CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

clinical benefits and costs of three strategies for EID in Zimbabwe for infants 6 weeks of age: 1) lab-based EID (LAB), 2) strengthened lab-based EID (S-LAB), defined as improved sample transport, two additional lab staff, and increased lab maintenance, and 3) POC EID. Assays differed in sensitivity (LAB and S-LAB 100%, POC 96.9%) and specificity (LAB and S-LAB 99.6%, POC 100%). LAB/S-LAB/POC algorithms also differed in: probability of result return (79/91/98%), time until result return (61/53/0 days), probability of linking to ART after confirmed positive result (52/71/86%), and total cost/ test ($17.09/$29.80/$31.26), which included transport, salary, training, and maintenance costs derived from a resource utilization analysis in Zimbabwe. Monthly cost of HIV care and ART varied by age, CD4 count, regimen, and weight. We projected life expectancy (LE) and average lifetime per-person cost for all HIV-exposed infants, including those who did and did not acquire HIV. We calculated incremental cost-effectiveness ratios (ICERs) from discounted (3%/ year) LE and cost results in $/year-of-life saved (YLS), defining cost-effective as an ICER <$1,330/YLS (Zimbabwe per-capita GDP). In multi-way sensitivity analyses, we varied differences between S-LAB and POC in: result return probability, result return time, and cost. Results: For infants who acquired HIV, LAB/S-LAB/POC led to projected one-year survival of 67/70/76% and undiscounted LE of 21.77/22.75/24.51 years. For all HIV-exposed infants, undiscounted LE was 63.34/63.38/63.42 years, at undiscounted costs of $330/$360/$390 per infant. S-LAB was dominated in cost-effectiveness analysis; the ICER of POC vs. LAB was $870/ YLS. In multi-way sensitivity analyses, S-LAB was only cost-effective if it cost $10 less than POC, had the same result return probability as POC, and had 10-day result return time (Figure). Conclusion: Current EID programs will attain greater benefit for additional investments by integrating POC EID rather than strengthening lab-based systems; decreases in POC test cost will amplify the benefits of POC EID.

69.0% in group B and 75.3% of group C (adjusted Risk Ratio (aRR)=1.13 for the MI intervention vs. group C (95% Confidence Interval (CI): 1.0-1.3) and aRR 1.2 vs. group B (95%CI: 1.1-1.4)). Overall only 58 (8.2%) children were tested at 18- months (10.7% group A, vs 5.5% in group C, RR 2.0, 95% CI: 1.0-3.7) with a final vertical transmission rate of 0.7%. Maternal retention and VL suppression rates were similar across randomisation groups at 349 (49%) retained at six months (180/226 VL suppressed), 151 (21%) at 12 months (93/114 VL suppressed), 130 (18%) at 18-months (99/111 suppressed). Conclusion: MI retention counselling by unskilled lay personnel is feasible and can reduce delays in the uptake early infant diagnostic tests for HIV-exposed infants. However, greater efforts are needed to improve adherence to the 18-months child antibody test, postpartummaternal retention in HIV care and viral monitoring.

Poster Abstracts

787 MOTHERS’ ADHERENCE HELPS IN IDENTIFYING MORE INFANTS IN NEED OF EXTENDED PROPHYLAXIS Sara Dominguez Rodriguez 1 , Pablo Rojo Conejo 1 , Maria G. Lain 2 , Afaaf Liberty 3 , Shaun Barnabas 4 , Elisa López Varela 5 , Kennedy N. Otwombe 3 , Siva Danaviah 6 , Eleni Nastuoli 7 , Miquel Serna Pascual 1 , Viviana Gianuzzi 8 , Carlo Giaquinto 9 , Louise Kuhn 10 , Alfredo Tagarro 1 , for the EPIICAL Consortium 1 Hospital Universitario 12 de Octubre, Madrid, Spain, 2 Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique, 3 Perinatal HIV Research Unit, Soweto, South Africa, 4 Tygerberg Hospital, Cape Town, South Africa, 5 ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain, 6 Africa Health Research Institute, Mtubatuba, South Africa, 7 University College London, London, UK, 8 PENTA Foundation, Padovo, Italy, 9 University of Padova, Padovo, Italy, 10 Columbia University Medical Center, New York, NY, USA Background: The WHO recommends extended HIV prophylaxis (ePCP) for infants at high-risk of PMTCT. High risk is defined by maternal factors: a mother first identified as HIV-infected at delivery or postpartum, a known HIV+ mother not on ART, viral load (VL)>1000 copies/mL <1 month before birth, or unavailable VL but ART for <4 weeks by delivery. Well controlled cohorts of pregnant women show that 10% of pregnancies are high risk and contribute to 57% of vertical infections. 90% of pregnancies are low risk and result in 43% of infections. In practice, some of the high-risk infants are miscategorized and treated with standard prophylaxis instead of ePCP. The aim is to evaluate the sensitivity of WHO algorithm to correctly identify high risk infants, based on the given outcome which is HIV infected infant, and to assess the improvement of adding extra information to the algorithm Methods: EARTH is a multicenter prospective cohort, part of the EPIICAL consortium, enrolling HIV-perinatally infected infants,diagnosed in the first 3 months of life and treated in the first 3 months after diagnosis, in Mozambique and South Africa. We categorized infants as high risk or low risk, based on WHO criteria and then re-categorized infants after including mother self-reported adherence Results: 135 children were analyzed. Median age at enrolment was 38 days (31-75), and median age at ART was 33 days (19-66). Prophylaxis after birth was prescribed to 80%. Only 26% of high-risk infants received extended ePCP with NVP and AZT. Median mother’s age at enrollment was 28 years and only 68% had detectable VL. Of those, their last median VL was log 10 4.21. To date, no mothers died. Only 58 (43%) mothers were classified as high risk and 77 (57%) as low risk. Of these, 74/77 (96%) had not a recent VL prior to delivery but were on ART for >4 weeks. Maternal self-reported adherence was good in 52% and 56%,

786 MOTIVATIONAL INTERVIEWING RETENTION COUNSELING AND CHILD HIV TESTING IN SOUTH AFRICA Dorina Onoya 1 , Nelly Jinga 1 , Cornelius Nattey 1 , Constance Mongwenyana 1 , Sithabile Mngadi 1 , Gayle G. Sherman 1 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa Background: The improvement of health outcomes of vertically infected infants requires earlier HIV diagnosis through greater adherence to the HIV testing schedules for HIV-exposed children. Methods: This is a randomised controlled trial among HIV positive postpartum mother-baby dyads enrolled immediately after the postnatal consultation at four midwife obstetric units in Gauteng (South Africa) and randomised into (A) Motivational Interviewing (MI) retention counselling by lay counsellors at baseline and telephonically at six and 12-month, (B) bi-annual tracing calls, (C) standard care. Mother-baby pairs were followed up to 18 months postpartum telephonically and via paper files (25 primary care clinics) and electronic medical records (a search of the National Health Laboratory Services database). Log-binomial regression was used to assess the timing of the ten-weeks infant polymerase chain reaction (PCR) test, the uptake of the child 18-months antibody test, maternal retention and viral load (VL) suppression at six, 12 and 18-month postpartum. Results: Overall, 710 mother-baby pairs were recruited with a median age of 30 years (interquartile range: 25-34). While, 70.1% of HIV-exposed babies received a second HIV PCR test by six-month (70.0% in the MI intervention group, 70.5% in the control groups B and 70.0% in group C), among those tested (n=501), 85.0% of the intervention (A) children were tested at 7-90 days of age,

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