CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

clinics. Of those screened, 3,448 (11%) were diagnosed with HTN, of whom 85%were given lifestyle modification advice or started on treatment. Severe disease (BP >180/110) requiring immediate treatment with ≥ 2 drugs was noted in 38%. Of all patients on antihypertensive treatment for 6 months, 26% had achieved controlled BP (Table). Of the 3,448 persons diagnosed with HTN, 53%were male, of whom 46%were 40-49 years of age; 200 men aged 40-49 received treatment for six months and 25% achieved BP control. ART adherence for hypertensive patients receiving HTN medications was similar with patients not on HTN medications (80% vs. 79%, respectively). The annual cost of treatment of the entire cohort with HTN was approximately $14,000 or $4/ patient. Conclusion: HTN screening and management can be successfully integrated into PEPFAR-funded HIV service delivery sites at low cost and with moderate blood pressure control rates. These findings support integration of NCD and HIV services to enhance HIV care as well as to target middle-aged men.

(OR=4.7) or –mRNA-E6/E7 (OR=9.0) test increased odds of hHSIL as well. Fully-adjusted models showed diagnostic accuracy for historical & current Paps together, current Pap test alone, & hrHPV-DNA differed little & only hrHPV- mRNA-E6/E7 test more accurately predicted hHSIL: 0.76 (ref), vs. 0.74 (p=0.16), 0.78, (p=0.6), & 0.83 (p=0.05) respectively. A positive hrHPV-mRNA-E6/E7 test more accurately predicted hHSIL than a single (current) Pap test showing >ASC-US (p=0.003). The hrHPV-mRNA-E6/E7+ test also better predicted hHSIL than a hrHPV-DNA+ test finding (p=0.007). Conclusion: A single hrHPV-mRNA-E6/E7 test may more accurately predict hHSIL than a single Pap or hrHPV-DNA test finding. While multiple abnormal Pap findings 6-30 months prior to HRA increased odds of detecting hHSIL, the accuracy of historical Pap was no greater than a single Pap measure. More research is needed.

1117LBCOST-EFFECTIVENESS OF URINE TB SCREENING FOR HOSPITALIZED PEOPLE WITH HIV IN AFRICA Krishna P. Reddy 1 , Ankur Gupta-Wright 2 , Katherine Fielding 2 , Sydney Costantini 1 , Amy Zheng 1 , Elizabeth L. Corbett 2 , Liyang Yu 1 , Joep J. van Oosterhout 3 , Stephen C. Resch 4 , Doug K. Wilson 5 , C. Robert Horsburgh 6 , Robin Wood 7 , Kenneth Freedberg 1 , Stephen D. Lawn 2 , Rochelle P. Walensky 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 London School of Hygiene & Tropical Medicine, London, UK, 3 Dignitas International, Zomba, Malawi, 4 Harvard University, Boston, MA, USA, 5 University of KwaZulu-Natal, Durban, South Africa, 6 Boston University, Boston, MA, USA, 7 Desmond Tutu HIV Foundation, Cape Town, South Africa Background: The STAMP trial showed urine-based tuberculosis (TB) screening in unselected people with HIV (PWH) hospitalized in Malawi and South Africa (SA) reduced 2m all-cause mortality by 2.8% and increased TB diagnoses by 7.3%. We examined the cost-effectiveness of this screening strategy, projecting outcomes at longer time horizons. Methods: We used the CEPAC-International model to project clinical and economic outcomes of 2 TB screening strategies among hospitalized PWH: (1) Intervention: testing sputumwith Xpert MTB/RIF and urine with Xpert and Determine TB-LAM; (2) Standard of Care: sputum Xpert alone. The modeled cohort matched the trial cohort (median CD4 219/µL [Malawi], 236/µL [SA]). Costs of Xpert/LAM were US$26/$3 in Malawi and $15/$3 in SA. We calibrated model output at 2m to STAMP trial outcomes and then projected longer-term outcomes including life expectancy (LE), costs, and incremental cost- effectiveness ratios (ICERs), discounted at 3%/y. We considered the Intervention cost-effective if its lifetime ICER was less than that of second-line antiretroviral therapy in each country: $740/year of life saved (YLS) in Malawi and $950/ YLS in SA. Informed by the trial, in the base case true TB prevalence in Malawi/ SA was 18%/28%, proportion of patients providing sputumwas 39%/75%, and probability of empiric TB treatment was 4%/10%, all of which were varied in sensitivity analysis. We estimated the 5y clinical and budget impact of implementing the Intervention countrywide in Malawi and SA. Results: Model-generated absolute reductions in mortality by the Intervention in Malawi/SA were 3.5%/2.2% at 2m, and LE increased by ~0.5y (undiscounted) in both settings. The Intervention’s lifetime ICER was $490/YLS in Malawi and $850/YLS in SA (Table). The Intervention’s ICER was lower (more attractive) at higher TB prevalence, lower proportion of patients providing sputum, and lower empiric treatment rate. When we modeled a modified intervention, testing urine with only LAM was more cost-effective and possibly cost-saving. Implementing the Intervention countrywide over 5y among hospitalized PWH was associated with ~35,000 and ~171,000 YLS in Malawi and SA, with budget

Poster Abstracts

1116 HISTORICAL & CURRENT ANAL CYTOLOGY, HRHPV-DNA AND -MRNA-E6/ E7 TESTS PREDICT ANAL HSIL Dorothy J. Wiley 1 , Hilary K. Hsu 1 , Martha Ganser 1 , Jenny Brook 1 , David Elashoff 1 , Matthew G. Moran 1 , David H. Morris 2 , Ronald T. Mitsuyasu 1 , Stephen Young 3 , Nancy Joste 3 , Teresa Darragh 4 , Hilary Robbins 5 , Gypsyamber D’Souza 5 , Otoniel Martínez-Maza 1 , Roger Detels 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Desert AIDS Project, Palm Springs, CA, USA, 3 Tricore Reference Laboratories, Albuquerque, NM, USA, 4 University of California San Francisco, San Francisco, CA, USA, 5 Johns Hopkins University, Baltimore, MD, USA Background: Accuracy for anal cytology (Pap) & high-risk HPV (hrHPV) tests to predict anal histological high-grade squamous intraepithelial lesions (hHSIL) is unclear. Methods: Historical anal Pap test findings, concurrently sampled Pap & two high-threshold HPV tests, High-Resolution Anoscopy (HRA) & biopsy results were gathered from 201 MSM (n=198) & transgender women (n=3). Dacron-swab Paps were evaluated as >Atypical Squamous Cells of Unknown Significance (>ASC-US), unsatisfactory, & no intraepithelial lesions (NIL, referent). Historical Pap findings were gathered frommedical records or a large longitudinal study (Multicenter AIDS Cohort Study). Concurrent Pap & histology analyses were performed by one CLIA-certified lab; historical Paps were not. HRA-biopsy findings were classified as hHSIL vs. <=”” div=””> Results: On average, subjects were 55 (σ=12) years old, White (73%), smokers (77%); 39%were HIV+ with >500 CD4 cells/mm 3 , & 19%with <500. Few receptive anal sex partners were reported the 6-30 months before HRA: 58% reported none; 28%, 19%, & 4% reported 1, 2, or >3, respectively. The fully- adjusted models suggested, separately, that >2 Paps >ASC-US (OR=5.7) or a current >ASC-US Pap (OR=2.3) increased odds of hHSIL. A positive hrHPV-DNA

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