CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: The study was conducted in the comprehensive population cohort run by the Africa Health Research Institute (AHRI) in KZN. We linked PLHIV engaged in HIV care to their cohabiting household members aged ≥15 years using a unique identifier for homesteads. We implemented regression discontinuity quasi-experiments fitting Weibull and Cox survival models to establish the causal effect of ART utilization on uptake of TB, HTN, and DM treatment among household members. We ran unadjusted models and models adjusting for age and sex, restricting the analysis to a narrow CD4+ cell count range around the regression discontinuity threshold. Results: There were 4867 PLHIV enrolled in care living with 17,253 household members ≥15 years in 4212 unique homesteads between 2008-2014. Most PLHIV in care were women (77%) with mean age of 33 years. Cohabiting household members were 55% female with mean age of 31 years and a median household ART utilization exposure of 1.7 years (IQR: 0.6-3.2). During the study period, 3.0% (95.6% of those with TB), 11.4% (86.0% of those with HTN) and 3.1% (83% of those with DM) of cohabiting household members reported that they were currently being treated for TB, HTN, or DM, respectively. Household ART utilization increased treatment for diabetes (RR 1.90: 95% CI 1.07-3.40) but not for TB (RR 1.12: 95% CI 0.71-2.03) or hypertension (RR 1.31: 95% CI 0.97-1.77) (Table 1). Conclusion: Household exposure to public-sector HIV treatment programs substantially increased uptake of DM treatment but not for HTN and TB treatment among household members. Future research needs to establish the mechanisms leading to these effects and how HIV treatment programs can be even better leveraged to improve access to other needed chronic care in Africa.

TB. Isoniazid preventive therapy(IPT) decreases TB risk by 65% and up to 80% when combined with antiretroviral therapy. Despite this benefit, countries have been slow in implementing this intervention. This study describes processes, outcomes and lessons learnt in IPT scale up in Kenya Methods: We conducted a desk-review of guidelines, standard operating procedures(SOPs), Ministry of Health (MOH) and PEPFAR work plans, meeting notes, reports, and analyzed MOH IPT uptake and treatment outcome data from January 2014 to December 2016 in MS Excel®. Treatment outcomes were defined as: Treatment completed- completion of 6 month IPT; Dead- died while on IPT; Default- lost to followup; not evaluated- no outcome and; discontinued- stopped IPT. Results were presented as counts, percentages, and graph. Results: From 2009 to 2013, revision of national guidelines allowed wider IPT implementation, TB screening was institutionalized and Xpert MTB/RIF testing rolled out. Pilot projects were implemented, documented and used to inform scale-up. IPT was included in HIV and TB program performance contracts. A joint MOH, US government and implementing partner technical working group was formed, SOPs and materials for training of counties and site level staff developed and IPT launched nationally in 2015. Joint procurement planning was done, drugs purchased by the TB program and distributed by the HIV program. IPT was integrated into the standard package of HIV care and prioritized in HIV treatment acceleration initiatives. PEPFAR implementing partners (IP) were assigned targets and engaged in quarterly progress reviewmeetings. IPT uptake among 1050000 PLHIVs increased almost 50-fold from 9,981 at end-2014 to 493436 in December 2016 and to 80% national coverage by August 2017. Among 28,483 patients initiating IPT in 2015 in 14 Nairobi sites, 90% completed treatment, 0.4% died, 4.9% defaulted, 2.0%were not evaluated and 3.0%were discontinued. Among those discontinued, 0.2% had TB while 0.5% had adverse drug reactions. Challenges included occasional stock out of drugs and reporting tools. Conclusion: IPT can be scaled up with high completion rates. Strong MOH leadership, integration of IPT in routine HIV care, IP involvement, and accountability are critical to program success.

Poster Abstracts

1115 HYPERTENSION SCREENING AND MANAGEMENT IN TWO PEPFAR- FUNDED CLINICS IN MALAWI Sam Phiri 1 , Hannock Tweya 2 , Alice Maida 3 , Sundeep Gupta 4 , Colin Speight 2 , Denise Giles 4 , Oliver J. Gadabu 5 , Fleetwood Loustalot 4 , Pragna Patel 4 1 Lighthouse Trust Clinic, Lilongwe, Malawi, 2 Lighthouse Trust, Lilongwe, Malawi, 3 CDC Malawi, Lilongwe, Malawi, 4 CDC, Atlanta, GA, USA, 5 Baobab Health Trust, Lilongwe, Malawi Background: As HIV-infected persons live longer, common comorbidities shift from opportunistic infections to chronic conditions. The PEPFAR-supported clinic network in Malawi provides a unique opportunity to leverage the established clinic structure to incorporate screening and management of noncommunicable diseases (NCDs) such as hypertension (HTN) and provide enhanced HIV care. In addition, integrated services can facilitate testing among adult men, a hard-to- reach population for PEPFAR. Methods: We integrated a HTN screening and management program using standardized HTN treatment protocols and cohort monitoring with HIV service delivery at two PEPFAR- supported clinics in Lilongwe, Malawi. Persons with at least three elevated blood pressures (SBP >140 or DBP>90) on each of two separate visits were diagnosed with HTN. The first elevated value was be rechecked during the same visit. Patients with HTN who had stable HIV were treated using a stepwise approach based on the Malawi Standard Treatment Guidelines with adaptation for HIV patients. We enhanced an electronic medical record system by developing a HTN module to monitor this subpopulation for outcomes of interest. Antiretroviral (ART) adherence was measured using pill counts. Results: From 2/15 to 7/16, 29,359 adults >20 years old [median age 38 (interquartile range: 32-45) and 61% female] were screened for HTN at two

1114 THE EFFECTS OF HIV TREATMENT ON UPTAKE OF TB AND NCD TREATMENT BY HOUSEHOLD MEMBERS Suzue Saito 1 , Andrea Howard 1 , Magdalena Cerda 2 , Frank Tanser 3 , Deenan Pillay 3 , Wafaa M. El-Sadr 1 , Till Bärnighausen 4 1 Columbia University, New York, NY, USA, 2 University of California Davis, Davis, CA, USA, 3 Africa Health Research Institute, Mtubatuba, South Africa, 4 Harvard University, Cambridge, MA, USA Background: The global response to the HIV epidemic has achieved remarkable increase in access to antiretroviral therapy (ART) through largely vertical programs. Whether the HIV treatment programs have strengthened the broader health system to achieve better outcomes for tuberculosis (TB) and non- communicable diseases (NCDs) is unclear. We conducted a quasi-experimental study in rural Kwazulu-Natal (KZN), South Africa to determine whether exposure to health benefits from ART utilization by a person living with HIV (PLHIV) in the household affects uptake of TB, hypertension (HTN) and diabetes (DM) treatment by other household members with these conditions.

CROI 2018 429