CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1080 HIV CARE DELIVERY BY ID PHYSICIANS, OTHER PHYSICIANS, AND ADVANCED PRACTICE PROVIDERS John Weiser 1 , Guangnan Chen 2 , Wendy S. Armstrong 3 , Linda Beer 1 1 CDC, Atlanta, GA, USA, 2 ICF International, Atlanta, GA, USA, 3 Emory University, Atlanta, GA, USA Background: The United States is facing a shortage of HIV care providers. Ensuring workforce stability requires knowledge of the demographics, clinical practices, and work satisfaction of infectious disease (ID) physicians, other physicians, nurse practitioners (NPs) and physician assistants (PAs) who provide HIV care. Methods: We surveyed 1,234 HIV care providers between 6/2013-1/2014. Providers were eligible if practicing in a facility sampled for the Medical Monitoring Project, a survey designed to produce nationally representative data about adults receiving HIV care in the United States. Data were weighted to represent all HIV care providers. We assessed associations between provider type and other characteristics. Results: In the United States, 45% of HIV care providers were ID physicians, 35% other physicians (15% internal medicine, 13% family medicine, 1% pediatrics, 6% not board certified, other, or unknown), 15% NPs, and 5% PAs. Compared to ID physicians, larger percentages of other physicians provided primary care and care in a language other than English (Table). More NPs than ID physicians cared for >50 HIV patients and worked at Ryan White HIV/AIDS Program-funded facilities. Larger percentages of other physicians and NPs were black or Hispanic and were lesbian/gay/bisexual compared to ID physicians. There were no differences among providers in ordering of genotypes on all new patients or initiating antiretroviral therapy (ART) regardless of CD4+ T-lymphocyte cell count. Larger percentages of NPs than ID physicians provided comprehensive ART adherence counseling and reproductive counseling for women, and adequate sexual and substance use risk-reduction services. Nearly half of ID physicians provided HIV expert assistance to other providers. One-third of ID physicians and one-quarter of other physicians were satisfied with salary and with administrative burden. Conclusion: Performance on most key HIV quality measures was comparable across provider types, although NPs outperformed ID physicians in several areas. ID physicians played a critical role in providing HIV expert assistance to NPs, PAs, and other physicians, nearly all of whom also provided primary care in addition to HIV treatment. Of concern, a large majority of physicians, particularly non-ID physicians, were dissatisfied with salary and administrative burden. Addressing concerns about provider remuneration could help retain and attract providers to the field of HIV care.

1081 BETTER RETENTION AMONG PATIENTS ON ART ARGUES FOR UNIVERSAL TREATMENT IN KENYA Irene Mukui 1 , Maureen Kimani 1 , Samuel M. Mwalili 2 , Agnes Natukunda 3 , Evelyne Ngugi 2 , Abraham Katana 2 , Lucy Ng’ang’a 2 , Peter W. Young 2 , George Rutherford 3 1 Ministry of Health, Nairobi, Kenya, 2 US CDC Nairobi, Nairobi, Kenya, 3 University of California San Francisco, San Francisco, CA, USA Background: Understanding outcomes of patients in HIV care and on antiretroviral therapy (ART) is critical in monitoring progress towards achieving the 90-90-90 treatment targets. The Longitudinal Surveillance of Care and Treatment in Kenya surveyed outcomes for retrospective cohorts of adult and adolescent patients in care Methods: We studied a nationally representative random sample of HIV infected patients aged ≥15 years enrolled in care between 2003-2013 from 50 health facilities providing ART. We evaluated overall, pre-ART and ART retention, defined as being alive and not missing last appointment by >90 days. We analyzed baseline demographic, clinical and laboratory variables, ART initiation and retention using Kaplan-Meier analyses and log-linear modeling; data were weighted to account for survey design Results: We sampled 3152 patients followed for a median of 30.3 months (IQR 6.5-65.8 months). Overall, 1161 (33.8%) were retained in care at the end of follow up, 187 (5.9%) died, 427 (14.5%) transferred out and 1,329 (44.3%) were lost to follow up. Baseline factors associated with overall retention were female sex (p<0.001), being married (p<0.001), higher enrollment CD4 (p<0.001) and enrollment under recent ART guidelines (CD4 based ART eligibility of ≥ 350 cells/µL versus eligibility at < 350 cells/µL) (p<0.001). Among all patients median pre-ART retention was 23 months (Figure); 2,152 (68.3%) began ART after a median of 2.0 months (IQR, 0.7-11.4) in care. Among those who started ART, 122 (5.9%) died, 276 (13.3%) transferred out, 576 (26.9%) were LTFU and 1131 (51.8%) were retained a median of 132 months. Factors associated with ART retention were being employed (p=0.006), higher enrollment CD4 (p=0.001) and enrollment during more recent guideline period (p<0.001). Those initiating ART versus those not were more likely to be older (>25 years, OR=1.8, 95% CI 1.4-2.2) and enrolled in care from 2010–2013 versus 2003–2005 (OR=1.5, 95% CI 1.1–2.1) Conclusion: Data from the pre-universal ART era in Kenya demonstrate that almost one third of patients in pre-ART care had not started ART by the end of 2016, but once initiating ART, patients were retained a median of 11 years. Our study suggests that by encouraging early treatment initiation, new guidelines implementing universal ART should improve overall retention of PLHIV in care.

Poster Abstracts

CROI 2018 414