CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Results: The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% for non-drug costs). For individuals who remain uninfected, but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding one HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided.

Figure 1: Cumulative discounted lifetime costs from time of infection at age 35 (2012 US dollars) Conclusions: The potential medical cost savings from HIV prevention in the US are substantial given the high cost of HIV disease treatment. 1105 Online Partner Notification: A Cost-Effective Tool to Reduce HIV-1 Epidemic Among MSM Brooke E. Nichols 1 ; Hannelore M. Götz 2 ; Eric C. van Gorp 1 ; AnneliesVerbon 3 ; Casper Rokx 3 ; Charles Boucher 1 ; David A. van deVijver 1 1 Erasmus University Medical Center, Rotterdam, Netherlands; 2 Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands; 3 Erasmus Medical Center, Rotterdam, Netherlands Background: Earlier antiretroviral treatment initiation prevents new HIV infections. Unfortunately, a key problem in HIV prevention and care is the high number of patients diagnosed late as these undiagnosed patients can continue forward HIV-1 transmission. Partner notification is a tool that can identify HIV infected patients earlier. These patients can then start treatment sooner which can then reduce the number of infections to others. The aim of this study is to use mathematical modeling to determine the preventative impact and cost-effectiveness of partner notification on new HIV-1 infections. For this purpose, we used data from the Rotterdam-Rijnmond Public Health Service (the Netherlands) which has implemented an online partner notification system that has successfully identified persons at risk of infection by using an anonymous notification system via the contacts of recently diagnosed patients. Methods: A model was validated and accurately reconstructed the Dutch HIV epidemic among MSM from 2008 through 2012. Late diagnoses are common among MSM in the Netherlands: 37% had CD4 <350 cells/ m l including 20%with CD4 <200 cells/ m l. The online partner notification system resulted in nine new HIV diagnoses among 366 MSM notified for any STI and tested for HIV in 2013. This represented 3% of all new diagnoses in the region. Costs and quality adjusted life years (QALYs) were assigned to each disease state and calculated over a 5, 10 and 20 year period. Cost-effectiveness ratios were obtained for the use of partner notification to identify 3% of all new diagnoses versus no partner notification. Results: Partner notification is predicted to avert a total of 14 infections (interquartile range [IQR] 10-18) over the course of 5 years countrywide to 148 (IQR 98-205) over 20 years. Partner notification was considered borderline cost-effective in the short term, with increasing cost-effectivity over time: € 54,035 (IQR € 52,578- € 54,655), € 21,307 ( € 20,411- € 21,984) and € 8,619 ( € 7,864- € 9,541) per QALY gained over a 5, 10, and 20 year period, respectively. The full monetary benefits of partner notification by preventing new HIV infections become more apparent over time. Conclusions: The partner notification tool is a cost-effective tool for HIV prevention in MSM in the long run, with little additional effort required from healthcare professionals. There is also an additional clinical benefit of both early identification of HIV and identification and treatment of other STIs. 1106 Cost-Effectiveness of Preexposure Prophylaxis for High-Risk HIV-Discordant Couples Roger Ying 1 ; Renee Heffron 1 ; Jared Baeten 1 ; Connie Celum 1 ; Elly Katabira 2 ; Nulu Bulya 2 ; RuanneV. Barnabas 1 1 University of Washington, Bellevue, WA, US; 2 Makerere University College of Health Sciences, Kampala, Uganda Background: Antiretroviral-based HIV prevention strategies, including antiretroviral treatment (ART) for HIV-positive persons and pre-exposure prophylaxis (PrEP) for HIV- negative persons, have the potential to reduce HIV transmission, but questions remain regarding the cost of implementation. Methods: We estimated the incremental costs of screening and providing high-risk HIV discordant couples with ART for the HIV-positive partner and six months of PrEP for the HIV-negative partner, based on the design of an ongoing PrEP and ART demonstration project in Kampala, Uganda. Micro-costing and time and motion studies were conducted in February 2014. The cost analysis was conducted from the programmatic perspective over a 10-year time horizon and includes all incremental clinical costs incurred and averted. We used a mathematical model parameterized for HIV transmission in Uganda to compare the incremental cost-effectiveness ratio (ICER) of the high-risk discordant couples ART and PrEP program to increasing ART coverage to 70% of HIV-positive persons with CD4 ≤ 500 cells/ m L. In the model, high-risk discordant couples were defined as couples with projected annual HIV incidence of >6%. Results: Based on enrollment and retention rates in the demonstration project, 73% of screened couples would be enrolled and 97% of couples would be retained in care at one year. Using current Ministry of Health costs, the annual incremental cost per couple is $454, with the majority of costs attributable to laboratory monitoring (54%). With public- sector salaries and annual PrEP drug costs reduced to $75 per person, the annual incremental cost per couple is $322. Use of point-of-care viral load tests and task shifting with brief directed counseling further reduces the annual incremental cost per couple to $92, with laboratory monitoring decreasing to 37% of the cost. The ICER of PrEP and ART for high-risk discordant couples was $1,001 per HIV infection averted at 10 years. Scaling up ART for persons with CD4 ≤ 500 cells/ m L without PrEP was less cost-effective. However, an ART program for persons with CD4 ≤ 500 cells/ m L is more cost-effective for increasing quality-adjusted life-years (QALYs) at $245 per QALY gained versus $1,146 per QALY gained in the PrEP program.

Poster Abstracts

642

CROI 2015