CROI 2015 Program and Abstracts

Abstract Listing

Oral Abstracts

Strategic priorities within VMMC scale up have evolved as programs matured. Stakeholders have progressively focused on: community engagement and sensitization; establishing favorable policy environments; instituting safe surgical services and safety monitoring systems; and, balancing supply and demand in continually expanding programs. As experience has grown, global and national stakeholders expanded focus to identify supply- and demand-side efficiencies through implementation research and delivery science. Population-based survey and study data show disproportionately low health service uptake among men, including poor HIV-related service uptake and outcomes. VMMC is uniquely positioned to initiate positive health system encounters and support HIV case finding among males who may not otherwise test for HIV. As care and treatment programs endeavor to achieve the UNAIDS 90-90-90 goals by 2020, it will be important to maximally leverage the VMMC platform to help ensure requisite male representation within the treatment cascade. Global health resources, including those for VMMC, are under increasing scrutiny to deliver demonstrable impact. Continued investment in VMMC will require refocusing efforts on intensifying HIV incidence reductions by prioritizing geographic areas and age groups according to HIV risk. Offering VMMC to those most at risk achieves epidemic control with fewer procedures and keeps VMMC on pace to support the UNAIDS goal of ending the global AIDS epidemic by 2030. 176 Scale-Up of HIV Interventions for PeopleWho Inject Drugs: Quality and Coverage Anna Deryabina ICAP at Columbia University, Almaty, Kazakhstan It is estimated that, of the estimated 13 million people who inject drugs (PWID) worldwide, 13% are living with HIV. Eastern Europe, Central Asia, South and South East Asia have the largest injection drug-use driven HIV epidemics. However, recent data show an increasing role of injection and non-injection drug use in HIV transmission in several African countries, including South Africa, Kenya and Tanzania. Criminalization of drug use, restrictive drug policies, aggressive law enforcement practices and lack of availability of harm reduction as well as HIV prevention, care and treatment programs for PWID undermine the ability to respond effectively to the HIV epidemic among PWID. The recommended package for PWID includes nine interventions, four of which (needles and syringe programs, opioid substitution therapy (OST) programs, HIV testing and counseling, and antiretroviral therapy (ART)) are core and have synergistic impact of reducing HIV transmission and enhancing outcomes among PWID with HIV. However, in many countries availability and access to evidence-based interventions remains limited. In many of the most affected countries programs like OST remain small-scale pilots, while coverage of eligible PWID with HIV prevention interventions and ART remains by far insufficient to effectively control the epidemic in this population. Rapid scale-up of effective interventions to reduce drug consumption and unsafe injecting practices is needed to prevent further spread of HIV among PWID, their intimate partners and the society in general. Scale up is about quality and comprehensiveness of services delivered. Effective and comprehensive programs to prevent HIV transmission from PWID to others include implementation of accessible HIV testing and counseling services, including rapid HIV testing, prompt initiation of ART, especially among those living in discordant couples, and scale up of OST programs to reduce HIV burden among PWID; and for PWID living with HIV to enhance their engagement and adherence to HIV treatment. Scale up is also about access and engaging PWID in the design and implementation of programs and prioritizing health of individuals and health of the community at all level of decision-making and implementation. Programs need to ensure that HIV interventions are low-thresh hold, utilize innovative and flexible models to meet the needs of PWID. 177 HIV Testing and Counseling: Emerging Issues, New Directions Rachel C. Baggaley World Health Organization, Geneva, Switzerland With 14 million people on ART the push is now to reach the remaining estimated 20 million who are living with HIV, many of whom are undiagnosed. The UNA I DS 90-90-90 target aims for 90% of all people living with HIV to know their status by 2020. 33%more people were tested in 2013 compared with 2009, however it is estimated that over half (54%) of people with HIV are still unaware of their status. Routine offer of provider initiated testing and counselling (PITC), recommended by WHO since 2007, is widely accepted in ANC and TB services, including in countries with low HIV prevalence, but has not been as well adopted in other clinical settings, even where HIV prevalence is high. This has led to disparities in testing: men, adolescents and people from key populations are less likely to be reached by HTC through clinical services, resulting in lower testing coverage and later access to HIV care. Reliance on testing through clinical services also partly explains the persistent late presentation of people living with HIV to care. In 2013 WHO recommended that countries expand testing to include a range of community based approaches to overcome PITC limitations. Approaches to reduce structural and legal barriers to community HTC include legitimising lay testing and the use of rapid tests outside clinical settings; exploring effective HIV self-testing models; and reviewing age of consent to support adolescent testing. Recent approaches to increase the proportion of people diagnosed include community-based testing accompanied by geographic prioritization and targeting populations at greatest risk and partner and family testing. Recent evidence also points to several interventions to rationalize and simplify re-testing for those at ongoing risk and better link people to HIV prevention and care. In response to emerging evidence of significant problems with testing quality, with reports of up to 7% false positive diagnoses of HIV in people being offered ART, WHO re- emphasised its recommendation to all countries to re-test all people before initiating ART. The causes of these misclassifications and measures to reduce them are being explored to avoid the social and public health consequences of misdiagnosis. HTC approaches have evolved and a range of complementary strategies are now available to reach greater numbers of people. HTC is the first step in both accessing care and preventing further transmission. It will be key to achieving global targets. 178 Ten Years of Strengthening Laboratory Services and Systems: Then, Now, and the Future John Nkengasong US Centers for Disease Control and Prevention, Atlanta, GA, US The last 10 years have been transformational for laboratory medicine in Africa thanks to increase in global health funding, especially from the world bank, PEPFAR, the Global fund—etc. Laboratory networks have been established, systems developed, and human competent work force developed—etc. In fact a recent Institute of Medicine (IOM) report has described laboratory health system strengthening as a “signature achievement” for PEPFAR and also concluded that the progress in strengthening laboratory medicine has also impacted other health systems. The talk will expand on some of these aspects and address key challenges that remain. It will also demonstrate how laboratory systems build for HIV are being leveraged on to support other program areas such as global health security and TB.

Oral Abstracts

194

CROI 2015