CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

care was defined as a clinic visit 3-9 months after ART initiation and compared between patients who picked up food vs patients who did not pick up food. Differences in demographics were compared using Wilcoxon and Chi-Square tests. Logistic regression was used to examine the effect of food pick-up on retention, controlling for age, gender, province, weight and CD4 count. Results: 1,909 patients initiated ART and were eligible for food during the study period. 492 patients voluntarily picked up food (case cohort) and 1,417 did not (control cohort). Reasons for not picking up food were inconvenient wait times, unavailable food on day of HIV clinic, disinterest, and lack of knowledge of food availability. Cases were older (39.0 vs 37.1 years), weighed less (59.0 vs 61.2 kg), and more likely to be female (61.6% vs 55.9%) compared to controls (p<0.001). Residence (87% Port-au-Prince), annual income (77%≤$1/day), CD4 count (mean 445 cells/uL), and ART regimen (97% 3TC+TDF+NVP/EFV) were not significantly different between the cohorts. Median time to first food pick-up after ART initiation was 14 days [IQR 12, 59], median time between pick-ups was 30 days [IQR 2, 64], and median number of pick-ups was 5 packages. Early retention in care was 86% in cases vs 67% in controls, with an adjusted OR 2.81 [95% CI: 2.05, 3.84]. There is a significant difference in the likelihood of being retained in care seen at ≥ 4 food pick-ups [Table 1]. Conclusion: Among HIV patients who newly initiated ART, there was a positive association between receiving food and early retention in HIV care. Causality is not established and the effect of longer term retention must be evaluated. However, these positive initial results suggest time-limited interventions, including food, may reduce early attrition in HIV care.

(IQR: 2.38-6.23) showing declining trends from 1996 to around 2010 and small increases thereafter. The percentage of diagnosed was lower among MSW (Men/women who have sex with Women/men) compared to that in MSM (Men sex with Men) or PWID (People Who Inject Drugs), and MSW had also the longest time interval from SC to diagnosis. Most MSM were linked to care, while a substantial proportion of PWID were not. When linked to care, 2/3 of PWID initiated ART. However, when PWID started ART, they remained on care in similar proportions to MSM. Unlike PWID, a high proportion of the MSM and MSWwho remained on care achieved viral suppression. Conclusion: At the end of 2013, there were weaknesses in the HIV CoC in Greece, which also differed across risk groups. Targeted interventions are necessary focusing on early diagnosis and timely linkage. A by risk group 6-stage CoC accompanied by quality indicators provide useful public health data and should be implemented when possible.

Poster Abstracts

1097 IMPACT OF SYSTEMS NAVIGATION AND COUNSELING ON ART, SUT AND DEATH IN PWID: HPTN 074 William C. Miller 1 , Irving Hoffman 2 , Brett Hanscom 3 , Tran V. Ha 2 , Kostyantyn Dumchev 4 , Zubairi Djoerban 5 , Scott M. Rose 6 , Kathryn E. Lancaster 1 , Vivian Go 2 , Sarah Reifeis 2 , Estelle Piwowar-Manning 7 , Carl A. Latkin 7 , David Metzger 8 , David Burns 9 1 The Ohio State University, Columbus, OH, USA, 2 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 3 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 4 Ukrainian Institute on Public Health Policy, Kyiv, Ukraine, 5 University of Indonesia, Jakarta, Indonesia, 6 FHI 360, Durham, NC, USA, 7 Johns Hopkins Hospital, Baltimore, MD, USA, 8 University of Pennsylvania, Philadelphia, PA, USA, 9 NIAID, Bethesda, MD, USA Background: People who inject drugs (PWID) experience high HIV incidence, poor access to HIV care, and high mortality in worldwide. Interventions to engage HIV-infected PWID in care and reduce transmission are needed. We report the impact of an integrated systems navigation and psychosocial counseling intervention on HIV and substance use outcomes. Methods: HPTN 074 is a randomized, controlled vanguard study among PWID conducted in Ukraine, Indonesia, and Vietnam. HIV-infected index participant eligibility included age 18-60 years; active injection drug use; viral load ≥1,000 copies/mL, CD4 >50cells/mm 3 , and ability to identify and enroll at least 1 HIV-uninfected injection partner. Up to 5 HIV-uninfected active injection partners were enrolled per index. Index PWID were randomly assigned to standard of care (SOC) or a systems navigation and psychosocial counseling intervention (SNPC). Session number and topics varied based on indexes’ needs. Antiretroviral therapy (ART) and substance use treatment (SUT) referrals were made to existing local services. Outcome measures included ART uptake (indexes only), SUT uptake, mortality, and HIV incidence (partners only). Results: Overall, 502 indexes and 806 partners were enrolled over 15 months and followed for 12-24 months. Among indexes, 85%were men; most women enrolled in Ukraine. Median age was 35 years. Retention was high at week 52 (86% index; 75% partners). At week 26, SNPC indexes were twice as likely to report ART use as compared to SOC (77% vs 38%, risk ratio (RR)=2.0, [95% CI: 1.7, 2.5]; Figure 1). The effect persisted at week 52 (77% vs 49%; RR=1.6 [CI: 1.3, 1.8]). Among SNPC indexes, SUT uptake was increased (hazard ratio (HR)=2.7 [CI: 1.8, 4.1]) and mortality was reduced by half (mortality rate=5.6/100 person-years (PY) vs 12.1/100 PY, HR=0.47 (CI: 0.22, 0.90). The survival benefit was also significant among SNPC partners (HR=0.17 (CI: 0.01, 0.84). Incident HIV

1096 HIV CASCADE OF CARE IN GREECE: USEFUL INSIGHTS FROM ADDITIONAL STAGES Giota Touloumi 1 , Georgia Vourli 1 , Vasileios Paparizos 1 , Athanassios Skoutelis 2 , Simeon Metallidis 3 , Panagiotis Gargalianos 1 , Antonios Papadopoulos 1 , Maria Chini 4 , Nikolaos Sipsas 1 , Mina Psychogiou 1 , Georgios Chrysos 5 , Helen Sambatakou 1 , Charalambos Gogos 6 , Dimitra Paraskeva 7 , Georgios Nikolopoulos 8 1 University of Athens, Athens, Greece, 2 Evaggelismos General Hospital, Athens, Greece, 3 Aristotle University of Thessaloniki, Thessaloniki, Greece, 4 Red Cross Athens General Hospital, Athens, Greece, 5 Tzaneio General Hospital of Piraeus, Piraeus, Greece, 6 University of Patras, Patras, Greece, 7 Hellenic Center of Disease Control and Prevention, Athens, Greece, 8 University of Nicosia, Nicosia, Cyprus Background: Aiming to HIV infection elimination, UNAIDS set the 90-90-90 target by 2020. We aimed to construct a six-stages HIV Cascade of Care (CoC) in Greece (overall and by risk group) along with qualitative indicators, to depict the current situation towards the UNAIDS goal and to assess risk group and stage- specific weaknesses. Methods: The CoC included: i) number of people living with HIV (PLHIV) by the end of 2013; ii) proportion of PLHIV ever diagnosed; iii) proportion of diagnosed linked to care iv) proportion of linked who ever initiated ART; v) proportion of treated retained in care vi) proportion of the retained in care who are virally suppressed (≤200 copies/mL) at last visit (01/07/2012-31/12/2013)]. It combined surveillance data from the Hellenic Center of Disease Prevention and Control and the AMACS HIV seropositive cohort study. The number of PLHIV was estimated using back-calculation models. The interval from seroconversion (SC) to diagnosis was estimated based on a recently published method while from diagnosis to treatment initiation based on the AMACS. Results: 14147 PLHIV were in Greece at the end of 2013; of these, 78.4%were diagnosed; of the diagnosed, 86%were linked to care; 78.5% of those linked initiated ART; 86.4% of the ever treated group were retained on care; and of these, 87.1%were virally suppressed (Table). Overall, 42.6% of PLHIV were virally suppressed. The median time from HIV SC to diagnosis was 3.89 years

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