CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: The tool scoring was based on (i) age under 25 years, (ii) cohabitation with partner, (iii) secondary education, (iv) bleeding between periods and (v) the number of sex partners without condom use (minimum score 0, maximum score 5). Women’s risk was categorized as low (score=0), moderate (score=1-2) and high (score>=3). In a clinical trial of IUD use among HIV+ women in Cape Town, South Africa (NCT01721798), a nurse administered the screening tool prior to RTI testing for Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) via GeneXpert® nucleic acid amplification testing; Trichomonas vaginalis (TV) and bacterial vaginosis (BV) via OSOM® BV Blue and Trichomonas for genital tract specimens; and Treponema pallidum (TP) with Alere® Determine Syphilis rapid diagnostic tests for whole blood. The sensitivity, specificity, and likelihood ratio of both positive and negative results for any RTI, as well as for NG/CT/TV and for NG/CT were calculated. We also explored categorizing the score as 0 vs 1-5, 0-1 vs. 2-5 and 0-2 vs. 3-5. Results: Of 302 women included, 47% (n=144) were antiretroviral treatment (ART) naïve and the mean age was 31.2 years (range, 18-41). The overall prevalence of any RTI was 37% (NG=8%, CT=10%, TV=11%, BV=16% and TP=2%; 7% of women with multiple infections). RTI prevalence was higher for ART-naïve women compared to women using ART (Table 1). Overall, 4%, 27% and 69% of women had screening tool scores of 0, 1 or 2+, respectively; mean scores did not differ by RTI (infected=1.97 vs uninfected=1.93, p=0.727) but were significantly higher in ART-naïve women vs those on ART (2.17 vs 1.7, p<0.001). At the recommended threshold of 1+, the tool demonstrated high sensitivities but very low specificities; at a threshold of 2+ and 3+, the tool demonstrated high negative predictive values. The performance of the tool did not differ by ART use or specific type of RTI. Conclusion: This risk screening tool provided little value in distinguishing women with RTI. Given the high prevalence of RTI in HIV+ women in this setting, there is an urgent need for low-cost diagnostic testing technologies.

ART services utilized. Data from the 10 clinics were pooled to evaluate median time per patient spent for each activity and total duration of stay in the clinic. Results: The percentage of observed clinical time spent on direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4 minutes, interquartile range [IQR] 2-7), 46.1% for nurses (3 minutes, IQR 2-4), 57.2% for pharmacy technicians (2 minutes, IQR 1-2), and 78.5% for clinical officers (3 minutes, IQR 2-5). Direct patient workloads for the HCWs were heaviest between 8AM and 12PM with little or no clinical activities observed after 2PM (Figure). The length of patient clinic visits was inversely associated with arrival time – patients arriving prior to 8AM spent nearly twice as much time at the clinic as those arriving after 8AM (277 vs. 171 minutes). Overall, patients spent 219 minutes on average for non-clinical visits, and 244 minutes for clinical visits, but this difference was not significant in rural clinics. In comparison, total time patients spent directly with clinic staff were 9 and 12 minutes on average for non-clinical and clinical visits. Conclusion: Current Zambian ART clinic operations include substantial inefficiencies for both patients and HCWs, with workloads heavily concentrated in the first few hours of clinic opening, limiting HCW and patient interaction time. Redistributing workloads throughout operational hours and preventing backlogs of patients waiting for hours before clinic opening may substantially improve ART delivery in the Zambian context.

Poster Abstracts

1077 EFFECT OF UNDISCLOSED HIV+ STATUS ON LINKAGE TO AND RETENTION IN CARE Neena M. Philip 1 , Yingfeng Wu 1 , Margaret McNairy 2 , Averie B. Gachuhi 1 , Matthew R. Lamb 1 , Harriet Nuwagaba-Biribonwoha 1 , Veli M. Madau 3 , Sean Burke 3 , Zandile Mnisi 4 , Wafaa M. El-Sadr 1 1 ICAP at Columbia University, New York, NY, USA, 2 Weill Cornell Medicine, New York, NY, USA, 3 ICAP at Columbia University–Swaziland, Mbabane, Swaziland, 4 Ministry of Health, Mbabane, Swaziland Background: Link4Health, a cluster randomized controlled trial in Swaziland, found that a combination intervention strategy (CIS) versus standard of care (SOC) was associated with a 50% increase in linkage to care and 12-month retention after a HIV-positive (HIV+) test. CIS comprised five interventions: point of care CD4 count, accelerated ART initiation, health educational packages with disclosure support messaging, SMS reminders, and non-cash financial incentives. We assessed predictors of HIV disclosure and its effect on linkage and retention outcomes. Methods: Adults ≥18 years, newly testing HIV+ were recruited. Demographics, psycho-social factors, and disclosure of HIV+ status were collected at baseline, month 1 (M1) and month 12 (M12). The primary outcome was a combined measure of linkage to care within one month plus retention in care at 12 months after HIV testing. Hierarchical Poisson regression models with random effects of study sites were used to estimate adjusted relative risk ratios and 95% confidence intervals (CI) (Table).

1076 IDENTIFYING OPERATIONAL CHALLENGES IN ZAMBIAN ART CLINICS: A TIME AND MOTION STUDY Radhika Tampi 1 , Taniya Tembo 2 , Arianna L. Zanolini 2 , Anjali Sharma 2 , David Dowdy 1 , Charles B. Holmes 1 , Mpande Mukumbwa-Mwenechanya 2 , Carolyn Bolton Moore 2 , Izukanji Sikazwe 2 , Austin Tucker 1 , Hojoon Sohn 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Center for Infectious Disease Research in Zambia, Lusaka, Zambia Background: The mass scale-up of antiretroviral therapy (ART) in Zambia has taken place in the context of limited infrastructure and human resources resulting in many operational side-effects. In this study, we aimed to empirically measure current workload of ART clinic staff and patient wait times and service utilization. Methods: We conducted time and motion (TAM) studies from both the health care worker (HCW) and patient perspectives at 10 ART clinics in three provinces (Lusaka, Southern, and Eastern) in Zambia. A team of trained personnel recorded times for consecutive discrete activities based on direct observation of clinical and non-clinical activities performed by counselors, clinical officers, nurses, and pharmacy technicians. For patient TAM, we recruited consecutive consenting patients and recorded their times of arrival and departure and major

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