CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

enrolment in HIV care, using data from 239,311 adult ART-naïve patients at 151 International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium sites in 22 countries where national treatment guidelines changed between 2007-14. We assessed CI ART before and after major eligibility expansions for asymptomatic adults (i.e., to treat persons with CD4≤350 cells/µL and CD4≤500 cells/µL). CI ART was estimated via competing risks regression, with death and pre-ART loss-to-clinic treated as competing events. Random effects meta- regression models were used to estimate absolute changes in CI ART at each site between those enrolling in HIV care prior to ART eligibility expansion and those afterwards. Results: The crude pooled estimate of change in CI ART within 6 months of care enrolment was +4.3 percentage points (pp) (95% CI: +2.6,+6.0) after eligibility expansion to CD4≤350, from a baseline median CI-ART of 53.7%, and +16.0 pp (95% CI: +14.4,+17.6) after eligibility expansion to CD4≤500, from a baseline median CI-ART of 59.2%. For eligibility expansion to CD4≤350, changes in CI ART were largest at sites where patients had higher baseline median enrolment CD4 counts and at sites with lower baseline levels of CI ART. For eligibility expansion to CD4≤500, changes in CI ART were largest at sites with lower baseline levels of CI ART, and among women and patients <25 years old. For both policy changes, the largest effects were observed among patients newly eligible for treatment (+18.5 pp after expansion to CD4≤350 and +43.3 pp after expansion to CD4≤500), with no change or small improvements among those eligible under prior guidelines. Conclusion: Timely ART initiation among adults substantially improved after ART eligibility expansion, especially among younger patients and at sites with lower initial levels of CI ART. ART initiation among newly eligible patients with less advanced disease did not appear to negatively affect ART initiation among previously eligible patients with more advanced disease. These findings underscore the utility of ART eligibility expansion as an essential strategy in support of global UNAIDS 90-90-90 targets.

1 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 3 University of California Berkeley, Berkeley, CA, USA, 4 University of California San Francisco, San Francisco, CA, USA Background: Multi-step ART initiation algorithms result in loss of patients between eligibility and treatment, thus eroding gains towards the 90-90-90 targets. Although individual randomized trials show improved outcomes with accelerated ART initiation, the success of accelerated ART practices in real world settings is less understood. We evaluated a revised ART initiation approach based on same-day readiness assessment and point of care CD4 assessment, among public facilities in Zambia as compared to standard of care (SOC) procedures including protracted pre-treatment counseling sessions. Methods: The rapid treatment approach was implemented between March and July 2016 in two rural and two urban public health facilities and compared to 5 comparator sites practicing standard of care (SOC) among ART naïve, treatment eligible patients and followed for 12 months. Demographic and clinical data were abstracted from patient charts. We estimated the average treatment effect on time-to-ART initiation using survival-time inverse- probability-weighted regression adjustment models. The mean survival time was modeled as WeibulL, controlling for sex and WHO stage and treatment assignment as logit with covariates sex, WHO stage, and clinic site. Results: A total of 962 patients were available for analysis, with 313 exposed to intervention and 649 to SOC groups. Except for sex and WHO stage, there was no difference in age, marital status, level of education or income between the two groups. The median CD4 count was 249 (IQR=133, 394) and the median age was 35 years (IQR=29, 42). The median time-to-ART initiation was 2 days (IQR: 0, 13) in the intervention group compared to 28 days (IQR: 14, 70) in the SOC group, with more frequent same day ART initiation in the intervention group (Figure 1). The average time to ART initiation was 24 days (95%CI: [16, 32]; p<0.0001) less in the intervention (or START) group compared to 40 days (95%CI: [34, 45] in SOC group. This difference was maintained up to one year of follow up. Conclusion: Rapid ART initiation as part of routine care in public sector facilities can increase both the rate of ART initiation as well as overall completeness of uptake among treatment eligible patients. Ongoing expansion of treatment guidelines to include all persons living with HIV may be able to achieve greatest gains when coupled with rapid ART initiation practices, which should include CD4 determination to identify patients with advanced disease and at risk of increased morbidity and mortality.

Poster Abstracts

1106 SAME-DAY ART INITIATION IN THE SLATE TRIAL IN SOUTH AFRICA: PRELIMINARY RESULTS Mhairi Maskew 1 , Alana T. Brennan 2 , Matthew P. Fox 2 , Willem D. Venter 3 , Lungisile Vezi 1 , Bruce Larson 2 , Isaac Tsikhutsu 4 , Margaret Bii 4 , Sydney Rosen 2 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 Boston University, Boston, MA, USA, 3 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 4 KEMRI/Walter Reed Proj, Kericho, Kenya Background: The World Health Organization recommends “same-day” initiation of ART for patients who are eligible and ready and initiation within 7 days of diagnosis for all patients. Identifying efficient operational procedures for

1105 A STREAMLINED ART INITIATION ALGORITHM OF CARE REDUCES TIME TO ART Izukanji Sikazwe 1 , Samuel Bosomprah 2 , Jake Pry 2 , Mpande Mukumbwa- Mwenechanya 2 , Anjali Sharma 2 , Paul Somwe 2 , Nancy Padian 3 , Monika Roy 4 , Carolyn Bolton Moore 2 , Charles B. Holmes 2 , Elvin Geng 4

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