CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: HIV testing, linkage to and retention in HIV medical care and achievement of viral suppression are critical to prevent disease progression. Assessing HIV care outcomes among Hispanics/Latinos is important for guiding targeted prevention efforts and monitoring progress towards national goals. Methods: Data from the National HIV Surveillance System from 42 jurisdictions that reported complete CD4 and viral load laboratory results to CDC through December 31, 2018 were used to determine the numbers of Hispanics/ Latinos aged ≥13 years newly diagnosed and diagnosed at Stage 3 (AIDS) and percentages linked to care within one month, retained in care and virally suppressed by sex, age and transmission category. These data provide more granularity than in HIV surveillance reports. Results: Among 8,517 Hispanics/Latinos with HIV infection diagnosed in 2017, 1,825 (21.4%) had infection classified as stage 3 (AIDS). Among males, the highest percentage of infections diagnosed as stage 3 (AIDS) was at 25-34 years (34.3%) and among females, 45-54 years (28.2%). By transmission category, the highest percentage of infections diagnosed at stage 3 (AIDS) attributed to injection drug use was at 45-54 years for both males (29.1%) and females (40.9%) and for infection attributed to heterosexual contact, among males, 35-44 years (33.0%) and females, 45-54 years (26.8%). In 2017, 6,750 (79.3%) were linked to care within 1 month after diagnosis. For males, females and all transmission categories, 13-24 years had the lowest linkage to care except for males with infection attributed to male-to-male sexual contact and injection drug use [25-34 years (67.1%)] and heterosexual contact [35-44 years (75.5%)]. Among 181,145 Hispanics/Latinos living with diagnosed HIV infection at year-end 2016, 130,195 (71.9%) received any care, 106,101 (58.6%) were retained in care and 111,107 (61.3%) were virally suppressed. The lowest retention in care for females was 25-34 years (56.5%) and for males was 35-44 years (55.7%). The lowest viral suppression was among males 25-34 years with infection attributed to injection drug use (43.8%) and 35-44 years with infection attributed to heterosexual contact (43.8%), followed by females 25-34 years with infection attributed to injection drug use (47.9%). Conclusion: Tailored strategies for Hispanics/Latinos that increase care and achieve viral suppression in different groups such as those <35 years and persons who inject drugs are needed as highlighted in the national HIV prevention goals. 1100 IMPROVEMENTS ACROSS NAIROBI COUNTY’S HIV CARE CONTINUUM : CASE OF A FAST-TRACK CITY Sindhu Ravishankar 1 , Erlyn Macarayan 2 , Caroline Ngunu 3 , Molly Pezzulo Collier 1 , Harriet Kongin 4 , Jose M. Zuniga 1 , Ingrid Katz 5 1 International Association of Providers of AIDS Care, Washington DC, USA, 2 Harvard T.H. Chan School of Public Health, Boston, MA, USA, 3 Nairobi City County, Nairobi, Kenya, 4 UNAIDS, Geneva, Switzerland, 5 Harvard Medical School, Boston, MA, USA Background: The Fast-Track Cities initiative is supporting municipalities to measure and monitor progress against the global 90-90-90 targets. Using 2016- 2018 trend data from Nairobi County’s Fast-Track City dashboard, we assessed progress against 90-90-90 targets at county and sub-county levels. Methods: HIV care continuum data from 2016 (baseline) to 2018 (current) for Nairobi County and its 17 sub-counties were obtained from the Fast-Track City dashboard. Improvements in data from baseline to current were measured using two parameters: 1. Progress made against the 90-90-90 targets; and 2. completeness of HIV care continuum data. 90-90-90 targets (which use a floating denominator) were converted to care continuum indicators (using a consistent denominator of estimated PLHIV) resulting in the following targets: 90% of PLHIV diagnosed; 81% of PLHIV on ART; and 72.9% of PLHIV virally suppressed. Results: The HIV care continuum for Nairobi County improved from 77% PLHIV diagnosed, 74% PLHIV on ART, and 41% of PLHIV virally suppressed in 2016 to 79% PLHIV diagnosed, 79% of PLHIV on ART, and 72% of PLHIV virally suppressed in 2018. Trend data between 2016 and 2018 were reported for eight of the 17 sub-counties. Of these eight sub-counties, seven demonstrated improvement across one or more indicators. As of 2016, no sub-county had surpassed the 90-90-90 targets but one sub-county had surpassed the second and third target. In 2018, two sub-counties reported surpassing all three targets, with five sub- counties surpassing one or more of the 90 targets. Ranges of improvement for the sub-counties from 2016-2018 were 4-11 percentage points on the first 90 target; 4-13 percentage points on the second 90 target; and 1-14 percentage points on the third 90 target. Between 2016-2018, the completeness of data also improved

1098 IMPACT OF HIV CONTINUUM OF CARE INTERVENTIONS AND PREEXPOSURE PROPHYLAXIS IN KENYA Liem Binh Luong 1 , Stephen S. Wanjala 2 , Elisabeth Szumilin 3 , Pierre Mendiharat 3 , Yazdan Yazdanpanah 1 , Kenneth Freedberg 4

1 INSERM, Paris, France, 2 MSF, Nairobi, Kenya, 3 MSF, Paris, France, 4 Massachusetts General Hospital, Boston, MA, USA Background: In Western Kenya up to one quarter of the adult population was HIV-infected in 2012. Médecins Sans Frontières (MSF) has implemented an HIV care program to reach the 90-90-90 UNAIDS targets and has surpassed those. In this generalized epidemic, our objective was to compare effectiveness of Pre-exposure Prophylaxis (PreP) with improving the continuum of care coverage to 95-95-95. Methods: We developed a time-discrete, dynamic microsimulation model to project HIV incidence and infections averted resulting from different strategies in the adult population. We used two age group risk strata, younger adults (YAs), as the age strata where HIV incidence is the highest: women 15-30y and men 20-40y, and older adults (OAs): women >31y and men >41y. We modeled 3 strategies compared to a 90-90-90 continuum of care base case: 1) Scaling up the continuum of care to 95-95-95 (85.7% suppression), 2) PreP targeting the YA with 10% coverage, and 3) Scale up to 95-95-95 and PreP. The time horizon was 2018 to 2030. Transmission parameters, including number of sexual contacts within and outside the same age group, were calibrated to fit overall prevalence (24.1%) and incidence (1.9/100 PY) in 2012. Monthly probabilities for continuum of care matched the 2012 levels (61.8% tested, 68.2% on ART among tested, and 73.0% viral suppression among on ART) and 90-90-90 in 2020; PreP efficacy was set at 75%. We did sensitivity analyses on key parameters, including PrEP impact starting at higher continuum levels, as obtained in 2018 (93.0% tested, 95.0% on ART among tested, and 97.0% suppression among on ART). Results: In the base case, by 2030 HIV incidence was 0.31/100 Person-Years (PY) in YAs, 0.35/100 PY in OAs, and 0.32/100 PY overall. Improving continuum levels to 95-95-95 averted 4.0% of infections in YAs, 9.0% in OAs, and 5.2% overall. PreP averted fewer infections: 3.7% in YAs, 1.5% in OAs, and 3.2% overall. Combining 95-95-95 and PreP averted 7.9% of infections in YAs, 9.1% in OAs and 8.1% overall. Sensitivity analysis shows that PreP coverage had to be 20% to avert as many infections as 95-95-95. With 88.0% overall suppression, as MSF has achieved, adding PreP is even less effective. Conclusion: In a generalized epidemic with continuum of care levels at 90- 90-90, improving continuum to 95-95-95 is substantially more effective than providing PreP. Continued focus on improving the continuumwill have the greatest impact on decreasing new HIV infections.

Poster Abstracts

1099 DIFFERENCES IN HIV CARE OUTCOMES: US HISPANICS/LATINOS WITH DIAGNOSED HIV INFECTION Sonia Singh 1 , Yonggang Li 2 , Alexandra Balaji 1 1 CDC, Atlanta, GA, USA, 2 ICF International, Atlanta, GA, USA

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