CROI 2016 Abstract eBook

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Poster Abstracts

Methods: In a cohort study of HIV-infected adolescents (age 10-19 years) on ARVs in Botswana, we utilized a 2-question medication-specific reactance tool to assess a) whether having someone tell them to take their ARVs makes adolescents want to avoid taking them and b) whether the adolescents get angry when reminded to take their ARVs. Both questions were scored on a 5-point Likert scale from “definitely false” (1 point) to “definitely true” (5 points). Virologic failure was defined by an HIV viral load >400 copies/mL in the 24 months prior to reactance measurement. Adolescents were classified as “reactant” if their score on the medication-specific reactance tool was >4. Reactance scores were compared between adolescents with and without virologic failure using logistic regression. Results: 289 adolescents were evaluated. 106 (36.7%) had virologic failure during the follow-up period and 89 (30.8%) were classified as reactant. Reactant adolescents had a 2.5-fold (95% CI 1.5-4.2) greater odds of failure than non-reactant adolescents (p<0.001). The risk of failure was 21% greater (95% CI 9%-35%) for each single point elevation in reactance score (p<0.001) (see Figure). Conclusions: Psychological reactance is a novel risk factor for treatment failure among HIV-infected adolescents. Reactance may be a useful interventional target for improving adolescent ARV adherence.

834 Economic Evaluation of a Novel Adherence Strategy in Perinatally HIV-Infected Youth Naomi Lin 1 ; Jolene Skordis-Worrall 1 ; Sarah J. Fidler 2 ; Caroline Foster 3 1 Univ Coll London, London, UK; 2 Imperial Coll London, London, UK; 3 Imperial Coll Hlthcare NHS Trust, London, UK

Background: Perinatally HIV-infected youth (PHY) frequently require support to achieve optimum virological control. We identified ART non-adherent patients at risk of AIDS- defining illness in a UK cohort of PHY; explored the cost to the National Health Service of non-adherence in this group and subsequently the potential effect on healthcare costs of providing a financial incentive (FI) and motivational interviewing (MI) based adherence-enhancing intervention to these patients. Methods: 122 patients in receipt of suppressive ART regimens were selected from a service for 141 PHY aged 17-31 years (2006-2015). Patients annually at risk of AIDS-defining illness were defined as having 2 CD4 counts < 350 cells/ml 3 with detectable HIV viral load > 3 months apart during 1 year. Patients annually at risk for > 1 year of their clinic record were designated ‘at risk’ overall. HIV-related hospitalisations were retrospectively identified, costed from the healthcare provider perspective and compared in ‘at risk’ and ‘not at risk’ patients (2010-2015). The published effect of an FI/MI intervention was subsequently applied over a 24-month model to all ‘at risk’. Patients newly adherent post-intervention accrued the annual health benefits and healthcare costs of their ‘not at risk’ peers. Total sample pre/post intervention costs were compared, including: standard outpatient care; HIV-related hospitalisation and intervention provision to ‘at risk’ patients. Results: 60/122 (49%) patients were designated ‘at risk’ overall. Median age was significantly higher in these patients (D = -0.3, p = 0.003). However, crude rates of social stress, comorbidity, AIDS experience, ART toxicity experience and neurocognitive deficit did not differ significantly between ‘at risk’ and ‘not at risk’ groups (X 2 (1)=1.9, n = 122, p = 0.2; X 2 (1)=0.03, n = 122, p = 0.9; X 2 (1)=0.1, n = 122, p = 0.7; X 2 (1)=0.2, n = 122, p = 0.7; X 2 (1)=0.005, n = 122, p = 0.9). The 5-year rate of hospitalisation was significantly higher in ‘at risk’ than ‘not at risk’ patients (X 2 (1)=17.6, n=95, p = 0.00003). Median hospitalisation costs accrued per person-year contributed to the analysis were 113-fold greater in ‘at risk’ patients. Expansion of the FI/MI intervention to all ‘at risk’ was cost saving over 24 months, producing a pre/post-intervention total sample healthcare cost ratio of 1:0.98. Conclusions: This novel strategy to enhance ART adherence amongst a vulnerable group of PHY not only conveys enhanced clinical outcomes but could be cost saving.

Poster Abstracts

349

CROI 2016