CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

minimizing cumulative drug costs. The number on treatment will not decrease by 2030, even if the elimination threshold is reached.

1158 220 VULNERABLE COUNTIES: ONE YEAR LATER

Alana Sharp , Brian Honermann, Austin Jones, Gregorio A. Millett amfAR, New York, NY, USA Background: In 2016, the Centers for Disease Control and Prevention (CDC) published an assessment of county-level vulnerability to an HIV or hepatitis C (HCV) outbreak among injection drug users, finding 220 counties at high risk. Preventing outbreaks will require the delivery of preventive services including addiction treatment and syringe services programs (SSPs) to prevent HIV and HCV transmission. Twelve months after the publication of this analysis, we assess the status of access to healthcare services to prevent such an outbreak. Methods: We compiled the number of outpatient facilities providing at least one form of medication-assisted treatment (MAT) from the National Survey of Substance Abuse Treatment (N-SSATS). The location of SSPs are taken from the North American Syringe Exchange Network (NASEN) database, current and archived from 2014. Minimum distance to a MAT-offering program or an SSP is calculated as the distance between the coordinates of each ZIP code tabulation area (ZCTA) in a vulnerable county and the nearest ZCTA containing a treatment program. ZCTA population is from the 2010 Census. Results: Of the 220 vulnerable counties, 29.7% contained a treatment program providing MAT in 2014; by 2017, 36.4% of counties had a MAT program. Of all other counties, 34.5% contained a MAT facility in 2014 and 39.9% did in 2017. Of vulnerable counties, 1.4% contained an SSP in 2014 and 7.3% did in 2017; in all other counties, the percent rose from 4.6% in 2014 to 6.2% in 2017. In 2017, 56.4% of the population in vulnerable counties lived in or within 10 miles of a ZCTA containing a MAT program and 11.1% live within 10 miles of an SSP. In the rest of the country, 75.3% lived within 10 miles of a MAT program and 26.1% lived within 10 miles of an SSP. While the proportion of counties with treatment program and SSPs increased by 22.6% and 433.3%, respectively from 2014 to 2017, a significant proportion of the population continues to experience geographic barriers to care. Conclusion: Many clients do not access SSPs unless they are within a ten minute walk from their home. As such, the finding that more than one-third of people in vulnerable counties are more than 10 miles away fromMAT, and nine in ten are more than 10 miles from an SSP, suggests that geographic and capacity barriers persist. This analysis does not account for program capacity or insurance policies; as such, the availability of treatment and prevention services may be lower still.

1157 COST-EFFECTIVENESS OF MEDICAL CARE COORDINATION FOR HIGH-RISK PWH IN LA COUNTY Moses J. Flash 1 , Wendy H. Garland 2 , Bruce R. Schackman 3 , Sona Oksuzyan 2 , Justine A. Scott 1 , Philip J. Jeng 3 , Emily B. Martey 1 , Marisol Mejia 2 , Elena Losina 4 , Emily P. Hyle 1 , Sonali P. Kulkarni 2 , Kenneth Freedberg 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Los Angeles County Department of Public Health, Los Angeles, CA, USA, 3 Weill Cornell Medicine, New York, NY, USA, 4 Brigham and Women’s Hospital, Boston, MA, USA Background: Many people with HIV (PWH) face psychosocial needs that impact their health status but are not typically addressed through routine HIV clinical care. The Los Angeles County (LAC) Division of HIV and STD Programs developed a comprehensive medical care coordination (MCC) program to improve HIV treatment access, retention, and adherence for PWH facing multiple psychosocial co-morbidities, including homelessness and substance use disorder. Methods: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-US model to project the lifetime clinical and economic outcomes for these high-risk PWH under two strategies: 1) usual care ( no MCC ), and 2) a 2-year MCC program. Model inputs were based on data from a cohort of high-risk PWH who started the LAC-MCC program in 2013 and were followed for 24 months. The baseline cohort included: mean age 40yr (SD 11yr), 87%male, 33% virologic suppression, and mean CD4 count 429/µL (SD 293/µL). High-risk characteristics included: 65% drug/alcohol use in past 6m, 51% current mental health diagnosis, 38% previously incarcerated, and 22% homeless in past 6m. Two-year virologic suppression was projected at 37%with no MCC and was 57% with MCC . MCC cost an additional $2,700/person annually (2017 USD), which included a mean of 17.3 service hours/person/year. For the MCC strategy, we applied program efficacy and costs for two years, assuming that individuals revert to their pre-program adherence after two years. The primary outcome was the incremental cost-effectiveness ratio (ICER, Δcost/Δquality-adjusted life year (QALY)). In sensitivity analyses, we examined the impact of varying the MCC program efficacy, program costs, and other parameters on the overall results. Results: MCC increased quality-adjusted life expectancy from 9.99 to 10.63 QALYs; lifetime HIV-related medical costs increased from $381,570 to $402,840, resulting in an ICER of $33,100/QALY for MCC (Table 1). MCC had an ICER <$50,000/QALY gained if 2-year virologic suppression was at least 41%, annual program costs were below $8,100/person, or if there was moderate virologic suppression (47%) and annual costs were below $5,400. Conclusion: Based on virologic suppression during the first two years of implementation, the LA County MCC programwill improve survival and is cost- effective for high-risk PWH. Similar programs should be implemented in other settings to improve HIV outcomes among PWH with complex co-morbidities.

Poster Abstracts

CROI 2018 449