CROI 2016 Abstract eBook

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Poster Abstracts

534 Project INSPIRE: A Comprehensive Care Coordination Program for HCV Infection Fabienne Laraque 1 ; Marie P. Bresnahan 2 ; Mary Ford 3 ; Payal Desai 2 ; Eric Rude 4 ; Shuchin Shukla 5 ; JeffreyWeiss 6 ; Ponni Perumalswami 6 ; Alain Litwin 5 ; for the Project INSPIRE ImplementationTeam 1 New York City DHMH, Queens, NY, USA; 2 New York City DHMH, Long Island City, NY, USA; 3 New York City DHMH, New York City, NY, USA; 4 New York City DHMH, Queens, NY, USA; 5 Montefiore Med Cntr, Bronx, NY, USA; 6 Mount Sinai Hosp, New York, NY, USA Background: New York City (NYC) has an estimated 146,500 Hepatitis C (HCV)-infected residents and <10% have been treated.HCV infection is a complex disease coexisting in patients with co-morbid conditions such as substance abuse, HIV, and mental illness, making treatment in a supported setting critical. Project INSPIRE, a Round II Innovation Award from the Centers for Medicaid and Medicare Services, was designed by the NYC Health Department to offer comprehensive care coordination and to develop a payment model for currently unpaid care coordination services. Methods: The goals of Project INSPIRE are to improve HCV cure rates and patient self-sufficiency through evidence-supported care coordination services. Program components include a comprehensive assessment and care plan, clinic-based care coordination services, health promotion, and medication adherence support. INSPIRE medical providers participate in case conferences with care coordinators and are trained via weekly tele-mentoring sessions on HCV care. INSPIRE aims to enroll 3,200 patients, initiate treatment for 75%, and achieve a cure for 50% of cirrhotic and 90% of non-cirrhotic patients. Program data will be used to support rigorous evaluation activities and develop a payment model, in collaboration with two managed care organizations. Results: Between January – August, 2015, 919 HCV-positive patients were enrolled. The majority of participants are male, (n=570, 62%) Hispanic (n=408, 44%) or Black (n=319, 35%). The median age was 56, and 693 (75%) were born between 1945-1965. In the first year, 664 enrollees (72%) completed HCV medical evaluation, and 655 (71%) received a comprehensive assessment. Of those assessed, 426(65%) have past or present IV drug use, 222 (34%) are co-infected with HIV, and 35 (5%) have serious mental illness. Of 580 eligible treatment candidates, 311 (54%) initiated HCV treatment. To-date, 31 INSPIRE treatment candidates have achieved SVR-12 and the rest are still undergoing treatment. Project INSPIRE experts conducted 54 tele-mentoring sessions with 123 attendees. Conclusions: Project INSPIRE is successfully enrolling high need patients and starting many on treatment with the expectation that the vast majority will be cured. Over the next two years, DOHMH will work with project partners to develop cost estimates and a payment model that, if adopted by CMS, will be instrumental in making these services available and sustainable nationwide. 535 HCV Treatment As PreventionWill Require Massive Scale-up to See Prevention Benefits Luis Mier-y-Teran-Romero 1 ; Derek A. Cummings 2 ; David L.Thomas 3 ; Carl Latkin 1 ; John B.Wong 4 ; Gregory D. Kirk 1 ; Shruti H. Mehta 1 1 Johns Hopkins Univ, Baltimore, MD, USA; 2 Univ of Florida, Gainesville, FL, USA; 3 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 4 Tufts Univ, Boston, MA, USA Background: Modeling has suggested HCV prevalence reductions of >50%with widespread treatment in people who inject drugs [PWID]). However, there has been inadequate consideration of 1) howmuch transmission can be targeted by treatment given realistic delays and empirical data on age specific hazards; and 2) population-level mixing characterizing counterfactual transmission if those treated remain untreated and continue to infect. We explore the impact of treatment strategies on HCV incidence using data frommulti-decade studies of HCV transmission among PWID in Baltimore, Maryland. Methods: We developed an age-specific compartmental model of HCV transmission in a community of current and former PWID parameterized using empirical data from studies in Baltimore to obtain age-specific 1) HCV prevalence from 1988-2008; 2) rates of injection initiation, cessation and relapse; and 3) mortality. We varied contact matrices from random to fully age-specific. We compared strategies from conservative: 1) treating only abstinent PWID ~ 15 years after infection to aggressive: 2) treating all PWID regardless of injection 1-5 years after infection with and without harm reduction scale-up. We estimated reductions in incidence/prevalence over 20 years. Results: Our model supports that widespread HCV treatment can have significant positive impact – reduction in prevalence of 40%with 20,000 treatment courses over 20 years. At this level, HCV prevalence decrease varied little by who was treated (active, abstinent vs. all) or when they received it (1-15 years after infection, Figure). Further, at coverage <88% of the PWID population, almost all prevalence reduction was due to direct effects of curing people. Indirect effects were negligible because the hazard of HCV infection is so high that significant treatment is needed to reduce it. In order to impact transmission (indirect effects), treatment needs to be scaled to >90% of the population (>40,000 doses) targeted 1-3 years after infection with simultaneous harm reduction scale up. Even at these levels, only 0.8 incident cases are averted per treatment. Conclusions: To truly impact HCV transmission in PWID, treatment programs need to be aggressive in treating large numbers of PWID almost immediately after HCV acquisition and comprehensive by integrating harm reduction. Given the vast amount of treatment need to impact transmission, programs should prioritize clinical considerations and the relative impact of harm reduction.

Poster Abstracts

209

CROI 2016