CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1103 EFFECT OF FAST TRACK INITIATION COUNSELLING ON ART INITIATION IN SOUTH AFRICA Sophie Pascoe 1 , Matthew P. Fox 2 , Amy Huber 1 , Joshua Murphy 1 , Mokgadi Phokojoe 3 , Marelize Gorgens 4 , Sydney Rosen 2 , David Wilson 4 , Yogan Pillay 3 , Nicole Fraser 4 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 Boston University, Boston, MA, USA, 3 South African National Department of Health, Pretoria, South Africa, 4 World Bank, Washington, DC, USA Background: In response to suboptimal adherence and retention outcomes, South Africa’s National Department of Health introduced National Adherence Guidelines (AGL) for Chronic Diseases. We conducted an evaluation of the AGL and report here the short-term effects of one AGL strategy, Fast Track Treatment Initiation Counselling (FTIC). Under FTIC, patients receive additional counselling but can initiate ART over two visits within one week of eligibility. Methods: A cluster-randomized evaluation was conducted in 4 provinces at 12 intervention clinics which implemented FTIC and 12 control clinics which delayed implementation of FTIC. Follow up was by passive surveillance using clinical records and electronic databases between 20 June 2016 and 12 May 2017. The primary outcome was ART initiation within 30 days of eligibility for FTIC. We estimated risk differences (RD) and 95% confidence intervals (CI) with adjustment for clustering using generalized estimating equations. We further controlled for baseline differences using a difference-in-differences analysis by comparing to all patients at intervention and control sites eligible for FTIC prior to the intervention being rolled out (Jan 1, 2015 through Dec 31, 2015). Results: We enrolled 362 FTIC patients in the intervention arm and 368 eligible for FTIC in the control arm (65%< age 40, 61% female, median CD4 224). In crude analyses, FTIC was associated with an increase of less than 1 percentage point in the proportion of patients who initiated ART within 30 days (83% vs 82%, risk difference (RD) 0.5%; 95% CI: -5.0% to 6.0%) (Table). However, differences in 30-day initiation rates existed between arms prior to the intervention period (RD -3.9%; 95% CI: -5.0 to -2.8%). After adjusting for baseline differences, we found a 4% increase in initiation associated with the intervention (RD 4.4%; 95% CI: 0.03% to 8.8%). The difference increased to 6% after adjusting for the cluster randomized design and for baseline covariates (RD 6.3%; 95% CI: -0.6% to 13.3%). Conclusion: We saw a modest short-term benefit to fast track initiation counselling. In view of the need to add millions of new patients to South Africa’s ART program under “treat all,” any changes that increase timely uptake of ART can make a valuable contribution to achieving national and global targets.

1102 SHORT-TERM EFFECTS OF ALTERNATIVE MEDICATION REFILL STRATEGIES IN SOUTH AFRICA Matthew P. Fox 1 , Sophie Pascoe 2 , Amy Huber 2 , Joshua Murphy 2 , Mokgadi Phokojoe 3 , Marelize Gorgens 4 , Sydney Rosen 1 , David Wilson 4 , Yogan Pillay 3 , Nicole Fraser 4 1 Boston University, Boston, MA, USA, 2 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 3 South African National Department of Health, Pretoria, South Africa, 4 World Bank, Washington, DC, USA Background: Tailoring service delivery to meet the needs of different groups of patients (“differentiated care”) has been proposed to improve HIV care and treatment outcomes and reduce costs. We evaluated alternative medication pickup models in the first phase of implementation of South Africa’s National Adherence Guidelines (AGL) for Chronic Diseases. Methods: The AGL has two strategies for streamlining medication pickup: decentralized medication delivery (DMD) and adherence clubs (AC). We conducted a cluster-randomized evaluation in 12 intervention and 12 control health facilities in 4 provinces. We sampled patients who received the intervention at intervention sites or would have been eligible at control sites. We used clinic records to estimate the proportion of patients who picked up medication within four months of enrolling in DMD or an AC. We estimated risk differences (RD) with cluster adjustment using generalized estimating equations. We controlled for baseline differences using difference-in- differences (DiD) by comparing to all patients eligible for AC or DMD prior to AGL implementation (Jan 1, 2015). Results: For ACs, we included 206 intervention and 212 control subjects. Over half were under age 40 (58%), just above 70%were female, and median ART initiation CD4 count was 268 cells. By randomized group, ACs were associate with a 4.4% (95% CI -0.6% to 6.4%) percentage point increase in initiation. Using the DiD approach, ACs were associated with a 6.7% (95% CI: 3.4% to 10.4%) point increase adjusting for baseline pickup rates (Table) that remained after adjusting for clusters and baseline covariates (RD 7.5%; 95% CI: -1.3% to 16.2%). For DMD, we included 125 intervention and 315 control patients. For DMD we saw no benefit for medication pickup but pickup data were incomplete for DMDs (47% of intervention cohort were missing pickup data). Qualitative data suggest that DMD is popular among health care providers and patients. Conclusion: Adherence clubs showed a small but significant difference in the proportion of patients who completed medication pickups in their first 4 months of enrollment. If the AC effects translate into higher retention and viral suppression, they could be employed to improve overall ART outcomes. For decentralized medication delivery, data systems have not kept up with practices, making it difficult to determine if there are any benefits. Further experience with DMD and improvements in data flow are needed.

Poster Abstracts

1104 ART ELIGIBILITY EXPANSION AND TIMELY ART INITIATION: 22-COUNTRY META-ANALYSIS Olga Tymejczyk 1 , Ellen Brazier 1 , Constantin T. Yiannoutsos 2 , Kara K. Wools- Kaloustian 2 , Keri N. Althoff 3 , Brenda Crabtree-Ramírez 4 , Kinh V. Nguyen 5 , Elizabeth Zaniewski 6 , François Dabis 7 , Jean d’Amour Sinayobye 8 , Nanina Anderegg 6 , Nathan Ford 9 , Radhika Wikramanayake 1 , Denis Nash 1 1 City University of New York, New York, NY, USA, 2 Indiana University, Indianapolis, IN, USA, 3 Johns Hopkins University, Baltimore, MD, USA, 4 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 5 National Hospital for Tropical Diseases, Hanoi, Vietnam, 6 Institute of Social and Preventive Medicine, Bern, Switzerland, 7 University of Bordeaux, Bordeaux, France, 8 Rwanda Military Hospital, Kigali, Rwanda, 9 WHO, Geneva, Switzerland Background: Over the past decade the World Health Organization has expanded antiretroviral therapy (ART) initiation criteria. The influence of eligibility expansions on the timeliness of ART initiation has not been assessed. Methods: We examined the influence of eligibility expansions on cumulative incidence of ART initiation (CI ART) at the original site within 6 months of

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