CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1 Univ of California Los Angeles, Los Angeles, CA, USA, 2 Botswana–UPenn Partnership, Gaborone, Botswana, 3 Princess Marina Hosp, Gaborone, Botswana, 4 Univ of Pennsylvania, Gaborone, Botswana Background: Linkage to HIV care has the potential to shorten the time from symptom onset to tuberculosis (TB) diagnosis. This study describes the HIV treatment cascade among TB/HIV co-infected patients and the impact of prior engagement in HIV care over the timeliness of TB diagnosis. Methods: A cross-sectional study was conducted among new TB patients in Botswana from September 2012 through March 2016. We defined four stages of the HIV treatment cascade as: 1) all TB/HIV co-infected patients; 2) previously known HIV status prior to TB; 3) linked to HIV care (defined as having any CD4 count or receiving antiretroviral therapy); 4) currently on ART. Patients who were diagnosed with TB within 30 days of symptom onset were considered as having received expedited TB diagnosis. We used chi-square statistics to compare proportions of patients receiving expedited TB diagnosis across various stages of HIV care continuum vs. HIV-uninfected TB patients. Results: Of 4,375 TB patients included in the analyses, 2,537 (58.0%) were co-infected with HIV. Of those, 2,422 (95.5%) had known HIV diagnosis prior to their TB diagnosis. Seventy-six percent (1,928/2,537) of patients were already linked to HIV care, and 44.8 % (1,136/2,537) were on ART at the time of TB diagnosis. Women were more likely than men to have been linked to HIV care (79.7% vs. 72.5%, respectively; P<0.001) and to have been on ART (48.7% vs. 41.1%, respectively; P<0.001). Overall, expedited TB diagnosis was reported in 53.1% of HIV-uninfected patients, 55.1% of HIV-positive TB patients, 55.2% of those with previously known HIV diagnosis, 54.6% of those linked to HIV care, and 55.4% of those on ART. No statistically significant differences were found when each HIV care group was compared to the HIV-uninfected group. Conclusion: While most TB/HIV co-infected patients were previously diagnosed, only 76%were linked to HIV care and less than half were on ART at the time of TB diagnosis. While it is clear that linkage to HIV care and ART use positively impact clinical and public health TB outcomes, we found no evidence of a difference in expedited TB diagnosis between stages of the HIV care continuum. Public health efforts are needed to improve linkage to HIV care and reduce TB diagnostic delays among TB/HIV co-infected patients in Botswana.

Poster and Themed Discussion Abstracts

730 IMPROVEMENT OF HIV/TB CARE: TIME-SERIES ANALYSIS OF HEALTH-FACILITY DATA

Nehaben Ramanlal 1 , Dulce Bila 1 , Orvalho Augusto 2 , Nello Macuacua 1 , Victorino Chavane 1 , Leonel Zevo 1 , Chadreque Muluana 3 , Esmeralda Karajeanes 1 , Paula Vaz 1 1 Fundação Ariel Glaser Contra o Sida Pediatrico, Maputo, Mozambique, 2 Univ Eduardo Mondlane, Maputo, Mozambique, 3 Direcção Provincial de Saude de Maputo, Maputo Provincia, Mozambique Background: Tuberculosis (TB) is the most common opportunistic infection in Human Immunodeficiency Virus 1 (HIV-1) infected individuals. TB/HIV co-infection makes diagnosis, treatment and presentation of TB a challenge resulting in high mortality from TB in HIV-infected population. In 2012, the Ministry of Health of Mozambique strategically adopted a one-stop model of care, aiming to increase TB screening and treatment for HIV infected patients. Here we evaluate the effect of this strategy on access and retention to TB and HIV services at health facility (HF) level in Maputo province. Methods: HF offering HIV and TB care services before 2012 and after 2013 are included. Indicators per HF were computed from an electronic patient track system (ePTS). Interrupted time series (ITS) analysis of HF level indicators was conducted. Time segments included before July 2012 (PRE:segment 1), the 12 months between PRE and POST (segment 3) and after June 2013 (POST: Segment 3) and Generalized estimating equation (GEE) linear and logistic regressions with robust standard errors were used to estimate per indicator the change on the level and the slope from PRE to POST. Results: In total 24 HF were included in the analysis (N=3; Urban and N=21; Rural). Of these, one provided secondary level of care. The odds of TB screening increased significantly from end of segment 1 to beginning of segment 3 (OR: 4.10; 95%CI 2.41 - 6.99) and from a monthly odds-ratio of 1.06 to 1.12 respectively. Conversely, the mean time to ART initiation decreased from 180 days at the end of period 1 to 108 days at beginning of period 3 (relative decrease: 40%; 95%CI 32-47%) (Figure 1) and frommonthly mean decrease of 2% to 5%. By July 2015, the mean time to ART initiation was less than 1 month. The odds to access to cothrimoxazole prophylaxis within 3 months of registration increased from end of period 1 to end of period 3 (OR: 2.21; 95% CI 1.75 – 2.81). Overall, no significant changes were observed in retention at 12 months, however it has improved from 77% to 88% among adolescents Conclusion: Our results suggest benefit of this model of care for co-infected patients. Of note is the reduced time to ART initiation to less than 30 days coupled to improved access to cothrimoxazole prophylaxis. These two factors together with improved screening may significantly contribute to a reduction in mortality and morbidity associated to TB/HIV co-infection.

CROI 2017 318