CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

diagnosed). Of the 149 ARV initiates, 126 (85%) were men reporting sex with men, 100 (67%) were Hispanic or black; 70 (47%) were foreign born. Median age was 29 years; 15 (10%) had AHI; 25 (17%) had CD4<200; 46 (31%) had baseline VL ≥100,000. 24 of 127 with baseline genotyping had evidence of PDR, most commonly to non-nucleoside ARVs. One patient required a change in therapy due to PDR. 30-day linkage to care was 84% (82/98) among new positives and 63% (32/51) among previous positives. Of 149 ARV initiates, 64 (43%) required a second month of ARV from SHC. The majority of these patients (41/64; 64%) had attended an appointment at a linkage facility. Among those with VL testing at SHC follow-up, 87% (45/52) had achieved VLS by day 45. Conclusion: Incorporation of same-day HIV navigation and ARV initiation is feasible in the setting of a public health clinic system, with high patient acceptability. Scale up to all 8 SHC clinics is expected in 2018. Future evaluation will assess impact of these efforts on time to VLS. 1109 A RAPID ENTRY PROGRAM IN THE SOUTH: IMPROVING ACCESS TO CARE AND VIRAL SUPPRESSION Jonathan Colasanti 1 , Jeri Sumitani 2 , Cyra Christina Mehta 1 , Yiran Zhang 3 , Minh Ly Nguyen 3 , Wendy S. Armstrong 1 , Carlos del Rio 1 1 Emory Center for AIDS Research, Atlanta, GA, USA, 2 Grady Health System, Atlanta, GA, USA, 3 Emory University, Atlanta, GA, USA Background: Time between presentation to HIV care and viral suppression has been too long. Rapid entry programs (REP) have demonstrated efficacy for select populations in San Francisco, South Africa and Haiti but no REPs have been reported from the Southern U.S. We assessed the feasibility and effectiveness of a REP in a large Ryan White (RW) funded clinic in Atlanta, Georgia. The clinic serves a predominantly minority and economically disadvantaged population. The REP goal was to enroll patients into clinic, complete a social needs assessment, provider visit, labs and give the option to start ART within 72 hrs. Methods: A cohort of consecutive patients was enrolled in the REP protocol fromMay 16, 2016 to July 31, 2016. To assess the effectiveness of the REP, the intervention group was compared to new enrollees to clinic from the months preceding the REP (January 1, 2016 - May 15, 2016). Inclusion criteria were HIV+, new to the clinic (not necessarily new diagnosis) and viremic at intake. Six-month follow-up data were analyzed for each group. Time to viral suppression (VS) was the primary outcome. Time to provider visits and time to ART start, were secondary outcomes. A survival analysis compared time to viral suppression for the groups. Linear regression models were run for the secondary outcomes. Results: The sample size was 118 pre-REP and 91 post-REP. Pre-REP demographics include age 33 (IQR 24, 44), 81%male, 86% Black, 60%MSM, 58% uninsured, $8,808 (IQR 0, $18,668) annual income, 67% unstably housed, 9% incarcerated in last 6 months, 42% active substance use, CD4 141 cells/uL (IQR 33, 301) and 59% ART naïve. The post-REP group differed only in age being slightly older at 38 yo (IQR 27, 48) (p=0.039). The median time to VS decreased from 63 days (IQR 36, 112) to 45 days (30, 72) post-REP (p=0.0038). Regression analyses evaluating time to 1st scheduled visits, time to attended visit and time to ART start are shown in the table. Time to VS, first provider visits and ART start remained significant when adjusted for age, sex, race, ART nativity, INSTI use and baseline log 10 VL. Conclusion: This is the largest rapid entry cohort described in the U.S. Time to viral suppression, in an economically and socially disenfranchised population in the South, was significantly improved through implementation of a REP. This was likely due to shortening the time to initial provider visit and ART prescription. REP programs are feasible in the area of the US with greatest numbers of new infections.

Poster Abstracts

1110 EARLY RETENTION DOES NOT MEDIATE/MODERATE EFFECT OF SEX/ SEXUAL BEHAVIOR ON SURVIVAL Lara Coelho 1 , Peter F. Rebeiro 2 , Jessica L. Castilho 2 , Yanink Caro-Vega 3 , Fernando A. Mejia 4 , Carina Cesar 5 , Claudia P. Cortes 6 , Denis Padgett 7 , Catherine McGowan 2 , Valdilea Veloso 1 , Timothy R. Sterling 2 , Beatriz Grinsztejn 1 , Bryan E. Shepherd 2 , Paula M. Luz 1 1 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro. Brazil, 2 Vanderbilt University, Nashville, TN, USA, 3 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 4 University Peruana Cayetano Heredia, Lima, Peru, 5 Fundación Huésped, Buenos Aires, Argentina, 6 Fundación Arriarán, Santiago, Chile, 7 Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras Background: Early retention in care (RIC), sex, and sexual mode of HIV acquisition have each been associated with mortality risk among persons living with HIV (PLWH). We therefore assessed whether early RIC mediates or modifies the effect of sex and sexual mode of HIV acquisition on mortality among PLWH on antiretroviral therapy (ART) in the Americas. Methods: ART-naïve, adult PLWH (≥18 years old) enrolling at Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and Vanderbilt Comprehensive Care Clinic sites 2000-2015, starting ART, and with ≥1 visit after ART-start were included. Early RIC was defined as ≥2 HIV care visits/ labs ≥90 days apart in the first year after ART-start. Sex and sexual mode of HIV acquisition were categorized as women, heterosexual men, and men who have sex with men (MSM). Individuals were followed from one year after ART-start to date of death, last clinic visit or study closure. Cox regression models assessed the association between early RIC, sex and sexual mode of HIV acquisition, and mortality beyond the first year of ART; interactions between RIC and sex and sexual mode of HIV acquisition were tested. Associations were estimated for each site separately and pooled. Results: Among 11,721 PLWH with ≥1 visit after starting ART, 647 subsequently died (rate=10.9/1000 person-years) and 1985 were lost to follow-up (rate=33.6/1000 persons-years). Early RIC substantially decreased mortality during subsequent years at all sites (Figure), adjusting for age, sex and sexual mode of HIV acquisition, ART-start year, and pre-ART nadir CD4, AIDS, and HIV-1 RNA. Sex and sexual mode of HIV acquisition were also associated with mortality beyond the first year of ART, with MSM having lower risk (pooled adjusted aHR=0.75; 95%CI: 0.61-0.92) and heterosexual men having similar risk (aHR=0.92; 95%CI: 0.74-1.13) to women. Point estimates for sex and sexual mode of HIV acquisition were similar whether or not retention was included. Moreover, there was no evidence of an interaction between sex and sexual mode of HIV acquisition and early RIC (p>0.05). Conclusion: In the Americas, early RIC significantly decreased mortality risk after one year on ART. Additionally, MSM had a lower mortality risk than women. We found no evidence of RIC mediating or modifying the association between sex and sexual mode of HIV acquisition and mortality in our population.

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