CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Implemented at previously-documented scale-up, these would reduce incidence by 30.8% (95% credible interval: 19.2%-43.8%) (Seattle) to 50.1% (41.5%-58.0%) (NYC) by 2030, at ICERs ranging from cost-saving in Miami to $136,718/QALY in Atlanta. These rose to 39.8% (26.7%-54.1%) in Seattle to 85.1% (72.3%-88.5%) in Baltimore at ideal implementation. Combined costs of implementing strategies at previously-documented scale-up totaled $671M/ year at peak levels (2.3 times the initially-proposed 2020 funding allocation); however, costs were offset by long-term reductions in new infections and delayed disease progression, with Miami projecting cost-savings over the 20-year study period. Conclusion: Evidence-based interventions can deliver considerable value, however, complementary strategies to overcome social and structural barriers to HIV care will be required to reach national ‘Ending the HIV epidemic’ targets by 2030.

1095 ACHIEVING 95-95-95 MAY NOT BE ENOUGH TO END THE AIDS EPIDEMIC IN SOUTH AFRICA Dobromir Dimitrov 1 , James R. Moore 1 , Deborah J. Donnell 1 , Marie-Claude Boily 2 1 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 2 Imperial College London, London, UK Background: The ambitious 95-95-95 strategy was announced by UNAIDS in 2014, aiming to end the AIDS epidemic by 2030 by achieving 95% diagnosed among all people living with HIV (PLHIV), 95% on antiretroviral therapy (ART) among diagnosed, and 95% virally suppressed (VS) among treated. An intermediate goal of 90-90-90 was set for 2020. These targets have been adopted by many countries implying that treatment should be prioritized in resource allocation. We estimate the expected reduction in HIV incidence if the UNAIDS targets are met in South Africa by 2030 reaching different PLHIV groups by sexual risk behavior. Methods: A risk equation model was used to simulate annual HIV incidence by tracking the transmission from PLHIV assuming 30% of them engaged in high- risk behavior (more frequent sex with multiple partners). Two baseline scenarios with different risk group coverage were parameterized with the HIV prevalence and 85-58-76 treatment cascade (i.e. 37% viral suppression of PLHIV), estimated in 2015 in South Africa, and calibrated to the 2015 HIV incidence among adult population (15-49 years). They were compared to scenarios in which UNAIDS targets are achieved and newly diagnosed, treated and virally suppressed PLHIV were: i) proportionally distributed between risk groups (proportional); ii) predominately recruited from the high-risk group (optimistic) and iii) predominately recruited from the low-risk group (pessimistic) with stable HIV prevalence up to 2030. Results: Annual HIV incidence was estimated 1.05% - 1.31% in 2015 depending on how treatment coverage was distributed between risk groups (see figure). Reaching the 90-90-90 target by 2030, resulting in 73% overall VS, may reduce annual HIV incidence to 0.29% if the cascade is predominately improved through recruitment from the high-risk group or to 0.74% if the cascade is improved with low-risk PLHIV. Reaching the 95-95-95 target, resulting in 86% overall VS, may result in 0.15% and 0.39% annual HIV incidence if the cascade is improved with high-risk and low-risk PLHIV, respectively. The HIV incidence projections in all scenarios remain above the elimination threshold of 0.1% (1 infection/1000 person-years). Conclusion: Reaching UNAIDS treatment cascade targets does not equate the end of the HIV epidemic in South Africa. Expected HIV incidence strongly depend on the risk heterogeneity and the ART and VS coverage achieved among high- risk PLHIV. Scale-up of other HIV prevention tools is needed to bridge the gap to AIDS elimination.

Poster Abstracts

1094 ASSESSING THE IMPACT AND COST-EFFECTIVENESS OF HIV AND NCD INTEGRATED CARE IN KENYA Parastu Kasaie 1 , Brian Weir 1 , Melissa Schnure 1 , Chen Dun 1 , Jeff Pennington 1 , Yu Teng 2 , Richard Wamai 3 , Kipkoech Mutai 4 , David Dowdy 1 , Chris Beyrer 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Avenir Health, Glastonbury, CT, USA, 3 Northeastern University, Boston, MA, USA, 4 National AIDS Control Council, Nairobi, Kenya Background: With increasing ART coverage, non-communicable diseases (NCDs) are a growing cause of death and disability in many high HIV burden countries. Integrated community-based screening and treatment for HIV and NCDs is a promising approach for addressing the dual burden of these diseases. We model the national scale-up of this approach in Kenya to estimate its population-level impact and cost-effectiveness. Methods: Coupling a microsimulation of cardiovascular diseases (CVDs) with a population-based model of HIV dynamics (the Spectrummodel), we created a hybrid model of HIV/CVDs. We applied this model to estimate the impact of a community-wide integrated program for screening and treatment of HIV, hypertension and diabetes in Kenya. The intervention was projected to run from 2019 to 2023, with a model time horizon of 2033. We assumed that 20% of the population would be targeted on an annual basis, 73% of HIV-positive people would start ART if screened, and 50% of eligible post-screening NCD treatment time would be covered. Results: At a national level in 2018, an estimated 7.62 million individuals were living with untreated hypertension, 692,000 with untreated diabetes, and 592,000 individuals in need of ART. ART coverage increased from 68% at baseline to 88% in 2033, and HIV incidence decreased by 64%. Providing NCD screening and treatment would avert 116,000 CVD events and 43,600 CVD deaths by 2033. The integrated HIV/NCD intervention could avert 7.76 million disability-adjusted life years (DALYs) over 15 years at an estimated total cost of $6.68 billion ($445.27 million per year), or $860 per DALY averted (Table 1). At a cost-effectiveness threshold of $2,010 per DALY averted, the probability of cost-effectiveness was 0.92. Conclusion: Integrated screening and treatment of HIV and NCDs would be a cost-effective approach to avert substantial death and disability in Kenya. Substantial investments would be required to address the identified disease burdens.

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