CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Methods: One hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 hours of delivery. The group in the intervention arm received phone calls fortnightly. At 6 and 10 weeks following randomization we collected data on infant adherence to nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results: Seventy five women were each randomized to the intervention and control arms respectively. At 6 weeks follow-up 68 (90.7%) participants in the intervention arm reported adherence to infant NVP prophylaxis, compared with 54 (72%) participants in the control group (p = 0.005). Participants in the intervention armwere also significantly more likely to be retained in care than those in the control group. At 6 weeks 59 mother-infant pairs (78.7%) attended scheduled visits with the visits coinciding with the appointment date versus 44 (58.7%) in the control arm (p = 0.009). At 10 weeks the revisit rates were 69.3% (52) in intervention arm and 37.3% (28) in control arm for the 150 mother-infant pairs evaluated (p < 0.001). Conclusions: These results suggest that phone calls can be an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. 890 HIV Care Continuum for PostpartumWomen in Philadelphia: Barriers and Facilitators JoellaW. Adams 1 ; Kathleen Brady 1 ;Yvonne Michael 3 ; Baligh R.Yehia 4 ; Florence Momplaisir 2 1 Philadelphia Department of Public Health, Philadelphia, PA, US; 2 Drexel University College of Medicine, Philadelphia, PA, US; 3 Drexel University School of Public Health, Philadelphia, PA, US; 4 University of Pennsylvania, Philadelphia, PA, US Background: There are 280,000 women with HIV in the U.S. and the number of HIV-infected women giving birth increased 30% from 2001-2010. HIV-infected women are at risk of virologic failure postpartum. We evaluated factors influencing HIV outcomes in postpartum HIV-infected women. Methods: Using 2005-2011 surveillance data, we conducted a retrospective cohort study of 733 deliveries from 591 HIV-infected women in Philadelphia. Outcomes of interest included retention in care at 1 and 2 years postpartum ( ≥ 1 CD4 or viral load (VL) in each 6 month interval of the 12 or 24 month period with ≥ 90 days between tests) and viral suppression at 1 and 2 years postpartum (VL <200 copies/ml at the last measure of the 12 or 24 month period). Multivariate logistic regression models evaluated factors associated with the last two steps of the care continuum. Predictors of interest included early postpartum care engagement ( ≥ 1 CD4 or VL within 90 days of delivery), timing of HIV diagnosis (made ≥ 2 years, <2 years, or during pregnancy), viral suppression at delivery, previous pregnancy with HIV and quality of prenatal care evaluated with the Kessner Index, a validated measure taking into account the trimester of entry into care, week of gestational delivery, and number of prenatal visits. Results: Of 733 deliveries, 43% engaged in care within 90 days postpartum, 46% and 30%were retained in care and virally suppressed at year one, and 25% and 32%were retained in care and virally suppressed at year two. Retention in care and viral suppression significantly improved over time (p<.0001). Timing of HIV diagnosis and early postpartum engagement were the only 2 variables associated with both retention and viral suppression (Table1). Women diagnosed with HIV during pregnancy were half as likely to be retained at year one and two postpartum (AOR 0.53, 95% CI 0.32-0.88; AOR 0.50, 95% CI 0.29-0.88) and half as likely to suppressed at year two postpartum (AOR 0.51, 95% CI 0.32-0.83). Women with early postpartum care engagement were more likely to be retained (AOR, 7.7, 95% CI: 5.3-11.2) and virally suppressed (AOR, 1.9, CI: 1.3-2.7) at year one postpartum. Early engagement was associated with retention (AOR, 4.8, CI: 3.2-7.2) but not viral suppression at year two postpartum.

Poster Abstracts

Conclusions: Postpartum HIV-infected women have low rates of retention in care and viral suppression. Interventions aiming at early HIV diagnosis and engaging women in care after delivery have the potential to improve long term clinical outcomes.

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CROI 2015