CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

832 BASELINE POPULATION HIV CASCADE AND 2-YR OUTCOME OF HIV+ CHILDREN IN THE SEARCH TRIAL

Laura B. Balzer 1 , Norton Sang 2 , Albert Plenty 1 , Teri Liegler 1 , Craig Cohen 1 , Elizabeth A. Bukusi 2 , Moses R. Kamya 3 , Maya L. Petersen 4 , Diane V. Havlir 1 , Theodore Ruel 1 1 Univ of California San Francisco, San Francisco, CA, USA, 2 Kenya Med Rsr Inst, Nairobi, Kenya, 3 Makerere Univ, Kampala, Uganda, 4 Univ of California Berkeley, Berkeley, CA, USA Background: SEARCH (NCT01864603) is a community randomized trial evaluating an HIV test-and-treat strategy in rural Uganda and Kenya. We evaluated the population-level HIV care cascade among children (2-14years) at baseline and interim outcomes of HIV+ children receiving streamlined ART delivery in the 16 intervention communities. Methods: At baseline residents were enumerated through a household census and HIV-serostatus was determined by multi-disease health campaigns and targeted home-based testing of at-risk (mother’s HIV-status unknown/positive) non-attendee children. Streamlined ART including patient-centered care and viral load counseling was universally offered. HIV RNA levels were measured at health campaigns or with home-based testing at baseline and after 1 and 2 years. With multivariable adjustment for untested children, we estimated at baseline: the prevalence of HIV; the proportion of HIV+ children previously diagnosed; of those, the proportion receiving ART; and of those, the proportion virally suppressed (HIV RNA< 500 copies/ml). For HIV+ children at baseline, we estimated HIV viral suppression probabilities over 2 years, adjusted for missing measures and right- censoring with targeted maximum likelihood estimation. Results: Of 70,511 baseline stable resident (in community >6mo/past year) children, we ascertained HIV status on 89%; 665 were HIV+. The adjusted baseline HIV prevalence was 1.1% (95%CI:1.0-1.2%) overall. Before the SEARCH intervention, 64% (95%CI:59-70%) of infected children had known status; of these, 84% (95%CI:79-89%) had been prescribed ART. Among those prescribed ART, 64% (95%CI:56-74%) were virally suppressed at baseline. The estimated population-level viral suppression among all HIV+ children was 35% (95%CI:29-41%) at baseline. Two years into SEARCH, the probability of viral suppression was 62% (95%CI:58-66%) overall, 59% (95%CI:51-66%) for new diagnoses, and 63% (95%CI:51-74%) for previous diagnoses newly initiating ART, but only 33% (95%CI:23-44%) among children on ART but not suppressed at baseline. 12% (95%CI:6-18%) of children suppressed at baseline were viremic at 2 years (Figure). Conclusion: Within 2 years, SEARCH increased overall HIV viral suppression among HIV+ children from 35% to 62%with gains driven by new diagnoses and initiation of treatment in ART-naïve children. However, additional strategies to address retention, adherence, and drug resistance are needed to achieve and maintain higher rates of viral suppression.

Poster and Themed Discussion Abstracts

833 COST-EFFECTIVENESS OF HIV SCREENING: US ADOLESCENTS AND YOUNG ADULTS (AYA) AGED 13–24 Anne M. Neilan 1 , Richard Dunville 2 , Cheryl B. Ocfemia 2 , Joshua A. Salomon 3 , Li Yan Wang 2 , Katherine K. Hsu 4 , Elizabeth DiNenno 2 , Rochelle P. Walensky 1 , Robert A. Parker 1 , Andrea L. Ciaranello 1 1 Massachusetts General Hosp, Boston, MA, USA, 2 CDC, Atlanta, GA, USA, 3 Harvard SPH, Boston, MA, USA, 4 Massachusetts Dept of Pub Hlth, Boston, MA, USA Background: Of new HIV diagnoses in the US, 22% occur in AYA. Despite 2006 CDC guidelines for one-time HIV screening, few AYA are screened. We projected the clinical and cost- effectiveness of HIV screening in AYA ages 13 to 24 without identified HIV risk factors.

CROI 2017 360