CROI 2018 Abstract eBook

Abstract eBook

Oral Abstracts

Results: From June 2016-May 2017, 400 adults were enrolled (CHCs: 382, clinic: 18), 12 (3%) withdrew before 24 weeks, and 383 (96%) completed 24 weeks by August 31, 2017. Participants’ mean age was 38 years, 57%were women, and median daily income was US$0.86. At baseline, the mean CD4 count among participants was 557 cells/μL and 76% had VL<400 copies/ml. In ITT analyses, 8% of participants in both groups did not have a 24-week VL measure and were considered unsuppressed. There was a trend towards higher VS at 6 weeks in the intervention group (83%) than the control group (76%, p=0.09). However, there was no significant difference between intervention and control groups in proportion achieving VS at 24 weeks (85% vs. 82%, p=0.42). Likewise, incentives had no effect among those not suppressed at baseline, with 60% and 53% achieving 24-week VS in the intervention and control group, respectively (p=0.55). Per-protocol analyses among 351 participants with 24-week VL measures showed no difference in VS, as 90% and 92% achieved VS in both groups (p=0.67). Conclusion: Over a six-month period, FI had no effect on VS rates among HIV-positive ART eligible adults. Provision of VL results to the control group and high baseline VS may have contributed to high rates of VS in both study groups, and incentives may have been provided too infrequently to influence daily medication adherence.

linkage to care and viral suppression. Linkage to care was defined as presenting at the facility within 90 days after tested HIV-positive. Viral suppression was defined as viral load <100 copies/mL 12 months after tested HIV-positive. All analyses were done according to intention to treat. Trial registration: NCT02692027 Results: A total of 274 ART-naïve individuals were enrolled from February to July 2016 (137 in each arm). Baseline participant characteristics were balanced: 65.7% female, median age 39 years, median CD4-cell count of 378 cells/µL, 78.1%were clinically asymptomatic. Linkage to care within 90 days was 68.6% (94/137) in the SD and 43.1% (59/137) in the SOC arm (p<0.001). In the SD arm 50.4% (69/137) had suppressed viral load 12 months after tested HIV-positive versus 37.9% (52/137) in SOC (p=0.039, see figure 1). Ninety days after tested HIV positive, 68.6% (94/137) in the SD and 31.4% (43/137) in the SOC arm had initiated ART (p<0.001). Retention in care 12 months after tested HIV-positive remained higher in the SD arm (56.2% (77/137) versus 43.1% (59/137), p=0.03). Conclusion: Offering same-day ART initiation increased effectiveness of home-based HIV testing through higher proportions linking to HIV care at the facility and being retained in care with viral suppression 12 months after tested HIV-positive. Same-day ART initiation requires little additional resources as health care workers providing home-based HIV testing are already at the patients’ home. If confirmed in other settings, same-day home-based ART initiation could become policy in countries with established home-based HIV testing.

Oral Abstracts

96 EXTENDED-RELEASE NALTREXONE IMPROVES VIRAL SUPPRESSION IN HIV+ PRISONERS Sandra Springer , Marwan Azar, Angela DiPaola, Russell Barbour, Breanne

Biondi, Maua Herme, Frederick Altice Yale University, New Haven, CT, USA

Background: People with HIV, opioid (OUD) and alcohol use disorders (AUD) are concentrated within the criminal justice system (CJS). Upon release from incarceration, drug and alcohol relapse is common and contributes to poor HIV treatment outcomes, increased HIV transmission risk, recidivism and mortality. The specific aim of these two studies was to evaluate extended-release naltrexone (XR-NTX), an FDA-approved medication for OUD and AUD, as a means to improve HIV viral suppression (VS) among persons living with HIV (PLH) released from prison or jail to the community with OUD and AUD. Methods: Two separate double-blind placebo controlled randomized trials were conducted among HIV+ inmates with (1) AUD (INSPIRE, N=100); and (2) OUD (NEW HOPE, N=93) who were transitioning to the community. Participants were randomized 2:1 to receive 6 monthly injections of XR-NTX or placebo starting one week prior to release and continuing for 6 months post-release. The primary outcome was the proportion that maintained VS (<50 copies/mL) at 6 months in an intention to treat (ITT) analysis. Results: Baseline characteristics did not statistically significantly differ between treatment groups in either study. For INSPIRE, the ITT analyses revealed the XR-NTX group was statistically more likely to achieve VS as compared to placebo at 6 months post-release (56·7% vs. 30·3%; p=0.015). After controlling for other factors, receipt of XR-NTX remained independently predictive of VS (aOR=4·54; 95%CI=1·43-14·43, p=0.009). Participants receiving 3 or more injections, irrespective of allocation, were also more likely to achieve VS (aOR=6.34; 95%CI=2.08-19.29, p=0.001 respectively), as were reductions in alcohol consumption (aOR=1·43; 95%CI=1·03-1·98, p=0.033) and white race (aOR=5·37; 95%CI=1·08-27·72, p=0.040). For NEW HOPE, the ITT analyses revealed that the XR-NTX group was more likely to achieve VS at 6

95 RANDOMIZED CONTROLLED TRIAL OF FINANCIAL INCENTIVES FOR ACHIEVING VIRAL SUPPRESSION Harsha Thirumurthy 1 , Devy Emperador 2 , Alex Ndyabakira 3 , Dalsone Kwarisiima 4 , Carol S. Camlin 2 , Moses R. Kamya 5 , Diane V. Havlir 2 , Gabriel Chamie 2 1 University of Pennsylvania, Philadelphia, PA, USA, 2 University of California San Francisco, San Francisco, CA, USA, 3 Makerere University–University of California San Francisco Research Collaboration, Kampala, Uganda, 4 Makerere University Joint AIDS Program, Kampala, Uganda, 5 Makerere University College of Health Sciences, Kampala, Uganda Background: Viral suppression (VS) among HIV-positive individuals is essential for protecting health and preventing new infections. Financial incentives (FI) have shown promise in modifying health behavior in low- income countries but few studies have assessed whether they can increase the likelihood of VS. Methods: Antiretroviral therapy (ART) eligible HIV-positive adults diagnosed at community health campaigns (CHCs) or at a rural clinic in Uganda were randomized to receive FI for achieving VS (viral load<400 copies/mL) at 6, 12, and 24 weeks or to a control group with no FI (NCT02890459). Viral load (VL) was measured at baseline, 6, 12, and 24 weeks; results were disclosed to all participants. At each interval, FI amounts rose from 15,000-45,000 Uganda Shillings (US$4–12.50) with a reset contingency if VS was not achieved. The primary outcome was VS at 24 weeks. The proportions achieving VS in intervention and control groups were compared using chi-squared tests. Intention-to-treat (ITT) analyses and per-protocol analyses were performed for participants enrolled at least 24 weeks prior to August 31, 2017.

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CROI 2018