CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

1022 OUTCOMES OF AHI SCREENING AND IMMEDIATE ART INITIATION IN COASTAL KENYA Eduard Sanders 1 , Oscar Chirro 2 , Clifford Oduor 2 , Juma Mangi 3 , Elizabeth Wahome 2 , Matt A. Price 4 , Huub C. Gelderblom 4 , Elisabeth M. van der Elst 2 , Susan M. Graham 5 1 Kenya Med Rsr Inst, Kilifi, Kenya, 2 KEMRI Wellcome Trust Rsr Prog, Kilifi, Kenya, 3 Malindi Sub-County Hosp, Malindi, Kenya, 4 Intl AIDS Vaccine Initiative, New York, NY, USA, 7 Univ of Washington, Seattle, WA, USA Background: The World Health Organization recommends treatment of all HIV-infected patients with ART upon diagnosis. However, patients with acute HIV infection (AHI) are rarely identified at care seeking in Africa, and data on linkage and ART initiation following AHI diagnosis is lacking. We assessed outcomes following AHI screening among outpatients seeking urgent care in a large Government hospital in coastal Kenya, estimating time to successful care linkage and time to ART initiation. Methods: Patients aged 18-35 years with unknown HIV-status were eligible to be screened for prevalent and acute HIV when the sum of a 7-item published consensus risk score was ≥2 (age 18-29 years, reported fever, fatigue, body pains, diarrhea, and sore throat scored a “1”, and genital ulcer disease a “3”). A 5-ml blood sample was used to diagnose prevalent HIV infection by two rapid tests (Determine and Unigold). AHI testing was conducted with a point-of-care X-pert Qual RNA test when rapid HIV tests were negative or discordant. Patients awaited X-pert results (1.5 hours), and all infected patients were offered immediate ART upon diagnosis, in accordance with Kenyan guidelines. Results: From February-August 2016, 1058 (42.7%) of 2475 patients were eligible for screening, including 318 men and 720 women. Of these, 205 (64.5%) men and 496 (68.8%) women agreed to be screened (p=0.4). Eight (3.9%) men and 16 (3.2%) women had prevalent HIV (p=0.7). Six (1.3%) of 480 seronegative women had AHI, including 3 in Fiebig Stage II (RNA positive, seronegative) and 3 in Fiebig Stage III (RNA positive, discordant rapid tests). No men had AHI (p=0.1). Of 30 new HIV diagnoses, 10%were in women who would not otherwise have been diagnosed and 10%were in women with discordant test results, who may not have followed up with repeat testing as recommended. Overall, 22 (73.3%) HIV-infected patients (6 men and 16 women) registered for care after a median of 0 days (range: 0-51). Fifteen patients (50.0%, 6 men and 9 women) started ART after a median of 2 days (range: 0-71). Five of (83.3%) of 6 AHI patients started ART after a median of 0 days (range: 0-11). Conclusion: Targeted AHI screening among young adult symptomatic outpatients identified a substantial number of undiagnosed prevalent HIV infections. Moreover, AHI screening led to an increase in confirmed diagnoses by 25% (from 24 to 30 cases). While the majority of AHI patients started ART immediately, same-day treatment initiation for all HIV patients needs strengthening. 1023 TEN YEARS OF SUPPORTING SCALE-UP OF HIV CARE AND EXPANSION OF ART IN 4 COUNTRIES Chloe A. Teasdale , Chunhui Wang, Jessica E. Justman, David Hoos, Mark Hawken, Zenebe Melaku, Antonio Mussa, Wafaa M. El-Sadr, Elaine J. Abrams ICAP at Columbia Univ, New York, NY, USA Background: Scale up of HIV care and expansion of ART to reach all eligible patients has been a global priority for more than 15 years. We describe patient characteristics and attrition pre and post-ART among patients at 358 sites in four countries over 10 years. Methods: We examined demographic and HIV disease characteristics at enrollment in care and ART initiation at PEPFAR-funded ICAP-supported clinics in Ethiopia, Kenya, Mozambique and Tanzania from 2005-2014. We analyzed the proportion of patients eligible for ART at enrollment based on prevalent WHO guidelines at enrollment and the proportion starting ART. We also examined attrition (loss to follow-up (LTF) and death) pre-ART initiation using competing risk estimators (ART as competing risk) and post-ART initiation with Kaplan-Meier estimators. LTF was defined as no visit within 6 months prior to ART and 12 months after ART start. We examined outcomes by year with Cochran- Armitage tests, Kendall Tau coefficients, log rank tests and unadjusted sub-distributional hazards models. Results: From 2005-2014, 902,709 patients were enrolled in care at 358 ICAP-supported health facilities across four countries. Overall, 66.5%were female, median age was 32 years[IQR 26-40], 32.8% enrolled through VCT and 10.0% through PMTCT. At enrollment, 34.7%were WHO stage 3/4 and median CD4+ cell count was 235cells/mm3[IQR 104-427] (CD4 missing for 45.9%). As a result of changing WHO guidelines, ART eligibility at enrollment increased from 31.6% in 2005-2006 to 54.8% in 2013-2014(p<0.0001), however median CD4 increased from 172 cells/mm3[IQR 71-340] to 289 cells/mm3[IQR 132-484](p<0.0001). Overall, 484,621(53.7%) patients started ART; 44.1%were WHO stage 3/4 and median CD4 was 166 cells/mm3[IQR 79-260](CD4 missing for 31.1%). The proportion of patients starting ART increased from 53.1% in 2005-06 to 63.2% in 2013-14(p<0.0001). Attrition pre-ART at 12 months overall was 35.2% (95%CI 35.1-35.3) and decreased over time from 36.5%(95%CI 36.3-36.8) in 2005-06 to 25.7%(95%CI 25.3-26.1) in 2013-

CROI 2017 441