CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Methods: R2 was from June 2015–September 2016. Included in analysis are adults (≥18 years) who consented to participate, and who self-reported HIV+ or were newly diagnosed HIV+ by the CHiPs (“known HIV+”). Our main outcomes are the percentage on ART by the end of R2 and the percentage retained on ART at the time of consenting to participate in R2, both self-reported. To help understand how the ART coverage outcome was achieved, we used “time to event” methods to estimate the percentage who initiated ART by 6 months after referral to HIV care. Results: Among adults resident during R2, 65% (34,538/53,486) of men and 87% (49,648/57,269) of women consented to participate. Of these, 10% (n=3,405) of men and 16% (n=7,995) of women were known HIV+. On the date of consenting to participate in R2, 64% (n=2,196/3,405) of known HIV+men and 69% (n=5,504/7,995) of known HIV+ women were on ART, increasing with age from 41% overall among 18-24 year olds to 82% among those ≥55 years; 24% of men and 20% of women were newly diagnosed HIV+. Among those who reported ever taking ART, 92% (2,154/2,329) of men and 95% (5,424/5,730) of women were on ART and missed 0 pills in the last 3 days. By the end of R2, among those still resident according to the last CHiP visit, 78% of men and 79% of women were on ART, ranging from 59% among 18-24 year olds to 88% among those ≥55 years. Compared to R1, initiation on ART by 6 months after referral to HIV care increased from 40% to 60%. Conclusion: By the end of R2, among adults known to be HIV+, the percentage on ART approached 80%, lower among younger than older adults, retention on ART was high, and the time to initiate ART after referral to care was shortened compared with R1. 1011 REACHING 90-90-90? FINDINGS AFTER 2 YEARS OF HPTN 071 (POPART) INTERVENTION IN ZAMBIA Richard Hayes 1 , Sian Floyd 1 , Ab Schaap 2 , Kwame Shanaube 2 , Peter Bock 3 , Sam Griffith 4 , Nulda Beyers 3 , Helen Ayles 5 , Sarah Fidler 6 , for the HPTN 071 (PopART) StudyTeam 1 London Sch of Hygiene & Trop Med, London, UK, 2 Zambart, Lusaka, Zambia, 3 Desmond Tutu TB Cntr, Western Cape, South Africa, 4 FHI 360, Durham, NC, USA, 5 London Sch of Hygiene & Trop Med, Lusaka, Zambia, 6 Imperial Coll London, London, UK Background: The UNAIDS 90-90-90 targets aim to substantially decrease HIV transmission but it is unknown whether they can be achieved at scale in generalised epidemics. We report data from HPTN 071 (PopART), the largest programme to deliver universal testing and treatment at population level in Southern Africa, to determine how close we are to reaching the targets after two years of intervention. Methods: The intervention comprises annual rounds of home-based HIV counselling and testing delivered by Community HIV Care Providers (CHiPs) who also support linkage to care, retention on ART and other HIV-related services. CHiP data from four communities in Zambia receiving the full PopART intervention (including universal ART irrespective of CD4 count), were used to determine proportions of adults who knew their HIV-positive (HIV+) status before and after the second annual round (R2: Jun 2015 - Sep 2016), and the proportions of known HIV+ adults who were on ART. Extrapolating from these data, we estimated overall proportions of HIV+ adults in these communities who knew their HIV+ status (first-90) and the proportion of these who were on ART (second-90) before and after R2. Results: By the end of August 2016, 45,616 households had been visited by CHiPs for the second annual round; 110,755 adult residents of these households (aged 18+) were enumerated, of whom 84,186 (76%) were contacted and consented to the intervention. Based on data from these participants, estimated total numbers of HIV+ adults in these four communities were 6,216 men and 10,341 women (Table), of whom 78% of men and 90% of women (86% overall) knew their HIV+ status following the R2 annual visit (first- 90). Among these known HIV+ adults, 80% of men and 80% of women were estimated to be on ART by the end of R2 (second-90). For both targets, coverage was higher in those who had participated during R1 than in those who had not. Comparison of R1 and R2 estimates shows a continuing increase in coverage particularly for the second-90. Conclusion: After two rounds of intervention, 86% of HIV+ adults were estimated to know their HIV+ status, close to the first-90. Of those known HIV+, an estimated 80%were on ART, approaching the second-90. Continuing efforts are needed to speed up linkage to care and ART initiation in order to reach the second-90. Lower coverage in the large number of clients who had not participated during R1 emphasises the need for annual re-visits in urban communities with high rates of mobility and migration.

Poster and Themed Discussion Abstracts

1012 HEALTH CARE COVERAGE AND VIRAL SUPPRESSION PRE- AND POST-ACA IMPLEMENTATION Heather Bradley 1 , Joseph Prejean 1 , Lindsey Dawson 2 , Antigone Dempsey 3 , Jennifer Kates 2 , Pamela W. Klein 3 , R. L. Shouse 1 1 CDC, Atlanta, GA, USA, 2 Kaiser Family Fndn, Washington, DC, USA, 3 HRSA, HIV/AIDS Bureau, Rockville, MD, USA

Background: The Affordable Care Act (ACA), fully implemented in 2014, expanded health care coverage options for many people living with HIV in the US It is unknown how health coverage among persons in HIV medical care has changed since ACA implementation and how such changes may be associated with prevalence of viral suppression. Methods: We used 2012 and 2014 data from the Medical Monitoring Project (MMP) to examine pre- and post-ACA implementation changes in health care coverage types and viral suppression among adults receiving HIV medical care. MMP is a surveillance system utilizing a national probability sample of adults receiving HIV care in the US We computed weighted percentages of adults who were uninsured or had private, Medicaid, or Medicare coverage in each time period. We also assessed, in each time period, the percentage of adults receiving Ryan White HIV/AIDS Program services for low-income, un- and under-insured persons, and the percentage of persons virally suppressed (<200 copies/mL) at last test. All analyses were stratified by residence in a Medicaid vs. non-Medicaid-expansion (ME vs. NME) state, defined as expansion anytime in 2014. Results: In 2012, 26% [95% confidence interval (CI): 20–31] of persons in HIV medical care were uninsured in NME states compared to 13% (CI: 10–16) in ME states. There was no change in health care coverage of persons receiving HIV care in NME states from 2012–2014. In ME states, the percentage uninsured declined from 13% to 7% (CI: 6–8), and

CROI 2017 436