CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Clinics with services that increase accessibility and comprehensiveness of care as well as actively monitor retention and ART adherence have faster time to ART initiation and VS. Our findings highlight aspects of HIV care models that may optimize patient outcomes.

(p<0.001). 1215 PLHIV had baseline VL >400 c/ml (85 in co-pay). Co-pay PLHIV had greater odds of virological suppression odds ratio (OR 1.51 [95%CI:1.15- 1.98]) after adjusting for baseline age, sex, ART regimen and CD4 -Fig. 1. We found a lower risk of LTFUP from the co-pay compared to general clinic (OR 0.63 (95%CI:0.45-0.89) in the adjusted model. There was a lower risk of death in the co-pay clinic compared to (OR 0.46 [95%CI:0.31-0.71] but this was non- significant in adjusted model. Conclusion: The co-pay clinic was accessed by harder to reach sub-sets of PLHIV (e.g men, formally employed PLHIV) and uptake of this differentiated care model was associated with favourable clinical outcomes.

Poster Abstracts

1123 CLINIC-LEVEL FACTORS ASSOCIATED WITH TIME TO VIRAL SUPPRESSION IN WASHINGTON DC Anne K. Monroe 1 , Nabil Rayeed 2 , Maria Jaurretche 1 , Lindsey Powers Happ 1 , Kevin Trac 1 , Arpi Terzian 1 , Alan Greenberg 1 , Amanda D. Castel 1 1 The George Washington University, Washington, DC, USA, 2 Cerner Corp, Kansas City, MO, USA Background: Multiple individual-level factors are associated with prolonged time to antiretroviral therapy (ART) initiation and viral suppression (VS), e.g., younger age and higher CD4 cell count. Less is known about the impact of clinic-level factors, i.e., characteristics of the clinic where care is received. The DC Cohort, an observational cohort with 14 clinics enrolling people with HIV (PWH) in Washington, DC, offers a unique opportunity to examine multiple clinics in one city. We examined the association between clinic-level factors and time to ART initiation/VS. Methods: We included data from 2011-2016 from PWH who were not on ART and not virally suppressed at enrollment, had ≥ 12 months of follow-up, and had baseline and follow-up HIV RNA values. Outcomes were ART initiation and VS (HIV RNA < 200 copies/mL) anytime post-enrollment. We conducted a clinic survey and calculated an assessment score (range 0-9; high score 7-9) based on clinic hours, outside referrals, visit wait time, reengagement after missed visits, text messages, and availability of group visits, urgent care, and subspecialty medical services. Additional variables were: 1) “retention monitoring,” i.e., review of clinic databases and electronic health records and 2) “ART monitoring” i.e., routine review of medication pick up. We performed univariate and multivariate Cox proportional hazards analyses to identify factors associated with time to ART initiation/VS. Results: The median age of the 672 participants was 42 years, 82%were black, 74.3%were male, and 42.3%were men having sex with men. Almost half attended a clinic with a high assessment score, 62.8% attended a clinic with retention monitoring, and 48.5% attended a clinic with adherence monitoring. VS was achieved by 82% of participants. Clinic-level factors associated with the outcomes included attending a clinic with a high assessment score (for ART initiation adjusted Hazard Ratio (aHR)=1.41, 95% CI 1.14, 1.75; for VS aHR=1.50, 95% CI 1.19, 1.89); retention monitoring (for ART initiation aHR=1.37, 95% CI 1.02, 1.83; for VS aHR=1.43, 95% CI 1.15, 1.78); and adherence monitoring (for ART initiation aHR=1.32, 95% CI 1.07, 1.62; for VS aHR=1.26, 95% CI 1.00, 1.58) (Figure).

1124 PREDICTORS OF PERSISTENT LOW LEVEL VIREMIA AND TRANSIENT VIRAL BLIPS Allahna L. Esber 1 , Christina Polyak 1 , Jonah Jonah Maswai 2 , John Owuoth 3 , Lucas Maganga 4 , Akindiran Akintunde 5 , Hannah Kibuuka 6 , Julie Ake 7 , Trevor Crowell 1 1 US Military HIV Research Program, Silver Spring, MD, USA, 2 KEMRI/Walter Reed Proj, Kericho, Kenya, 3 KEMRI/Walter Reed Proj, Kisumu, Kenya, 4 Walter Reed Program– Tanzania, Mbeya, Tanzania, United Republic of, 5 Walter Reed Program–Nigeria, Abuja, Nigeria, 6 Makerere Univ Walter Reed Proj, Kampala, Uganda, 7 Walter Reed Army Institute of Research, Silver Spring, MD, USA Background: WHO guidelines identify HIV RNA less than 1000 copies/ml as the goal of antiretroviral therapy (ART). However, the clinical implications of and factors associated with persistent viremia below this threshold are unclear in the African context. We examined factors associated with persistent low level viremia (pLLV) and transient viral blips among HIV-infected participants in four African countries.

CROI 2018 433