CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Rai Prachanukroh Hospital, Chiang Rai, Thailand, 5 Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand, 6 Hat Yai Hospital, Songkhla, Thailand, 7 Sanpasitthiprasong Hospital, Ubon Ratchathani, Thailand, 8 FHI 360, Bangkok, Thailand, 9 United States Agency for International Development, Washington, DC, USA Background: Despite the World Health Organization’s recommendation on same-day antiretroviral therapy (ART) for clients who are ready, there are still concerns around the effect of immediate ART on care outcomes. This study evaluates the influence of different ART initiation durations on retention, viral load suppression, and adverse events on clinically-eligible clients in same-day ART cohort in Thailand. Methods: Data was obtained from HIV-positive clients from 10 facilities in 6 provinces (Chiang Rai, Chiang Mai, Chonburi, Ubonratchathani, Bangkok and Songkhla) between July 2017–July 2019. Baseline laboratory tests and chest X-rays were performed according to national guidelines. ART eligibility was determined by a physician. Clinically-eligible clients were included in the analysis, and categorized into the duration between care engagement and ART initiation: same-day, 2-7 days, 8-14 days, 15-21 days, and more than 21 days. Logistic regressions were performed to identify factors associated with loss to follow-up at months 3, 6, and 12 after ART initiation, as well as adverse events (AEs). Results: Of 4,642 clients who agreed to start ART, 3,888 (83.8%) were clinically eligible and started ART; 30%, 64%, and 6% of these identified as general population, men who have sex with men (MSM), and transgender women (TGW), respectively. The following results presented are in order of same-day, 2-7 days, 7-14 days, 14-21 days, and more than 21 days categories. The numbers of clients were: 3,053 (78.5%), 484 (12.5%), 164 (4.2%), 67 (1.7%), and 120 (3.1%), respectively. At month 3, retention rates were: 98.8%, 94.5%, 96.2%, 95.1%, and 96.5%. (p=0.695) At month 6, retention rates were 92%, 95.5%, 96.6%, 90.9%, and 90.7%. (p=0.153) At month 12, retention rates were: 95.6%, 95.7%, 100%, 100%, and 95.2%. (p=0.921) Reports on clinical AEs were: 15.5%, 15.3%, 14%, 13.4%, and 10.8% (p=0.685); Reports on death were: 0.4%, 0.6%, 0.6%, 0%, and 0.8% (p=0.895). Viral load suppression rates were: 94%, 94%, 84.4%, 100%, and 88.2% (p=0.054). When compared to general population, TGWwere more likely to be lost to follow-up (aOR:1.7;95%CI:1.03-2.8;p<0.05) and had AEs (aOR:1.52;95%CI:1.07-2.17;p<0.05). Conclusion: Same-day ART did not lead to an increase in loss to follow-up, adverse events, or death among clinically eligible clients, and viral load suppression did not differ by timing of ART initiation. Service for TGWmay need to integrate gender-affirming care to enhance ART retention. 1073 RAPID START LEADS TO SUSTAINED VIRAL SUPPRESSION IN YOUNG PEOPLE IN THE SOUTH Lorna Seybolt 1 , Katherine Conner 1 , Isolde Butler 1 , Nicholas Van Sickels 1 , Jason Halperin 1 1 CrescentCare, New Orleans, LA, USA Background: HIV incidence continues to increase in young men of color. Youth living with HIV, also, have lower rates of viral suppression and retention in care. Rapid Start is a linkage-to-care intervention to start people newly diagnosed with HIV immediately on ART and support equity in care. Our prior data has shown that rapid ART initiation improves linkage and viral suppression. Rapid Start data for US youth has not been published. To verify that youth were achieving similar outcomes, we developed a continuum of care for our young adult rapid start population and compared this continuum to our adult population. Methods: Newly diagnosed patients were linked within 72 hours of diagnosis (often same-day) to CrescentCare, a Federally Qualified Health Center in New Orleans. The first dose was directly observed and patients were provided a 30-day dose pack. Labs were drawn and patients underwent expedited insurance enrollment. The proportion achieving viral suppression, time to viral suppression, sustained viral suppression 12 months post-diagnosis and engagement in care at 12 months were compared between youth (18 – 24) and adults. Results: 124 patients were enrolled in our rapid start intervention between 12/1/2016 and 5/15/2018. Ninety-three were 25 or older with a median age of 33. Thirty-one were under 25 with a median age of 21. All patients chose to start ART, and none stopped due to adverse effects. 96.8% (30/31) of the youth population achieved viral suppression with a median of 29 days from diagnosis. 83.9% (26/31) remained virally suppressed at 12 months post-diagnosis and 96.8% (30/31) remained engaged in care.

1071 ASSOCIATION BETWEEN TIME TO ART AND LOSS TO CARE AMONG NEWLY DIAGNOSED PLWH IN RWANDA Jonathan Ross 1 , Gad Murenzi 2 , Donald R. Hoover 3 , Qiuhu Shi 4 , Hae-Young Kim 4 , Benjamin Muhoza 2 , Athanase Munyaneza 2 , Remera Eric 5 , Sabin Nsanzimana 5 , Marcel Yotebieng 1 , Denis Nash 6 , Kathryn Anastos 1 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 Rwanda Military Hospital, Kigali, Rwanda, 3 Rutgers University, Piscataway, NJ, USA, 4 New York Medical College, Valhalla, NY, USA, 5 Rwanda Biomedical Centre, Kigali, Rwanda, 6 City University of New York, New York, NY, USA Background: Nearly all countries have adopted WHO “Treat All” guidelines to initiate antiretroviral therapy (ART) for all people living with HIV (PLWH) as soon as possible after diagnosis. An emerging literature suggests it is important to characterize the relationship between time to ART initiation and subsequent clinical outcomes under Treat All. We compared loss to follow up (LTFU) and viral suppression (VS) among PLWH in Rwanda by time from diagnosis to ART initiation. Methods: Cohort study in 10 Rwandan health centers of adults (≥15 years) who were newly diagnosed with HIV from 1 July 2016 to 15 September 2018. We used Kaplan-Meier survival curves and Cox proportional hazard regression to examine associations between time from diagnosis to ART initiation (same day, 1-7, 8-30, >30 days) and LTFU (>120 days since last clinic visit and did not knowingly die or transfer) in the 15 months after diagnosis. Among patients with measured viral loads after ART initiation, we used log binomial regression to calculate risk ratios for VS (<200 copies/ml on most recent viral load >3 months after ART initiation), by time to ART. Results: Among 1971 patients, 1895 (96%) initiated ART. Of ART initiators, 293 (15%) initiated on the same day as diagnosis, 452 (24%) from 1-7 days, 768 (41%) from 8-30 days, and 382 (20%) >30 days after diagnosis. Compared to those initiating ART later, same day initiators were more likely to be female (70 vs 54%), had lower median age (30 vs 33 years) and had higher median baseline CD4 count (468 vs 411 cells/mm 3 , p<0.001 for all). LTFU occurred among 25%, 15%, 17% and 17% of same day, 1-7, 8-30, and >30 day initiators, respectively. After adjusting for health center, age, sex, enrollment source, BMI, WHO stage, and CD4 count, compared to those initiating on the same day, hazard of LTFU was lower among patients initiating ART later (1-7 days: adjusted hazard ratio [aHR] 0.66, 95% CI 0.47-0.92; 8-30 days: aHR 0.68, 95% CI 0.51-0.92; and >30 days: aHR 0.47, 95% CI 0.32-0.68). Among 1084 patients with measured viral loads >3 months after ART initiation, 958 (88%) were suppressed; there were no differences in probability of VS by time to ART. Conclusion: In this cohort of PLWH entering care after implementation of Treat All, patients initiating ART on the day of diagnosis were more likely to be lost to care than those initiating later. Ensuring adequate support for PLWH initiating ART rapidly is important to maintain engagement in care. 1072 SAME-DAY ART IN THAILAND: THE IMPACT OF ART INITIATION PERIODS ON TREATMENT OUTCOMES Pich Seekaew 1 , Sorawit Amatavete 2 , Nipat Teeratakulpisarn 2 , Prattana Leenasirimakul 3 , Suwimon Khusuwan 4 , Teerarat Chuntachon 5 , Ampaipith Nilmanat 6 , Suriyong Boonprachern 7 , Oranuch Nampaisarn 2 , Reshmie Ramautarsing 2 , Stephen Mills 8 , Ravipa Vannakit 9 , Praphan Phanuphak 2 , Nittaya Phanuphak 2 1 Columbia University, New York, NY, USA, 2 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 3 Nakornping Hospital, Chiang Mai, Thailand, 4 Chiang

Poster Abstracts

CROI 2020 403