CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

792 Continuity of Care Among Pregnant Women Lost to Follow-up After Initiating ART Kate Clouse 1 ; Sten H.Vermund 1 ; Mhairi Maskew 2 ; Given Malete 2 ; Matthew P. Fox 3 1 Vanderbilt Inst for Global Hlth, Nashville, TN, USA; 2 Univ of the Witwatersrand, Wits Hlth Consortium, Johannesburg, South Africa; 3 Boston Univ, Boston, MA, USA Background: African countries are implementing Option B+, but high loss to follow-up (LTF) among pregnant women on antiretroviral therapy (ART) threatens program success and mother/infant lives. Due to the lack of linked data, LTF estimates do not account for unreported transfers. We hypothesize that “clinic shopping” and rural-urban travel after delivery may inflate LTF estimates. To test this, we traced lost patients using a national lab database in South Africa to assess continuity of care and update LTF estimates. Methods: We included all HIV+ women initiating ART during pregnancy at seven clinics in Gauteng Province from 1 Jan 2012 to 31 July 2013 and considered LTF (no visit >3 mo; n=312). Using name and date of birth, we manually searched the National Health Laboratory Service database. Records were categorized as from the initiation site or a new facility. Continued HIV care was defined as accessing care after ART initiation at a new facility shown by ≥1 CD4 or viral load test on record, or any record from a new ART clinic. “Clinic shoppers” were defined as seeking care at a new ART facility within Gauteng. Results: At ART initiation, median age was 29 years (IQR:25-33) and CD4+ cell value was 268 cells/µL (200-340). Median time between initiation and last clinic visit was 112 days (29-268). Records were missing—including from the initiation site—for 115 (36.9%) women. Of the 197 located, 97 (49.2%) continued HIV care at a new facility. Most (71.1%) were clinic shoppers; 28.9% sought care in other provinces. Overall median time out of care was 406 days (238-734). Compared to women accessing care in other provinces, clinic shoppers stayed out of care longer (median 530 days, IQR:332-808 vs. 269, IQR:72-409, p<0.01) and median CD4 upon care reentry trended lower (317 cells/µL, IQR:159-610 vs. 499, IQR:213-571). Considering all 97 women as engaged in care, cohort LTF drops from 38.1% to 26.3%. Conclusions: We found substantial continued care among women considered LTF after initiating ART during pregnancy, both within the same city and in other provinces. This highlights the difficulty of producing accurate estimates of retention in care and underscores the need for a unique identifier and a national, linked health database. We also found that women are suspending care for extended periods of time with consequent immunosuppression. More must be learned as to how women choose HIV facilities, access care, and travel around the time of delivery; continuum of care estimates may be overly pessimistic. 793 Disclosure and Knowledge Are AssociatedWith Retention in Malawi’s Option B+ Program Risa M. Hoffman 1 ; Khumbo Phiri 2 ; Julie Parent 2 ; Jonathan F. Grotts 1 ; SaraYeatman 3 ; Paul Kawale 2 ; David Elashoff 1 ; Judith S. Currier 4 ; Alan Schooley 2 1 Univ of California Los Angeles, Los Angeles, CA, USA; 2 Partners in Hope Med Cntr, Lilongwe, Malawi; 3 Univ of Colorado, Denver, CO, USA; 4 David Geffen Sch of Med at Univ of California Los Angeles, Los Angeles, CA, USA

Background: There are limited data on factors associated with retention in Option B+. We sought to explore characteristics of women retained in Option B+ in Central Malawi, with a focus on the role of HIV disclosure, pre-ART education, and knowledge around the importance of Option B+ for maternal and child health. Methods: We performed a case-control study of HIV-infected women in Malawi initiated on ART under Option B+. Cases were enrolled if they met criteria for default from Option B+ (out of ART for >60 days) and controls were enrolled in ~3:1 ratio if they were retained for at least 12 months. We surveyed sociodemographic characteristics, HIV disclosure (participant to partner and participant aware of partner status), self-report about receiving pre-ART education, and Option B+ knowledge using six questions. Univariate logistic regression was performed to determine factors associated with retention. A multiple logistic regression model was used to evaluate HIV disclosure and Option B+ knowledge while adjusting for age, schooling, and travel time to clinic. Results: We enrolled 50 cases and 153 controls. Median age was 30 years (IQR 25-34) and the majority (82%) initiated ART during pregnancy at a median gestational age of 24 weeks (IQR, 16-28). 91% of the cases (39/43) who started ART during pregnancy defaulted by 3 months postpartum. HIV disclosure to the primary sex partner was more common among women retained in care (100% versus 78%, p<0.001). Odds of retention were significantly higher among women with: age > 25 years (OR 2.44), completion of primary school (OR 3.06), awareness of partner HIV status (OR 5.20), pre-ART education (OR 6.17), higher number of correct answers to Option B+ knowledge questions (OR 1.82), and one or more methods of support while taking ART (OR 3.65) (Table). Pre-ART education and knowledge were significantly correlated (r = 0.43, p<0.001). Travel time of > 3 hours to clinic and later gestational age at ART initiation were associated with significantly reduced odds of retention (OR 0.13 and 0.95, respectively). In multivariate analysis, awareness of partner HIV status (OR 4.07, 95%CI 1.51, 10.94, p=0.02) and Option B+ knowledge (OR 1.60, 95%CI 1.15, 2.23, p=0.004) remained associated with retention. Conclusions: Interventions that address partner disclosure and strengthen pre-ART education around the benefits of ART for maternal and child health should be evaluated as strategies to improve retention in Malawi’s Option B+ program.

Poster Abstracts

794

Initiating cART in Pregnancy: Impact on HIV RNA Decay Jasmini Alagaratnam 1 ; Sarah Chitty 2 ; Annemiek DeRuiter 3 ; Fionnuala Finnerty 4 ; Rebecca Marcus 5 ; AchyutaV. Nori 3 ; Liat Sarner 5 ; Rimi Shah 6 ; GrahamTaylor 1 ; for the London HIV Perinatal Research Group (LHPRG) 1 St Mary’s Hosp, Imperial Coll NHS Trust, London, UK; 2 Chelsea and Westminster Hosp NHS Fndn Trust, London, UK; 3 Guys and St Thomas’ NHS Fndn Trust, London, UK; 4 Brighton and Sussex Hosps NHS Trust, Brighton, UK; 5 Royal London Hosp, London, UK; 6 Royal Free Hosp, London, UK Background: cART reduces HIV mother-to-child transmission, allowing vaginal delivery if viral load is low. cART is evolving and the optimal regimen for initiating treatment in pregnancy uncertain. Methods: Routine clinical care data from nine London and Brighton sites, 2001 to 2015, were anonymised and collated. Demographics, baseline and subsequent HIV plasma loads, delivery information and ART were collected retrospectively. Essentially women started cART during this pregnancy and had HIV load re-measured after 14 days (+/-3 days). Elite

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CROI 2016