CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

determining same-day eligibility and readiness is now a priority. The Simplified Algorithm for Treatment Eligibility (SLATE) trial is testing a clinical algorithm that allows nurses to determine eligibility for immediate ARV dispensing at the same clinic visit. We report early results from South Africa. Methods: SLATE is an individually randomized trial at 3 public outpatient clinics in informal settlements in Johannesburg. Ambulatory patients presenting for any HIV care, including an HIV test, but not yet on ART were enrolled, consented, and randomized to the SLATE algorithm arm or standard care. The SLATE algorithm used a symptom self-report, medical history questionnaire, brief physical examination, and readiness assessment to distinguish between patients eligible for immediate ARV dispensing and those who should have further care, tests, or counseling before starting treatment. Follow up was by passive record review. We report the primary outcome of ART initiation ≤28 days of study enrollment. Results: FromMar 7-Jul 28, 2017, we enrolled 602 adult, HIV+, non-pregnant patients not yet on ART (median [IQR] age 34 [29-40] and CD4 count 288 [140- 487]; 63% female). In the SLATE arm, 149 (50%) were found to be eligible for immediate initiation and were dispensed ARVs at the same visit. The other 50% met one or more algorithm criteria for referral for additional services before initiation, of whom 2/3 (100/149) had TB symptoms. Table 1 reports time to initiation. In the SLATE arm, 83% of patients initiated ≤28 days, compared to 71% in the standard arm (risk difference (RD) [95% CI] 12% [5-19%]; relative risk (RR) 1.16 [1.06-1.28]). Within 7 days, 69% of SLATE arm patients and 39% of standard arm patients had initiated (RD 30% [22-38%], RR 1.75 [1.49-2.07]). Conclusion: The SLATE algorithm, comprising simplified steps for ART initiation, increased uptake of ART within 28 days by 16% and 7 days by 75%. Nurses were able to implement it in routine care settings without additional equipment or clinical supervision. Longer follow-up is needed to draw conclusions about overall effectiveness, but early results suggest that simpler treatment initiation procedures are feasible and can increase and accelerate ART uptake and reduce the visit burden on patients and facilities.

<.01 on likelihood of subsequent engagement in HIV care and viral suppression, controlling for study group. Results: Of 801 patients, 124 (15%) were prescribed ART in the hospital; this did not differ by study arm (p=.525). Opioid use (OR=2.06, 95%CI [1.35,3.13]) and having participated in substance use treatment (OR=1.87, 95%CI [1.17,2.98]) were associated with greater likelihood of receiving ART in the hospital, and opioid use with higher likelihood of substance treatment (OR=3.75, 95%CI [2.50,5.62]). Controlling for rates of in hospital ART prescription, substance treatment and opioid use, which differed by site (all p<.001), sites in the South (compared to North) were less likely to prescribe ART in the hospital (OR=0.48, 95%CI [0.25,0.93]). At the 12-month follow-up, median days before first HIV primary care visit was 29 in those who started ART in the hospital and 54 in those who did not (p=0.015) (Figure). Controlling for these factors and study group, there was no association between starting ART in the hospital and viral suppression at 6- or 12-months (OR=1.51, 95%CI [0.98,2,34]) and (OR=.83, 95% CI [.53, 1.31]), respectively. Conclusion: Starting ART during hospitalization was associated with shorter time to engagement in HIV care. Although not significant, there was a trend towards those prescribed ART in the hospital being more likely to be virally suppressed at 6 months than those who were not. Further research should assess the impact that rapid initiation of ART in hospitalized substance users may have on treatment engagement and virologic outcomes.

Poster Abstracts

1108 GETTING A JUMP ON HIV: EXPEDITED ARV TREATMENT AT NYC SEXUAL HEALTH CLINICS, 2017 Susan Blank , Christine M. Borges, Michael A. Castro, Kelly Jamison, John Winters, Tarek Mikati, Julie Myers, Demetre C. Daskalakis New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: Early HIV viral load suppression (VLS) is associated with decreased mortality and HIV transmission. The New York City Department of Health & Mental Hygiene Sexual Health Clinics (SHC) identify 10% of new HIV cases and 20% of acute HIV infections (AHI) citywide. The NYC SHC recently introduced Jumpstart (JS): on-site HIV antiretroviral (ARV) treatment with navigation. JS was designed to expedite HIV treatment initiation, support VLS, and improve adherence. We report on implementation and preliminary outcomes of the JS efforts available at 6 of 8 SHC. Methods: NYC SHC patients are routinely tested for HIV via rapid antibody test; individuals at highest risk are screened for AHI via pooled Nucleic Acid Testing. Patients eligible for JS were > 18 years, lived in-state and reported no prior ARV treatment. Initiation visits included 30-day supply of ARVs, navigation, medical monitoring and linkage to HIV primary care. Using medical record data, we described JS initiates 11/23/16-7/31/17, their pretreatment drug resistance (PDR) patterns, CD4, viral load, care linkage, and VLS of those requiring additional ARV from SHC. Results: 149 patients initiated ARVs. 108 patients were newly diagnosed at SHC offering JS; of these, 78 (72%) initiated ARVs (38/78 (49%) at diagnosis; 68/78 (87%) within 7 days). 71 additional patients initiated ARVs (20 newly diagnosed patients were transferred from SHC that did not yet have JS; 51 were previously

1107 STARTING ART IN HIV+ DRUG USERS WHILE HOSPITALIZED PREDICTS HIV TREATMENT ENGAGEMENT Petra Jacobs 1 , Daniel Feaster 2 , Yue Pan 2 , Lauren Gooden 3 , Carlos del Rio 4 , Eric Daar 5 , Gregory M. Lucas 6 , Mamta K. Jain 7 , Eliza Marsh 8 , Lisa Metsch 3 1 National Institute on Drug Abuse, Rockville, MD, USA, 2 University of Miami, Miami, FL, USA, 3 Columbia University, New York, NY, USA, 4 Emory University, Atlanta, GA, USA, 5 University of California Los Angeles, Los Angeles, CA, USA, 6 Johns Hopkins Hospital, Baltimore, MD, USA, 7 University of Texas Southwestern, Dallas, TX, USA, 8 Trinity College, Hartford, CT, USA Background: Project HOPE (CTN0049) was a randomized controlled trial that tested the effect of 6 months of Patient Navigation alone or with Contingency Management vs. treatment as usual on viral suppression rates (<200 copies/ mL) at 6 and 12 months post-randomization among substance using HIV+ patients recruited from the hospital. Antiretroviral therapy (ART) was initiated at providers’ discretion. This secondary analysis examined factors related to initiating ART in the hospital and its association with engagement in care and viral suppression. Methods: Project HOPE recruited 801 HIV+ substance users in 11 hospitals across US. We examined differences in socio-demographics, HIV treatment history and other service use, site, substance use and social determinants of health by those prescribed and not prescribed ART while hospitalized (chi- square and t-tests). We explored the relationship of predictors with a p-value

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