CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Methods: We developed a deterministic compartmental model of HIV transmission among MSM and simulated the HIV epidemic in nine selected countries. The model incorporates infectivity by type of sex act, sexual mixing by role preference, condom use, three stages of HIV with varying infectivity, and assumes a 40%-67%MC efficacy during insertive anal sex. The model was calibrated to country-specific HIV prevalence and current coverage of MC (Figure), and accounted for the uncertainty in other parameter values based on literature review. We compared intervention strategies of MC scale-up where 25%, 50% and 100% of uncircumcised, uninfected MSM engaging in insertive anal intercourse more than 50% of the time were circumcised over the course of 5 years. Impact was measured as cumulative fraction of new HIV infections averted over 10 years. Results: The predicted impact of MC varied substantially across settings (0%-17%). Countries with high existing levels of MC (e.g. USA or Ghana) would see a minimal impact (<3%/6%when circumcising 25%/50% of insertive MSM). The maximum impact of 8%/16%was observed in countries with low existing levels of MC (e.g. Peru and India). An upper bound of 38% impact is predicted using the 100% coverage intervention. The impact was most pronounced among MSM receiving MC, although herd effects were also observed among their partners. In uncertainty analysis, the intervention impact was positively correlated with role segregation in each setting (greater impact was seen when MSM had a strong preference for either insertive or receptive intercourse). Conclusions: MC among MSM is likely to have the greatest impact in highly role-segregated settings with lowMC coverage, such as Peru or India. However, our results suggest that the public health benefits among MSMwould likely be modest, with the intervention unlikely to avert more than 17% of infections even in the most favorable of settings under realistically achievable coverage.

1061 What Does Community HIV Testing Really Cost in South Africa? Guillermo Martínez Pérez 1 ; Aline Aurore Niyibizi 2 ; Jessie Kurkunar 1 ; Amir Shroufi 3 ; Sarah Jane Steele 4 ; Gilles Van Cutsem 3 1 Médecins Sans Frontières, South Africa & Lesotho, Eshowe, South Africa; 2 Médecins Sans Frontières, Roma, Lesotho; 3 Médecins Sans Frontières, Cape Town, South Africa; 4 Médecins Sans Frontières, South Africa & Lesotho, Cape Town, South Africa Background: The World Health Organization 2015 Consolidated HIV Testing Guidelines recommends community testing but this strategy is not widely used in the South African public sector due to cost concerns. Médecins Sans Frontières has rolled out three innovative models in rural KwaZulu Natal; mobile testing units (MTU) and fixed-testing sites (FTS) manned by counselors, and door-to-door testing (D2D) delivered by community health workers. These models reach more children and adolescents than clinics, and create opportunities to link negative people to preventive services and to link positive people to care. To illustrate the financial cost of realizing such benefits we estimated the costs related to performing an integrated “Test & Link” per model. Methods: This cross-sectional cost analysis from a service provider perspective used an ingredients approach. Costs were stratified: diagnostics; staff time; sensitization;

Poster Abstracts

infrastructure; communication; and, transport and equipment. We used programme statistics, and financial and procurement data to calculate the monetary value of all resources. The cost in USD of one “Test & Link” per model in 2014 was our primary outcome. Up-front and running costs were calculated. Assumptions were that: “Test & Link” providers worked 18 days/ month in average and used 20-25 minutes per negative test, and 40-50 minutes per positive test. Results: The cost of one “Test & Link” was $7,82 per positive test for D2D testing, $7.97 for clinic-based testing, $11,12 for FTS and $14,93 for MTU. For FTS and MTU the main driver of cost difference was staff time, which comprised 63,5% (FTS) and 45,7% (MTU) of the cost of each positive test. D2D testing was the least expensive, and the only community-based model of testing that was delivered more cheaply than clinic-based testing. Diagnostics comprised 40,8% of the cost of each positive test at the D2D. Conclusions: Cost per positive “Test & Link” was lower for D2D testing than clinic-based testing. Community testing needs not cost more than clinic-based testing if lay cadres can be engaged. This evidence supports wider adoption of community testing in South Africa, especially door to door testing, to reach populations such as children (at high risk of morbidity), young adults and men (at high risk of acquiring as well as transmitting HIV).

455

CROI 2016