CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

988

Home-Based HIV Counseling and Testing Using Index Patients in Lesotho Abby L. DiCarlo 1 ; Allison Zerbe 1 ; Zach Peters 2 ; Koen Frederix 1 ; Joanne E. Mantell 3 ; Robert Remien 3 ; Wafaa M. El-Sadr 1 1 ICAP at Columbia Univ, New York, NY, USA; 2 ICAP, Columbia Univ Mailman Sch of PH, New York, NY, USA; 3 HIV Cntr for Clinical and Behavioral Studies, Columbia Univ and New York State Psychiatric Inst, New York, NY, USA Background: HIV testing coverage in Lesotho has expanded in recent years with the percent of persons aged 15-49 who have ever tested increasing from 2009 (39.3% of men; 68.6% of women) to 2014 (65.2% of men; 85.5% of women). To achieve universal HIV testing coverage, novel approaches are needed. The use of clinic-based index patients (IPs) for home-based HIV counseling & testing (HBCT) has the potential to expand testing coverage by facilitating access to homes and persons at risk for HIV. Methods: Between December 2012 and September 2013, 192 IPs were recruited from 2 health centers in Mafeteng and Mohale’s Hoek districts as part of the NIH-funded Enhanced Prevention in Couples (EPIC) study. IPs were asked to approach their household (HH) members regarding testing. Home visits were scheduled with IPs and HBCT was offered to both IPs and HH members who did not self-report HIV+. Demographic and acceptability measures were collected by in-person surveys.

Results: At recruitment, 119 (62%) of 192 IPs self-reported as HIV+ and 73 IPs self- reported as HIV- or status unknown and were offered HBCT; 58 (81%) accepted and of these, 2 IPs were identified as HIV+. A total of 661 HH members were identified through IPs; 98 (15%) HH members self-reported as HIV+. HBCT was offered to the remaining 563 HH members and 495 (88%) accepted (90% of women and 84% of men); 54 (10.9%) HH members were newly diagnosed HIV+ via HBCT. In total, 56 (10%) of 553 tested IPs and HH members were newly diagnosed as HIV+; 70% of newly diagnosed were women. HIV+ IPs (both self-reported and newly diagnosed) yielded a higher percent of new HIV diagnoses among HH members than HIV-/status unknown IPs (13% vs. 7% p=0.04). Of 123 couples with at least one partner tested by HBCT, 57 serodiscordant couples were identified: 51 couples included a partner who was diagnosed as HIV+ prior to this study and for whom one HIV- partner was identified via HBCT; 6 couples included a partner who was newly identified as HIV+ via HBCT. Nearly all tested persons (99%) were “very satisfied” with HBCT; 97% said they would recommend HBCT to family and friends. Conclusions: The study demonstrated the feasibility of utilizing IPs to access HH members and provide HBCT. Using HIV+ IPs to reach HH members and conduct HBCT may be an efficient approach to advance HIV prevention through identification of other HIV+ persons in HHs and identification of new discordant couples. HBCT was highly acceptable through this approach.

989

Prevention for HIV-Infected Persons in HPTN 065: Room for Improvement Wafaa M. El-Sadr 1 ; Ann Kurth 2 ; Jennifer H. Farrior 3 ; Kate Buchacz 4 ; Brett Hanscom 5 ; Laura McKinstry 5 ; Richard Elion 6 ;Viraj Patel 7 ; Deborah Donnell 5 ; Bernard Branson 8 1 ICAP at Columbia Univ, New York, NY, USA; 2 New York Univ, New York, NY, USA; 3 FHI 360, Durham, NC, USA; 4 CDC, Atlanta, GA, USA; 5 SCHARP, Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 6 George Washington Univ Sch of Med, Washington, DC, USA; 7 Montefiore Med Cntr, Bronx, NY, USA; 8 Scientific Affairs, Atlanta, GA, USA Background: HPTN 065 examined the feasibility of a test, link-to-care, plus treat strategy for HIV prevention in the Bronx, NY and Washington, DC. Few data are available on patient perspectives about the effect and use of antiretroviral therapy (ART) for prevention. As part of HPTN 065, we surveyed a sample of HIV-infected patients to assess knowledge and attitudes on ART use for treatment and prevention. Methods: We recruited patients at 10 HIV care sites (Bronx 4, DC 6). Patients completed a computer tablet-based 21 question survey during December 2013 to December 2014. Results: Characteristics of 725 patients who participated in the survey were as follows: median age 52 years (range 18-77); 69%male; 62% African American; 42%men who had sex with men, and 95% on ART. Regarding reasons for taking ART, 90% indicated they would take ART “to improve their own health” and 62% “to lower the chance of passing HIV to a sex partner.” Respondents also indicated ART should be started “when someone is sick from HIV” (76%) and “when a doctor tells a person they need HIV medicines” (73%); fewer (54%) indicated ART should be started “to lower the chance of passing HIV to sex partners.” With regards to the chance of transmitting HIV during sex while taking ART versus not taking ART, 24% indicated that risk was higher, 35% that it was lower and 32% indicated the same risk. With regards to chances of transmission with a low versus high viral load, 11% indicated higher, 41% lower, and 38% the same risk. Most (87%) indicated it was possible to transmit HIV with an undetectable viral load. Among the 614 (85%) patients who saw an HIV provider within the last 3 months, 48% had talked with the provider about sex partners or condom use, 30% about sex partner HIV status, and 29% about disclosing their HIV-positive status to sex partners. Only 49% had been asked about alcohol use and 24% about injection drug use. With regards to sexual behavior among 691 patients on ART, 2% reported more sex partners and 4% indicated condom use less often since starting ART (Table). Conclusions: Overall, patients favored using ART for their own health but had more limited knowledge about using ART to reduce risk of HIV transmission to partners. HIV providers need to discuss with patients HIV risk behaviors and the importance of viral suppression for prevention of HIV transmission. We also found little evidence in our study for risk compensation among patients on ART in HIV care.

Poster Abstracts

421

CROI 2016