CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

higher proportion of MAC patients presented as known HIV-positive or TFIs (64% vs 14%). TFIs at MAC were on ART longer (median:3.3yrs[IQR:2.1-5.2] vs 1.9yrs[IQR:1-2.4] at SBMC) with similar retention in care 6 months after TFI(86%). Among new initiates 6-month retention in care was 95%(35/37) at MAC and 88%(140/159) at SBMC. Conclusion: STI care is an excellent opportunity to link men to HIV services. While SBMC had more patients, MAC attracted a different patient population, and had higher initiation and retention rates. Given these contrasting successes, further research should investigate whether aspects of both services could be rolled out to attract more men to HIV services. 999 THE IMPACT OF CARE NAVIGATORS ON ENGAGEMENT IN HIV CARE IN WESTERN KENYA Becky L. Genberg 1 , Violet Naanyu 2 , Alfred Keter 3 , Anthony Ngeresa 3 , Juddy Wachira 2 , Joseph Hogan 4 , Paula Braitstein 4 1 Brown Univ, Providence, RI, USA, 2 Moi Univ, Eldoret, Kenya, 3 Academic Model Providing Access to Hlthcare, Eldoret, Kenya, 4 Univ of Toronto, Toronto, Canada Background: Retention in HIV care remains challenging in resource-limited settings. Peer interventions are a strategy for addressing contextual barriers, such as stigma and inefficient care delivery. The objective of this study was to determine the impact of peer care navigators (CN) on engagement in care among patients enrolling in the AMPATH (Academic Model Providing Access to Healthcare) HIV care program in western Kenya. Methods: CNs were outreach or support staff living with HIV with excellent adherence. CNs received new patients and provided counseling and information. All patients newly accessing HIV care from September 2013 to June 2014 at two AMPATH facilities with CNs were eligible for inclusion. 1118 patients who received CN services and completed an initial encounter were matched on age, sex, facility, and date of enrollment (+/- 6 months) with up to 3 controls that did not use CNs. Differences in demographics by case status were examined with Chi-squared and Wilcoxon rank sum tests. Adjusted logistic regression models were used to examine the impact of CNs on further engagement in HIV care, controlling for potential confounders. Outcomes included: follow-up visit (>14 days from enrollment), CD4 testing (<45 days from enrollment), as well as ART initiation, lost-to- follow-up (LTFU), or death within 12 months of enrollment. Results: Of 1025 cases and 2954 controls, 64%were female, with a median age of 32 years. There were no statistically significant (p>0.05) differences by case in sex, age, education, or travel time to clinic. Cases were less likely to have electricity (p=0.001) or piped water (p=0.01). Overall 85% had a follow-up visit and 26% had a CD4 test. At 12 months, 65%were on ART, 33% became LTFU, and 5% died. Cases were as likely as controls to have had a follow-up visit (adjusted odds ratio (AOR)=1.14, 95% confidence interval (CI): 0.91-1.43), initiated ART (AOR=0.99, 95% CI: 0.83-1.18), become LTFU (AOR=0.96, 95% CI: 0.81-1.13), or died (AOR=1.30, 95% CI: 0.94-1.79). Cases were less likely than controls to have had a CD4 test (AOR =0.61, 95% CI: 0.51, 0.74). Conclusion: This study provided no evidence that CNs led to improved engagement in HIV care. Facility-based peers may not have an impact on further engagement in care following linkage. Since this analysis was restricted to patients already linked to care, the impact of peers on linkage to care is unknown. Additional research is needed to identify interventions to improve engagement in HIV care following linkage. 1000 IMPROVED RETENTION WITH LONGER FOLLOW-UP INTERVALS FOR STABLE PATIENTS IN ZAMBIA Aaloke Mody 1 , Nancy Padian 2 , Nancy Czaicki 1 , Monika Roy 1 , Carolyn Bolton Moore 3 , Charles Holmes 4 , Elvin Geng 1 , Izukanji Sikazwe 5 1 Univ of California San Francisco, San Francisco, CA, USA, 2 Univ of California Berkeley, Berkeley, CA, USA, 3 Univ of Alabama at Birmingham–CIDRZ, Lusaka, Zambia, 4 The Johns Hopkins Univ– CIDRZ, Bethesda, MD, USA, 5 Cntr for Infectious Disease Rsr in Zambia, Lusaka, Zambia Background: Extending appointment intervals for stable HIV-infected patients in sub-Saharan Africa can reduce opportunity costs to patients and decongest overcrowded facilities, but has not been prioritized as a strategy, with shorter intervals still being more common, in part due to concerns of waning engagement with longer absences. Methods: As part of the Better Info study, we analyzed a cohort of stable HIV-infected adults (on treatment >6m, CD4 >200 cells/μl) who presented for a routine clinical visit from January 1, 2013 to July 31, 2015 in Zambia. We used missed visits (>14d late to next visit), gaps in medication (>14d late to next pharmacy refill), and loss to follow-up (LTFU, >90d late to next visit) as indicators of retention. We utilized multilevel logistic regression adjusting for patient characteristics-including an individual’s prior retention history-to assess the association between scheduled appointment intervals and subsequent lapses in retention. Results: 127,448 patients (66% female, median age 39y [IQR 33-46], median CD4 444 cells/μl [IQR 325-595]) made 857,900 routine visits to 71 sites. Most visit intervals were 30d (25-45d, 43%), followed by 60d (46-75d, 21%), and 90d (76-105d, 33%); 3.3%were <25d and 0.9%were >105d. Patients given longer follow-up (>76d) were slightly more on time to current visit and had a history of slightly fewer missed visits and slightly higher medication possession ratio, but were of similar age and gender makeup. Longer visit intervals were associated with improved probability of making the next visit on time (Figure). After adjustment and as compared to patients scheduled for 30d follow-up, patients with longer appointment intervals were less likely to have subsequent lapses: 60d follow-up (late aOR 0.82, p<0.001; medication gap aOR 0.91, p<0.001; LTFU aOR 0.96, p<0.03), 90d follow-up (late aOR 0.56, medication gap aOR 0.69, LTFU aOR 0.94; p<0.001 for all), and >106d follow-up (late aOR 0.37, medication gap aOR 0.59, LTFU aOR 0.71; p<0.001 for all). Patients with very short follow-up (<25d) were more likely to have retention lapses (late aOR 1.89, medication gap aOR 1.56, LTFU aOR 1.29; p<0.001 for all). Conclusion: Longer visit intervals are associated with decreased lateness, gaps in medication, and LTFU in stable HIV-infected patients even when adjusting for prior retention history. Extending visit intervals to 3 months, and potentially up to 6 months, may represent a promising strategy to reduce patient burden of care and decongest clinics. 1001 EXPERIENCES WITH RETENTION IN CARE AND VIRAL SUPPRESION IN A PHARMACY REFILL PROGRAM Arvind Kaimal 1 , Barbara Castelnuovo 1 , Martha Atwiine 1 , Rachel Musomba 1 , Maria S. Nabaggala 1 , Rosalind P. Ratanshi 2 , Mohammed Lamorde 1 1 Makerere Univ, Kampala, Uganda, 2 Univ of Cambridge, Cambridge, UK Background: Following implementation of routine annual HIV-1 RNA monitoring at the Infectious Diseases Institute HIV clinic (Kampala, Uganda), a Pharmacy Refill plus Program (PRP) was introduced to reduce patient visit loads on doctors and nurses by incorporating pharmacy-only visits in patient monitoring algorithms. The PRP patients would have only 4 visits in a year(every 3 months) alternating a doctor visit and a pharmacy-only visit to pick up their drugs as opposed to standard of care where a doctor or nurse would be seen every 2 months. The PRP schema comprised: doctor visit (enrollment), pharmacy-only visit (month 3), doctor and adherence counseling visit (month 6), pharmacy-only visit (month 9), doctor visit (month 12). Patients were included into the PRP if they were stable on first-line antiretroviral therapy for at least 24 months, and had no opportunistic infections or non-communicable diseases. Pregnant women were excluded. Methods: Between 10Aug15 and 23Sep16, 708 patients were screened of which 624 patients met program criteria. A cross sectional analysis was conducted including 288 patients who had at a minimum completed the month 3 visit. Data was extracted from the IDI electronic medical record (Integrated Clinic Enterprise Application) database and clinical records of patients that dropped out of the PRP were examined in detail by one reviewer. Median duration of time for patients to be dropped off the program for any reason and the proportion of patients with HIV-1 RNA suppression was calculated. Results: Overall among patients enrolled; 354/624(56.7%) were females with median age 46[Interquartile range(IQR) 40-51] years and median CD4 492(IQR 367-653) cells/ul. Only 2/288 patients were discontinued from the program due to NCD diagnoses at months 3 and 11 resulting an overall retention at 99.3%. Median time among those on program was 11.1(IQR 5.0-12.4) months and 6.95(IQR 3.2-10.7) months among those who discontinued. Of the 84/624 completed a month 12 visit, 83/84(98.8%) had viral suppression at month 12. Conclusion: Implementing a monitoring approach and incorporating pharmacy-only visits for stable patients was feasible in Infectious Diseases Institute HIV clinic (Kampala, Uganda). High retention rates and virologic suppression rates suggest that this approach should be considered for wider implementation 1002 VIROLOGIC OUTCOMES WHEN ANTIRETROVIRAL THERAPY IS USED FOR PREVENTION: HPTN 052 Jessica M. Fogel 1 , Xinyi C. Zhang 2 , Estelle Piwowar-Manning 1 , Nagalingeswaran Kumarasamy 3 , James G. Hakim 4 , Beatriz Grinsztejn 5 , Ying Q. Chen 2 , Myron S. Cohen 6 , Susan H. Eshleman 1 , for the HPTN 052 StudyTeam

Poster and Themed Discussion Abstracts

CROI 2017 432