CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1138 HIV CARE TRAJECTORIES IN THE ERA OF UNIVERSAL TEST-AND-TREAT IN RURAL SOUTH AFRICA Delphine Perriat 1 , Hassimiou Diallo 2 , François Dabis 3 , Deenan Pillay 4 , Joanna Orne-Gliemann 3 , Joseph Larmarange 2 1 L’Université de Bordeaux, Bordeaux, France, 2 IRD, Paris, France, 3 INSERM, Bordeaux, France, 4 Africa Health Research Institute, Mtubatuba, South Africa Background: The test-and-treat strategy requires that HIV-infected individuals enter care and start an antiretroviral treatment (ART) as soon as possible after diagnosis. Little is known yet about the care continuum in such context. We aimed to describe the timing and sequencing of individual HIV care events from referral to viral suppression by identifying groups of individuals with similar care trajectories and identifying factors associated with each group. Methods: We used prospective longitudinal data from the ANRS 12249 TasP trial, a cluster-randomized trial that investigated the impact of universal ART following home-based testing, on HIV incidence in rural KwaZulu-Natal, South Africa (2012-2016). The care status of all participants >16 years, identified HIV+, not in care at referral and followed-up for ≥18 months was classified at each calendar day: not in care, in care but not on ART, on ART but not virally suppressed, virally suppressed. We used state sequence data analysis to identify homogeneous groups of care trajectories. Individual and cluster characteristics at referral were analysed using multinomial logistic regression to characterize the profile of each group. Results: 1,827 HIV+ participants were included. Median age was 34 years [IQR 27-45], 75%were female. We identified four groups of care trajectories (Figure): (i) participants who mostly did not enter care (53%), (ii) participants with inconstant care, visiting a clinic occasionally but leaving care thereafter (median time to exit care: 8.3 months [3.9-10.5]) (12%), (iii) participants who took extensive time at each step of the care continuum (median time between care referral and ART initiation: 7.6 months [5.8-9.4]) (11%) and (iv) participants who rapidly progressed towards continuous care (median time between care referral and ART initiation: 1.5 month [0.7-4.2]) (23%). Participants who were living further than a kilometre from a clinic, who were newly diagnosed and who were offered pre-ART services (vs immediate ART), were more likely to present with incomplete, inconstant and slow care trajectories. Conclusion: Care trajectories are heterogeneous. To maximise the impact of test-and-treat strategies, differentiated care and support should be scaled-up, especially between diagnosis and ART initiation, which constitutes the main bottleneck of HIV programs in this South African rural study area.

Poster Abstracts

1139 THE IMPACT OF “TREATMENT FOR ALL” ON EARLY GAPS IN ART- A MULTISITE COHORT STUDY Ingrid Katz 1 , Nicholas Musinguzi 2 , Kathleen Bell 3 , Anna Cross 4 , Bosco M. Bwana 2 , Gideon Amanyire 2 , Stephen Asiimwe 5 , Catherine Orrell 4 , David R. Bangsberg 6 , Jessica E. Haberer 3 1 Brigham and Women’s Hospital, Boston, MA, USA, 2 Mbarara University of Science and Technology, Mbarara, Uganda, 3 Massachusetts General Hospital, Boston, MA, USA, 4 Desmond Tutu HIV Foundation, Cape Town, South Africa, 5 Kabwohe Clinical Research Center, Kabwohe, Uganda, 6 Oregon Health and Sciences University, Portland, OR, USA Background: Treatment eligibility has expanded throughout sub-Saharan Africa (SSA) in response to the WHO 2015 policy promoting “treatment for all” people living with HIV (PLWH). We evaluated the impact of early vs. late treatment initiation on early gaps in ART usage across two countries in SSA – South Africa (SA) and Uganda (UG) – and identified clinical and psychosocial predictors of losses. Methods: Two cohorts of men and women initiating ART in routine care were prospectively enrolled in Cape Town, SA and southwestern UG: one initiating early (CD4>350 cells/ml) and one initiating late (CD4<200 cells/ml). Participants were seen at 0, 6 and 12 months for socio-behavioral questionnaires and HIV RNA levels. Adherence was monitored in real-time (Wisepill); early gaps were defined as >30 consecutive days without evidence of adherence in the first 6 months of ART. Demographic and clinical factors were compared across groups using chi-square to identify potentially confounding covariates, and logistic regression models were used to estimate predictors of early gaps in ART usage, adjusting for age, gender, employment, education and marital status. Results: Of the 904 PLWH who were enrolled, 868 (96%) completed follow up, and 670 (77%) were eligible for this analysis (pregnant women were excluded). There were 92 (14%) early gaps in ART use, with a median time to early gap

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