CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

with all 17 sub-counties reporting HIV care continuum data in 2018 compared to eight sub-counties reporting such data in 2016. Conclusion: Nairobi County and many of its sub-counties have seen improvements across the HIV care continuum since their 2016 baseline. Given the quickly approaching 2020 deadline to attain the 90-90-90 targets, targeted focus to improve the HIV care continua in the poorest performing sub-counties is crucial. By reporting data on all sub-counties, Nairobi County is taking the steps needed to assess gaps and subsequently address geographic priorities.

1102 CHALLENGES TO HIV CARE ENGAGEMENT AMONG MOBILE POPULATIONS IN RURAL KENYA AND UGANDA James Ayieko 1 , Edwin D. Charlebois 2 , Monica Getahun 2 , Irene Maeri 1 , Patrick Eyul 3 , Pamela M. Murnane 2 , Moses R. Kamya 4 , Elizabeth A.Bukusi 1 , Monica Gandhi 2 , Diane V. Havlir 2 , Carol S. Camlin 2 1 Kenya Medical Research Institute, Nairobi, Kenya, 2 University of California San Francisco, San Francisco, CA, USA, 3 Infectious Diseases Research Collaboration, Kampala, Uganda, 4 Makerere University, Kampala, Uganda Background: Population mobility may negatively impact care engagement for people living with HIV by disrupting continuity and this may portend poor treatment outcomes for patients while increasing the risk of onward disease transmission. We sought to identify the challenges mobility imposes on vital aspects of care engagement (enrollment in HIV care, being on ART, and treatment interruptions) Methods: We conducted an analysis of survey data collected in 2016 among a random sample of 1,119 mobile adults within 12 communities across three regions (South West Uganda, East Uganda and West Kenya) out of the 32 communities participating in the SEARCH HIV test-and-treat cluster randomized trial (SEARCH NCT:01864603). The 12 communities were matched by trial intervention with individuals sampled on baseline residential stability and HIV status. We evaluated self-reported challenges to HIV care engagement across multiple metrics of mobility with specific attention to sex differences. We used multivariate logistic regression adjusting for age, educational level, marital status, household wealth and region to identify factors associated with poor engagement in HIV care. Results: A total of 1,119 adults participated in the survey, 53.2% (595) were female, 82.2% (926) had primary or secondary level of education and 74.2% (830) were involved in informal low HIV risk occupations such as farming. Of the 1119, 106 reported missing clinic appointments, the median duration of missed appointment was 0.5 (IQR 0.25-2) months. The most common reasons for missing appointments, HIV medication interruptions and changing HIV clinics was mobility and inability to afford transport to clinics. Those who reported migration within the previous year had lower odds of receiving regular care and treatment OR 0.42(95%CI 0.19, 0.95) p=0.04 with males having lower odds (OR 0.31(95%CI 0.10, 1.01) p=0.05) as compared to females (OR 0.57(95%CI 0.18, 1.86) p=0.35). Factors associated with poor care engagement (failure to receive regular care and treatment) were younger age and poverty (being in the lowest wealth index quartile vs. higher quartiles) OR 0.28(95%CI 0.14, 0.54) p=<0.001. Conclusion: Population mobility may hamper the gains made in controlling the HIV epidemic if care engagement for mobile persons remains unaddressed. Attention to different forms of mobility and differences by sex are warranted. 1103 PUBLIC HEALTH REFERRALS IMPROVE RE-ENGAGEMENT FOR ART INTERRUPTED PATIENTS Jon H. Kremer 1 , Lu Wang 1 , Katherine Lepik 1 , Jenny Li 1 , David M. Moore 1 , Kate Salters 2 , Julio S. Montaner 1 , Trevor Corneil 3 , Rolando Barrios 1 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, 2 Simon Fraser University, Burnaby, BC, Canada, 3Interior Health Authority, Kelowna, Canada Background: In 2016, the BC HIV Drug Treatment Program (DTP) partnered with regional public health offices to expand its prescriber alert system for ART interruptions to include person-specific outreach support for those who

Poster Abstracts

1101 HIV CARE CONTINUUM AMONG NEWLY DIAGNOSED INDIVIDUALS IN MEXICO Lorena Guerrero-Torres 1 , Yanink Caro-Vega 1 , Erika Barlandas 1 , Brenda Delgado-Avila 1 , Juan Sierra-Madero 1 , José Sifuentes-Osornio 1 , Pablo F. Belaunzaran-Zamudio 1 , Brenda Crabtree-Ramírez 1 1 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Background: The HIV care continuum (CC) is useful for monitoring HIV care. However, the impact of HIV diagnosis in circumstances of hospitalization in the CC is unknown. The aim of this study was to compare engagement in-care (EIC), proportion of patients on ART and viral load suppression (VLS) in patients who were hospitalized within diagnosis from those treated as outpatients. Methods: We used retrospective, longitudinal data collected at a tertiary hospital in Mexico City. We included all adults newly diagnosed with HIV (within 3 months) between 2005 and 2015. All patients diagnosed in circumstances of hospitalization due to an AIDS-defining illness (ADI) or requiring hospitalization within 3 months of diagnosis were classified as severe group (SG). All o¬ther patients were classified as non-severe group (NSG). HIV CC was evaluated at one, three and five years from enrollment, estimating proportions of those contributing to follow-up at each period. EIC was defined as those who had 2 or more medical visits, ART prescriptions, CD4 or viral load (VL) tests at least 3 months apart in the previous year. VLS was defined as most recent VL of <50 copies/mL. Results: Among 911 people living with HIV (PLWH) enrolled, 199 (22%) were classified as SG. Median age was 33.5 (IQR 28-42) years, and 91%were male. PLWH in the SG were more likely to be older (36 vs 33 years, p<0.001) and to have acquired HIV through heterosexual contact (35% vs 23%, p<0.001), had lower median baseline CD4 count (41 vs 203, p<0.001) and higher proportion of ADI (85% vs 28%, p<0.001) than individuals in the NSG. Figure 1 describes CC across time. Mortality and loss to follow-up (LTFU) were higher in the SG only within the first year (26% vs 2%, p<0.001; 15% vs 5%, p<0.001, respectively). In contrast, no significant differences in mortality, LTFU, proportion of patients on ART and VLS were found at three and five years of enrollment between groups. Conclusion: Similar long-term outcomes in both groups along the HIV CC strongly suggest that first year disparities are mainly due to a higher early mortality and LTFU among hospitalized patients within 3 months of HIV diagnosis. Our findings emphasize the urgent need of strategies that increase early diagnosis in populations not traditionally considered at risk.

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