CROI 2016 Abstract eBook

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Poster Abstracts

1005 Increased Gonorrhea and Chlamydia Case Detection in a Multisite US HIV Cohort Julia Goldberg Raifman 1 ; Anne K. Monroe 2 ; Kelly A. Gebo 3 ; Khalil Ghanem 4 ; Allison L. Agwu 3 ;Todd Korthuis 5 ;Wm. Christopher Mathews 6 ; Aditya Gaur 7 ; Stephen A. Berry 3 ; for the HIV Research Network 1 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 2 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 3 Johns Hopkins Univ, Baltimore, MD, USA; 4 Johns Hopkins BayviewMed Cntr, Baltimore, MD, USA; 5 Oregon Hlth & Sci Univ, Portland, OR, USA; 6 Univ of California San Diego, San Diego, CA, USA; 7 St Jude Children’s Rsr Hosp, Memphis, TN, USA Background: U.S. guidelines recommend annual Gonorrhea (NG) and Chlamydia (CT) screening for persons living with HIV. Detecting these diseases may decrease HIV transmission by leading to sexual risk counseling and treatment. In some HIV clinics in the U.S. and Canada, increased NG/CT screening has not increased case detection, prompting considertion of more targeted screening approaches. During 2004-2010, annual NG/CT testing increased steadily from 22% to 39% of patients in the HIV Research Network multi- site U.S. clinical cohort. We evaluated, 1) trends in the proportion of patients who tested positive among those tested each year (test positivity), and 2) trends in the proportion of patients positive among all patients in care, whether tested or not (case detection). Methods: Seven adult clinical sites had NG/CT test result data. We included all patients with at least one calendar year of active clinical follow-up and restricted the analysis to person-years (PY) of active follow-up. We tested for linear trends in test positivity and case detection using generalized estimating equations and adjusting for clustering within person. We adjusted for age, race, injection drug use, CD4 count, number of HIV provider visits, viral load, and HIVRN clinical site. Results: Of 19,368 patients, 40%were men who have sex with men (MSM), 31%were men who have sex with women (MSW), and 29%were female. The median age in the first year of inclusion was 42 years. During 68,458 PY of follow-up, NG/CT tests were done in 21,561 PY. As testing increased, test positivity increased from 2.7% in 2004 to 4.9% in 2010, adjusted odds ratio (AOR) per year 1.13 (1.09-1.18). Case detection increased from 0.6% in 2004 to 2.0% in 2010 (Figure), AOR per year 1.28 (1.23-1.33). Case detection increased among all sexual risk groups, with the greatest increase among MSM (AOR per year 1.31, 1.25-1.38), followed by MSW (1.18, 1.06-1.31), and by women (1.17, 1.05-1.29). For two clinical sites with available data to distinguish body site of testing, test positivity was greater for the rectal (7.9%) than the genital site (4.0%). Conclusions: As NG/CT testing increased, the test positivity also increased, yielding an overall improvement in case detection in this large cohort. Test positivity may have increased because providers were more successfully targeting higher risk patients and/or body sites. Increasing the testing rate above 39%may further improve case detection. There is a need to further promote NG/CT screening in HIV clinics. 0 1 2 3 4 Percent ofAll Patients Positive 2004 2005 2006 2007 2008 2009 2010 Year Overall MSM MSW Women Annual Gonorrhea/Chlamydia Case Detection Background: Testing and treating HIV-infected patients for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection benefits their health and has been to shown to reduce HIV transmission risk in some cases. Men who have sex with men (MSM) are disproportionately affected by GC and CT infection and (per US guidelines), if HIV-infected, should be screened for them at least annually. GC and CT infections in MSM occur most often in the anorectum or pharynx. Extragenital testing substantially improves diagnostic yield, yet rates of extragenital GC and CT testing have been low historically. Methods: We used 2009-2012 data from the Medical Monitoring Project (MMP) to estimate proportions of sexually active MSM who were tested in the previous 12 months for GC and CT infection in urine and anorectal and pharyngeal sites. We estimated the positivity for each test type; patients could be tested at multiple sites, precluding statistical comparisons. MMP is a US surveillance system producing nationally representative estimates about HIV-infected adults in medical care. GC and CT testing data were abstracted frommedical records. Sexual behavior data were self-reported in interviews. Results: Of 6,079 HIV-infected MSM, 29.9% (95% CI: 26.8 – 33.0) were tested for GC and 30.1% (95% CI: 27.0 – 33.2), for CT; positivity was 5.3% (95% CI: 4.2 – 6.4) for GC and 5.7% (95% CI: 4.6 – 6.8) for CT. Approximately 8.5%were tested for GC or CT with no site specified. For GC, lower proportions of MSM were tested at anorectal (3.5%) and pharyngeal (2.8%) sites than in urine (17.6%); however, positivity was higher among anorectal (9.9%) and pharyngeal (8.4%) samples than among urine samples tested (3.8%). For CT, lower proportions of MSM were also tested at anorectal (3.6%) and pharyngeal (2.2%) sites than in urine (18.0%), and positivity was higher for anorectal samples (11.6%) than for urine samples (4.5%), but similar for pharyngeal samples (5.9%) and urine samples. Conclusions: Less than one-third of sexually active MSM in HIV medical care in the US were tested for GC and CT in the previous 12 months, per current recommendations. Fewer than 5% of patients were tested at extra-genital sites, and GC and CT test positivity was more than twice as high for anorectal compared with urine tests. Providers should perform routine extragenital screening for GC and CT among sexually active HIV-infected MSM to diagnose treatable infections and decrease HIV transmission risk. 1006 Gonorrhea and Chlamydia Testing in US HIV-Infected MenWho Have Sex With Men Monita Patel 1 ; Shikha Garg 1 ; JohnT. Brooks 1 ;YunfengTie 2 ; Heather Bradley 1 1 CDC, Atlanta, GA, USA; 2 ICF Intl, Atlanta, GA, USA

Poster Abstracts

429

CROI 2016