CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: To reduce the time spent with unsuppressed HIV RNA after linkage to care, interventions that jointly improve consistent engagement in care, ART use, and VS among PWH receiving care are needed, particularly for women and blacks.

infections among partners occurred only in the SOC arm (SNPC=0 cases/215.6 PY; SOC=7 cases/683.6 PY). Conclusion: Facilitating ART and SUT referrals through systems navigation, combined with flexible counseling, doubled ART and SUT uptake. Mortality among HIV-infected PWID and their HIV-uninfected partners was reduced. HIV incidence among uninfected partners of indexes receiving the intervention may have been reduced, but the overall number of incident infections was low.

1099 OUTCOMES OF PATIENTS LOST TO FOLLOW-UP IN AFRICAN ART PROGRAMS: MULTI-COHORT STUDY

Frédérique Chammartin 1 , Kathrin Zürcher 1 , Hannock Tweya 2 , Paula Braitstein 3 , Ralf Weigel 4 , Kathryn Chu 5 , Elvin Geng 6 , Agnes Kiragga 7 , Charles Kouanfack 8 , Cristina Ardura-Garcia 4 , Takuma Kato 9 , Hilary Gunguwo 10 , James R. Hargreaves 11 , Matthias Egger 1 1 University of Bern, Bern, Switzerland, 2 Lighthouse Trust Clinic, Lilongwe, Malawi, 3 University of Toronto, Toronto, ON, Canada, 4 Liverpool School of Tropical Medicine, Liverpool, UK, 5 MSF, Johannesburg, South Africa, 6 University of California San Francisco, San Francisco, CA, USA, 7 Makerere University, Kampala, Uganda, 8 Central Hospital of Yaoundé, Yaounde, Cameroon, 9 National Center for Global Health and Medicine, Tokyo, Japan, 10 Mpilo Central Hospital, Bulawayo, Zimbabwe, 11 London School of Hygiene & Tropical Medicine, London, UK Background: Following the massive scale up over the past 10 years of combination antiretroviral therapy (cART) in sub-Saharan Africa, retention in care has emerged as an important threat to reaching the UNAIDS 90-90-90 targets to end the HIV epidemic. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African ART programs. Methods: Collaborative multi-cohort analysis. Longitudinal studies of patients who started ART for their own health in programs in sub- Saharan Africa, were LTFU and actively traced to establish their vital status were eligible. We searched PubMed, EMBASE and LILACS to identify eligible studies and asked authors to participate. We analyzed outcomes ‘died’, ‘stopped cART’, ‘transferred to other clinic’ and ‘not found’ in a competing risk framework using non-parametric cumulative incidence functions. We used a proportional hazards model for the sub-distribution of competing risks (Fine & Gray 1999) to assess associations of patient characteristics with outcomes. Results: Ten studies contributed data on 8,529 patients who started cART in one of seven countries (Cameroon, Kenya, Malawi, Mozambique, Uganda, Zambia, Zimbabwe). Most patients were adults (8,329; 97.7%) and from one of three treatment programs in Malawi (5472; 64.2%). The median CD4 count at the start of cART was 120 cells/µl (interquartile range [IQR] 46-212), the median year of starting cART was 2007 (IQR 2006-2009). Five years after ART initiation, an estimated 23.1% (95% CI 22.1-24.0%) had died, 23.1% (22.2-24.1%) were alive but had stopped cART, 15.5% (14.7-16.3%) had transferred to another clinic and 32.3% (31.3-33.3%) could not be found (Figure). Mortality was associated with male sex and lower baseline CD4 count, stopping cART with higher CD4 count and transfer with female sex and less advanced clinical stage. Death, stopping cART and unsuccessful tracing were all associated with shorter duration of cART. Unsuccessful tracing was also associated with younger age. Conclusion: Mortality is high among patients LTFU. It is essential to account for outcomes of patients LTFU for unbiased assessments of program outcomes and UNAIDS targets in sub-Sahara Africa. Early tracing of patients LTFU should be a priority.

1098 TRENDS IN UNSUPPRESSED HIV RNA AFTER LINKAGE TO CARE AMONG KEY POPULATIONS Fidel A. Desir 1 , Catherine R. Lesko 1 , Richard D. Moore 1 , Michael A. Horberg 2 , Peter F. Rebeiro 3 , Michael John Gill 4 , Mari Kitahata 5 , Michael J. Silverberg 6 , Julie H. Levison 7 , Marina Klein 8 , Angel Mayor 9 , Amy C. Justice 10 , Keri N. Althoff 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 3 Vanderbilt University, Nashville, TN, USA, 4 University of Calgary, Calgary, AB, Canada, 5 University of Washington, Seattle, WA, USA, 6 Kaiser Permanente Northern California, Oakland, CA, USA, 7 Harvard University, Cambridge, MA, USA, 8 McGill University Health Centre Research Institute, Montreal, QC, Canada, 9 Universidad Central del Caribe, Bayamon, Puerto Rico, 10 VA Connecticut Healthcare System, West Haven, CT, USA Background: Maintaining consistent engagement in care, antiretroviral therapy (ART) use, and viral suppression (VS) after linkage to HIV care among persons with HIV (PWH) is a cornerstone of HIV transmission prevention. The US National HIV/AIDS Strategy set forth goals to improve HIV care in PWH from specific key populations, including men who have sex with men (MSM). Our objective was to examine trends in unsuppressed HIV RNA among PWH from key populations newly linked to care. Methods: We studied adult PWH from 8 key populations who successfully linked to care (i.e., ≥2 HIV care visits in ≤12 months) for the first time between 2000-10 in 11 US clinical cohorts in the NA-ACCORD: MSM, men who have sex with women (MSW; men with known transmission risk who did not report male- to-male sexual contact), women, young PWH (ages 18-24), blacks, Hispanics, PWH living in the South (PLS), and persons who inject drugs (PWID). PWH were followed from HIV care linkage until 5 years after linkage, 31 December 2014, or death, whichever occurred first. We added and subtracted cumulative incidence curves for ART initiation, disengagement from care (i.e., not having ≥1 HIV care visit, CD4 count, or HIV RNA measure in ≤12 months), re-engagement in HIV care, VS (HIV RNA ≤200 c/mL), and loss of VS. We then integrated the area between the curves to estimate the mean person-time spent in care but not on ART or virally suppressed (i.e., unsuppressed HIV RNA) in the first 5 years after linkage to care in each key population and its corresponding counter-population (e.g., MSM vs. non-MSM), by year of linkage to care. As appropriate for each key population, analyses were adjusted for age, sex, race, HIV transmission risk, site, CD4 count, and HIV RNA at linkage. Results: A total of 28,839 PWH (54%MSM, 20%MSW, 22%women, 44% black, 13% Hispanic, 12% PWID, 47% PLS, and 9% youth) were included. The average percentage of person-time spent with unsuppressed HIV RNA decreased with increasing year of linkage in all groups (Figure). Women, blacks, PLS, and youth generally spent more time with unsuppressed HIV RNA than their respective counter-group. This disparity remained statistically significant with increasing year of linkage among women and blacks.

Poster Abstracts

CROI 2018 422