CROI 2016 Abstract eBook

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Oral Abstracts

Rates were much higher (202–5234 events/1,000 PYFU) in the first year of ART than later on (35-475/1,000 PYFU). Discontinuation rates improved over calendar periods and the implementation of new ART guidelines, particularly during the first year of ART. Rates were highest for adolescents (15-24 years of age) and children (0-3 years). Although the peak in adolescence was evident in all calendar periods, it decreased over time. Rates were similar for female and male patients across all age groups. After excluding women on Option B+, the peak in female adolescents discontinuing treatment in the first year of ART almost disappeared (data not shown). Conclusions: Discontinuation rates have improved dramatically over time but remain high in children and adolescents, particularly during the first year of ART. Future interventions should focus on retention of children and women on Option B+ in the first year of ART.

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Option B+: A Stepping Stone to Universal Treatment Andreas Jahn , Ministry of Hlth, Lilongwe, Malawi

Malawi has an estimated 1.1 million HIV infected population. Extreme financial and health system constraints have catalysed the development of highly standardized and simplified national guidelines and monitoring tools for HIV management. The program has relied on nurses for clinical staging and ART initiation since 2005. Quarterly supervision for all PMTCT/ART sites has been key for safe implementation of task shifting and decentralization to peripheral health centres. In 2010, improved program data systems revealed low PMTCT coverage, attributed to unreliable CD4 count access, complex protocols and erratic supply of test kits and PMTCT ARVs. Option B+ was developed to address these challenges in the face of high pediatric HIV burden, short birth intervals and long breastfeeding. Implementation began in July 2011. Over 5000 health worker were retrained and the number of PMTCT/ART sites doubled to 595 within 9 months. The test & start policy for all HIV infected pregnant and breastfeeding women has led to a 47% increase in new ART initiations each quarter. By the end of 2015, 85,000 pregnant and 30,000 breastfeeding women had begun ART. ART population coverage among women increased rapidly, and half of all HIV infected women getting pregnant were already on ART. Option B+ uptake and retention varies greatly between sites. Routine program data probably misclassify a considerable proportion of transferring patients as lost to follow-up. Operational studies fromMalawi suggest that good public education and individual patient preparation/support are key for high uptake and retention among asymptomatic patients who may not see immediate health benefits from ART. ART start on the day of diagnosis has been successfully implemented under these conditions. Malawi has refocused its HIV testing program and added several quality assurance mechanisms to reduce the risk of starting lifelong ART based on an inaccurate HIV rapid test result. The routine system for quantification, ordering and distribution of essential medicines remains too weak and unresponsive to ensure uninterrupted supplies and to account for high value drugs such as ARVs. Malawi has built a highly efficient central supply management system for HIV commodities based on site level stock and service data verified during supervision. Based on lessons learnt, Malawi will start a universal test & start policy for all PLHIV in 2016 and treatment coverage will approach the 90-90-90 target by 2020. 120 Missing But in Action: Where Are the Men? Helen Ayles , London Sch of Hygiene & Trop Med, London, UK In Sub-Saharan Africa men are under-represented at all stages in the cascade of HIV care. Men have a lower uptake of HIV testing, access care at later stages than women and have higher mortality than women. To realise the global targets of 90:90:90 we need to do much more to find men. In addition unless we reach near universal access we cannot hope to have any impact on reducing HIV incidence and ultimately stopping the HIV epidemic. From published and unpublished literature the gaps where men are failing to attain the 90:90:90 targets will be described and possible reasons for this will be discussed. In particular data will be presented from the HPTN 071 trial of combination prevention and universal test and treat where population level estimates of coverage in men is available in 21 communities in Zambia and South Africa. Various initiatives have been tested to improve the involvement of men at each stage of the treatment and prevention cascades. Some of these will be reviewed and the evidence of effect analysed. In order to reach universal coverage of HIV interventions, in generalised epidemics such as in sub-Sharan Africa, much more attention must be paid to men and their specific needs. If we fail to understand the barriers to accessing HIV care for men we will fail in our goal of ending the HIV epidemic. 121 Antiretroviral Therapy for Life: Understanding and Improving Retention Elvin H. Geng , Univ of California San Francisco, San Francisco, CA, USA Retention in HIV care can be thought of as the dynamic fit between the demand for treatment, as determined by a patient’s psychological, social, and economic characteristics, on the one hand and the accessibility, quality, and efficiency of health systems suppling HIV services on the other. Although recognition of the critical role of retention has led to rapid growth of research in this area, further insights depend on addressing both practical and conceptual barriers. First, while numerous studies have shown high rates of missed visits and loss to follow-up, greater clarity about retention requires both better data and different data. Documenting outcomes among patients ostensibly “lost” in

Oral Abstracts

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CROI 2016