CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Results: At the monitored health centers, the number of HIV tests performed increased from 161,647 in the first six-month period, to 246,604 in the second, and fell to 223,612 in the third. HIV-positive yield rose from 3.0%, to 5.4%, to 5.5%, respectively. The frequency of ART stock-outs decreased over the course of the project. Stock-outs were recorded during 23.6% (95% CI 19.9%-27.2%) of health center visits in the first period, declining to 16.4% (95% CI 13.6%-19.3%) in the second, and 15.2% (95% CI 12.3%-18.1%) in the third. The number of viral load tests performed more than doubled, increasing from 16,532 in the first period, to 31,472 in the second, to 33,376 in the third. The rate of viral suppression also increased dramatically, from 48.3% in the first period, to 67.9% in the second, and 77.4% in the third. According to patients, the quality of services improved. The average quality of care rating rose from 3.8/5.0 in the first period, to 4.0/5.0 in the second, to 4.2/5.0 in the third. Conclusion: The treatment observatory improved data transparency, creating a culture of collective problem-solving among patients, healthcare workers and policy-makers. The project triangulated anecdotal evidence of facility-level improvements with macro data trends that show regional-level progress. This provides proof of concept for the positive effects of community-led monitoring when done at scale. The approach should be expanded to help achieve global HIV treatment targets. 1081 ROUTINE LABORATORY DATA FOR ESTIMATING POPULATION VIRAL SUPPRESSION IN SOUTH AFRICA Elton E. Mukonda 1 , Nei-Yuan M. Hsiao 2 , Landon Myer 1 , Maia Lesosky 1 1 University of Cape Town, Cape Town, South Africa, 2 National Health Laboratory Service, Cape Town, South Africa Background: There are few population-wide data on viral suppression (VS) that can be used to monitoring programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from ART programmes can be extrapolated to population VS and validate this using a combination of empiric and model-based estimates. Methods: We used routine VL testing data for the Western Cape province for the January 2008 to September 2018, obtained from the South African National Health Laboratory Service. We carried out record linkage using a combination of deterministic and probabilistic linkage with hierarchical clustering to obtain linked results for individuals. Test- and individual-level VS rates were based on test VL values <1000 cps/ml, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census derived mid-year population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data. Sensitivity analyses examined subgroups by age, year and gender. Results: Approximately 1.9 million tests from 530 clinical sites were included, with VL testing volumes increasing by 500% between 2008 and 2018. Among individuals in care, VS increased from 84% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies including surveys specifically designed to estimate HIV prevalence and population viral suppression (HSRC National HIV Prevalence, Incidence, Behaviour and Communication Survey - SABSSM V), where 54.7% of PLWH had VS in 2017. This method also demonstrates close alignment with National Department of Health estimates (<2% difference across all years). Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed ART coverage and population HIV prevalence. Conclusion: While validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.

1082 POPULATION-BASED HIV IMPACT ASSESSMENTS AND VIRAL LOAD RESULTS: IMPLICATIONS FOR U=U Gregory C. Chang 1 , Trista Bingham 1 , Katrina Sleeman 1 , Irene Benech 1 , Yen T. Duong 2 , Jessica E. Justman 2 , Suzue Saito 2 , Melissa Metz 2 , Anna Awor 3 , Yohannes Mengistu 4 , Judith Shang 5 , Alice Maida 6 , Nzali Kancheya 7 , Optatus Malewo 8 , Bharat S. Parekh 1 1 CDC, Atlanta, GA, USA, 2 ICAP at Columbia University, New York, NY, USA, 3 CDC Uganda, Kampala, Uganda, 4 CDC Lesotho, Maseru, Lesotho, 5 CDC, Yaoude, Cameroon, 6 CDC Malawi, Lilongwe, Malawi, 7 CDC Zambia, Lusaka, Zambia, 8 CDC Tanzania, Dar es Salaam, Tanzania, United Republic of Background: Undetectable equals Untransmittable (“U=U”) is a message that conveys no risk of sexual transmission when people living with HIV (PLHIV) have a viral load (VL) <200 HIV RNA copies per milliliter of blood (cp/mL). VL assays that use dried blood spots (DBS) have a minimum detection threshold of 700-839 cp/mL, in contrast to VL assays that use plasma which can detect <200 cp/mL. Because some countries rely on DBS-based VL testing that is unable to detect the U=U threshold of <200 cp/mL, some providers are reluctant to adopt U=U messaging, especially in areas where plasma VL assays are not universally available. To address this potential barrier, we assessed the proportion of those with VL <200 cp/mL among PLHIV participants with VL <1000 cp/mL and were taking antiretroviral therapy (ART). Methods: We conducted a pooled multi-country secondary data analysis using complex survey design and weights of the 2015-2018 cross-sectional Population-based HIV Impact Assessments (PHIA) in six sub-Saharan African countries. Inclusion criteria were: adults aged 15-59 years who tested HIV- positive in the PHIA surveys; on ART, defined as detectable antiretrovirals and/ or self-report of current ART use; and available plasma VL results. Of the HIV- positive adults on ART who had a VL <1000 cp/mL (World Health Organization’s definition of viral load suppression (VLS)), we calculated the proportion who met the U=U cutoff of <200 cp/mL. . participants on ART with a VL <1000 cp/mL, 95.1% (95% CI 94.7-95.4) had a VL <200 cp/mL. Of the 4,970 participants with a VL <1000 cp/mL who were on ART and self-reported current ART for ≥12 months, the proportion with VL <200 cp/ mL was 96.6% (95% CI 96.2-96.9). Conclusion: These nationally representative population-based data demonstrate that a very high proportion of all HIV-positive adults on ART with VL <1000 cp/mL also had VL <200 cp/mL, suggesting that U=U messaging may be suitable even in settings limited to DBS-based VL measures. With continued ART adherence and high-quality laboratory sample collection and systems to verify VLS, PHIA data supports that the scale-up of U=U messaging may be appropriate regardless of which VL testing platform is available. Results: Overall, of the 8,031 HIV-positive adults on ART, 86.9% (95% confidence interval (CI) 86.4-87.4) had a VL <1000 cp/mL. Of the 7,003

Poster Abstracts

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