CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: From 348 health facilities, a total of 526,059 HIV positive adults (67% females) were enrolled in CTC prior to receiving ART. The majority (85%) had working functional status, 82% had a CD4 count within three months of enrolment and 93%were screened for TB at every visit. The overall mortality rate was 37.6 deaths per 1000 person years (95% CI 36.9 - 38.3). Through the years mortality has ranged from 32.0 to 60.4 deaths per 1000 person years. Independent predictors of pre-ART mortality were: WHO stage 3 (AHR=2.37; 95% CI 1.94-2.90), WHO Stage 4 (AHR=4.53; 95% CI 3.64-5.64), female sex (AHR=0.62; 95% CI 0.56 -0.70), CD4 count ≥ 200 (AHR=0.17; 95% CI 0.15-0.20) and weighing more than 45kg at CTC enrolment (AHR=0.53; 95% CI 0.46-0.62) were significantly associated with a lower hazard of death Conclusions: Mortality among patients in the pre-ART phase was high, especially among those with low CD4 counts, and at WHO stage 3 and 4. This indicates the need to initiate ART before patients get very sick. Analyzing routinely collected electronic information in Tanzania for pre-ART mortality and its predictors provides information for policy makers to drive program improvements and to establish effective interventions for patients in the pre ART phase. 1077 Impact of the Ebola Outbreak on the Quality of Care of People LivingWith HIV Taking Antiretroviral Treatment at Donka National Hospital in Conakry, Guinea Mohamed Cisse 2 ; Mohamadou Saliou Diallo 4 ; CheickTidianeTidiane 3 ; Cece Kpamou 4 ; Justeau Dimitri 4 ; Eric Dortenzio 1 ; Jacques D. Ndawinz 1 1 Solthis International NGO, Paris, France; 2 Hôpital National de Donka, Conakry, Guinea; 3 Ministre de la Santé et de l’Hygiène Publique, Conakry, Guinea; 4 Solthis NGO, Conakry, Guinea Background: Routine monitoring of people living with HIV (PLHIV) taking antiretroviral therapy (ART) is essential to improve the quality of care in the context of Ebola outbreak in Guinea. The Guinea Ministry of Health with Solthis International NGO conduct supervisory visits to all public HIV facilities to strengthen access to care and quality of reported data. Donka national hospital (DNH) is the largest HIV facility in Guinea and is the only isolation and treatment center for Ebola patients in Conakry. From April to June 2014, 55 Ebola confirmed cases were admitted at DNH. The objective of this study was to assess the impact of the Ebola outbreak on the quality of care of PLHIV taking ART in Conakry. Methods: Prescriptions of ART-patients attending the pharmacy unit of DNH during January to June 2014 were reviewed to gather visit schedules, antiretroviral regimen, and individual information. A defaulters was defined as a patient who did not attend the last scheduled clinic visit within x time since a given time point. We considered three lengths of time: x=70, 80, or 90 days. We described PLHIV’s follow-up at DNH during the first months of Ebola outbreak. Results: From January to June 2014, 15384 prescriptions of 8403 ART-patients were reviewed. Sixty three percent were female and the median age was 37 years [interquartile range (IQR):30-46]. The common ART regimens were AZT+3TC+NVP (53%) and TDF+3TC+EFV (28%). Median duration between two consecutive visits was 61 days (IQR: 57-65). The number of visits in clinic/pharmacy decreased from 3062 in April to 2794 in June. When the length of time x=90 days, the proportion of defaulters increased from 1% in April to 15% in June, from 2 to 22%when x=80 days and from 4 to 34%when x=70 days.

Poster Abstracts

The number of patients who did not attend the last scheduled clinic visit within x time since a given time point (defaulters) at Donka national hospital, period April-June 2014 Conclusions: From January to June, it seems there is a trend of an increase in the number of defaulters which could be attributed to the Ebola outbreak. Data and analysis for July, August and September will be updated to confirm this result. We recommend that timing visits, number of visits in clinic/pharmacy and defaulters should be continuously measured in order to identify eventual changes, during this Ebola outbreak. New strategies, such as 3 months ART deliveries and mobile clinics should be considered in Guinea to ensure the continuum of care of PLHIV. 1078 The African Diaspora Health Initiative: Enhancing Access to Health Care for African and Caribbean Immigrant Populations in Philadelphia Helena Kwakwa ; RahabWahome; Oumar H. Gaye; Natasha Z. Mvula Philadelphia Department of Public Health, Philadelphia, PA, US Background: Travel and immigration to the US from areas of the world with higher prevalence of HIV is growing. Many persons in the US from resource-poor countries have limited access to health care including HIV testing. We describe the African Diaspora Health Initiative (ADHI), a project of health screening, integrated HIV testing and linkage to care in the African and Caribbean communities of Philadelphia. Methods: Launched in 2011, ADHI is a series of Clinics Without Walls (CWW) conducted in settings where African and Caribbean persons are scheduled to gather. Individuals are screened for hypertension, diabetes and HIV. A Project Clinician meets with individual participants to advise them on lifestyle changes including risk reduction. All those returning an abnormal test result or found to have any other health needs are referred to the public city health centers of Philadelphia, and are subsequently followed up to ensure attendance. We present project outcomes data for the first three project years. Results: Between March 2011 and September 2014, 4,100 first generation African and Caribbean persons were screened in 299 Clinics Without Walls. Of these, 520 were referred for further care and 467 attended an initial medical visit. Acceptance rate for HIV testing was 92%. Previously undiagnosed HIV was detected in 95 participants, and 93 of these were successfully linked to care. Rates of hypertension ranged from 21.6% among African men to 26.4% for Caribbean women. Diabetes rates ranged from 6.7% in African women to 14.6% in Caribbean men. HIV prevalence was lowest among Caribbean women at 0.5% and highest for Caribbean men at 8.6%. Among the 467 linked to care, chronic Hepatitis B prevalence was 13% among Africans and 2% among Caribbean individuals.

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CROI 2015