CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

as a function of patients’ age, gender, education, duration since ART initiation, adherence behavior, and the willingness-to-pay threshold. We compared the cost-effectiveness of the personalized monitoring strategies to fixed monitoring intervals every 1, 3, 6, 12 and 24 months. Results: Shorter fixed VL monitoring intervals yielded increasing benefits (6.034 to 6.221 quality-adjusted life-years (QALYs) per patient with monitoring every 24 to 1 month over 10 years, respectively, standard error 0.005 QALY), at increasing average costs: US$ 3445 (annual monitoring) to $5393 (monthly monitoring) per patient (standard error $3.7). The adaptive policy optimized for Uganda’s context achieved 6.111 average QALYs at a cost of $3483 (incremental cost-effectiveness ratio of 490.8 USD/QALY compared to fixed 24-month monitoring). Compared to monitoring VL every 3 months, the adaptive policy optimized for middle-income resource settings yields 0.008 fewer QALYs per person, but saves $204. The adaptive policy optimized for high-income settings yields 0.007 fewer QALYs per person, but saves $1,180 compared to monthly monitoring. Conclusion: Focusing on patients most at risk of virological failure improves the efficiency of VL monitoring. In low-income countries, adaptive policies achieve similar outcomes to fixed interval at lower costs. In middle- to high-income settings, adaptive policies may lead to significant reductions in costs compared to fixed interval monitoring policies. Background: The resources available for the HIV response in aid-recipient countries reflect a balance between the financial needs to care for the growing HIV-infected population, donor resources, which have been mostly flat or declining, and domestic resources, which reflect national wealth and the prioritization of HIV. Increased prioritization of HIV aid for global functions, such as vaccine trials or surveillance, could offer high returns. In this context, the extent to which low and middle-income countries (LIC & MIC) can finance HIV control programs is poorly understood and could inform future planning. Methods: To project the amount of potentially “repurposable” donor HIV resources, the amount of future domestic resources for HIV was calculated based on each country’s total projected gross domestic product (GDP), the portion of GDP spent on health, and the share of overall disease burden made up by HIV. Percent of GDP spent on health was taken from observed trends relating GDP per capita and health spending, and HIV burden share was assumed to be stable at 2013 levels. We used UNAIDS estimates of full financing needs for HIV in each country through 2030 and assumed a stable gap between the full financing needs and actual financing of HIV programs. The difference between domestic plus donor resources and the financing needs was taken as repurposable donor resources. Results: We estimate that domestic resources available for HIV could increase in LIC 2.5 fold between 2016-2030, from $13.3 million to $32.9 million on average per country (range $335,920 in Afghanistan to $407 million in Tanzania). The amount of repurposable HIV aid from increased domestic spending in LIC ranged from $0 in low-aid countries such as Burundi and Niger to upwards of $150 million in Ethiopia, Mozambique, Tanzania, and Uganda (58%-85% of current HIV aid levels). Between 2016-2030, we estimate that increasing domestic resources could enable repurposing $11.1 billion of HIV aid in LIC, $21.7 billion in lower-MIC, and $11.6 billion in upper-MIC. Conclusion: If the GDP of low and middle-income countries grows according to projections, a substantial portion of HIV financial needs could be met with domestic resources. Although low-income countries receive the most aid, we project that more HIV aid could be repurposed frommiddle-income countries than low-income countries. Knowledge on financing trends can allow donors to make better-informed financing decisions. Background: The rapid emergence and spread of the Zika virus prompted the increased availability of screening assays in the US. LabCorp launched an RT-PCR-based test (RealStar® Zika Virus RT-PCR, Altona Diagnostics) to qualitatively detect Zika virus RNA in serum and urine (RNA test), and was the first commercial lab to provide the CDC’s MAC-ELISA test for detection of Zika IgM antibodies in serum or CSF (IgM test). This analysis characterizes over 10,000 results from these two tests, providing age, gender, and geographical views of the results. Methods: The data from Zika tests performed between June and mid-September 2016 for both RNA (June to mid-Sept) and IgM tests (mid-Aug to mid-Sept) were downloaded from the LabCorp database and were filtered such that only those with complete records were included in the analysis. The data were analyzed to determine frequencies of female and male testing, negative vs non-negative results, age distributions, and geography. Results: A total of 11,129 result records, of which 6410 were from the RNA test and 4719 from the IgM test. We found negative result rates of 94.2% and 98.2% from the RNA and IgM assays, respectively. Testing in females represented 78.7% of all samples submitted and 83% of these samples came from patients between the ages of 21-40. Comparatively, 60.6% of male samples came from the 21-40 age group and 15% came from the 41-50 age demographic. For the RNA test, we found a concordance rate of 97% between the serum and urine results. For females, the concordance rate was 97.2%, and for males it was 96.3%. A statistically significant difference (p=0.0001) in the frequency of urine samples testing positive between females (4.39%) and males (6.67%) was observed, but was not seen between male and female serum results. Nearly half of the samples (48.6%) came from Florida, which demonstrated a negative rate of 97.8%. Conclusion: Our data represents one of the first characterizations of Zika virus testing in the United States. This early review demonstrates that approximately one in every 25 samples results is presumptive positive/positive result. The high negative result rate from Florida is consistent with the broader screening approach that has occurred due to endemic Zika virus concerns. The significant difference in positive Zika RNA detection in the urine of males versus females was unexpected. The high rate of testing in males was generally a surprise because there is no screening algorithm for males. 1055LB ZIKA VIRUS PERSISTENCE IN BODY FLUIDS Gabriela Paz-Bailey 1 , Eli Rosenberg 2 , Katherine Doyle 1 , Jorge Munoz-Jordan 1 , Gilberto Santiago 1 , Liore Klein 3 , Janice Perez 1 , Stephen Waterman 1 , Luisa Alvarado 4 , Tyler Sharp 1 1 CDC, Atlanta, GA, USA, 2 Emory Univ, Atlanta, GA, USA, 3 Caduceus Healthcare Inc, Ponce, PR, USA, 4 Ponce Univ, Ponce, PR, USA Background: A detailed understanding of the dynamics of the early stages of Zika virus (ZIKV) infection is needed to inform diagnostic testing algorithms and prevention interventions, as existing evidence is based on case reports and cross-sectional observations, primarily from returning travelers. To estimate the presence and duration of detection of ZIKV RNA in body fluids and anti-ZIKV IgM antibody in individuals with acute ZIKV infection, we established the Zika virus Methods: Persons in whom ZIKV was detected by RT-PCR in urine or blood in a Puerto Rico enhanced arboviral clinical surveillance site were enrolled. Serum, saliva, urine, and semen/vaginal secretions were collected weekly for the first month and at 2, 4, and 6 months. All specimens were tested by RT-PCR and serumwas tested by anti-ZIKV IgM ELISA. Among those with ZIKV RNA in any specimen at week 4, biweekly collection continued until all specimens tested negative. Time to loss of ZIKV RNA detection in each body fluid was estimated using parametric Weibull regression models. We estimated the 50th and 95th quantiles with their 95% confidence intervals (95% CI). Results: Among 150 participants, 88% (132/150) of participants had detectable ZIKV RNA in ≥1 serum specimen, 62% (92/149) in urine, 10% (15/147) in saliva, 1/50 (2%) in vaginal secretions and 56% (31/55) in semen. The 50th and 95th percentile for days post-illness-onset until loss of ZIKV RNA detection were respectively, 14 (95% CI: 11-17) and 54 (95% CI: 43-64) in serum, 8 (95% CI: 6-10) and 39 (95% CI: 31-47) in urine, and 34 (95% CI: 28-41) and 81 (95% CI: 64-98) in semen. Few had detectable RNA in saliva and vaginal secretions. Conclusion: Our interim analyses provides crucial information about time to clearance of ZIKV RNA in persons with acute ZIKV infection and detectable ZIKV RNA at enrollment. Prolonged time to ZIKV RNA clearance in serummay have implications for diagnosis and prevention. Current sexual prevention guidelines recommend that men use condoms/abstain from sex for 6 months after ZIKV exposure; in this study 95% of men cleared ZIKV RNA from semen over this time period. 1053 PROJECTING FUTURE DONOR ASSISTANCE FOR HIV/AIDS GLOBAL FUNCTION SUPPORT Eran Bendavid 1 , Marco Marco Schäferhoff 2 , Jessica Kraus 2 , Dean Jamison 3 , Sebastian Martinez 2 1 Stanford Univ, Stanford, CA, USA, 2 SEEK Development, Berlin, Germany, 3 Univ of California San Francisco, San Francisco, CA, USA 1054 CHARACTERIZATION OF MORE THAN 10,000 ZIKA VIRUS TEST RESULTS IN THE US Joseph M. Volpe 1 , Dajie Luo 1 , Arren Fisher 1 , Mindy Nye 2 , Barbara Body 2 , Marcia Eisenberg 1 1 LabCorp, Durham, NC, USA, 2 LabCorp, Burlington, NC, USA

Poster and Themed Discussion Abstracts

CROI 2017 455