CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

FSWs and their clients) only. Results suggest that the importance of sustaining condom use in key populations while scaling-up ART should not be underestimated in order to maintain the prevention gains achieved in the past years and to realise the full potential of scaling-up treatment as prevention. 1048 ART RETENTION AND VIRAL SUPPRESSION KEY TO MAXIMISING TREATMENT AS PREVENTION IMPACT Nicky McCreesh 1 , Ioannis Andrianakis 1 , Mark Strong 2 , Rebecca N. Nsubuga 3 , Ian Vernon 4 , Trevelyan J. McKinley 5 , Jeremy E. Oakley 2 , Michael Goldstein 4 , Richard Hayes 1 , Richard G. White 1 1 London Sch of Hygiene and Trop Med, London, UK, 2 Sheffield Univ, Sheffield, UK, 3 MRC/UVRI Rsr Unit on AIDS, Entebbe, Uganda, 4 Durham Univ, Durham, UK, 5 Exeter Univ, Exeter, UK Background: UNAIDS call for fewer than 500,000 new HIV infections/year by 2020, with treatment-as-prevention being a key part of their strategy for achieving the target. A better understanding of the contribution to transmission of people at different stages of the care pathway can help focus intervention services at populations where they may have the greatest effect. We investigate this using Uganda as a case study. Methods: An individual-based HIV/ART model was fitted using history matching. 100 model fits were generated to account for uncertainties in sexual behaviour, HIV epidemiology, and ART coverage up to 2015 in Uganda. A number of different ART scale-up intervention scenarios were simulated between 2016-2030. The incidence and proportion of transmission over time from people with primary infection, post-primary ART-naïve infection, and people currently or previously on ART was calculated. Results: In all scenarios, the proportion of transmission by ART-naïve people decreases, from 70% (61%-79%) in 2015 to between 23% (15%-40%) and 47% (35%-61%) in 2030 (Figure). The proportion of transmission by people on ART increases from 7.8% (3.5%-13%) to between 14% (7.0%-24%) and 38% (21%-55%). The proportion of transmission by ART dropouts increases from 22% (15%-33%) to between 31% (23%-43%) and 56% (43%-70%). Conclusion: People who are currently or previously on ART are likely to play an increasingly large role in transmission as ART coverage increases in Uganda. Improving retention on ART, and ensuring that people on ART remain virally suppressed, will be key in reducing HIV incidence in Uganda.

Poster and Themed Discussion Abstracts

1049LB COST-EFFECTIVENESS OF A COMBINATION STRATEGY FOR THE HIV CARE CASCADE IN SWAZILAND Elizabeth Stevens 1 , Kimberly Nucifora 1 , Qinlian Zhou 1 , Lingfeng Li 1 , Scott Braithwaite 1 , Margaret McNairy 2 , Averie B. Gachuhi 2 , Matthew R. Lamb 3 , Velephi Okello 4 , Wafaa M. El-Sadr 2 1 New York Univ, New York City, NY, USA, 2 ICAP Columbia Univ, New York, NY, USA, 3 Columbia Univ, New York, NY, USA, 4 Swaziland Ministry of Hlth, Mbabane, Swaziland Background: The Link4Health (L4H) study demonstrated that a combination strategy including point of care CD4 testing, rapid ART initiation, SMS reminders, financial incentives, and provision of health packages to motivate linkage and retention, significantly improved linkage to plus retention in care for HIV+ persons in Swaziland (SZ). We evaluated cost- effectiveness of the scale-up of L4H strategy in SZ. Methods: We incorporated the observed effects and costs of L4H into a computer simulation of the HIV pandemic in SZ (increasing proportion of HIV-positive persons linked/ retained in care and on ART from 39% to 53%with an annual program cost of $95 per person), comparing a scenario in which L4H was scaled up with a counterfactual scenario with no scale-up. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, and was calibrated to SZ epidemiological data with the goal of replicating trends in SZ HIV prevalence, incidence, deaths, and persons with HIV from 1997 to 2015. We conservatively assumed that effects only persisted while the programwas continued. Concordant with methodological guidelines, we assessed the incremental cost-effectiveness ratio from a societal perspective using $2015, a time horizon of 20 years, and a discount rate of 3%. Results: In base case analyses, the L4H strategy reduced the number of new HIV infections over 20 years by 8,466 for total of 154,639 versus 163,105 HIV+ persons, reduced the number of HIV-related deaths over 20 years by 6,324 from 65,543 to 59,219; and reduced the overall infectiousness of HIV+ persons from 0.046 to 0.044 new infections per person per year. Incremental HIV treatment costs were reduced by $2 per person per year because of reduced AIDS cases. Overall, cost per HIV infection averted was $18,100 and cost per quality-adjusted life-year (QALY) gained was $3,820. Using time horizons of 5 years and 10 years rather than 20 years increased the incremental cost-effectiveness ratio of L4H to $12,380 and $6890, respectively. In other sensitivity analyses, the incremental cost-effectiveness ratio varied between $1500 and $5000 per QALY, indicating that L4H has favorable value in the context of estimated SZ GDP of $3000. Conclusion: Our findings suggest that scale-up of the L4H strategy would substantially reduce HIV-related deaths, avert HIV infections, and would have favorable value in confronting the HIV epidemic in SZ over 10 year timeframe or longer. 1050 COST-EFFECTIVENESS OF SAME-DAY TREATMENT INITIATION IN SOUTH AFRICA Lawrence Long 1 , Mhairi Maskew 1 , Alana Brennan 2 , Constance Mongwenyana 1 , Cynthia Nyoni 1 , Given Malete 1 , Ian Sanne 1 , Matthew Fox 2 , Sydney Rosen 2 1 Univ of the Witwatersrand, Johannesburg, South Africa, 2 Boston Univ, Boston, MA, USA Background: The RapIT RCT of same-day ART initiation among non-pregnant adults using accelerated procedures and point-of-care (POC) laboratory instruments in Johannesburg, South Africa reported a 26% increase in viral suppression compared to standard initiation. We report the cost and cost-effectiveness of the rapid (same-day) strategy. Methods: For the primary health clinic study site, we compared the provider cost per patient virally suppressed 10 months after study enrollment under the rapid strategy to the corresponding cost under standard care. We used study forms and routine patient records to estimate resource utilization for each patient over the 10-month observation period and multiplied the number of units of each resource used by the unit cost for the resource, estimated in rand and converted at R12.74/$1. We estimated the average and total

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