CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

638 COMPOSITE “HIV/ HYPERTENSION/ DIABETES CONTROL” OUTCOME IN SEARCH CHRONIC CARE MODEL Dalsone Kwariisima 1 , Jeanna Wallenta 2 , James Ayieko 3 , Florence Mwangwa 4 , Asiphas Owaraganise 4 , Tamara D. Clark 2 , Edwin D. Charlebois 2 , Maya L. Petersen 5 , Diane V. Havlir 2 , Moses R. Kamya 6 1 Makerere Univ Joint AIDS Prog, Kampala, Uganda, 2 Univ of California San Francisco, San Francisco, CA, USA, 3 Kenya Med Rsr Inst, Nairobi, Kenya, 4 Infectious Diseases Rsr Collab, Kampala, Uganda, 5 Univ of California Berkeley, Berkeley, CA, USA, 6 Makerere Univ Coll of Hlth Scis, Kampala, Uganda Background: With the aging HIV population, health outcomes for HIV-infected adults need to be evaluated in a broader outcomes model that incorporates non-communicable diseases (NCD) such as hypertension (HTN) and diabetes (DM). We assessed prevalence and predictors of composite HIV, HTN and DM control in a multi-disease chronic care management delivery system used in the ongoing SEARCH HIV test and treat study (NCT01864603) Methods: Population-based screening for HIV, HTN and DM was conducted in 10 rural Ugandan communities on 39,569 adults (≥15 years) attending multi-disease community health fairs. We examined outcomes in HIV+ adults with DM, HTN or both receiving care through an integrated HIV streamlined care model that included nurse triage, 3 month visits and patient centered care at a local government sponsored clinic. Disease “control” definitions were 1) HIV: RNA<500 copies/ml; 2) HTN: systolic< 40 mm Hg and diastolic<90 mm Hg; and, 3) DM: blood sugar < 12 mmol/L). We evaluated multivariate predictors of control over 3 years (missing=fail), adjusting for occupation, age, sex, baseline viral suppression, and mobility using logistic regression with robust standard errors. Results: Of 193 HIV infected adults with a NCD, the majority were co–diagnosed with HTN only (178/193(92%)), 13(7%) had DM only and 2 (1%) had both HTN and DM. The median age of those with HIV and any NCD was 44 years (IQR: 38, 51) overall, 45 (IQR: 38, 52) among the 73 males and 44 (IQR: 37.5, 51) among the 120 females. After up to 3 years of follow up, 174/193 (90%) of persons had ever achieved HIV RNA suppression. However the composite endpoint of both HIV and HTN control was achieved in only 67% (114/178). In those adults with DM, 12/13 had blood sugar controlled and 69% (9/13) achieved both HIV and DM control. Among the 2 patients with both HTN and DM, all 3 diseases were controlled. Among adults with HIV and HTN, only mobility (defined as >1 month living outside of community in the past 12 months) was associated with a lower risk for composite control (OR: 0.35; 95% CI: 0.13, 0.98; p-value=0.046) Conclusion: Using a composite endpoint, 69% (133/193) of adults had controlled HIV and NCD after 2 years, lagging behind HIV control only (90%) in this population receiving an integrated chronic care model. Composite endpoint should be used to assess progress in the future in integrated HIV/NCD care. 639 THE ART ADVANTAGE: HEALTHCARE UTILIZATION FOR DIABETES & HYPERTENSION IN SOUTH AFRICA Jennifer Manne-Goehler 1 , Livia Montana 2 , Xavier Gomez-Olive 3 , Guy Harling 4 , Ryan Wagner 5 , Alisha Wade 6 , Julia K. Rohr 2 , Stephen Tollman 7 , Till Baernighausen 8 , Thomas Gaziano 9 1 Beth Israel Deaconess Med Cntr, Boston, MA, USA, 2 Harvard Univ, Cambridge, MA, USA, 3 Tintswalo Hosp, Acornhoek, South Africa, 4 Harvard Univ, Boston, MA, USA, 5 Univ of the Witwatersrand, Acornhoek, South Africa, 6 MRC/Wits Rural Pub Hlth and Hlth Transitions Rsr Unit, Johannesburg, South Africa, 7 Univ of Witwatersrand, Johannesburg, South Africa, 8 Heidelberg Univ, Heidelberg, Germany, 9 Brigham and Women’s Hosp, Boston, MA, USA Background: There is a growing recognition that HIV-infected populations also face an increasing burden of diabetes and hypertension but limited understanding of the role that ART programs play in the delivery of services for these comorbid conditions. The aim of this study is to assess the relationship between ART and utilization of healthcare services for diabetes and hypertension. Methods: The Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities (HAALSI) Study is a cohort of 5,059 adults aged 40+ in Agincourt, rural South Africa. The study collects biomarker-based data on HIV (HIV antibody and viral load, biomarkers for exposure to lamivudine and emtricitabine), diabetes (point-of-care glucose) and hypertension (systolic and diastolic blood pressure), as well as self-reported data on healthcare utilization (self-reported testing, awareness, preventive counseling and treatment for diabetes and hypertension). We calculated differences in healthcare utilization by HIV and ART status, where ART use was defined exclusively by biomarker-based testing for

CROI 2017 273