of whom 21,854 had a laboratory HIV test result available by mid-2015 and 21,776 answered questions on prior HIV testing. HIV prevalence was 12% in men (806/6674) and 27% (4048/15102) in women; 69% of men and 88% of women reported previously testing for HIV, with wide variation among communities. In Zambia, among HIV+men 46% (172/373) reported they were HIV+ and 31% (117/373) that they were on ART; among HIV+ women 55% (970/1760) reported being HIV+ and 36% (636/1760) were on ART. In SA, among HIV+men 27% (116/433) reported they were HIV+ and 18% (78/433) that they were on ART; among HIV+ women 48% (1103/2288) reported being HIV+ and 32% (724/2288) were on ART. Knowledge of HIV status and ART uptake varied considerably across communities, and increased with age.

418

CROI 2016