CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1082 IS DIFFERENTIATED CARE IMPLEMENTED? ANALYSIS OF SEVEN AFRICAN TREATMENT PROGRAMS Andreas D. Haas 1 , Leigh F. Johnson 2 , Izukanji Sikazwe 3 , Nathan Ford 4 , Matthew P. Fox 5 , Hans Prozesky 6 , Cleophas Chimbetete 7 , Jonathan Euvrard 2 , Matthias Egger 1 1 University of Bern, Bern, Switzerland, 2 University of Cape Town, Cape Town, South Africa, 3 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 4 WHO, Geneva, Switzerland, 5 Boston University, Boston, MA, USA, 6 Stellenbosch University, Tygerberg, South Africa, 7 Newlands Clinic, Harare, Zimbabwe Background: Since 2016, WHO has recommended differentiated HIV care models, which adapt the frequency of clinic visits to patients’ needs. WHO recommends virological and immunological criteria to identify stable patients who qualify for less frequent clinic visits, but data on how these criteria are used in African routine care settings are scarce. We compare the frequency of clinic visits among patients classified as stable and unstable according to virological or immunological criteria and assess time trends in appointment spacing. Methods: We included HIV-1 infected adults aged 16 years or older, starting ART between 2004 and 2015 in one of seven programs participating in the International Epidemiology Databases to Evaluate AIDS – Southern Africa (IeDEA-SA). Patients from South Africa (monitored with viral load testing) were classified as stable, if their viral load was <1,000 copies/mL. Patients from Zambia and Zimbabwe (monitored with CD4 cell counts) were classified as stable, if their CD4 cell count was >200 cells/µL and had increased since the last measurement. We analyzed visit times as multiple failure-time data in a survival analysis framework. Patients entered the analysis 1 year after start of ART and were censored at their last visit. We used univariable and multivariable flexible parametric survival models with restricted cubic splines to examine time-dependent effects of patient- and program-level characteristics and the rate of clinic visits. Results: We included 152,338 patients: 71% (108,179) came from two programs with CD4 monitoring, and 29% (44,159) came from five programs with viral load monitoring. The figure shows the rate of clinic visits (per year) and 95% CIs (shaded areas) for stable and unstable patients on ART. In CD4 monitoring sites, the rate of clinic visits in stable patients and unstable patients was similar (Figure A). In viral load monitoring sites, the rate of clinic visits in stable patients was substantially lower than in unstable patients (Figure B). In more recent years, stable patients were followed-up less frequently than in earlier years. This time trend did not change in multivariate models adjusted for CD4 cell count at ART initiation. Conclusion: Programs with viral load monitoring implemented differentiated care models and reduced the frequency of clinic visits in virologically suppressed patients. We found little evidence for differentiated appointment spacing in programs without access to viral load monitoring.

Poster Abstracts

1083 LINKAGE, TREATMENT AND SUPPRESSION IN THE BOTSWANA COMBINATION PREVENTION PROJECT

Pamela J. Bachanas 1 , Refeletswe Lebelonyane 2 , Mary Grace Alwano 3 , William Abrams 3 , Baraedi W. Sento 4 , Lisa Block 5 , Tendani Gaolathe 6 , Shahin Lockman 7 , Shenaaz El Halabi 2 , Janet Moore 1 1 CDC, Atlanta, GA, USA, 2 Botswana Ministry of Health, Gaborone, Botswana, 3 CDC Botswana, Gaborone, Botswana, 4 Tebelopele Voluntary Counseling and Testing Center, Gaborone, Botswana, 5 Intellectual Concepts, Atlanta, GA, USA, 6 Botswana Harvard AIDS Inst Partnership, Gaborone, Botswana, 7 Brigham and Women’s Hospital, Boston, MA, USA Background: Botswana has high rates of HIV diagnosis and treatment coverage, but substantial ongoing HIV incidence and high prevalence. Finding unidentified HIV-positive persons missed by the national testing programs and getting them on treatment is essential for reaching epidemic control. In the Botswana Combination Prevention Project (BCPP), we assessed the degree to which enhanced HIV testing, linkage to care, and universal ART increased HIV testing and treatment coverage, and whether age and gender were associated with differential rates of coverage. Methods: BCPP is a community-randomized trial designed to evaluate the impact of a combination prevention package on population level HIV incidence in 30 communities. HIV testing in the 15 intervention communities included home-based and targeted mobile testing of residents age 16-64. Newly- identified and known HIV-positive persons not on ART were referred to the local HIV clinic for care and universal ART initiation, and linkage to care support was provided for referred individuals who did not register at the clinic. Results: 3,554 HIV-positive persons were newly identified or were known to be HIV-positive but not on ART, and were referred for treatment. Ninety percent (3,184/3,554) of those referred linked to care, and 79% (2,791/3,554) initiated ART. Of those who initiated ART and had a viral load test, 98% (2,006/2,053) were virally suppressed (VL< 400 copies/mL) at > 6 months. Linkage to care rates were lower for males (86%) compared to females (92%), χ2 (1, N= 3,554) = 39.98, p<.0001, and a lower percentage of referred males (75%) initiated ART compared to females (81%), χ2 (1, N= 3,554) = 19.2, p<.0001. Age differences were also found; linkage to care rates were lower for younger persons 16-24 (82%) compared to persons ages 25 and older (91%), χ2 (1, N= 3,554) = 39.6,

CROI 2018 415