CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Access to care for immigrants as they integrate into US society is critical, and HIV testing must be included in this care. With the lifting of the HIV entry ban in 2010, novel strategies to provide testing are important, and integrating HIV testing into a larger access to health care initiative is not only needed but is accepted by the target population. Our current “test and treat” approach works for this marginalized population only to the extent that they access any care at all. Utilizing Clinics Without Walls facilitates the process since it eliminates the need to convene the target population. This model may be modified in resource-rich countries to engage immigrants from resource-poor countries in HIV testing and in care.

THURSDAY, FEBRUARY 26, 2015 Session P-X3 Poster Session

Poster Hall

2:30 pm– 4:00 pm Guidelines and Their Implementation 1079 Starting ART at 500 CD4 in Southern Africa: What Is the Impact on ART Eligibility? Helena Huerga 1 ; David Maman 1 ; GillesVan Cutsem 2 ; Beatrice Kirubi 3 ; Charles Masiku 4 ; Ruggero G. Giuliani 2 ; Irene Mukui 5 ; Benson Chilima 6 ; Elisabeth Szumilin 7 ; Jean-François Etard 1 1 Epicentre, Paris, France; 2 Médecins Sans Frontières, Cape Town, South Africa; 3 Médecins Sans Frontières, Nairobi, Kenya; 4 Médecins Sans Frontières, Lilongwe, Malawi; 5 National AIDS and STDs Control Program, Nairobi, Kenya; 6 Ministry of Health, Lilongwe, Malawi; 7 Médecins Sans Frontières, Paris, France Background: 2013 WHO guidelines recommending antiretroviral therapy (ART) initiation at 500 CD4/ m l and PMTCT option B+ are not yet applied in many countries. Direct evaluation in population of the impact on ART eligibility is critical to inform program’s decisions and validate model predictions. We present estimates of ART eligibility according to current and new ART guidelines from 3 population based studies. Methods: Cross-sectional surveys in Ndhiwa (Kenya), KwaZulu-Natal (South Africa) and Chiradzulu (Malawi). Persons aged 15-59 years were eligible. Face-to-face interviews were followed by rapid HIV testing on site and further tests on laboratory. ART intake was self-reported in Kenya and Malawi and blood-tested in South Africa. ART eligibility was defined as individuals eligible for ART among HIV positive. ART was initiated at 350 cells/ m l in the 3 countries at the time of the surveys; PMTCT options were A in Kenya, B in South Africa and B+ in Malawi. ART coverage was defined as individuals on ART among eligible. Results: In total 19,057 individuals were included: 6139 in Kenya, 5649 in South Africa and 7269 in Malawi. HIV prevalence was 24.1% (95%CI 22.9-25.2) in Kenya, 25.2% (95%CI: 23.6-26.9) in South Africa and 17.0% (95%CI: 16.1-17.8) in Malawi. ART coverage was 70.8% in Kenya, 75.0% in South Africa, and 80.4% in Malawi. Higher in women compared to men: 66.7% vs 60.7% (p=0.07) in Kenya, 78.5% vs 63.9% (p<0.001) in South Africa and 83.3% vs 72.2% (p<0.01) in Malawi. Lower in aged<35 years compared to ≥ 35years: 52.1% vs 74.6% (p<0.001) in Kenya, 64.3% vs 84.3% (p<0.001) in South Africa, 73.6% vs 84.3% (p<0.001) in Malawi. New ART guidelines would lead to an increase of ART eligibility ranging from 7.6% (from 80.4% to 88.0%) in Malawi, 10.7%(from 69.4% to 80.1%) in South Africa to 21.8% in Kenya (from 60.0% to 81.8%). This increase would be higher in people aged <35 years compared to ≥ 35 years (table). Test and treat strategy would involve a further increase of 12% in Malawi, 20% in South Africa and 18% in Kenya. ART eligibility rates by age group according to current (at the time of the survey) andWHO 2013 guidelines in 3 African countries Conclusions: Our studies suggest that the implementation of the 2013 WHO guidelines on adults would not represent a major difference in the proportion of ART eligible individuals particularly in some contexts such as the sites of South Africa and Malawi where option B has already been implemented. The application of the new guidelines could be less costly than initially thought using models and it would make a step forward towards the control of the HIV epidemic in the region. 1080 Impact of South Africa’s HIV Treatment Guidelines on Early Losses: A Cohort Analysis Ingrid T. Katz 1 ; Richard Kaplan 2 ; Garrett Fitzmaurice 4 ; Dominick Leone 3 ; David R. Bangsberg 1 ; Linda-Gail Bekker 2 ; Catherine Orrell 2 1 Harvard Medical School, Cambridge, MA, US; 2 Desmond Tutu HIV Foundation, Cape Town, South Africa; 3 Boston University School of Medicine, Boston, MA, US; 4 Harvard School of Public Health, Boston, MA, US Background: South Africa (SA) has the world’s largest antiretroviral treatment (ART) program. Prior to 2011, the immunological threshold for ART eligibility in adults was a CD4 count ≤ 200 cells/ m l. In September, 2011 the CD4 threshold was increased to ≤ 350 cells/ m L, and starting in 2015 it will again be increased to ≤ 500 cells/uL. While access to ART has expanded, it is unknown if these changes have influenced patients’ willingness to engage in care. We hypothesized that increasing the CD4 threshold to access ART would increase early discontinuation of treatment due to greater risk for loss among those with a higher CD4. Methods: We performed a retrospective cohort analysis of treatment-naive, non-pregnant, individuals who tested positive for HIV and were referred to the Hannan Crusaid Treatment Centre in Cape Town, SA over a five-year period, inclusive of the period when CD4 guidelines were changed. Data were abstracted from electronic records and paper charts, including baseline CD4 at referral, World Health Organization (WHO) stage, decision-making regarding ART initiation, and early discontinuation of treatment (< 16 weeks on ART, confirmed through patient tracking involving up to 3 home visits). Results: 4025 HIV-infected individuals who underwent CD4 testing between Jan 2, 2009 - Dec 31, 2013 were included. Overall, 90.4% initiated ART, of whom 1.6% died upon initiating ART, and 17.7% had early discontinuation of treatment. Patients in the later sub-cohort were significantly more likely to discontinue care <16 weeks into treatment (19.8% vs. 15.8%, p=.002, see Table 1 ). After controlling for baseline CD4, WHO stage, and age this effect remained significant (Adjusted OR [AOR]= 1.30, 95%CI: 1.09 – 1.55). When the analysis was restricted to include only those individuals in the later cohort who met earlier CD4 threshold (CD4<200 cells/ m L), the effect remained (AOR=1.34, 95% CI: 1.06-1.67).

Poster Abstracts

630

CROI 2015