CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

facility, we reviewed records at the receiving facility to verify transfer, assess whether treatment identifiers were preserved, identify the date of treatment re-initiation. We used the Kaplan-Meier methods to examine incidence of ART re-initiation after entry into new clinic. Results: Among 350 patients who were lost to follow up and who reported care at a new facility when contacted through intensive tracing effrots , 209 (60%) were successfully verified through chart review at new clinic. Of the 209 verified, 54 (26%) were male, median age was 34.3 (IQR 29-40) and 86%were on ART at the time of last visit at original clinical. The median visit gap did not differ significantly between within (261.5 days, IQR 118-544) vs. cross province transfer (219, IQR 117-599; p=0.95). At the receiving site, 123 (59%) were registered under new ART IDs, 110 (54%) received a new HIV test. Overall, 40.7% initiated ART on the same day as presentation to new facility. The proportion who restarted ART at the receiving clinic increased to 54.1% (95% CI: 47.5%- 60.9%) by 30 days, 66.0% (95% CI: 59.6%-72.4%) by 90 days, and 67.9% (95% CI: 61.6%-74.2%) by 180 days (Fig 1). Conclusion: Movement from clinic-to-clinic involves both administrative as well as clinical inefficiencies. Many patients use new identifiers and names at new facilities. Re-entry into a new clinics among the silent transfer is often delayed and timely reiinitiation of treatment is inconcsistent, suggesting interruptions in treatment. Health systems innovations to ensure smooth and safe between-clinic transfers is needed to advance the public health response.

1090 PHONE CALL FROM CLINICAL OFFICER AT HIV TESTING/RE-CONTACT IMPROVES LINKAGE TO CARE James Ayieko 1 , Erick Wafula 2 , Wilson Opudo 3 , Craig R. Cohen 2 , Elizabeth A. Bukusi 1 , Tamara D. Clark 2 , Laura B. Balzer 4 , Moses R. Kamya 5 , Edwin D. Charlebois 2 , Maya L. Petersen 6 , Diane V. Havlir 2 1 Kenya Medical Research Institute, Nairobi, Kenya, 2 University of California San Francisco, San Francisco, CA, USA, 3 Kenya Medical Research Institute, Kisumu, Kenya, 4 Harvard University, Cambridge, MA, USA, 5 Makerere University, Kampala, Uganda, 6 University of California Berkeley, Berkeley, CA, USA Background: In the SEARCH HIV test-and-treat study, linkage to care rates declined after two years. After achieving “90-90-90”, we noted that prior non- linkers and new infection cases were harder to link to care. We had separately observed that patients who linked but subsequently defaulted from care often re-engaged after a personal phone call from a clinical officer. We therefore tested whether a phone call to patients at time of initial HIV diagnosis or, among those not currently in care, at time of re-contact at community health campaigns (CHC) or home-based testing (HBT) could improve linkage. Methods: We conducted a nested randomized controlled trial during year two of the SEARCH study (NCT01864603; August-December 2016). Previously diagnosed HIV+ adults currently not engaged in care (Never linked and Lost to follow up) and newly diagnosed HIV+ adults were randomized at CHC or HBT to receive an immediate phone call from a clinical officer or no phone call. All participants received ART messaging and a one-time transport voucher for linkage. Intervention participants also received a phone call establishing a personal connection, reinforcing ART messaging, discussing linkage barriers and scheduling appointment. Linkage was defined as clinic enrollment and completion of first clinic visit. We compared the proportion linking by 7 and 30 days after randomization between intervention and control arms using Pearson chi-square tests without continuity correction. Results: A total of 130 participants were randomized (68 intervention, 62 control); 88 (68%) were newly diagnosed and 42 (32%) were not currently in care. Median age was 31 years (IQR 27-40), 26.9%were male. Participants in the intervention group were more likely than those in the control group to link to care by 7 days (24/68, 35.3% vs. 12/62,19.4%, p=0.043). The effect of the intervention was maintained at 30 days (28/68, 41.1% vs. 15/62, 24.2%, p=0.040). Conclusion: A single phone call from a clinical officer to participants at the time of HIV testing or re-contact significantly improved linkage to care. However, overall linkage rates were low two years after initiation of universal test-and-treat. As the demographics of new diagnoses change and “hard to engage” patients comprise an increasing proportion of those not linked, additional innovative linkage interventions are needed. 1091 UNDERSTANDING PATIENT MOBILITY IN HIV +VE ADULTS ACROSS MULTIPLE CLINICS IN ZAMBIA Kombatende Sikombe 1 , Sandra Simbeza 1 , Jillian L. Kadota 1 , Ingrid Eshun- Wilson 2 , Laura Beres 3 , Carolyn Bolton Moore 4 , Njekwa Mukamba 1 , Charles B. Holmes 3 , Izukanji Sikazwe 1 , Elvin Geng 5 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Stellenbosch University, Cape Town, South Africa, 3 Johns Hopkins University, Baltimore, MD, USA, 4 University of Alabama at Birmingham, Birmingham, AL, USA, 5 University of California San Francisco, San Francisco, CA, USA Background: Many patients in HIV care in Africa considered lost to follow up (LTFU) at one facility are report accessing care in another. To date, however, the success of these unofficial transfers – as measured by time to re-entry at the new facility, prevalence of treatment interruptions, speed of treatement re- initiation and preservation of identifiers – has not been characterized, but may reveal opportunities for improvement. Methods: We traced a random sample of HIV infected patients in Zambia who were lost to follow-up. Among those found alive and reporting care at a new

Poster Abstracts

1092 RISK FOR ATTRITION IN HIV-INFECTED CLIENTS ON TREATMENT IN URBAN HIV CLINICS IN KENYA Emily C. Koech 1 , Sylvia Ojoo 2 , Caroline Ngunu 3 1 University of Maryland, Baltimore County, Baltimore, MD, USA, 2 University of Maryland, Baltimore, MD, USA, 3 Ministry of Health, Nairobi, Kenya Background: Despite efforts to scale-up antiretroviral therapy (ART) in Kenya, 12 month retention is around 80%. Lack of a national referral system impedes patient tracking worsened in urban settings by numerous HIV clinics and highly mobile populations. Through PEPFAR-CDC funding, the University of Maryland, Baltimore (UMB) collaborates with NCC to provide ART for over 22,000 patients in 32 facilities by June 2017. To minimize attrition, (transfer-out {TO}, lost-to-follow-up {LFTU} or death) UMB developed a retention system comprising: patient education for self-management, case-management for vulnerable patients, and a robust appointment management and tracking system. Understanding risk factors for attrition may support enhancement of our retention strategies Methods: A retrospective analysis was undertaken of ART patient attrition between October 1, 2016 and June 30, 2017 from 25 facilities. Data was abstracted from both paper and electronic medical records, and statistical analysis conducted using Stata Version 13. Descriptive and bivariate analyses were used to determine statistical significance at 95% confidence interval (CI) Results: A total of 1,576 attritions occurred during this period; 803 (51%) TO, 654 (42%) LTFU and 117 (7%) died with a median duration on ART of 8 months (0-199 months). The majority were female 1,121(71%) and aged 25-49 years 1,117 (71%). Overall, 74% of attritions were from the facility of ART initiation, while 26% transferred-in (TI) on ART. Odds of attrition among TI were 6.2 times

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