CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: We simulated a cohort of 12 year-olds who faced age-specific risks of HIV infection, ranging between 0.6 and 71.3 per 100,000 person-years, peaking at age 24. We examined a one-time screen ($36) at age 15, 18, 21, 25, or 30, each in addition to current US screening practices (13% ever screened by age 18, 30% by age 24). We used published data on the HIV care continuum: screen acceptance (80%); linkage to care and ART initiation (76%); and disease progression; ART response; and HIV care costs. Model outcomes included CD4 count at diagnosis; HIV care continuum care outcomes (proportions HIV-diagnosed, linked to care, retained in care, and virally suppressed); life expectancy and lifetime costs; and incremental cost-effectiveness ratios (ICERs) in $/year of life saved (YLS). In sensitivity analyses, we varied HIV incidence, current practice screening rates, linkage rates, and screen cost. Results: All one-time screens detected only a small proportion of lifetime infections (0.1-10.3%), most of which occurred after age 24. An additional one-time screen at age 25 compared to current US screening practice modestly reduced the proportions of all HIV-infected persons being diagnosed via OI (35 vs. 39%) and never being diagnosed during their lifetime (11 vs. 12%). A screen at age 25 also led to the most favorable continuum of care outcomes at age 25 compared to current US screening practice, including proportion diagnosed (77 vs. 51%), linked to care (71 vs. 50%), retained in care(61 vs. 34%) and virally suppressed (49 vs. 32%). A screen at age 25 provided the greatest clinical benefit, and was cost-effective (ICER $61,900/YLS) by US standards (<$100,000/YLS) compared to the next most effective screen. In sensitivity analyses, this finding was robust to wide ranges of HIV incidence, current practice screening rates, linkage rates, and screen cost; it was most sensitive to peak age of incidence. Conclusion: For AYA in the US general population, a one-time routine HIV screen at age 25, after the peak of incidence, would optimize clinical outcomes and be cost-effective. Focusing screening on AYA ages 18 or younger is a less efficient use of a one-time screen among AYA than screening at a later age. 834 COMMUNITY INTERVENTION IMPROVES ADOLESCENT HIV STATUS KNOWLEDGE: HPTN 071 STUDY ZAMBIA Kwame Shanaube 1 , Mwate J. Chaila 1 , David Macleod 2 , Ab Schaap 1 , Sian Floyd 2 , Conred Jani 1 , Graeme Hoddinott 3 , Richard Hayes 2 , Sarah Fidler 4 , Helen Ayles 5 1 Zambart, Lusaka, Zambia, 2 London Sch of Hygiene and Trop Med, London, UK, 3 Univ of Stellenbosch, Cape Town, South Africa, 4 Imperial Coll London, London, UK, 5 London Sch of Hygiene and Trop Med, Lusaka, Zambia Background: The PopART for Youth (P-ART-Y) study aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment (UTT), among young people. It also assess the need for specific youth targeted interventions in the context of community wide UTT. The study’s primary outcome is uptake of HIV counselling and testing (HCT) in the previous 12 months among 15-19 year old adolescents. The study is nested within the HPTN071 (PopART) trial, a 3-arm community randomized study in 21 communities in Zambia and South Africa. Arm A of the study provides the “full” combination HIV prevention package including home based HCT which is delivered in annual rounds by Community HIV Care Providers (CHiPs) to all household members irrespective of age. Methods: Adolescents contacted in their homes were offered participation in the PopART intervention which included HCT and linkage to prevention and treatment. Uptake of the intervention was recorded electronically by the CHiPs during household visits. We present data on the uptake of HCT in 4 Arm A communities in Zambia among adolescents aged 15-19 years. Data were analysed for the second annual round of the intervention, October 2015 to June 2016. Results: A total of 13,828 adolescents were enumerated of which 71.9% (n=9,943) agreed to participate in the intervention; 1.6% (n=225) refused and 25.9% (n=3,576) were not found at home (figure 1). More males (2,052/6,267; 32.7%) than females (1,524/7,561; 20.2%) were not found at home. Acceptance of HCT was similar in females, 81.4% (4,643/5,706) and males, 80.4% (3,147/3,915). HIV prevalence as tested by the CHiPs was 1.3% (104/7,790) and varied by sex (Males, 0.6%; Females, 1.9%). Following the CHiPs’ visit, using the definition that they either reported they were HIV positive (n=62), or were tested by the CHiPs (n=7,790) or reported to have been tested in the previous 12 months (n=704 among those who declined, and n=1803 among those who accepted, HCT by CHiPs), knowledge of HIV status increased from 26.5% (2569/9,683) to 88.4% (8,556/9,683). Conclusion: Through a home-based approach of offering a combination HIV prevention package the percentage of adolescents who knew their HIV status increased from~27% to ~90%, among those who were contacted and consented to participate. Delivering a community level door-to-door combination HIV prevention package is acceptable but complementary strategies tailored to finding more males maybe required.

Poster and Themed Discussion Abstracts

835 A NOVEL MODEL OF COMMUNITY COHORT CARE FOR HIV-INFECTED ADOLESCENTS IMPROVES OUTCOMES Lindsey Reif 1 , Rachel Bertrand 2 , Vanessa Rivera 3 , Bernadette Jospeh 2 , Benedict Anglade 2 , Jean W. Pape 3 , Daniel Fitzgerald 3 , Margaret McNairy 3 1 Columbia Univ, New York, NY, USA, 2 GHESKIO, Port-au-Prince, Haiti, 3 Weill Cornell Med, New York, NY, USA

Background: Adolescents account for 40% of new HIV infections in Haiti and have worse outcomes than other age groups. A novel model of community cohort care was implemented to improve retention and viral load suppression among HIV+ adolescents in Port-au-Prince, Haiti. The intervention addressed barriers of social isolation, stigma, and long visits reported among adolescents. Methods: Adolescents 10-20 years, who newly tested HIV+ were enrolled in cohorts of 8-10 peers, stratified by age group – 10-15 and 16-20. Cohorts met monthly for integrated clinical care, counseling, and social activities in a community setting. All clinical services (laboratory tests, ART initiation/management, and pharmacy refills) were performed during the cohort meeting by a nurse; group counseling was provided by a peer counselor. Retention at 12 months was defined as being alive with a visit between 11 and 13

CROI 2017 361