CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

816 THE CASCADE OF HIV CARE FOR CHILDREN AND ADOLESCENTS IN WEST AFRICAN COHORTS Désiré L.Dahourou 1 , Karen Malateste 2 , Sophie Desmonde 3 , Tanoh Eboua 4 , Elom Takassi 5 , Lorna Renner 6 , Marcelline D’Almeida 7 , Madeleine Amorissani- Folquet 8 , Mariam Sylla 9 , Valériane Leroy 3 1 Institut de Recherches en Sciences de la Santé, Ouagadougou, Burkina Faso, 2 INSERM, Bordeaux, France, 3 INSERM, Toulouse, France, 4 CHU de Yopougon, Abidjan, Cote d’Ivoire, 5 CHU Sylvanus Olympio, Lomé, Togo, 6 Korle Bu Teaching Hospital, Accra, Ghana, 7 Centre National Hospitalier Universitaire Hubert Koutougou Maga de Cotonou, Cotonou, Benin, 8 CHU de Cocody, Abidjan, Côte d'Ivoire, 9 Hôpital Gabriel Touré, Bamako, Mali Background: The attrition across the continuum of care for children and adolescents living with HIV (CALHIV) from their HIV diagnosis is unknown in West Africa. We assessed the progress to the second and third 90-90-90 targets in the International epidemiological Databases on AIDS (IeDEA) paediatric West African Cohort (pWADA). Methods: The pWADA database, involves nine paediatric clinics in five countries (Benin, Côte d'Ivoire, Ghana, Mali, Togo). All CALHIV aged 0-18 years, ART-naïve at enrolment except for prevention of mother-to-child transmission, and diagnosed between 2004 and 2018 were included. We described the proportions of the CALHIV initiating ART, and attrition (death, loss to follow-up [LTFU]: last clinical visit >12 months) and the proportion of those on ART virally suppressed (first viral load <500cp/mL after 6-month post-ART). We presented cumulative incidence and factors associated with ART initiation, with death/ LTFU as competing risks. Results: Overall, 7570 CALHIV were enrolled in pWADA; 69%were enrolled before 2013. At enrolment, 49%were females, median age was 3.5 years [interquartile range (IQR): 1.2–7.6 years], 37%were <2 years, and 73% were eligible to initiate ART according to the WHO guidelines in effect at enrolment. During follow-up, 3% died, 3%were transferred out and 19%were LTFU before ART initiation; 3%were alive but had not initiated on ART while 72% (5475/7570) initiated ART. The median time between baseline and ART initiation was 1.4 months (IQR: 0.3-7.2 months]. At ART initiation, median age was 5.1 years (IQR: 2-9 years) and 80%were treated with a non-nucleoside reverse transcriptase inhibitors regimen. Adjusted for center, gender, clinical/ immunological ART eligibility, children aged <2 years (Ajusted Hazard ratio [aHR]: 0.59; 95% Confidence Interval [95%CI]: 0.54-0.65) and aged 2-4 years (aHR: 0.84; 95%CI: 0.77-0.92) at baseline were significantly less likely to initiated ART compared to those aged 10-15 years, as well as CALHIV enrolled before 2016 compared to those enrolled later. Among CALHIV on ART, 65% (3562/5475) performed at least one viral load test during follow-up. The cumulative probability of reaching viral suppression was 17%, 26%, 36% and 43% at 6, 12, 24 and 36 months, respectively. Conclusion: In West Africa, CALHIV had low retention in care, low access to viral load and far to meeting the second and third stages of the 90-90-90 targets. Additional supports is needed for this population to initiate ART earlier, using more potent drugs and to strengthen treatment adherence. 817 HIV VIRAL SUPPRESSION IN ADOLESCENTS AND YOUNG ADULTS: A NATIONAL SURVEY IN KENYA Irene Njuguna 1 , Jillian Neary 2 , Caren Mburu 3 , Danae Black 2 , Kristin Beima- Sofie 2 , Anjuli Wagner 2 , Cyrus Mugo 1 , Yolanda Evans 4 , Brandon Guthrie 2 , Janet Itindi 5 , Alvin Onyango 3 , Laura Oyiengo 6 , Barbra A.Richardson 2 , Dalton Wamalwa 3 , Grace John-Stewart 2 1 Kenyatta National Hospital, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 University of Nairobi, Nairobi, Kenya, 4 Seattle Children's Hospital, Seattle, WA, USA, 5 Kenya Medical Research Institute, Nairobi, Kenya, 6 Ministry of Health, Nairobi, Kenya Background: Adolescents and young adults (AYA) living with HIV are at high risk of virologic failure. While HIV clinics have developed innovative approaches to address unique AYA challenges, it is unclear if these influence viral suppression. To achieve UNAIDS 95-95-95 goals, there is need to understand modifiable and fixed individual and clinic correlates of suppression. Methods: We conducted a multi-level cross-sectional analysis using viral load data and facility surveys from HIV treatment programs throughout Kenya. We abstracted medical records of AYA in HIV care, analyzed the subset on ART for >6 months between January 2016-December 2017, and collected information on AYA services at each clinic. We used multi-level logistic regression models

815 CHILDREN <15 ARE LESS LIKELY TO BE AN INDEX TESTING CONTACT COMPARED TO ADULTS Hilary T. Wolf 1 , Melissa Bochnowicz 1 , Kayla Zhang 1 , Teeb Al-Samarrai 1 , Joseph S. Cavanaugh 1 , Shabeen Ally 1 1 Office of the Global AIDS Coordinator, Washington, DC, USA Background: According to UNAIDS, half of children with HIV globally remain undiagnosed. Children with HIV are being diagnosed after the first five years of life, and thus may have no routine contact with the health system until they become symptomatic. In April 2017, PEPFAR began to rapidly scale index testing of sexual contacts and biological children of people living with HIV across all sites and communities, as it has shown the highest testing yield across all countries. While some countries have been successful in scaling index testing among sexual contacts, many have struggled with using index testing effectively to find children with HIV who remain undiagnosed. This report evaluates the index testing cascade of pediatric contacts from October 2018 to June 2019. Methods: A descriptive analysis was used to assess the number of children (aged 1-14) and adults (aged 15-49) who newly tested positive for HIV and accepted index testing services in eight countries in sub Saharan Africa. We then evaluated the number of pediatric contacts and adult contacts of index participants who were elicited for HIV testing, the number of children who received an HIV test, and the number of children who were seropositive for HIV (yield). Results: Each index case elicited more adult contacts than pediatric contacts in all 8 countries, with noteworthy geographic variation. The percent of elicited contacts who were children ranged from 0.08% in Uganda to 40% in South Africa. For South Africa, Zambia and Malawi, >37% of elicited contacts were children, while for the Democratic Republic of Congo (DRC), Kenya, Lesotho, Nigeria, and Uganda, <25% of elicited contacts were children. HIV testing yield among children identified as contacts ranged from 1.1% in Lesotho to 10.1% in DRC, with an average yield of 4.5% across the 8 countries. Conclusion: Our results demonstrate high yields of new pediatric cases in specific geographic regions from index testing services. Failure to identify all pediatric contacts of index clients represents a missed opportunity to find undiagnosed children. Although we are unable to link the number of clients who accept index testing with the number of contacts that are elicited from index testing and ultimately the number of children who test positive; attention to pediatric contacts of new adult cases will allow life-saving therapy to be delivered to a vulnerable population.

Poster Abstracts

CROI 2020 303