CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

to determine individual-and clinic-level correlates of viral suppression at most recent assessment. Results: In 99 HIV clinics, among 10,096 AYA on ART >6 months, 2,683 (27%) had unsuppressed viral load (VL). Adjusted for individual-level factors, clinic-level correlates of individual suppression included designated adolescent spaces (aOR: 1.32, [95%CI: 1.07, 1.63]) and faster VL turnaround time (TAT) (aOR: 1.06 [95%CI: 1.03, 1.09]) per 10-day shorter TAT). Adjusted for clinic-level factors, AYA age 10-14 and 15-19 had lower odds of suppression compared to AYA age 20-24 years (aOR: 0.61 [95%CI: 0.54, 0.69] and 0.59 [95%CI: 0.52, 0.67], respectively). Compared to females, males had lower odds of suppression (aOR: 0.69 [95%CI: 0.62, 0.77]). Compared to ART duration of 6-12 months, ART for 2-5, >5-10 or >10 years was associated with poor suppression (p<0.001). In 16% of clinics, ≥80% of AYA were suppressed. Clinics with ≥80% AYA viral suppression were more likely to be in hyper-endemic counties (56% versus 22% p=0.04), have separate adolescent space, and a shorter viral load TAT (39% versus 15% and 9 days versus 12 days p=0.03, <0.001, respectively). Conclusion: Dedicated adolescent space, rapid VL TAT, and tailored approaches for specific groups may improve suppression. Routine summarization of VL suppression in clinics could provide benchmarking to motivate innovations in clinic- and individual-AYA care strategies. 818 CAN ADHERENCE INTERVENTIONS BE COST-EFFECTIVE AMONG YOUTH WITH HIV? Anne M. Neilan 1 , Audrey Bangs 1 , Michael Hudgens 2 , Kunjal Patel 3 , Allison Agwu 4 , Aditya Gaur 5 , Catherine Crespi 6 , Keith Horvath 7 , Caitlin Dugdale 1 , Kimberly A. Powers 2 , H. Jonathon Rendina 8 , Kenneth Freedberg 1 , Andrea L. Ciaranello 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 4 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 5 St. Jude Children's Research Hospital, Memphis, TN, USA, 6 University of California Los Angeles, Los Angeles, CA, USA, 7 University of Minnesota, Minneapolis, MN, USA, 8 Hunter College, CUNY, New York, NY, USA Background: Viral suppression (VS) among US youth with HIV (YWH) in care is only 25-59%. The Adolescent Medicine Trials Network for HIV/AIDS Interventions is evaluating several interventions to improve ART adherence among YWH. Our objective was to model the impact of a hypothetical adherence intervention, based on electronic reminders, to identify combinations of effectiveness and cost at which these programs would be cost-effective for YWH. Methods: Using the Cost-Effectiveness of Preventing AIDS Complications- Adolescent model, we simulated a cohort of YWH ages 13-24 using published YWH-specific data: cohort-level VS 59% (RNA <50c/mL), mean CD4 654/μL (SD 276). We compared 2 strategies: usual care (standard-of-care, SOC) and a 12 month (m) adherence intervention (AI) that led to an absolute increase in cohort-level VS (efficacy) of 10% compared to SOC at 12m and cost $100/m/ person. We assumed all YWH were in care and on ART for the first 12m in both SOC and AI, after which YWH were lost-to-follow-up/returned to care at 0.62/0.015%/m. We examined a range of AI efficacies (VS +1-20%) and costs ($50-2,000/m). Projected outcomes included opportunistic infections (OIs), life expectancy (LE), primary HIV transmissions averted during the intervention, HIV-related costs, and incremental cost-effectiveness ratios (ICERs, $/year-of- life saved (YLS); threshold ≤$100,000/YLS; discounted 3%/year). Results: Compared to SOC, AI reduced OIs by 15% and transmissions by 19% at 12m. Discounted LE for SOC vs. AI was 21.9 vs. 22.3 years. Discounted lifetime cost/person was $599,700 for AI and $599,500 for SOC. AI was +$200/person vs. SOC, a difference largely driven by added intervention costs (+$1,200) and ART (+$3,500); these costs were partially offset by savings from averted transmissions (-$3,800), less costly HIV-related care (-$300), and fewer OIs (-$200) and deaths (-$200). AI was cost-effective compared to SOC ($490/YLS). At base-case efficacy (10%), AI was cost-effective at costs up to $2,000/m; at base-case cost ($100/m), AI was cost-effective at efficacies ≥1% (Fig). When AI costs fell to $50/m, AI was cost-saving even when efficacy was as low as 7%. Conclusion: Adherence interventions among YWH that increase VS could reduce OIs, deaths, and transmissions, and be cost-effective. As novel interventions are evaluated, modeling can identify benchmarks for efficacy and cost that would render these interventions clinically and economically valuable for this vulnerable population.

819 TUBERCULOSIS INFECTION AND DISEASE IN HIV-INFECTED ADOLESCENTS ON ART: A COHORT STUDY

Lisa Frigati 1 , Katalin Wilkinson 1 , Leah Githinji 1 , Karryn Brown 1 , Sheena Ruzive 1 , Wonita Petersen 1 , Mark Cotton 2 , Landon Myer 1 , Heather Zar 1 1 University of Cape Town, Cape Town, South Africa, 2 Stellenbosch University, Cape Town, South Africa Background: There are limited data on TB in perinatally-infected adolescents living with HIV (PHIV+) in high burden settings. We examined the incidence of latent tuberculosis infection (LTBI) and TB disease in the Cape Town Adolescent Antiretroviral Cohort. Methods: PHIV+ adolescents between 9-14y, on ART >6m in routine public sector care and age-matched HIV-uninfected children were enrolled between 2013-2015 and followed 6-monthly until end 2018. Symptomatic screening (including history of having a TB contact and or being on Isoniazid prophylaxis) for TB, chest radiograph and sputum for Xpert MTB/RIF, microscopy and culture, viral load and CD4 count were performed at enrolment and annually. QuantiFERON (QFT, Qiagen, South Africa) was done at enrollment and then annually if prior QFT was negative. LTBI was defined by a QFT of >0.35 IU/ml in the absence of signs and symptoms of TB. TB diagnosis was defined as definite (culture-confirmed) or probable (clinical case definition). Time to event analyses were used to describe the incidence of LTBI and TB disease. Results: 485 PHIV+ and 95 HIV- adolescents (median age 12 years [IQR:10.6- 13.3]; 50%male) had QFT results at enrolment. PHIV+ had a median CD4 of 715 cell/µL(IQR:564-959) and 365 (75%) had viral load <40 cps/ml. 61% of PHIV+ had a history of TB disease before enrolment (vs 3% in HIV-, p<0.01) and 27%were on INH prophylaxis (vs 4% in HIV-) but with no difference in QFT positivity at enrolment (33% vs 28%, p=0.34). Over 3 years of follow-up, HIV+ participants had a similar rate of QFT conversion compared to HIV- [7.4 (5.9-9.4) vs 8.7 (CI:5.6-13.7) per 100- person years (PY), p= 0.31]. HIV+ participants had a higher rate of TB disease [2.2 (CI:1.6-3.1) vs 0.3 (0.00-2.2) per 100- PY, p= 0.07]. 46% of HIV+ participants with TB disease were QFT+. Figure 1 describes the cumulative prevalence of QFT positivity and TB incidence by age in HIV+ participants. Conclusion: In this high TB burden setting, the rate of QFT conversion did not differ between PHIV + and HIV- adolescents, but PHIV+ had a higher incidence of TB disease despite ART. INH prophylaxis, adequate viral suppression and other interventions are needed to reduce TB incidence during the adolescent period.

Poster Abstracts

820 LOWER SIZE-ADJUSTED BONE DENSITY AND MUSCLE FUNCTION IN ZIMBABWEAN CHILDREN WITH HIV Ruramayi Rukuni 1 , Celia Gregson 2 , Kate Ward 3 , Nicola Crabtree 4 , Andrea M. Rehman 5 , Rashida A. Ferrand 5 1 Biomedical Research and Training Institute, Harare, Zimbabwe, 2 University of Bristol, Bristol, UK, 3 University of Southampton, Southampton, UK, 4 Birmingham Children's Hospital, Birmingham, England, 5 London School of Hygiene & Tropical Medicine, London, UK

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