CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

Results: Among 2004 participants (N=744 CIS, 493 CIS+FI, 767 SOC), 64%were women and the mean age was 34 years (standard deviation = 10). As shown in the table, 57% receiving CIS and 55% receiving CIS+FI achieved the primary outcome versus 35% receiving SOC (RR vs SOC: 1.63 [95%CI:1.45-1.83] for CIS; 1.56 [95%CI:1.37-1.76] for CIS+FI). Participants in the CIS (94%, RR vs SOC 1.50 [95%CI:1.42-1.49]) and CIS+FI (94%, RR 1.49 vs SOC [95%CI:1.41-1.58]) groups had higher linkage to care at 1 month versus those in the SOC (63%) group; and higher 12-month retention (CIS 59%, RR vs SOC 1.31 [95%CI:1.19-1.45], and CIS+FI 55%, RR vs SOC 1.24 [95%CI:1.11-1.38]) relative to those in SOC (45%). In sensitivity analyses considering self-reported linkage and retention at any health facility, 73% in CIS, 72% in CIS+FI, and 47% in SOC achieved the primary outcome (RR vs SOC: 1.55 [95%CI: 1.35-1.77] for CIS; 1.53 [95%CI: 1.32-1.77] for CIS+FI). Conclusion: The CIS offers a feasible approach for enhancing outcomes across the HIV care continuum, particularly linkage to care following diagnosis. No additional benefit of non-cash financial incentives was observed.

Oral Abstracts

111 PEER NAVIGATION ENHANCES HIV CARE RETENTION: AN RCT IN SOUTH AFRICAN PRIMARY CLINICS Wayne T. Steward 1 , Emily Agnew 1 , Julia DeKadt 2 , Hailey Gilmore 1 , Mary-Jane Ratlhagana 2 , Jessica Grignon 3 , Starley B. Shade 1 , John Tumbo 4 , Scott Barnhart 3 , Sheri A Lippman 1 1 Univ of California San Francisco, San Francisco, CA, USA, 2 Intl Training and Educ Cntr for Hlth–South Africa, Pretoria, South Africa, 3 Univ of Washington, Seattle, WA, USA, 4 Rustenburg Sub- District Office, Rustenburg, South Africa Background: Engagement in care is critical to meeting UNAIDS 90-90-90 goals. South Africa has improved access to antiretroviral therapy (ART) through expanded ART initiation and monitoring at primary health clinics, however nearly half of HIV-positive clients are still lost to care. To improve retention in care, we designed and implemented short message service (SMS) reminders and peer navigation (PN) to address barriers to HIV care. Methods: The I-Care Trial (registration: NCT02417233) used a cluster randomized design to assign primary health clinics in North West Province, South Africa, to: 1) SMS check-in messages, along with appointment and healthy living reminders (6 clinics); 2) SMS reminders plus PN services (SMS+PN) to address personal barriers to care (7 clinics); and 3) standard of care (SOC; 4 clinics). From October, 2014, to April, 2015, we enrolled 752 recently HIV-diagnosed, consenting adults (292 men, 460 women) in SMS, SMS+PN, or SOC assigned clinics and followed them for up to 1 year. We extracted clinical record data and conducted intention-to-treat analyses of 12-month retention outcomes using generalized estimating equations (GEE). Retention in care was defined as: 1) an average of at least 1 clinic visit every 3 months for participants on ART, which corresponded to the minimum frequency with which ART was dispensed at the facilities; or 2) an average of at least 1 clinic visit every 6 months for pre-ART participants (those not yet eligible for ART at the time of the study). The trial is complete and results are final. Results: Participants receiving SMS+PN services had nearly 3 times the odds of being retained in care compared to SOC participants (Table 1). SMS services alone did not significantly improve outcomes relative to SOC, although SMS demonstrated protective trends for those on ART. When analyzed by gender, men (OR=3.34, 95% CI: 1.37-8.14) and women (OR=2.64, 95% CI: 1.60-4.37) had greater odds of being retained in care when receiving SMS+PN services than when receiving SOC. There were no differences between SMS and SOC conditions for men or women in stratified analyses. Conclusion: Peer navigation paired with SMS reminders substantially improves retention in HIV care at South African primary health clinics. The intervention offers a valuable strategy for meeting 90-90-90 campaign targets. Efforts are now needed to identify feasible strategies for wider-scale implementation in resource-constrained clinics.

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CROI 2017