CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

93 THE RAPID ART PROGRAM INITIATIVE FOR HIV DIAGNOSES (RAPID) IN SAN FRANCISCO Oliver Bacon 1 , Jennie C. Chin 1 , Ling Hsu 1 , Stephanie E. Cohen 1 , Darpun Sachdev 1 , Diane Jones 2 , Jonathan Fuchs 1 , Susan Scheer 1 , Susan P. Buchbinder 1 , Diane V. Havlir 2 1 San Francisco Department of Public Health, San Francisco, CA, USA, 2 University of California San Francisco, San Francisco, CA, USA Background: Early virologic suppression after HIV infection improves individual health outcomes and decreases onward transmission. In 2015 San Francisco Getting to Zero (SFG2Z) adapted the Citywide RAPID initiative, to link all new HIV cases to care within 5 days of diagnosis and start ART at the first care visit. This analysis compares time from diagnosis to care enrollment, ART initiation, and virologic suppression in the post-RAPID (2016) to the pre-RAPID care era (2013), by gender, race/ethnicity, age, and housing. Methods: HIV providers were trained on the RAPID protocol through passive (medical grand rounds, public SFG2Z consortiummeetings) and active (public health detailing) capacity building, with sites caring for vulnerable populations prioritized early. Health Department (SFDPH) and community linkage navigators were trained on RAPID and made aware of RAPID-trained HIV clinicians. Dates of HIV diagnosis, first care visit, ART initiation, and first virologic suppression (HIV RNA<200 c/mL) were abstracted from the SFDPH HIV case registry. Results: From 2013 to 2016, median time from diagnosis to first virologic suppression in San Francisco decreased 54%, from 134 to 61 days. Decreases were seen across the RAPID continuum, in time from diagnosis to care (38%, from 8 to 5 days), care to ART initiation (96%, from 27 to 1 day), and ART to first suppression (46% from 70 to 38 days). Among subpopulations (figure), by 2016, time from diagnosis to care ranged from 3 days (youth 13-29 years) to 6 days (African Americans); time from care to ART was lowest among youth, Latinos, and Asians/Pacific Islanders (0 days), and highest among African-Americans and the homeless (6 days), despite improvements in these latter two groups, with 82% and 76% decrease in 2013-2016, respectively. Conclusion: During a multisector initiative to optimize ART initiation across San Francisco, time from diagnosis to first virologic suppression was cut by more than 50%. Immediate ART initiation at care was achieved across many populations, but challenges remain in subpopulations such as the homeless.

Oral Abstracts

92 CLINICAL PRESENTATION OF HIV DIFFERS BY AGE IN VACS (2010-2015) Amy C. Justice 1 , Kirsha S. Gordon 2 , Shelli Feder 2 , Neel R. Gandhi 3 , Lydia A. Barakat 2 , Maria Rodriguez-Barradas 4 , Vincent C. Marconi 3 , Sheldon T. Brown 5 , Julie A. Womack 2 , Janet Tate 2 1 VA Connecticut Healthcare System, West Haven, CT, USA, 2 Yale University, New Haven, CT, USA, 3 Emory University, Atlanta, GA, USA, 4 Michael E. DeBakey VA Medical Center, Houston, TX, USA, 5 James J. Peters VA Medical Center, Bronx, NY, USA Background: Many clinicians tell concerning stories about older people being diagnosed with advanced HIV after undergoing extensive and extended workups for alternative causes at respected medical centers. While provider’s failure to consider HIV may explain some of the problem, we ask at time of HIV diagnosis: 1) Does HIV present differently among older compared with younger individuals? and 2) Among 60+ year old individuals, do conditions co-occurring at diagnosis differ from uninfected controls? Methods: Using a previously validated algorithm requiring detectable HIV-1 RNA prior to ART initiation, we reviewed incident HIV diagnoses from 2010-2015 within the Veterans Healthcare System and compared with demographically matched uninfected controls. Electronic health record data including diagnostic codes and laboratory data were obtained from the national corporate data warehouse. AIDS defining illnesses were identified using validated ICD-9 codes and present if assigned within 1 year before or 6 months after a confirmed HIV diagnosis. Results: 3000 incident HIV infections were matched to 5449 controls with complete data. Despite HIV+ diagnosed at 60+ years having been in care twice as long as HIV+ diagnosed under 40 years (5 vs. 10 years, p<0.001), those diagnosed at 60+ years were 1.5-2.4 times more likely to have advanced HIV disease indicated by AIDS defining conditions, CD4 count <200/ ml., or HIV-1 RNA>106 /ml (Table, p<0.001). Compared to HIV+ diagnosed when < 40 years of age, bacterial pneumonia, herpes zoster, anemia, lymphocytopenia, and thrombocytopenia were 2-3 times more common at diagnosis among HIV+ 60+ years. While these conditions also increased with age for controls, they remained 2-7 times more common among HIV+ than uninfected 60+ year olds. Conclusion: At the time of diagnosis with HIV, older people present with more advanced disease than younger counterparts. Associated conditions including: pneumonia, herpes zoster, anemia, lymphocytopenia, and thrombocytopenia are more common among HIV+ at all ages, but increase with age among both HIV+ and controls which may contribute to the delay in HIV diagnosis.

94 SAME-DAY ART INITIATION AFTER HOME-BASED HIV TESTING: A RANDOMIZED CONTROLLED TRIAL Niklaus D. Labhardt 1 , Isaac Ringera 2 , Thabo I. Lejone 2 , Thomas Klimkait 3 , Josephine Muhairwe 2 , Alain Amstutz 1 , Tracy R. Glass 1 1 Swiss Tropical and Public Health Institute, Basel, Switzerland, 2 SolidarMed, Luzern, Switzerland, 3 University of Basel, Basel, Switzerland Background: In sub-Saharan Africa, home-based HIV testing is frequently used to increase awareness of HIV status. However, effectiveness of this approach is limited by low percentages of individuals tested positive who link subsequently to care and start antiretroviral therapy (ART). The CASCADE trial tests if same-day home-based ART initiation improves linkage to care, retention in care and viral suppression in rural Lesotho, Southern Africa. Methods: This open-label randomized controlled trial assigned individuals to either same-day ART start ([SD] arm) or referral to nearest clinic for preparatory counseling and ART start after ≥2 pre-ART clinic visits (standard of care SOC arm). Consenting ART-naïve HIV-infected individuals aged ≥18 years found HIV positive during home-based testing were eligible. Primary endpoints were

34

CROI 2018