CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

these facilities contributed 23% of all VL tests done in the period. Across the period, younger patients were less likely to have VS (Figure 1b) but formed a minority of the patient population: for example 16-24 year-olds were 8-10% less likely to have VS at any time point, but comprised only 6-8% of all VL tests performed in the period. Conclusion: In this setting, achieving the ‘third 90’ remains an ongoing challenge despite significant progress in increasing ART access, and reaching this target will likely require increasingly targeted interventions. At a facility level, the heterogeneity in VS rates points to the need for targeted strengthening of services at specific facilities. At a patient level, young people clearly remain a key population for adherence support. More generally these data demonstrate the value of VL monitoring systems to gauge progress and focusing efforts to achieve global treatment targets. 990 CONTEMPORARY DISENGAGEMENT FROM ANTIRETROVIRAL THERAPY IN KHAYELITSHA, SOUTH AFRICA Samantha Kaplan 1 , Christa Oosthuizen 2 , Kathryn Stinson 2 , Francesca Little 2 , Jonathan Euvrard 2 , Meg Osler 2 , Katherine Hilderbrand 2 , Andrew Boulle 2 , Graeme Meintjes 2 1 Yale Univ Sch of Med, New Haven, CT, USA, 2 Univ of Cape Town, Cape Town, South Africa Background: Retention in care is an essential component of meeting the UNAIDS “90-90-90” targets. In Khayelitsha township (population ~500,000) in Cape Town, South Africa, >50,000 patients have received ART since the inception of this public sector program in 2001. Disengagement from care remains an important challenge. We sought to determine incidence of and risk factors associated with disengagement from care in 2013-4, and outcomes for those who disengaged. Methods: We conducted a retrospective cohort study of all patients >=10 years who visited one of the 13 Khayelitsha ART clinics in 2013-14 regardless of the date they initiated ART. We described the cumulative incidence of first disengagement (>180 days) in the study window by time on ART and time in the study, as well as risk factors for disengagement based on a Cox proportional hazards model. We ascertained outcomes after disengagement using province-wide health databases and the National Death Registry. Results: Of 39,895 patients meeting our eligibility criteria, the median time on ART to 31 Dec 2014 was 33.6 months (IQR 12.4-63.2). Of the total study cohort, 595 (1.5%) died in the study period, 1,231 (3.1%) formally transferred out, 984 (2.5%) were “silent transfers” and visited another provincial clinic within 180 days, 9008 (22.6%) disengaged, and 28,077 (70.4%) remained “in care.” Cumulative incidence of disengagement from care was 25.1% by two years in the study and 37.7% by ten years on ART estimated from time contributed in the study window. Key factors associated with disengagement were younger age, male sex, pregnancy at ART start, and lower last CD4 count; protective factors were ART club membership and lower baseline CD4 (Table 1). Of those who disengaged (excluding silent transfers), the two most common outcomes by 30 June 2015 were return to ART care after six months (33.0%), and being alive but not in care in the Western Cape (25.0%). After disengagement, a total of 1464 (16.3%) were hospitalized and 238 (2.6%) died. Conclusion: One quarter of patients in Khayelitsha disengaged from ART care at least once in a contemporary two-year period. Although the majority either subsequently returned to care or remained alive without hospitalization, a challenge to meeting the 90-90-90 targets is finding service adaptations to accommodate mobile populations and retain them in long-term care. This should be guided by risk factors for disengagement as observed in this study.

Poster and Themed Discussion Abstracts

991 SELF-REPORTED AND BIOMARKER HIV TREATMENT CASCADES FOR OLDER SOUTH AFRICAN ADULTS Julia K. Rohr 1 , Jennifer Manne-Goehler 2 , Xavier Gomez-Olive 3 , Joshua A. Salomon 4 , Pascal Geldsetzer 5 , Ryan Wagner 6 , Molly Rosenberg 7 , Chodziwadziwa Kabudula 4 , Kathleen Kahn 4 , Till Baernighausen 7 1 Harvard Univ, Cambridge, MA, USA, 2 Beth Israel Deaconess Med Cntr, Boston, MA, USA, 3 Tintswalo Hosp, Acornhoek, South Africa, 4 Univ of the Witwatersrand, Acornhoek, South Africa, 5 Indiana Univ, Bloomington, IN, USA, 6 Univ of the Witwatersrand, Johannesburg, South Africa, 7 Heidelberg Univ, Heidelberg, Germany Background: HIV treatment cascades are important for highlighting gaps in care, yet data sources for constructing cascades vary, and often include self-reported information or are based from clinical cohorts. We compare treatment cascades from biomarker data and self-report in a population-based cohort of older South African adults, who constitute a growing segment of the HIV+ population in South Africa. Methods: Data came from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) 2015 baseline survey, which includes 5,059 adults aged 40+ years, sampled from the Agincourt Health and Demographic Surveillance System. At-home interviews asked about HIV testing, knowledge of status, linkage to care, and antiretroviral therapy (ART). Dried bloodspots (DBS) were screened for HIV, ART, and viral load. We calculated proportions and 95% confidence intervals for each stage of the treatment cascade, conditional on completion of the previous stage, using (1) self-reported responses (2) biomarker data and (3) combined self-report or biomarker evidence, where screening positive for ART was considered positive for earlier stages. Cascades were framed within the UNAIDS 90-90-90 target. We explored variations in the cascade through stratification by age, sex and wealth. Results: There were 4,560 participants with valid DBS results. 1,048 (23%) screened positive for HIV and formed the denominator for the cascades. The biomarker cascade showed that 63% (95% CI: 60-66) were on ART and 46% (95% CI: 43-49) were virally suppressed, which is significantly lower than the UNAIDS target (Figure 1). Self-report under-estimated testing, diagnosis, and ART (only 47% [95% CI: 44-50] reported ART use). The combined cascade indicated high HIV testing (89% [95% CI: 87-91]), but lower awareness of being HIV+ (71% [95% CI: 68-74]), and while nearly all who identified themselves as HIV+ were linked to care, only 72% (95% CI: 68-75) of individuals on ART had viral suppression.

CROI 2017 428