CROI 2016 Abstract eBook

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Poster Abstracts

Conclusions: Among HIV+men around one-third knew their HIV status and one-quarter were on ART, and among HIV+ women around half knew their HIV status and one-third were on ART, across the trial communities. These levels are far below 90-90-90 targets; the HPTN071 trial will determine whether, with household interventions, the targets can be reached. 983 HIV Testing and Linkage to Care in the Botswana Combination Prevention Project Pamela J. Bachanas 1 ; Mary G. Alwano 2 ; Stephanie K. Behel 1 ; JohnWen 1 ;Winnie Sento 3 ; Jan S. Moore 1 ; Molly Pretorius Holme 4 ;Tendani Gaolethe 5 ; Refeletswe Lebelonyane 6 ; Lisa A. Mills 2 1 CDC, Atlanta, GA, USA; 2 CDC, Gaborone, Botswana; 3 Tebelopele Counseling and Testing Cntr, Gaborone, Botswana; 4 Harvard Sch of PH, Boston, MA, USA; 5 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana; 6 Ministry of Hlth, Gaborone, Botswana Background: To identify 90% of PLHIV, effective community models to test and link men and women are needed. The Botswana Combination Prevention Project (BCPP) is a randomized controlled trial designed to evaluate the impact of high coverage of a combination prevention package on population level HIV incidence in 30 communities. The trial is ongoing; we describe preliminary data on uptake of HIV testing and linkage to care (LTC) in the first 7 intervention communities. Methods: HIV testing campaigns conducted October 2013-May 2015 included home-based and mobile testing. Enumeration was attempted at all inhabited households, and interviews and HIV testing were offered to residents >16 years who did not have documentation of an HIV test in the previous 3 months. Newly identified and known HIV-positive persons not on ART were given point of care CD4 tests, referrals, and LTC interventions if they did not register at the HIV clinic. Results: Of the 19,043 enumerated community residents ages 16-64, 17,282 completed HTC interviews; 70% (12,183/17,282) through home-based testing and 30% (5099/17,282) at mobile venues. Overall refusal rate for testing was 4%. Home-based testing reached more women (62%; 7496/12183); mobile testing reached more men (56%; 2879/5099). The rate of newly identified HIV-positives was 7% for both home and mobile testing. The highest rate of newly identified HIV-positives for both males and females was in the 31-40 age group (range 10-13%) for both home and mobile testing. Sixteen percent (2,743/17,284) of those who completed HTC interviews had documentation of prior HIV-positive status; 84% (2,317/2,743) of themwere on ART. More women (72%; 1973/2743) already knew their HIV-positive status than men (28%; 770/2743). Among the newly diagnosed, known HIV-positive persons not on ART and ART defaulters referred to the HIV clinic, 77% (1138/1479) registered at the local clinic. Conclusions: Discussion : Preliminary data from BCPP indicates that both home-based and mobile testing campaigns are effective modalities for finding newly identified HIV-positive persons and known HIV-positive persons not on ART. Both modalities reach men and women; however, efforts to target age groups where new infections are highest and to increase testing among men should be strengthened and prioritized to reach the goal of identifying 90% of PLHIV. Tracking referrals to the clinic and providing follow up to those who do not link initially are important for high LTC rates. 984 Cross-Sectional HIV Incidence at Scale-up of ART in 24 Rural Communities in Botswana Sikhulile Moyo 1 ; Coretah Boleo 1 ;Terence Mohammed 1 ; Lucy Mupfumi 1 ; Simani Gaseitsiwe 1 ; Rosemary Musonda 1 ; Erik vanWidenfelt 1 ; Joseph Makhema 1 ; M. Essex 2 ;Vladimir Novitsky 2 1 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana; 2 Harvard Sch of PH, Boston, MA, USA Background: Direct real-time estimates of HIV incidence using cross-sectional sampling can provide critical information for design and evaluation of HIV prevention interventions. The ongoing scale-up of ART in southern African countries presents a substantial challenge to the accuracy and reliability of cross-sectional methods used for identification of HIV recency. Methods: HIV recency was estimated at the baseline of the Botswana Combination Prevention Project (BCPP). Cross-sectional data were collected during household surveys in 24 rural communities from Nov 2013 to Aug 2015. An HIV incidence testing algorithm combining the Limiting-Antigen Avidity Assay (LAg-Avidity EIA) with ART status and level of HIV-1 RNA load (multi-assay algorithm described in Rehle et al., PLoS One 2015;10:e0133255) was used. The LAg cut-off normalized optical density was 1.5. ART status was documented. The HIV-1 RNA cut-off was 400 cps/mL. The Mean Duration of Recent Infection was 130 days and the False Recent Rate was set to zero. Results: A total of 2,727 individuals tested HIV-positive among 9,745 individuals with definitive HIV status (28.3% HIV prevalence after adjustment for study design; 95% CI: 25.6%–31.2%) during the baseline household surveys. About 70% of HIV-positive individuals were already on ART. LAg-Avidity EIA data was generated for 2,710 of 2,719 (99.7%) HIV-positive individuals with research blood draw available, and 234 cases were identified as LAg-Avidity EIA recent. Among those, 198 individuals were considered chronically infected based on their documented ART status. Eleven of 36 LAg-Avidity EIA recent, ARV-naïve individuals had an HIV-1 RNA load ≤400 cps/mL, and were classified as having long-term HIV infections. Thus, 25 LAg-Avidity EIA recent, ARV-naïve individuals with HIV-1 RNA above 400 cps/mL were classified as individuals with recent HIV infections. HIV incidence across 24 communities was estimated at 1.00% (95% CI 0.60%–1.41%). Conclusions: The increasing scale-up of ART in southern African communities requires adjustment of cross-sectional methods for identification of HIV recency. An algorithm that combines LAg-Avidity EIA testing with ART status and HIV-1 RNA data was used to estimate baseline HIV recency in 24 rural communities at baseline of the BCPP. This algorithm should be validated by longitudinal HIV incidence data in the future. HIV incidence in rural communities in Botswana was estimated at 1.0% in 2013–2015. 985 Local Social Network Features Predict HIV Testing Uptake in a Rural Ugandan Community Wenjing Zheng 1 ; Laura Balzer 2 ; Lillian Brown 1 ; Norton Sang 3 ;Tamara Clark 1 ; Edwin Charlebois 1 ; Moses R. Kamya 4 ; DianeV. Havlir 1 ; Maya Petersen 5 ; for the SEARCH Collaboration 1 Univ of California San Francisco, San Francisco, CA, USA; 2 Harvard Sch of PH, Boston, MA, USA; 3 Kenya Med Rsr Inst, Nairobi, Kenya; 4 Makerere Univ Coll of Hlth Scis, Kampala, Uganda; 5 Univ of California Berkeley, Berkeley, CA, USA Background: Understanding social dynamics behind HIV testing may provide novel ways to achieve high testing coverage more efficiently. We tested whether social network data predicted testing uptake in a community wide mobile HIV testing campaign. Methods: We built a social network for a rural Ugandan community with 4810 adults where, as part of the SEARCH Trial (NCT01864603), a hybrid approach of community health campaigns (CHC) followed by home based testing (HBT) for non-attendees tested 94% of adult stable residents (82% by CHC, 12% by HBT). In a baseline census, adult residents (>=15 years old) provided contact information for up to 6 friends in each of five social domains (health, money, emotional, food, and free time). Named contacts were matched to a census enumeration to build the network. Associations between testing uptake and network characteristics, including local network density (proportion of realized edges among all possible), clustering (proportion of trios that are fully connected), and number of named contacts from each social domain, were evaluated using logistic regression with cluster-robust standard errors, adjusting for age, gender, occupation, education, marital status, and wealth. Structural features of a subnetwork of HIV+ adults were compared to 1000 simulated populations of the same prevalence and network topology. Results: The community-wide network contained 25148 links across all domains, with 96% of individuals connected in a single cluster (Figure 1). After adjusting for demographics, subjects with fewer named contacts in any domain and subjects with a denser local network were both significantly less likely to attend CHC and more likely to fail to test at either CHC or HBT. The greatest risk for not testing was conferred by higher network density (aOR 2.9, 95%CI 1.47, 5.74) and fewer named free time contacts (aOR 1.24, 95%CI 1.11, 1.38). Increased risk for CHC nonattendance was also associated with high local network clustering (aOR 1.78, 95%CI 1.06, 2.97). A subnetwork of 100 HIV+ adults was denser and had more clusters of size >=4 than expected by chance, and showed multiple social links to non-testers. Conclusions: Network-based testing strategies that target dense and clustered local networks and increase social outreach may achieve high coverage more efficiently. Social network data identified clusters of HIV+ individuals with social links to multiple non-testers, potentially informing identification of hidden high-risk individuals.

Poster Abstracts

419

CROI 2016