CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1008 TREATMENT NEED AND FAST-TRACK ART IN THE BOTSWANA COMBINATION PREVENTION PROJECT Refeletswe Lebelonyane 1 , Lisa A. Mills 2 , Joe Theu 1 , Lisa Block 3 , Michael Kasonde 2 , Tony Chebani 1 , Shenaaz el-Halabi 1 , Elliot Raizes 3 , Shahin Lockman 4 , Joseph N. Jarvis 2 1 Botswana Ministry of Hlth, Gaborone, Botswana, 2 CDC Botswana, Gaborone, Botswana, 3 CDC Atlanta, Atlanta, USA, 4 Harvard Univ, Boston, MA, USA Background: To ensure the success of Universal Test and Treat (UTT) it is essential that untreated HIV-infected adults are identified and that there are no barriers to ART initiation. Since UTT implementation in June 2016 the Botswana Combination Prevention Project (BCPP) has offered fast-track ART initiation with enhanced counseling and ART at the first clinic visit. We evaluated the feasibility of identifying untreated adults in the community and the acceptability of fast-track ART initiation. Methods: BCPP is a cluster randomized trial evaluating the impact of a combination prevention package on HIV incidence in 30 communities. This sub-analysis of the 15 intervention communities evaluates 1) the cohort of patients identified through enhanced BCPP testing and linkage activities between October 2013 and May 2016, and 2) all individuals initiating ART prior to the introduction of UTT (October 2013-May 2016) and following UTT (1 June-31 August 2016) when participants with a positive HIV-verification test were immediately referred for ART initiation. Results: BCPP assessedHIV status in 40,628 individuals; 9,586 (24%) were HIV-infected. Among the 9,406 with complete data, 2,354 (25%) were not on ART, 34% of whom had CD4≤200; 1,120 qualified for treatment by pre-UTT national guidelines (CD4≤350), of whom 76% initiated ART.Overall, prior to UTT 1,775 HIV-infected treatment eligible participants attended HIV-clinics in the 15 intervention communities, of whom 1,359 (77%) initiated ART. Median time to ART initiation was 35 days, with 46% (571 of the 1,253 with a known start date) starting within 30 days. Following introduction of UTT and fast-track ART initiation 896 participants attended a clinic visit and had a positive HIV- verification test; 85% (629/743 with a known start date) initiated on the same day as their verification test, 95% (709/743) initiated ART within a week of their initial clinic visit, and 99% (735/743) initiated within 30 days. Only 15 (1.8%) of individuals initiating fast-track ART had a baseline creatinine clearance <60mls/min necessitating a clinic recall, and 4 (0.5%) required a treatment switch. Conclusion: Significant numbers of untreated HIV-infected individuals, many with advanced disease, were identified through intensified community testing.Fast track ART was acceptable and safe and led to increased rates of ART initiation and reduced times from initial clinic visit to treatment start, and could help ART programs in Africa reach the ambitious UNAIDS 90-90-90 targets.

Poster and Themed Discussion Abstracts

1009 LINKAGE TO CARE OUTCOMES IN THE BOTSWANA COMBINATION PREVENTION PROJECT Mary Grace Alwano 1 , Pamela J. Bachanas 2 , Catherine Motswere 1 , Tafireyi Marukutira 1 , Baraedi W. Sento 3 , Nokuthula Majingo 4 , Shahin Lockman 5 , Molly Pretorius Holme 5 , Huisheng Wang 6 , Janet Moore 1 1 US CDC, Gaborone, Botswana, 2 CDC, Atlanta, GA, USA, 3 Tebelopele HIV Testing and Counseling Cntr, Gaborone, Botswana, 4 Ministry of Hlth, Gaborone, Botswana, 5 Harvard Univ, Boston, MA, USA, 6 Northrup Grumman, Atlanta, GA, USA Background: To achieve UNAIDS 90 90 90 targets, the 90% of PLHIV who know their status must link to care and initiate treatment. We report linkage to care rates, time to link, and follow up provided to HIV-positive persons not on ART identified through the Botswana Combination Prevention Project (BCPP). Methods: BCPP is a randomized controlled trial designed to evaluate the impact of a combination prevention (CP) package on HIV incidence in 30 communities in Botswana. HIV testing was conducted in the 15 CP communities and included home-based and mobile testing. Newly identified and known HIV-positive persons not on ART were given point of care CD4 tests, referrals to local HIV clinics, SMS appointment reminders, incentives for keeping appointments (US $2 airtime cards) and home and/or phone counselor visits for up to 90 days if not registered at the HIV clinic. Results: Overall, 40,628 persons were assessed for HIV status (tested or showed documentation of HIV status); 24% (9,586/40,628) were HIV-positive. Among all HIV-positive persons identified, 2,593 not on ART were referred to the local HIV clinic. Of those referred, 77% (1,997/2,593) linked to care within 30 days, 82% (2,126/2,593) within 90 days, and 84% (2,182/2,593) within 1 year. For women age 16-24, linkage to care rates were 83%, but lower for same-age men (72%). Of persons over 24 years of age, linkage to care rates were similar for women (85%) and men (84%). Of those who linked, 68% (1,492/2,182) registered with only an SMS reminder, and 58% (858/1,492) of these received an incentive upon registering. Of the 32% (690/2,182) who did not keep initial appointments, counselors provided an average of 2.2 counseling visits and re-appointments before they linked to the clinic. Of HIV-positive persons who never linked (16%, 411/2,593), 70%were employed compared to 40% of those who did link. Persons who never linked reported being too busy, unable to miss school/work, or not ready to accept HIV status as reasons for not keeping appointments. Conclusion: Most HIV-positive persons referred to the clinic linked within the first 30 days, and linked with minimal follow up needed. Both women and men linked to care at high rates; however, men age 16-24 and employed persons may need additional tracking and expanded availability of clinical care to ensure they initiate treatment. Tracking referrals is a critical intervention to ensure resources are spent on those who do not link and need additional intervention to access care and treatment. 1010 ART COVERAGE AFTER 2 YEARS OF A UTT INTERVENTION IN ZAMBIA: FINDINGS FROM HPTN071 Sian Floyd 1 , Mwelwa Phiri 2 , Ab Schaap 2 , David Macleod 1 , Kwame Shanaube 2 , Sam Griffith 3 , Nulda Beyers 4 , Richard Hayes 1 , Sarah Fidler 5 , Helen Ayles 6 1 London Sch of Hygiene and Trop Med, London, UK, 2 Zambart, Lusaka, Zambia, 3 FHI 360, Durham, NC, USA, 4 Desmond Tutu TB Cntr, Western Cape, South Africa, 5 Imperial Coll London, London, UK, 6 London Sch of Hygiene and Trop Med, Lusaka, Zambia Background: The lack of effect of a universal test-and-treat (UTT) intervention on population-level HIV incidence reported by the TasP study emphasized the importance of high ART coverage. HPTN 071(PopART) is a community-randomized trial in 21 urban communities in Zambia and South Africa, testing the impact on HIV incidence of a household-based combination HIV prevention approach provided by community-HIV-care-providers (CHiPs). In 4 Zambian communities, from November 2013 CHiPs have delivered the “PopART” UTT package in annual “rounds”, during which they (re-)visit all households. CHiPs refer HIV-positive (HIV+) individuals to routine HIV clinic services, with re-visits to support linkage to care. We present data on ART coverage and retention from round 2 (R2) of delivering the intervention.

CROI 2017 435