CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

NC Disease Intervention Specialists (DIS) to locate and interview people diagnosed with AHI within 72 hours of case notification and HIV providers to expedite their care appointments. It takes approximately two weeks for the DIS to locate and interview non-AHI. We sought to determine if this elevated public health response improved retention in HIV care and viral suppression outcomes. Methods: For all persons newly-diagnosed with HIV during 2013-2016, we defined AHI as negative antibody test and 1) positive HIV RNA or 4th gen HIV Ag/Ab test, 2) negative HIV Ab test within 30 days, or 3) positive HIV RNA and symptoms specific to AHI. Using our NC Engagement in Care Database for HIV Outreach (NC ECHO), laboratory, drug dispense, and claims data were assessed for all HIV-infected persons (AHI and non-AHI) to determine linkage to care (a CD4 or viral load within one month), retention in care (virally suppressed during the year or two care visits at least 90 days apart), and viral suppression (viral load <200 copies/ml). Chi-square analyses were performed on the proportions of linked within one month, retention in care, and viral suppression within 12 months of both AHI and non-AHI. A Kaplan-Meier survival analysis was conducted to determine time to viral suppression for both AHI and non-AHI. Results: Between 2013 and 2016, a total of 5,357 (252 AHI; 5,105 non-AHI) persons were diagnosed with HIV in NC. Overall, 82% of people diagnosed with AHI were linked to care within one month of their initial HIV diagnosis, compared to 63% of people diagnosed with non-AHI (p<0.001). More people diagnosed during AHI were retained in care (83%) than non-AHI (76%) (p=0.01). The median time for viral suppression for AHI was 118 days (95% CI: 101-144) compared to 166 days (95% CI: 161-171) for non-AHI (log-rank test p<0.0001). Viral suppression was achieved within 12 months in 75% of AHI diagnoses versus 63% of non-AHI diagnoses (p=0.003). Conclusion: The prioritization of AHI as a public health emergency in NC and the subsequent coordinated effort between the health department and HIV providers to expedite care and treatment initiation may improve linkage to and retention in care, and viral suppression outcomes among AHI.

HOPWA based on the NYC HIV surveillance registry and housing administrative databases, including NYC eCOMPAS for HOPWA. The two groups were matched on as many of these factors as possible: age, gender, race/ethnicity, birth country, other housing program use, HIV transmission risk, area-level poverty, clinical status, and HIV diagnosis year; baseline attributes were balanced between groups after matching. Length of HOPWA enrollment was classified as short-term (<1 year) or long-term (≥1 year). Last CD4 count (grouped as <200, 200-499, ≥500 cells/µL, or missing) and VL were measured 1 year pre- and post-enrollment per laboratory tests electronically reported to the registry. Conditional logistic regression measured if HOPWA enrollees were more likely than matched controls to improve (e.g., from<200 or missing to 200-499) or maintain optimal (≥500) CD4 count. McNemar’s test analyzed if the proportion virally suppressed (VS; VL≤200 copies/mL) increased for each group. Results: Compared to their respective non-HOPWA controls, the 287 long-term HOPWA enrollees were 82%more likely (95% CI: 1.34-2.46), and the 274 short- term HOPWA enrollees 35%were more likely (95% CI: 0.99-1.83), to improve or maintain an optimal CD4 count. VS among long-term HOPWA enrollees increased from 78% pre-enrollment to 86% post-enrollment (p<0.01), while it was constant in their controls; neither short-term HOPWA enrollees nor their controls showed significant improvement in VS. By service category, enrollment length impacted SPH enrollees most: VS increased 14 percentage points for long-term SPH enrollees (p=0.05) but decreased 6 percentage points for short- term enrollees. Conclusion: Providing HOPWA housing services to PLWH resulted in improved CD4 count and VL within 1 year relative to matched controls, especially with longer enrollment. 1122 IMPROVED VIROLOGICAL OUTCOMES IN A CO-PAY MODEL SUPPORTING DIFFERENTIATED CARE Rosalind M. Parkes-Ratanshi 1 , Samuel Lewis 2 , Maria S. Nabaggala 1 , Adelline Twimukye 1 , Tom Kakaire 1 , Noela Owarwo 1 , Barbara Castelnuovo 1 , Agnes Kiragga 1 , Walter Schlech 3 , Mohammed Lamorde 1 1 Infectious Disease Institute, Kampala, Uganda, 2 Cambridge University, Cambridge, UK, 3 Dalhousie University, Halifax, NS, Canada Background: Differentiation of care is an increasingly important mechanism to help increase the number of people living with HIV (PLHIV) accessing anti-retroviral treatment (ART) in resource limited settings. At the Infectious Diseases Institute (IDI) HIV care is offered through a general and integrated specialized clinics (e.g. sexual reproductive health, young adults). In 2013 we introduced a co-pay (US$8-16) convenience clinic providing out of hours services with free ART and tests. We present a retrospective cohort analysis of the clinic. Methods: All patients enrolling at IDI with at least 2 clinic visits between 1st Aug 2013 and 31st Jan 2016 were included and followed up to 31st Jan 2017. Patients were eligible if they accessed the co-pay clinic for >2 visits during the period, otherwise they were considered general clinic patients. Using univariate and multivariate linear regression, we assessed these factors for association with co-pay clinic attendance: baseline demographics, CD4 count, Viral load [VL], WHO stage, ART regimen and duration. We used survival analysis to evaluate time to virological suppression (in those with initial VL >400copies/ ml), death and loss to follow up (LTFUP). Results: In the study period, 11,848 PLHIV had a clinic attendance; 710 in co-pay. 1555 new PLHIV registered; of these 212 (13.6%) were co-pay and 150 (9.6%) of these enrolled directly into the co-pay clinic. Co-pay PLHIV were more likely to be male (47.1% vs 34.7%; p<0.001 and older (44[IQR 37-51] vs 42[35- 48] p<0.001). Of co-pay patients 83.7%vs.52.4% had a greater than primary education and were less likely to be unemployed (13.7%vs.23.9%). There was no difference in baseline CD4, or VL>400 c/ml (p=0.27). Co-pay PLHIV were more likely to be either naïve, on 2nd/ 3rd line ART compared to general clinic PLHIV

Poster Abstracts

1121 CD4 COUNT AND HIV VIRAL SUPPRESSION IMPROVE AFTER HOUSING PROGRAM ENROLLMENT, 2013-16 Yaoyu Zhong 1 , Ellen Wiewel 1 , Christopher Beattie 1 , Xiomara Farquhar 1 , Jesse Thomas 2 , Sarah L. Braunstein 1 , John Rojas 1 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 RDE System Support Group, LLC, Little Falls, NJ, USA Background: The U.S. Housing Opportunities for Persons with AIDS (HOPWA) program provides housing assistance and related supportive services for low- income persons living with HIV (PLWH) and their families. The New York City (NYC) Department of Health and Mental Hygiene oversees 37 HOPWA contracts in NYC across three service categories: housing placement assistance (HPA), supportive permanent housing (SPH), and rental assistance (REN). We evaluated CD4 count and viral load (VL) improvements after NYC HOPWA enrollment compared with matched controls. Methods: We matched each of the 561 NYC residents newly enrolled in NYC HOPWA during July 2014-December 2015 with two NYC PLWH never enrolled in

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