CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Timely diagnosis of infant HIV infection is the sine qua non of successful antiretroviral therapy initiation, yet about 50% of mother-infant pairs are lost to follow-up during the postpartum period. In a randomized controlled trial, we found the TextIT intervention (a two-way theory-based text messaging system) to be efficacious for improving infant HIV testing rates and maternal postpartum retention in prevention of mother-to-child HIV transmission (PMTCT) programs. Using an implementation science approach, we aimed to evaluate real-world effectiveness of the intervention in western Kenya. Methods: In a pragmatic, cluster randomized, stepped-wedge trial with two time periods of observation, we randomly allocated 10 clinics to begin implementing the intervention immediately, and 10 clinics to begin implementing 6 months later. Inclusion criteria were minimal to approximate real world conditions. We used modified Poisson regression with robust variance estimation to estimate the relative risk and 95% confidence intervals (CI). Generalized estimating equations were applied on individual-level data to account for clustering by site. Results: Between February 2015 and December 2016, 4,681 women were assessed for study participation (6,404 screening visits) and 2,129 who were less than 28 weeks pregnant were excluded. Of 2,326 infants analyzed, 1,466 of 1,613 (90.9%) in the intervention group and 609 of 713 (85.4%) in the control group met the primary outcome of HIV virologic testing performed before eight weeks after birth (adjusted relative risk [aRR] 1.03; 95% CI 0.97-1.10; P=0.3). Of 2,472 women analyzed, 1,548 (90%) of 1,725 in the intervention group and 571 (76%) of 747 in the control group met the primary outcome of retention in care during the first eight weeks after delivery (aRR 1.12; 95% CI 0.97–1.30; p=0.1). Conclusion: A greater proportion of infants in the intervention group received HIV testing compared with the control group, but the difference was small, and not statistically significant. There was also a non-significant increase in maternal postpartum retention in the intervention periods. Despite the lack of a significant effect of the intervention, key lessons emerged, both for strengthening PMTCT and for implementation research in general. Perhaps most important, improving the implementation of usual care was sufficient to substantially improve infant HIV testing rates.

816 WITHDRAWN 817 QUANTIFYING VISIT ADHERENCE IN PREGNANT WOMEN INITIATING ART IN SWAZILAND Nontokozo Langwenya 1 , Harriet Nuwagaba-Biribonwoha 2 , William J. Reidy 2 , Averie B. Gachuhi 2 , Simangele Mthetwa 3 , Velephi Okello 3 , Landon Myer 1 , Elaine J. Abrams 2 1 University of Cape Town, Cape Town, South Africa, 2 ICAP at Columbia University, New York, NY, USA, 3 Ministry of Health, Mbabane, Swaziland Background: Several studies have reported poor retention among HIV+ pregnant women initiating antiretroviral treatment (ART) under Option B+, particularly at the start of treatment. However, there is limited data on visit attendance patterns among women on ART. We evaluated three measures of ART visit adherence based on the expected follow-up (FU) dates under the Option B+ ‘treat-all’ approach and Option A, CD4/clinical- eligibility based ART. Methods: At 12 health facilities in Swaziland, routine patient-level data of all HIV+ pregnant women not on ART making their first antenatal care (ANC) visit was abstracted as part of an implementation science study comparing maternal retention outcomes under Options A and B+. Among patients who initiated ART and had >=2 FU visits, we performed a descriptive analysis of missed visits (>28 days after expected FU), visit constancy (>=1 visit per each 3-month period) and gaps in care (>6 months without a clinic visit) from ART initiation. Associations between these outcomes and demographic and clinical characteristics at ANC entry were examined using cox proportional hazard models. Results: We analysed 1417 women; mean age=25.6 years (SD=5.53), median CD4=349 cells/µL (IQR=242-483), median gestation=19 weeks (IQR=15-24), at first ANC visit; with 11,595 FU visits. Of 1417 women, 84% (n=1190) had >= 2 FU visits, 90 % (n=446) under A vs 81% (n=789) B+, with a median observation time of 14.1 months on ART (IQR=9.1-17.3). More than a half (57%, n=680) had a missed visit, 40% (n=706) did not have a clinic visit in each 3-month period since ART initiation and 29% (n=346) experienced a gap in care >6 months. Among women with a missed visit, 64% did not achieve visit constancy and 48% had >6 month gap in care. In a cox proportional hazard analysis, the risk of experiencing a missed visit was independently associated with age and gestation at ANC entry; each one-year increase in age from 15 years decreased risk by 3% (aHR=0.97; CI=0.96-0.99) and one-week increase in gestation from 4 weeks gestation increased risk by 2% (aHR=1.02, CI=1.01-1.04). Measures of visit adherence did not significantly differ by Option B+. Conclusion: Given that non-adherence to clinic visit schedules may increase the risk of mother-to-child transmission, this high level of non-adherence to clinic visits is concerning. Younger age groups and late presenters may require targeted retention counselling and support services. 818 TEXT MESSAGING FOR RETENTION IN PMTCT: A STEPPED-WEDGE CLUSTER-RANDOMIZED TRIAL Thomas A. Odeny 1 , James P. Hughes 2 , Elizabeth A. Bukusi 3 , Eliud Akama 2 , Elvin Geng 4 , King Holmes 2 , R. Scott McClelland 2 1 Kenya Medical Research Institute, Kisumu, Kenya, 2 University of Washington, Seattle, WA, USA, 3 Kenya Medical Research Institute, Nairobi, Kenya, 4 University of California San Francisco, San Francisco, CA, USA

Poster Abstracts

CROI 2018 308