CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

months from enrollment. Viral load suppression was defined as <1000 copies/ml. Retention was compared between cohort care participants and teens receiving standard care at the Adolescent Clinic between 2009 and 2012. Kaplan-Meier methods estimated incidence of retention. Results: Fifty adolescents enrolled in cohort care between Nov 2014-Sept 2015 – 80% females, median age of 18 (IQR 15-19), and median CD4 count 537 cells/mL (IQR 339-805). In standard care, 710 adolescents enrolled in care from Jan 2009-Dec 2012 – 80% female, median age 18 (IQR 16-19), and median CD4 count 414 cells/mL (IQR 238-604). In cohort care, 100% of adolescents were assessed for ART eligibility on the day of testing, 22 (44%) were eligible for ART with CD4 <500 cells/uL, and 100% started ART with median time to initiation of 0 days. In standard care, 462 (65%) adolescents were assessed for eligibility, 330 (46%) were eligible with CD4 <350 cells/uL, and 305 (92%) started ART with median time to initiation of 20 days. At 12 months from enrollment, 86% (95% CI: 74-92) of adolescents in cohort care were retained compared to 66% (95% CI: 63-67) in standard care (p<.001) (Fig 1). In cohort care, among those with a viral load measurement 6-12 months from ART initiation, 5/19 (26%) had viral suppression. Viral load was not routinely collected prior to 2016. Conclusion: Community-based cohort care for HIV+ adolescents in Haiti significantly improved retention by an absolute difference of 20% and decreased time to ART initiation. Viral suppression remains poor indicating a need for increased efforts to improve adherence to ART among adolescents.

Poster and Themed Discussion Abstracts

836 LOCAL SOCIAL NETWORKS PREDICT RETENTION & SUPPRESSION IN YOUNG WOMEN IN SEARCH TRIAL Lillian Brown 1 , Wenjing Zheng 2 , James Ayieko 3 , Asiphas Owaraganise 4 , Florence Mwangwa 4 , Tamara D. Clark 1 , Edwin D. Charlebois 1 , Moses R. Kamya 5 , Diane V. Havlir 1 , Maya L. Petersen 2 1 Univ of California San Francisco, San Francisco, CA, USA, 2 Univ of California Berkeley, Berkeley, CA, USA, 3 Kenya Med Rsr Inst, Nairobi, Kenya, 4 Infectious Diseases Rsr Collab, Kampala, Uganda, 5 Makerere Univ, Kampala, Uganda Background: Young women in sub-Saharan Africa are at high risk of HIV infection, poor retention in HIV care, and virologic failure on ART. Peer support between HIV+ women may improve care cascade outcomes, but community-level social network data to inform network-based interventions are limited. We used comprehensive social network and HIV testing data from the intervention arm of the SEARCH test-and-treat trial (NCT01864603) to evaluate whether having HIV+ social network contacts predicted retention and viral suppression among young HIV+ Kenyan women. Methods: All adult (≥ 15) residents in 3 rural Kenyan communities were enumerated during a baseline census and asked to name social contacts that provided support in five domains: health, money, emotional support, food, and free time. Named contacts were matched to enumerated residents to build social networks among 15,162 stable adult residents; 85% of these residents were tested for HIV at baseline. We evaluated whether having gender-specific social network contacts with HIV predicted retention in care (not more than 90 days late to scheduled clinic visit) and viral suppression (HIV RNA < 400 copies/ml) at 12 months among young (15-24 years) HIV+ women who linked to care following baseline testing. We used Cox proportional hazards models and logistic regression with robust standard errors to adjust for prior HIV care and pre-ART CD4 count. Results: Baseline HIV prevalence was 14% among adults and 10% among young women. Of the 162 young women who linked to HIV care, 31% of young women named ≥1 HIV+ contact in any domain, 17% named ≥1 HIV+ female contact in any domain, and 6% named ≥1 HIV+ female contact in the health domain [Table]. At 12 months, 83% (95% CI: 76,88) of young women who linked were retained in care and 70% (95% CI: 62,78) of those in care were virally suppressed. Women with an HIV-infected female contact were more likely to be retained in care (aHR 2.63; 95% CI: 1.10, 14.3). Among those retained, young women with any HIV+ contact (aOR 3.2; 95% CI: 1.1,9.8), and specifically, those with a female HIV+ health contact (aOR 3.5; 95% CI: 1.1,12.7) were more likely to be suppressed. Conclusion: HIV+ female peers in the local social networks of young Kenyan women may support their engagement in HIV care. Interventions that strengthen existing social connections between HIV-infected women and increase social support in the health sector may contribute to improved clinical outcomes. 837 TEENAGE PREGNANCY: A CRITICAL BARRIER TO RETENTION ON ANTIRETROVIRAL THERAPY Harriet Nuwagaba-Biribonwoha 1 , Agnes Kiragga 2 , Constantin Yiannoutsos 3 , Beverly Musick 3 , Kara K. Wools-Kaloustian 3 , Elaine J. Abrams 1 , Batya Elul 4 , for the International Epidemiologic Databases to Evaluate AIDS (IeDEA) East Africa Collaboration 1 ICAP at Columbia Univ, New York, NY, USA, 2 Makerere Univ, Kampala, Uganda, 3 Indiana Univ, Indianapolis, IN, USA, 4 Columbia Univ, New York, NY, USA Background: Retention on ART is essential for reducing HIV-related morbidity and mortality. We compared loss to follow-up (LTFU) among adolescents and adults initiating ART in East Africa. Methods: We conducted a retrospective cohort analysis using routinely collected clinical data on patients enrolling into HIV care as young adolescents, YA (10-14 years), older adolescents, OA (15-19 years) and adults (20 years and older). We analyzed data from 2000-2012 at 33 health facilities participating in the IeDEA collaboration in Kenya, Uganda and Tanzania. We compared adolescent and adult LTFU (no clinic visit for 3 months) after ART initiation using competing risk methods. Patient- and site-level correlates of LTFU were examined using the Fine and Gray competing regression model, with death as a competing risk. Results: A total of 2,709 YA, 4,179 OA and 154,792 adults were enrolled, the majority female (56% YA, 84% OA, and 67% adults). One percent of YA, 27% OA and 9% adults were pregnant at enrolment. Median CD4 count (IQR) at ART initiation was 179 cells/µL (51-328) among YA, 186 cells/µL (72-329), among OA and 146 cells/µL (63-236) among adults. Cumulative probability of LTFU at 24 months after ART initiation was highest among OA (32%), lowest among YA (19 %), and 21% among adults, Figure 1. Compared to YA, the OA had 50% higher risk of LTFU adjusted Hazard Ratio (aHR) 1.50 (95% Confidence Interval, CI: 1.32-1.71), P<0.001, and aHR 1.04 (0.94 – 1.16) P=0.252 among the adults. Among OA,

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