(P161) A HIGH PREVALENCE OF DIAGNOSED- AND UNDIAGNOSED HIV IN UGANDAN ADULTS WITH GENITAL ULCER DISEASE: FINDING NEW HIV DIAGNOSES THROUGH COMMUNITY OUTREACH

Background:
Genital ulcer disease (GUD) is strongly associated with HIV acquisition and transmission. To reach 95-95-95 HIV elimination goals it is essential to identify those undiagnosed and ensure all people living with HIV (PLWH) are linked to care and have undetectable viral loads (VLs).

Methods:
Participants with GUD were enrolled at government clinics and through community outreach in Kampala and Wakiso, Uganda between 07/2023 to 03/2024.  After written informed consent, blood was collected for HIV/syphilis rapid diagnostic tests (RDT) (SD Bioline-Duo, Abbot, Princeton, NJ,), and genital swabs or urine collected for chlamydia and gonorrhea NAA testing (GeneXpert CT/NG, Cepheid, Sunnyvale, CA). A researcher-administrated demographic and biobehavioral questionnaire was administered.

Results:
Of 92 participants screened, 75(85.1%) with clinician-confirmed GUD enrolled; 10(13.3%) were men and 65(86.7%) women. Overall, the median (IQR) age was 29(23-37) years; 25(33.3%) had completed 7th grade education.  7 of 75(9.3%) reported >10 sex partners in the prior 3 months; 24(32.0%) were aware of HIV PrEP, of these 5(20.8%) had previously used it; 22(29.3%) reported transactional sex in the prior 6-months, and 27(36.0%) reported alcohol use in the past 3-months. HIV and syphilis positivity by RDT was 29(38.7%) and 9(12%) respectively; of 29 with a reactive HIV test, 8(27.6%) were newly diagnosed; none were pregnant and 7(87.5%) were linked-to-care. Most, 17(58.6) PLWH were identified during outreach activities including 6 of 8(75%) of those newly diagnosed. Of 21 previously diagnosed, 19(90.5%) reported current ART use; 8(38.1%) had a self-reported undetectable VL. Overall urogenital gonorrhea and chlamydia prevalence was 9.3% and 8.0%; in those LWH it was 13.8% and 0% respectively.

Conclusion:
HIV was common in this Ugandan population with GUD; of concern a substantial minority were previously undiagnosed, and - of those diagnosed - virally unsuppressed. Efforts to reach individuals with STI syndromes in community settings is crucial to meet 95-95-95 targets.