CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

baseline to week 12 was +14 cells/µL in the smart-bottle group and -16 cells/µL in the control group (p=0.36). At week 12, 75% of the smart-bottle group and 77% of the control group reported 100% adherence taking their antiretroviral medications over the prior 4 days. Conclusion: This pilot study demonstrates that in patients with HIV infection on ART, the smart-pill bottle service was associated with higher tenofovir diphosphate levels (though this did not reach statistical significance); HIV RNA suppression rates, CD4 cell counts, and self-reported adherence rates (over the prior 4 days) were not different.

499 DO PRESCRIBING DATA REFLECT ACTUAL TREATMENT IN PEOPLE LIVING WITH HIV (PLWH)? Joseph J. Eron 1 , Dushyantha Jayaweera 2 , Gregory D. Huhn 3 , Kelsey Milligan 4 , Scott Milligan 4 , Paul E. Sax5, Keith Spitz 4 , Richard A. Elion 6 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 University of Miami, Miami, FL, USA, 3 Rush University Medical Center, Chicago, IL, USA, 4 Trio Health, La Jolla, CA, USA, 5 Harvard University, Cambridge, MA, USA, 6 George Washington University, Washington DC, USA Background: Data created during the care continuum are challenging to assemble, and disparate sources may account for varied results in observational studies. To assess the limitation of one source, we contrasted adherence, duration, and regimen composition between prescription (RX) and pharmacy dispense (PD) data generated during care of PLWH. Methods: Antiretroviral (ARV) RX and PD data were obtained for 1270 treatment-experienced PLWH from the TRIO network, consisting of 11 HIV treatment centers servicing 39 US states. Follow up was ≥12 months (m) post index, defined as the first ARV regimen switch between 2014 to 2017 with final data collection Jun 2019. Adherence was based upon proportion of days (d) with all drugs. Regimen discontinuation was dated at exhaustion of all regimen components and/or upon addition of a new ARV drug. Time to discontinuation was assessed by Kaplan-Meier with log-rank. Univariate analyses were via chi-square, exact, or T-test. Results: Discontinuation rates (46% RX v 43% PD, p=0.060) and median time to discontinuation (29 m RX v. 29 m PD, p=0.448) were not significantly different by data source, though time to discontinuation/censoring differed by >90 d (+/-) for 29% (374) of PLWH, with 20% (258) discontinuing therapy >90 d before the end of the RX-based regimen [FIGURE]. ≥80% adherence was calculated for 90% (1143) PLWH based on RX v 92% (1166) PD (p=0.129) and ≥95% adherence for 86% (1087) RX v 87% (1110) PD (p=0.202). Of PLWH with <80% adherence by PD, 28% (29/104) were classified with ≥80% adherence by RX. Conversely, 41% (52/127) patients classified with <80% adherence by RX had ≥80% adherence by PD. Changes in multi-tablet regimen (MTR) due to early discontinuation of a component (>90 d before discontinuation of remaining regimen drugs) were indicated in 16% (75/478) PLWH by RX and 13% (63/478) by PD (p=0.311). Of PLWH with a change in MTR by PD, 14% (9/63) were not reflected by RX as having any early drug discontinuation and an additional 37% (23/63) were indicated as having a change that differed in time >90 d from observed by PD. In total, 37% (473/1270) of study patients had one or more of these differences in duration, adherence, and/or MTR composition. Conclusion: These data suggest a lack of concordance between what is prescribed and dispensed for over a third of PLWH. As dispensing data are more likely to reflect actual treatment, observational studies should include this information whenever possible.

Poster Abstracts

498 PHARMACIST-DRIVEN RAPID ART REDUCES TIME TO VIROLOGIC SUPPRESSION IN RHODE ISLAND

Amy L. Brotherton 1 , Rajeev B. Shah 1 , Joseph Garland 2 , Meghan L. McCarthy 1 , Fizza S. Gillani 2 , Martha C. Sanchez 2 1 The Miriam Hospital, Providence, RI, USA, 2 Brown University, Providence, RI, USA Background: Rapid start antiretroviral therapy (ART) protocols have emerged as an innovative care model for persons newly diagnosed with HIV (PNDWH). Shifting to a model where clinical pharmacists are at the forefront of rapid ART initiation may provide a sustainable solution for the logistical challenges that limit widespread implementation. Methods: We conducted a preliminary retrospective analysis at Rhode Island’s largest HIV clinic to compare clinical outcomes of PNDWH before (1/2017 – 12/2017) and after (1/2019 – 8/2019) implementation of a Pharmacist Driven Rapid ART (PHARM-D RAPID) protocol. Prior to implementation of the protocol at this Ryan White clinic, patients attended an intake visit with a nurse upon HIV diagnosis, which preceded their first provider appointment and ART initiation by approximately 2 weeks. Following implementation of the PHARM-D RAPID protocol, PNDWH are evaluated by a multidisciplinary team on intake and offered rapid ART initiation by clinical pharmacists prior to their first provider visit. During intake, clinical pharmacists provide education, assess readiness to initiate ART, evaluate drug-drug interactions, resolve medication access issues, and recommend patient-specific ART to the triage physician for initiation. Follow-up phone calls are conducted by pharmacists 2 weeks following ART initiation. Clinical and demographic data were extracted from the electronic medical record. The primary outcome was time from intake visit to viral suppression (HIV RNA <200 copies/mL). Results: A total of 88 patients were included in the preliminary analysis; 55 and 33 in the pre-group and PHARM-D RAPID group, respectively. Baseline characteristics were similar between groups. Mean age was 37 with 85% male, 58%white, 25% black, 30% Hispanic, and 53%with MSM as their sole reported risk factor. 26%were uninsured, 25% presented with AIDS, and half had history of substance use (54%) and/or mental illness (50%). Pharmacists’ recommendations for ART regimens were accepted in all PHARM-D RAPID patients. Medication access issues were preemptively resolved in 61% of PHARM-D RAPID patients. Time from intake to viral suppression (81 vs. 34 days, P=0.001) and time from intake to ART (16 vs. 0 days, P<0.001) significantly decreased in the PHARM-D RAPID group. Conclusion: Our PHARM-D RAPID protocol demonstrates a novel pathway for decreasing time to viral suppression and HIV transmission, which are key for achieving 90-90-90 efforts in a complex patient population.

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