CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Both the US Preventive Services Task Force and the Centers for Disease Control and Prevention recommend routine, voluntary, “opt-out” HIV testing for all adolescents and adults. Despite these recommendations, HIV testing is not routine practice. Furthermore, integrated HIV, STI, and hepatitis testing is even less common. Methods: We analyzed outpatient HIV, STI, and viral hepatitis-related insurance claims from the Oregon All Payers All Claims Database (APAC) for 2016. Using ICD-10 and CPT codes, we identified the number of patients that had an HIV test, an STI test, and a hepatitis B or hepatits C test. We excluded those aged <13 years and >64 years, pregnant women, and those previously diagnosed with HIV. We examined demographic, healthcare, and geographic predictors of HIV testing and integrated HIV, STI and hepatitis testing. Results: In 2016, 4.8% of the sample (n=1,780,612) had an HIV test, 13.0% had a test for an STI or hepatitis B or C,and 4.2% had integrated HIV and STI or hepatitis testing. At visits that included an HIV test, 88.3%were tested for an STI or hepatitis. Conversely, at visits that included an STI or hepatitis test, 31.5%were tested for HIV. HIV tests were most commonly accompanied by gonorrhea/chlamydia (62.4%), syphilis (53.0%), and hepatitis B (47.2%) testing. Women were more likely to be tested for HIV and experience integrated testing than men. Those aged 18-29 were most likely to have an HIV test and HIV/STI/hepatitis co-testing, while those aged 50-64 were least likely to be tested. Black/African Americans were most likely to be tested for HIV and to have integrated testing while Native American/Alaska Natives were least likely to experience these testing services. Compared to those with other insurance coverage, those with Medicaid were more than two times more likely to be tested for HIV and to have integrated testing. Those in rural and frontier regions were less likely to be tested for HIV and STI/hepatitis than those in urban areas. Conclusion: Routine HIV testing and integrated HIV/STI/hepatitis testing are not widespread practice. Routine, rather than risk-based, testing, is critical to the timely diagnosis and treatment and, thus, prevention of onward HIV, STI, and hepatitis transmission.

questionnaire, HCV screening was performed using rapid tests for these with any positive response and all participants between 50 and 70 years. Two multivariable models were created, one for participants younger than 50 and other for these older than 50. These models included the questions that exhibited the strongest association with a positive HCV result in the univariate analysis Results: A total of 7,936 questionnaires were completed and 4,705 HCV tests were performed, 46 of these (0.98%) were positive. Model identified, four out of the 22 questions, that predicted 90% of HCV status for participants younger than 50: HIV- or HCV-infected partner OR 26.6 95% CI (7.6–92.9), Male Sex Male 3.3 (0.8–13.5), illicit or recreational drug use 23.6 (4.2–131.8), and hepatitis or unexplained liver disease 51.0 (17.4–154.9). For patients over 50, five questions predicted 89% of HCV status: male gender 3.1 (1.4–7.2), illicit or recreational drug use 18.1 (4.2–77.8), the belief that there is any possibility of being HIV/HCV infeted 3.2 (1.4–7.5), a previous lymphoma 19.4 (2.1–183.3), and hepatitis or unexplained liver disease 20.8 (8.6 - 50.3). Nomograms appear in Figure Conclusion: Two easy-to-implement models that are age adapted can predict the majority of HCV status, in general population. This work contributes to the implementation of integrated, bundled, rapid HCV/HIV testing programs.

Poster Abstracts

948 HIV TESTING CRITERIA TO REDUCE TESTING VOLUME AND INCREASE POSITIVITY IN BOTSWANA Emily Rowlinson 1 , Jenny Ledikwe 2 , Shreshth Mawandia 2 , Odirile Bakae 2 , Lenna Tau 2 , Matias Grande 2 , Laura Seckel 1 , Goabaone Mogomotsi 3 , Esther Mmatli 3 , Modise Ngombo 3 , Matthew R. Golden 1 1 University of Washington, Seattle, WA, USA, 2 International Training and Education Center for Health, Gaborone, Botswana, 3 Botswana Ministry of Health, Gaborone, Botswana Background: Recent PEPFAR guidance seeks to diminish HIV testing volume and focus testing on higher positivity populations. We sought to define testing criteria to reduce total tests performed and increase positivity in Botswana. Methods: We analyzed data collected October 2018-August 2019 as part of routine HIV testing provided in 134 Botswana Ministry of Health facilities supported by the International Training and Education Center for Health (I-TECH). We randomly split the data into prediction and validation datasets of equal size and used multivariate logistic regression to identify demographic characteristics, testing strategies, and testing sectors (e.g., antenatal) associated with HIV positivity; factors with significant adjusted odds ratios (aOR) ≥1.5 were included in the testing criteria. Testing strategies and sectors where cessation of testing was deemed unacceptable a priori (TB, STD, VCT, partner services, antenatal, labor & delivery, pediatrics and gynecology) were excluded frommodel development and included in the testing criteria. We

947 AN AGE-ADAPTED, EASY-TO-IMPLEMENT SCORE FOR INTEGRATED BUNDLED, RAPID HIV/HCV TESTING Maria Jesus Perez-Elias 1 , Javier Martínez-Sanz 1 , Alfonso Muriel 1 , María J. Vivancos-Gallego 1 , Ana Moreno 1 , Margarita Herrero-Delgado 2 , Beatriz Romero 1 , Matilde Sanchez-Conde 1 , Almudena Uranga 3 , Pilar Perez Elias 3 , Yolanda De La Fuente-Cortés 4 , Rafael Barea 5 , Juan Carlos Galán 1 , Santos Del Campo 1 , for the DRIVE03 Study Group 1 Hospital Ramón y Cajal, Madrid, Spain, 2 Centro de Salud Mar Báltico, Madrid, Spain, 3 Centro de Salud García Noblejas, Madrid, Spain, 4 Centro de Salud Aquitania, Madrid, Spain, 5 Centro de Salud Canal de Panamá, Madrid, Spain Background: Undiagnosed or unlinked HIV-and/or HCV-infected populations still remain an issue worldwide. Integrated, bundled, rapid HCV/HIV testing has been proposed, but testing recommendations slightly differ between the two diseases: HCV testing is recommended for high-risk groups and all persons born between 1945 and 1965; HIV testing is recommended for everyone between the ages of 13 and 64. Our objective is to evaluate which HCV self-reported risk factors are associated with higher rates of infection, considering age as differences may exist. We also focus on creating an easy-to-implement score. Methods: We conducted a sub-analysis of the DRIVE03 study (NCT03145753), which was carried out at four primary care centers, including non HIV-infected people aged, 18 and 70 years. After participants completed an HIV/HCV risk

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