CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1069 ASSESSMENT OF IMMEDIATE INITIATION OF ANTIRETROVIAL THERAPY IN NEW YORK CITY Daniel Bertolino 1 , Erica D’Aquila 1 , Nadia Nguyen 2 , Denis Nash 3 , Abigail Baim- Lance 3 , Bisrat Abraham 1 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 New York State Psychiatric Institute, New York, NY, USA, 3 City University of New York, New York, NY, USA Background: Rapid or immediate initiation of antiretroviral therapy (iART) after a positive HIV test has been shown to decrease time to viral suppression (VS), in turn reducing transmission of HIV. New York City (NYC) and New York State (NYS) have expanded access to iART for people living with HIV (PLWH) through targeted programs at clinics in NYC. We evaluated iART knowledge, attitudes, and practices among clinical and non-clinical staff in NYC clinics, as well as barriers and facilitators to iART implementation. Methods: We recruited at least one clinical (i.e., medical provider) and one non-clinical (i.e., administrator or social service provider) staff member to complete an online survey from a purposive sample of 30 NYC clinics providing primary care to one or more PLWH. Clinics were selected to ensure a diverse representation of health outcomes (e.g., clinic VS), clinic resources (e.g., iART funding) and clinic location and type (e.g., borough, hospital-based clinic). Descriptive and bivariate analyses were performed on collected data. Results: We received 46 survey responses, representing 25 NYC clinics, 98% of which reported prior knowledge of iART. Over 80% of respondents identified iART as decreasing time to VS and increasing patient retention. Overall, 80% and 67% of respondents agreed that ART should be initiated on the same-day or within three to four days of a positive HIV test, respectively. Conversely, 51% of respondents believed ART should not be initiated prior to confirmatory test results, with non-clinical staff being more likely to hold this belief (odds ratio [OR]: 4.64, 95% confidence interval [CI]: 1.24-17.37). Among all respondents,66% reported zero to four days as the typical length of time from a positive HIV test to ART initiation. Clinics serving a majority people of color were less likely to meet the same-day benchmark (OR: 0.15, 95% CI: 0.02-0.95). Commonly reported facility-level and patient-level barriers to iART included: insurance barriers (76%), medication prior authorizations (50%), financial barriers (46%), and concern about false positives (37%). ART medication starter packs (63%) and patient education materials (52%) were the most commonly reported facilitators to iART. Conclusion: Despite high levels of knowledge around the benefits associated with iART, it is not yet the standard of care across NYC clinics. The proven benefits of iART warrant further efforts to overcome barriers to implementation, with a focus on achieving health equity.

1070 A STRUCTURED ALGORITHM FOR SAME-DAY ART INITIATION: SLATE II TRIAL PRIMARY OUTCOMES Mhairi Maskew 1 , Alana T. Brennan 2 , Matthew P. Fox 2 , Lungisile Vezi 1 , Willem D. Venter 3 , Peter Ehrenkranz 4 , Sydney Rosen 2 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 Boston University, Boston, MA, USA, 3 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 4 Bill and Melinda Gates Foundation, Seattle, WA, USA Background: Many countries, including South Africa, encourage same-day initiation (SDI) of antiretroviral therapy (ART), but evidence on how to implement SDI and its impact on outcomes remains scarce. Building on the Simplified Algorithm for Treatment Eligibility trial (SLATE I), in which nearly half of participants were ineligible for same day initiation due mainly to TB symptoms, we evaluated the revised SLATE II algorithm, which allowed SDI for patients with mild TB symptoms and other less serious reasons for delay. Methods: SLATE II was a 1:1 individually randomized trial at public outpatient clinics in Johannesburg that enrolled patients presenting for an HIV test or any HIV care but not yet on ART. Intervention arm patients were assessed with a symptom self-report, medical history, brief physical examination, and readiness questionnaire to distinguish patients eligible for immediate ART dispensing from those requiring further care, tests, or counseling before initiation. Standard arm patients received usual care. Using routine clinic records, we report initiation in 0 (same day), 7, and 28 days after study enrollment and retention in care 8 months after study enrolment. Results: From 3/14/18-9/21/18, we enrolled 593 adult HIV+, non-pregnant patients (median[IQR] age 35 [29-43]; 63% (n=373) female; median CD4 count 293 [133-487]). In the intervention arm, 87% initiated on the same day, compared to 38% in the standard arm (Table). Initiation was higher in the intervention vs standard arm by 7 days (91% vs 68%; RD: 23%; 95% CI: 17-29%) and 28 days (94% vs 82%; RD: 12%; 95%CI: 7-17%) after enrolment. By 8 months after study enrolment, 70% (207/296) intervention and 55% (163/297) standard arm patients had initiated ART ≤ 28 days and were retained in care (RD 15%; 95% CI 7-23%). Nearly half (140/296, 47%) of intervention arm patients reported >=1 TB symptom; 39 (13%) were severe enough to require delay for further investigation, and 6 (2%) were diagnosed with TB. No serious post- initiation adverse events were reported. Nearly all patients (98.5%) stated they would like to start same-day if possible. Conclusion: More than 85% of patients presenting for HIV testing or care, including those newly diagnosed, were eligible and ready for same-day initiation under SLATE II algorithm. The algorithm increased initiation in ≤ 7 days by 28% and retention in care at 8 months by 15%, offering a practical model for implementing guidelines that can be immediately utilized.

Poster Abstracts

CROI 2020 402