CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

initiation was shorter for patients enrolled in 2014 and 2015 compared to those enrolled in 2013 (HR 1.42 95% CI 1.09-1.84 and HR 2.16 95% CI 1.67-2.80, respectively, p<0.0001) (Figure). IPT outcomes were available for 425/438 with sufficient follow-up time. IPT completion was achieved by 83% (200/240) in CIP vs. 80% (147/185) in SOC (RR 1.24 95% CI 0.79-1.95). Among IPT completers with ≥4 monthly questionnaires, 94% (240/256) reported on average ≥90% IPT adherence over 4-6 months of follow-up. Among 456 IPT initiators enrolled in care before 6/2015, 6 month retention was 87% (227/261) in CIP vs. 80% (155/195) in SOC (RR 1.09, 95% CI 0.89, 1.34). Among patients on concurrent IPT and ART for ≥4 months, 98% (204/208) reported on average ≥90% ART adherence over 4-6 months of follow-up. Conclusion: High rates of IPT initiation, adherence and completion are achievable in HIV programmatic settings, even without additional enablers. Time to IPT initiation decreased over time. Retention in care and ART adherence were high in patients on concurrent IPT.

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IPT COVERAGE IN NURSE-LED SCREENING OF CHILD TUBERCULOSIS CONTACTS Nicole Salazar-Austin 1 , Silvia Cohn 1 , Grace Barnes 1 , Molefi Tladi 2 , Katlego Matlhaoleng 2 , Neil Martinson 2 , Richard Chaisson 1 1 The Johns Hopkins Univ, Baltimore, MD, USA, 2 Perinatal HIV Rsr Unit, Soweto, South Africa

Poster and Themed Discussion Abstracts

Background: HIV and tuberculosis (TB) disproportionately affect women of reproductive age in sub-Saharan Africa, resulting in increased exposure of HIV-infected and HIV- exposed children to TB in their households. Isoniazid preventive therapy (IPT) is highly-effective at preventing TB disease in children <5 years and has long been recommended by the WHO, but a number of provider and patient challenges have hampered its implementation. To address barriers, the WHO recently recommended symptom-based screening in child TB contacts, as opposed to the traditional TST-based screening, thereby facilitating IPT initiation in child contacts. Methods: We are conducting a cluster-randomized trial in 16 primary health clinics in the Matlosana sub-district of North West Province which are randomized to carry out child contact evaluations with either symptom-based screening or TST-based screening. We have introduced a standardized IPT file and child contact register to all 16 clinics including basic demographics and screening and treatment outcomes. TB nurses in decentralized clinics were given a baseline training on the use of the child contact file and register as well as training on the assigned screening mechanism. Feedback was provided to each TB nurse every 4-6 weeks for the first six months and then quarterly. Data was abstracted retrospectively from the index and child’s file. The primary outcome is the percentage of children initiated on IPT or TB therapy. We report here the aggregate results from the training and rollout phase of the trial. Results: During the training/rollout phase from October 1, 2015 through March 30, 2016, 1173 drug-susceptible TB index cases and 408 associated contacts <5 years were identified. Of these child contacts, 202 (50%) initiated screening and 185 (92%) initiated IPT. Contact tracing identified 0.35 contacts per case, vs. the expected 0.70 contacts per case determined in previous household-based studies in the Matlosana sub-district. Based on that expected number of contacts, we estimate 22% IPT coverage among child contacts exposed to TB in the Matlosana sub-district. Conclusion: Clinic-based contact tracing tools under ascertain child contacts in this high-burden area. Once identified, nearly 50% of child contacts do not present to clinic for evaluation, but most children who are brought to clinic initiate IPT. Results of the randomized intervention will be determined once the second phase of the study is complete.

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