CROI 2020 Abstract eBook

Abstract eBook

Oral Abstracts

Background: Among the 19,199 people living with HIV (PLWH) in Philadelphia, 6,401 (33%) were out of care (OOC) in 2017. Engagement in care is integral to decreasing HIV transmission and achieving Ending the HIV Epidemic outcomes. This analysis aims to characterize persons OOC and assess outcomes of a collaborative health department/medical provider data-to-care randomized control trial. Methods: OOC patients were randomized to Standard of Care (SOC) or Intervention, in which Disease Intervention Specialists assisted patients with reengagement. Criteria for inclusion were age >18, in-care at a participating clinic during a 12-month eligibility period and no care in the following 6 months. Chi-square testing was used to determine differences in demographics between study arms. Multivariable logistic regression was used to assess predictors of 3 outcomes: re-engagement (CD4/VL within 90 days), retention (2 or more CD4/ VLs at least 90 days apart within 1 year) and viral suppression (VL <200 c/mL within 1 year). Results: 449 OOC PLWH were randomized to each study arm between 8/2016- 12/2017, with no significant differences in demographic characteristics between arms. The majority of patients were evenly distributed across age groups >25, 65%were Black, 76%were male, 42%were MSM, and 21%were HIV/non-AIDS at diagnosis. Across arms, 53%were re-engaged, 52%were retained at 1 year, and 60%were virally suppressed at 1 year. Patients randomized to the intervention were 2.22 (95% CI: 1.69-2.92), 1.89 (1.44-2.48) and 1.44 (1.10-1.90) times as likely as SOC patients to re-engage in care, become retained in care, and achieve viral suppression, respectively, when controlling for race, birth sex, age, transmission category and disease stage at diagnosis. Conclusion: Results indicate that a collaborative data-to-care intervention can improve re-engagement in care, retention in care and viral suppression among PLWH who are OOC. Next steps include expansion of this model to determine feasibility of city-wide implementation.

Methods: We analyzed data from 105 communities in the PopART (21 communities in South Africa and Zambia, ~ 25,000 adults each), BCPP (30 communities in Botswana, ~3,600 adults each), ANRS 12249 TasP (22 communities in South Africa, ~1,300 adults each) and SEARCH (32 communities in Uganda and Kenya, ~5,000 adults each) studies. Communities ranged from rural to urban and varied in the mobility of their populations and their sex ratio (~30% to 50%male). HIV incidence was measured via repeat testing between 2012-2018. Population viremia ¬– % of all adults (HIV+ or HIV-) with HIV viremia – was estimated at midpoint of follow-up based on HIV prevalence and non-suppression among HIV+, with adjustment for differences between the measurement cohort and underlying population. Community-level regression, adjusted for study, was used to quantify the association between HIV incidence and viremia and to evaluate cross-study heterogeneity. Results: HIV prevalence (measured in 257,929 total persons, PopART: 37,006; BCPP: 12,570; TasP: 20,978; SEARCH: 187,375), ranged from 2% to 40% by community. Non-suppression among HIV+ (measured in 39,928 persons, PopART: 6,233; BCPP: 2,318; TasP: 6,617; SEARCH: 16,209) ranged from 3% to 70%. HIV incidence (measured over 345,844 person-years, PopART: 39,702; BCPP: 8,551; TasP: 26,832; SEARCH: 270,759) ranged from 0.03 to 3.4 per 100PY. Population-level viremia was strongly associated with HIV incidence; pooling across studies, HIV incidence decreased by 0.07/100PY (95% CI: 0.05,0.10, p<0.001) for each 1% absolute decrease in viremia. Incidence was significantly associated with viremia in each study; however, both strength of the incidence- viremia relationship (slope) and projected incidence at 0% viremia (intercept) differed (Figure). Conclusion: Lower population-level HIV viremia was associated with lower HIV incidence in all four Universal Test and Treat Studies, conducted in a wide range of epidemic contexts in sub-Saharan Africa. Differences in external infection rate (due to variation in community size, mobility, and sex ratio) may have contributed to heterogeneity between studies.

Oral Abstracts

48 DECREASING COMMUNITY VIREMIA IS ASSOCIATED WITH DECREASING HIV INCIDENCE IN AUSTRALIA Denton J. Callander 1 , Mark Stoové 2 , Hamish McManus 1 , Andrew Carr 3 , Richard Gray 1 , Jennifer Hoy 4 , Basil Donovan 1 , Margaret Hellard 2 , Andrew E. Grulich 1 , Christopher K. Fairley 5 , Martin Holt 1 , David J. Templeton 6 , Teng Liaw 1 , James McMahon 7 , Rebecca J. Guy 1 , for the TAIPAN Advisory Group 1 University of New South Wales, Sydney, NSW, Australia, 2 Burnet Institute, Melbourne, VIC, Australia, 3 St. Vincent's Hospital, Sydney, NSW, Australia, 4 The Alfred Hospital, Melbourne, VIC, Australia, 5 Monash University, Melbourne, VIC, Australia, 6 RPA Sexual Health, Camperdown, NSW, Australia, 7 Monash Health, Melbourne, VIC, Australia Background: Considerable public health resources have been dedicated to implementing HIV ‘treatment-as-prevention’ in an effort to reduce new infections. Although promising, no large-scale studies have yet evaluated the community-level impact of treatment-as-prevention on direct measures of HIV incidence among gay and bisexual men (GBM). This study assessed the temporal relationship between community viremia and HIV incidence among GBM living in New South Wales and Victoria, Australia’s most populous states. Methods: For 2012-2017, we established a longitudinal cohort of HIV-positive (n=12,200) and HIV-negative (n=45,719) GBM using data from a targeted sentinel surveillance system of 49 sexual health clinics, general practices, community HIV-testing sites and hospitals. Among GBMwith diagnosed HIV,

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POPULATION-LEVEL VIREMIA PREDICTS HIV INCIDENCE ACROSS UNIVERSAL TEST & TREAT STUDIES Maya L. Petersen 1 , Joseph Larmarange 2 , Kathleen Wirth 3 , Timothy Skalland 4 , Helen Ayles 5 , Moses R. Kamya 6 , Shahin Lockman 3 , Collins C. Iwuji 7 , François Dabis 8 , Joseph Makhema 9 , Diane V. Havlir 10 , Sian Floyd 11 , Richard J. Hayes 11 , for the UT3C 1 University of California Berkeley, Berkeley, CA, USA, 2 Paris Descartes University, Paris, France, 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 4 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 5 Zambart, Lusaka, Zambia, 6 Makerere University College of Health Sciences, Kampala, Uganda, 7 Africa Health Research Institute, Mtubatuba, South Africa, 8 L'Université de Bordeaux, Bordeaux, France, 9 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 10 University of California San Francisco, San Francisco, CA, USA, 11 London School of Hygiene & Tropical Medicine, London, UK Background: Improved understanding of the extent to which increased population-level viral suppression will reduce HIV incidence is needed. Using data from four large Universal Test and Treat Trials, we evaluated the relationship between viremia and incidence and its consistency across epidemic contexts.

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CROI 2020