CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

547 COST-EFFECTIVENESS OF HCV SCREENING AND LINKAGE IN MMT: RELEVANCE OF HIV COINFECTION Bruce R. Schackman 1 , Jared A. Leff 1 , Jake R. Morgan 2 , Sarah Gutkind 1 , Czarina N. Behrends 1 , Kevin L. Delucchi 3 , Courtney McKnight 4 , David C. Perlman 4 , Carmen L. Masson 3 , Benjamin Linas 5 1 Weill Cornell Med Coll, New York, NY, USA, 2 Boston Med Cntr, Boston, MA, USA, 3 Univ of California San Francisco, San Francisco, CA, USA, 4 Icahn Sch of Med at Mt Sinai, New York, NY, USA, 5 Boston Univ, Boston, MA, USA Background: We evaluated the cost-effectiveness of an HCV screening and linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco. Methods: We used a decision analytic model to compare the cost-effectiveness of 4 strategies: 1) no intervention; 2) HCV screening and education (control); 3) HCV screening and education for all and care coordination for all HCV-infected 4) HCV screening and education for all with care coordination only for HCV mono-infected patients (to explore trial results indicating that HIV co-infected participants linked through other systems of care). Trial data include population characteristics (67%male, mean age 48, 50% HCV mono- infected, 8% HCV/HIV co-infected) and linkage rates for HCV mono-infected (34% control, 68% intervention) and HCV/HIV co-infected (79% control, 87% intervention) individuals. Data from published sources include treatment efficacy and HCV re-infection risk. Clinical outcomes include proportions with chronic HCV linked and achieving SVR. We projected quality-adjusted life expectancy (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually. Results: The control strategy resulted in a projected 34% linking to care within 6 months and 30% achieving SVR (Figure). The cost was $156/person screened. HCV care coordination for HCV mono-infected patients resulted in 57% linkage and 51% achieving SVR at a cost of $470/person screened. Care coordination for all increased projected linkage to 58% and SVR to 52% at a cost of $514/person screened. The care coordination for all strategy was more efficient than (dominated) the care coordination for HCV-mono infected patients only strategy and the control strategy, and had an ICER of $21,600/QALY compared to no intervention. In sensitivity analyses varying the risk of re-infection, results were not highly sensitive to increasing the risk of reinfection (resulting in triple the number of reinfections) as long as re-infected patients were eligible for retreatment (resulting in an additional 8 treatments per 1000 patients treated). Conclusion: HCV care coordination interventions that include screening, education and linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients. 548 PROVIDING HCV CURES IN THE MEDICAL HOME: TRAINING A NEW GENERATION OF PROVIDERS Sarah Rojas , Christian B. Ramers, Stephanie Constantino Family Hlth Cntrs of San Diego, San DIego, CA, USA Background: With the development of non-invasive methods to assess liver fibrosis and HCV Direct Acting Antivirals (DAA’s), a major shift is underway in the HCV treatment paradigm. Community Clinics and FQHC’s, with their patient-centered medical home (PCMH) model, may be ideal venues for HCV testing, evaluation and treatment, as well as wrap-around primary care services for HCV-infected patients. Much attention has been given to training primary care providers to provide HCV care, but little research has shown effective strategies for doing so. Methods: Beginning in 2013, we developed an HCV treatment programwithin an urban FQHC in San Diego. Rapid point-of-care testing in clinics and alcohol/drug treatment programs identified HCV-infected individuals, and test counselors linked them to care. A patient navigator encouraged retention in care and guided patients through complex barriers to access, such as health insurance enrollment and prior authorizations. Fibrosis assessment occurred via non-invasive means. Patients were treated according to published guidelines and clinical outcome data was collected prospectively. Effective HCV screening led to a system bottleneck for assessment and treatment. The necesity for more providers prompted initiation of training programs, created with NIH support. Specifically, we 1) added Hepatitis C assessment, i.e. treatment readiness and preparedness to our HIV/HCV Training track for residents and PCPs, either primary medical Doctors (PMDs) or Nurse Practitioners (NPs) and 2) created a 6-month HCV Training track for PCP providers. Results: Between 1/1/13 and 8/1/16, 466 patients underwent HCV evaluation; 250 then completed HCV treatment, 58 pts are currently on treatment, 57 are approved; 69 are awaiting insurance approval. In 2013-4, a single ID MD treated 42 pts. Given great need, our ID MD trained one NP the end of 2014; and 2 more NPs & 2 PMDs by the end of 2015. In 2015, 147 patients were treated:106 by ID, 12 by NP. In 2016, 107 patients were treated: 91 by ID, 16 by NP; none had yet been treated by PMDs. 37% (N=113) had stage F3 or F4 fibrosis. 31 (10%) were HIV/HCV co-infected. Of those treated, 208 were >12 weeks post therapy; 144 had labs 12 weeks post-treatment (SVR12) to assess cure rates: 72.5% (per ITT analysis) and 96.7% (per protocol analysis). Of the 7 treatment failures, all had cirrhosis and were managed by ID MD. Conclusion: Focused training of PCPs can extend HCV treatment access without sacrificing cure rates. 549 HCV RNA DETECTION IN SMALL VOLUME CAPILLARY BLOOD FOR POINT-OF-CARE APPLICATIONS Mark Hopkins 1 , Rachael Dagnall 2 , Athanassios Papadimitropoulos 2 , Paula Davies 1 , Jillian William 1 , Eimear Railton 1 , Sarah Sarah Hau 1 , Apostolos Beloukas 2 , Anna Maria Geretti 2 1 Royal Liverpool Univ Hosp, Liverpool, UK, 2 Univ of Liverpool, Liverpool, UK Background: The rapid diagnosis of HCV infection is hampered by slow antibody responses and lack of reliable point-of-care tests (POCT). In addition, patients often report preferring blood collection by finger-prick rather than by venous puncture. The Cepheid GeneXpert platform provides a closed system for nucleic acid amplification and detection that makes it suitable for use outside of specialized laboratory settings including POCT; however, there are no published data on the use of small volume capillary blood for HCV RNA detection. This study assessed the performance of the GeneXpert HCV RNA assay in paired blood samples collected by venous puncture and by finger-prick in subjects with known HCV and HIV status.

Poster and Themed Discussion Abstracts

CROI 2017 230