1. Sexual activity and risk behaviors among HIV-infected patients initiating ART in rural district hospitals in Cameroon Preliminary results of a 24-month follow-up (Stratall ANRS 12110/ESTHER trial) Fabienne Marcellin 1,2,3, Charles Kouanfack 4, Julien Cohen 1,2,3, Sylvie Boyer 1,2,3, Jean-Paul Moatti 1,2,3, Maria Patrizia Carrieri 1,2,3, Eric Delaporte 5,6, Christian Laurent 5, Bruno Spire 1,2,3 1 INSERM, U912 (SE4S), Marseille, France 2 Université Aix Marseille, IRD, UMR-S912, Marseille, France 3 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France 4 Central Hospital, Yaoundé, Cameroon 5 Institut de Recherche pour le Développement (IRD), University Montpellier 1, UMR 145, Montpellier, France 6 Department of Infectious and Tropical Diseases, University Hospital, Montpellier, France Abstract n° WEPDD104

2. The Stratall ANRS 12110/ESTHER trial Randomized, 24-month, open-label, 459 HIV-infected ART-naïve adults 9 rural district hospitals in Cameroon PRIMARY OBJECTIVE Clinical efficacy of the WHO “public health” approach vs. that of the standard clinical approach for ART follow-up in resource-limited settings AMONG SECONDARY OBJECTIVES Changes in patients’ sexual behaviors before (M0) and after ART initiation (M6, M12, M24)

3. Months of follow-up % of patients * defined as reporting  1 sexual partner during the previous 3 months sexually active with HIV-positive partners with serodiscordant partners Women70% Age a Educational level ≥ secondary school Being married 36 [30-44] yrs 48% 20% Having children79% Desire for a child8% Depressive symptoms b 64% Low perceived social level c 39% Important place of religion in life60% Binge drinking d 13% CD4 count a 183 [89-342] c/µL WHO clinical stage IV25% a median [interquartile range] b CES-D score >16 c score 1 or 2 on a 10-point scale (Singh-Manoux A. et al, Psychom Med 2005) d drinks 3 big bottles and/or 6 glasses of alcohol or more on one occasion Changes in sexual activity* during the follow-up Characteristics of patients before ART initiation (M0, n=447)

4. AOR (95% CI) Age (for a 10-year increase)0.6 (0.5 to 0.7)* Being married4.1 (2.5 to 6.6)* Desire for a child2.3 (1.4 to 3.7)* Depressive symptoms0.5 (0.4 to 0.7)* Low perceived social level0.6 (0.4 to 0.9)** Important place of religion in life0.5 (0.3 to 0.7)* Binge drinking3.3 (2.0 to 5.5)* Time since ART initiation (for a 6-month increase) 1.3 (1.1 to 1.4)* * p<0.01 ** p<0.05 Factors associated with sexual activity (mixed-effect logistic regression) AOR = adjusted odds ratio; CI = confidence interval Sexual risk behaviors after ART initiation (M6, M12, M24) CONCLUSIONS ART initiation fosters resumption of sexual activity ICU remains less frequent among patients who resume sexual activity Need for exploring the role of adherence counseling in positive prevention P=0.002 Patients sexually abstinent before ART initiation (n=119) Patients sexually active before ART initiation (n=81) ICU 57% ICU 77% ICU = inconsistent condom use with serodiscordant partners during the previous 3 months