CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

BC Cntr for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada Background: Antiretroviral therapy (ART) scale-up is central to the global strategy to control the HIV/AIDS pandemic. To accelerate efforts towards ending the AIDS epidemic, the Joint United Nations Programme on HIV/AIDS released the “90-90-90” target. Thus, the present analysis was conducted to characterize the progress in British Columbia (BC), Canada, toward achieving the 90-90-90 target, and to predict whether BC is on track to reach this target by 2020. Methods: Using linked individual-level data sets of people living with HIV (PLWH) in BC, we estimated the number of PLWH (aged ≥19 years) from 1996/1997 to 2013/2014. We modeled the trends in HIV prevalence and each of the steps of the 90-90-90 target using generalized additive models. Subsequently, we forecasted these outcomes for the fiscal years from 2014/2015 to 2019/2020. Lastly, we performed a sensitivity analysis to account for uncertainty associated with prevalence estimates based on four different scenarios with increasing prevalence, based on the upper 95% confidence interval bound of our original forecasted estimates, and based on a 5%, 10% and 15% increase in these same estimates. Results: Among the estimated 10538 PLWH in BC in 2013/2014, 83% of PLWH were diagnosed, of these 81%were on ART, and among those who were on ART, 96%were virologically suppressed. Our model projections suggest further progress on these metrics in the next five fiscal years. By 2019/2020, the model projects that 93% of PLWH would be diagnosed, among these, 91%would be on ART and among those on ART, 97%would be virologically suppressed. Only one scenario in the sensitivity analysis met the 90-90-90 target by 2019/2020, the scenario based on the upper 95% confidence interval bound of our original forecasted prevalence estimates (90% of PLWH diagnosed). In the other scenarios, the proportion of PLWH diagnosed by 2019/2020 ranged from 81% to 88%. Conclusion: As we approach 2020, BC is rapidly moving towards achieving the 90-90-90 target. Our results provide strong evidence that integrated comprehensive free programs that facilitate testing, and the delivery of treatment and care to this population can be effective in controlling, and eventually, ending the AIDS epidemic.

Poster and Themed Discussion Abstracts

1043 THE CLINICAL AND ECONOMIC IMPACT OF ATTAINING NHAS TREATMENT TARGETS IN THE US Ethan D. Borre 1 , Emily P. Hyle 1 , Paul E Sax 2 , A. David Paltiel 3 , Anne M. Neilan 1 , Kenneth Freedberg 1 , Rochelle P. Walensky 1 1 Massachusetts General Hosp, Boston, MA, USA, 2 Brigham and Women’s Hosp, Boston, MA, USA, 3 Yale Univ, New Haven, CT, USA Background: The US National HIV/AIDS Strategy (NHAS) aims to achieve 72% viral suppression among people living with HIV (PLWH) in the US by 2020. We examine the clinical and economic impact of reaching this target, both in the general population (US) and among Black MSM (BMSM). Methods: We use a mathematical simulation (the CEPAC model) to project clinical outcomes, costs, and cost-effectiveness, over 5y and 20y, for two strategies: 1) Current Pace of detection, retention, and viral suppression; and 2) NHAS aspirational detection, linkage, and retention, resulting in 72% suppression by 2020. We assume that the US population of PLWH at model outset is 86% diagnosed, 37% diagnosed and in care, and 30% virally suppressed. For BMSM, these are 83%, 34%, and 28%. Under NHAS, we improve the average testing interval from 10 to 4 years, also incurring additional costs for testing ($32/test) and adherence to care interventions ($3,800/year). Transmission rates are HIV RNA-dependent (0.16-9.03/100PY) and include a reduction due to condom use (40% (US) and 10% (BMSM)). Annual ART costs are $25,000-$40,000. We define a strategy as “cost- effective” if its incremental cost-effectiveness ratio (ICER) is <$100,000/life-year saved (YLS). In sensitivity analyses, we examine alternative testing and adherence interventions and costs. Results: NHAS improves viral suppression at 5y from 53% to 73% compared to Current Pace in the US (BMSM: 48% to 64%). Over 20y, NHAS will avert 265,900 (51,400) transmissions and 192,600 (30,200) deaths and save 2,008,000 (298,000) years of life. Over 20y, BMSM represent 18% of PLWH nationwide and account for 20% of transmissions averted under NHAS vs. Current Pace. NHAS increases costs by $191.1 billion ($19.8 billion) over 20y, with ART costs making up 86% (80%) of the budget. The ICER for scale up to NHAS compared to Current Pace is $96,000/YLS for US ($66,000/YLS). If the adherence intervention cost is doubled and efficacy halved, scale up to NHAS remains cost-effective in the US at $97,000/YLS ($75,000/YLS). Halving ART costs reduces the ICER of NHAS to $45,000/YLS ($26,000/YLS). Conclusion: Reaching NHAS targets would yield substantial clinical benefits and be cost-effective in both the general US and BMSM populations. Interventions among BMSM will avert proportionally more transmissions at lower cost. The cost-effectiveness of NHAS scale up strategies is largely dependent on ART costs, less so on testing/adherence costs. 1044 IMPROVING THE PRISON CARE CONTINUUM REDUCES RACIAL HIV DISPARITIES: A MODELING STUDY Brandon D. Marshall 1 , Maximilian King 1 , Alexandria Macmadu 2 , Lauren Brinkley-Rubinstein 3 , M.-J. Milloy 4 , Curt G. Beckwith 1 , Frederick Altice 5 , Josiah D. Rich 1 1 Brown Univ, Providence, RI, USA, 2 The Miriam Hosp, Providence, RI, USA, 3 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Univ of British Columbia, Vancouver, British Columbia, Canada, 5 Yale Univ, New Haven, CT, USA Background: Prisons provide an opportunity for HIV screening and provision of antiretroviral therapy (ART). However, many individuals fail to re-engage with care post-release, increasing HIV transmission risk in the broader community. In this agent-based modeling study, we sought to determine how improved HIV diagnosis and ART initiation while incarcerated in prison-and continued transitional care post-release-could reduce HIV transmission and address racial HIV disparities in the non-incarcerated community. Methods: Using Atlanta, Georgia as a case study, we developed an agent-based model to simulate HIV transmission in a dynamic, population-based sexual and drug-injecting network. The base case model was parameterized using city- and race-specific inputs for population characteristics, incarceration rates, sentencing lengths, and ART coverage. The

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