CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Treatment Continuum for a population-based sample of younger Black men who have sex with men ages 16-29 in Chicago (n=626). Conclusions: Treatment continuummetrics among YBMSM are similar to the general HIV infected population. Several structural factors are associated with these metrics such as drug use; some like unemployment may have opposite than anticipated relationships. Notably, metrics such as retention in care and viral suppression are not associated with key structural factors that disproportionately affect YBMSM such as homelessness and incarceration. More research is needed to determine and intervene upon key drivers related to HIV treatment continuummetrics among YBMSM, with particular attention to the diversity of drivers related to each step. 1071 Population-Level HIV RNA and CD4+ Distribution in a Rural Ugandan Community WithWidespread Community HIV Testing and Universal ART Access Vivek Jain 1 ; Gabriel Chamie 1 ; Gideon Amanyire 2 ; Dalsone Kwarisiima 2 ; Jane Kabami 2 ; Maya L. Petersen 3 ;Tamara Clark 1 ; Edwin D. Charlebois 1 ; Moses R. Kamya 2 ; Diane Havlir 1 1 University of California San Francisco, San Francisco, CA, US; 2 Makerere University–University of California San Francisco Research Collaboration, Kampala, Uganda; 3 University of California Berkeley School of Public Health, Berkeley, CA, US Background: The new UNAIDS 90-90-90 initiative (90% diagnosed, 90% on ART, 90%with undetectable viral load [VL]) calls for treatment to achieve 73% overall viral suppression on a population level. We have been conducting community health campaign-based HIV testing and linkage to care, and have enabled access to ART for all persons including high CD4+ T cell counts (>350 cells/uL) (EARLI Study: NCT01479634) starting in 2011 in a rural Ugandan community. We examine trends in viral suppression among community health campaign participants. Methods: During a 6-day community health campaign in 2014 in Kakyerere Parish, southwestern Uganda, adults ( ≥ 18 years) and children were offered HIV testing (Determine, Inverness). In HIV-positive persons, HIV RNA level was measured via a validated fingerprick collection method followed by RT-PCR (Abbott; limit of detection, 1000 copies/mL). Three population viral load metrics were assessed among HIV+ adult residents and non-residents attending the health campaign: (1) proportion of persons with an undetectable VL, VL 1000-10000 c/mL, 10,000-100,000 c/mL, and ≥ 100,000 c/mL, (2) median VL, and (3) the mean log(VL). CD4+ count was also measured in HIV-positive persons (PIMA, Alere) and compared between community residents and persons from outside the community (where testing campaigns were not conducted and ART was available only for persons with CD4+ counts below government program threshold). Results: A total of 4897 persons attended the 2014 health campaign (86% coverage among adults based on estimated 2014 census projections). HIV prevalence among adults was 8.5%, and among children was 0.7%. Among community residents with HIV (n=220), 71% had an undetectable VL, increased from 55% in 2012 and 37% in 2011. Overall, 9% had VL 1000-10,000; 11% had VL 10,001-100,000; and 9% had VL>100,000 c/mL. Median VL was undetectable. Mean log(VL) was 3.38 log (95%CI, 3.28-3.49). Among persons living outside the community, only 54% had an undetectable VL (n=13). Median CD4+ count was 511 cells/uL among community adults, and was 417 cells/uL among adults living outside the community. Conclusions: In a rural Ugandan community with intensive community health campaigns with HIV testing and linkage, and universal ART access, we found viral suppression among HIV+ persons attending health campaigns increased from 37% in 2011 to 71% in 2014. Lower population viral suppression and a lower median CD4+ count were seen in persons living outside the study community. 1072 Facility-Level Factors Influencing Retention in HIV Care in East Africa Beth Rachlis 1 ; Giorgos Bakoyannis 2 ; Philippa Easterbrook 3 ; R. Scott Braithwaite 4 ; Craig R. Cohen 5 ; Elizabeth Bukusi 6 ; Andrew D. Kambugu 3 ; Mwebesa Bosco Bwana 7 ; Elvin H. Geng 5 ; Paula Braitstein 1 1 Academic Model Providing Access to Healthcare program, Eldoret, Kenya; 2 Indiana University, School of Medicine, Indianapolis, IN, US; 3 Infectious Diseases Institute, Kampala, Uganda; 4 New York University, New York City, NY, US; 5 University of California San Francisco (UCSF), San Francisco, CA, US; 6 Kenya Medical Research Institute, Nairobi, Kenya; 7 Mbarara University, Mbarara, Uganda Background: Retention in HIV care is critical for viral suppression and decreased HIV transmission among people living with HIV. Unfortunately, losses to follow-up (LTFU) remain an important programmatic challenge in many low and middle-income settings. Numerous patient factors have been linked with LTFU, but less is known about associated facility- level factors. Methods: Using data from the East African International epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium, we sought to identify facility-level factors associated with LTFU from care before and after antiretroviral therapy (ART) initiation. All facilities associated with IeDEA programs in Kenya, Tanzania and Uganda were included. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART, with no documentation of patient death or transfer. LTFU rates were stratified by country and program. Adjusting for patient-level factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Results: Data from 88,152 patients and 29 clinics (Kenya 23, Tanzania 3, Uganda 3) were analyzed. Median age at enrollment was 34.9 years (Interquartile Range: 29.0-42.1), 68.3%were women and 61.2% initiated ART. Median LTFU rates for the pre- and post-ART periods were 25.1/100 (95% Confidence Interval (CI): 24.7-26.6) and 16.7/100 (95% CI: 16.3-17.2) person-years respectively. Facility-level factors associated with increased LTFU before and after ART initiation included care provided at the primary level, HIV RNA PCR turnaround time >14 days, and only off-site availability of CD4 testing. Increased LTFU was also observed for the pre-ART period when no nutritional treatment was provided by the facility and TB symptomatic patients were treated within the ART program. After ART initiation, increased LTFU was associated with the facility being open ≤ 4 mornings per week.

Poster Abstracts

626

CROI 2015