CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

remain off treatment for >4 months. We examined outcomes before and after launch of this Re-Engagement and Engagement in Treatment for Antiretroviral Interrupted and Naïve populations (RETAIN) Initiative. Methods: We analyzed DTP participants with ART interruptions triggering a physician-directed alert (ART refill >2 months late) in pre-RETAIN (Jul-2013 to Apr-2016) and post-RETAIN periods (May-2016 to Oct-2017) with follow-up until Oct-2018. Persons who moved out of BC, died, or were on ART through other sources were excluded. We compared the proportions who re-started ART, or achieved viral suppression (pVL<200 copies/mL) in pre- and post- RETAIN periods and the time to ART re-initiation using generalized estimating equation. Cox modelling has been used to examine associations between time to ART restarts with time period (pre-RETAIN vs. post-RETAIN) as our primary explanatory variable. Results: A total of 1805 individuals contributed 3219 ART interruptions of ≥2 months triggering physician-directed alerts: 2050 in pre-RETAIN and 1169 in post-RETAIN periods. Participants were predominantly male (74%) had a median duration on ART of 5 years and a median age of 47 years. We found no differences between the two periods in terms of proportion who re-started ART within 4 months of a physician alert (73% vs 73%), or achieved viral suppression within six months (60% vs 60%). Among persons who remained interrupted >4 months after a physician-directed ART interruption alert was sent, the median time from interruption to ART re-initiation declined from 8.7 (5.8-14.9) months to 7.4 (5.5-10.9) months (p=<0.001) from the pre- to post-RETAIN period. Interruptions in the post-RETAIN era were more likely to re-start ART (adjusted hazard ratio 1.50; 95% CI 1.34 - 1.69). ART re-initiation was associated with pVL suppression prior to interruption and ART duration prior to interruption (Table 1.) Similar findings were also found when examining only the first interruption in our study period. Conclusion: Public health referrals for persons who did not re-engage in care after alerts to their physicians were sent shortens the length of ART interruptions. Similar programs should be considered in other jurisdictions.

Spain, 9 Hospital Universitario Miguel Servet, Zaragoza, Spain, 10 University Hospital of La Coruña, La Coruña, Spain, 11 Hospital Germans Trias i Pujol, Barcelona, Spain Background: For newly diagnosed persons with HIV (NDP), early initiation of ART is essential in reducing morbidity and mortality and decreasing the risk of transmitting HIV. Two indicators have been proposed to monitor HIV care among NDP: the percentage of those linked to HIV medical care within 1 mo. of diagnosis (process) and the percentage of those achieving viral suppression (VS) within 3 mo. of diagnosis (outcome). We analyzed trends in both indicators in the Cohort of the Spanish AIDS Research Network (CoRIS). Methods: The data source was the CoRIS database of ART-naïve adult persons living with HIV (PLWH) recruited from 2004 to 2018. VS was defined as ever having an HIV-RNA <200 copies/mL. We used logistic regression to assess differences by sex, country of origin, age, HIV transmission category, and CD4 count at diagnosis. Results: A total of 13,260 PLWH were enrolled in the study period; 84%males, 59% native-born Spaniards, median age 34 years, median CD4+ cell count 384 cells/uL, 58%MSM. The percentage of NDP linked to care within 1 mo. of diagnosis increased from 42% in 2004 to 71% in 2018 (Figure). The percentage of NDP achieving VS within 3 mo. of diagnosis, increased from 6% in 2004 to 35% in 2018 (Figure). The odds of achieving VS within 3 mo. of HIV diagnosis was higher among females (adjusted OR, 95%CI: 1.42, 1.20-1.69), among non- Spanish Europeans and Latin Americans compared to native-born Spaniards (1.39, 1.20-1.62 and 1.26, 1.09-1.45, respectively), and among those older than 50 years (1.28, 1.06-1.54). Opposite, the odds of achieving VS within 3 mo. of diagnosis was lower among IDU compared to MSM (0.48, 0.36-0.65) and those with CD4 counts between 200-500 cells/uL (0.59, 0.52-0.67) and CD4 counts >500 cells/uL (0.36, 0.30-0.42) compared to those with CD4 < 200 cells/uL. Conclusion: Progress has been made in HIV care among NDP in Spain during the 15-year analysis period, but there is still much room for improvement. The advance in the outcome indicator most likely reflects changes in treatment guidelines to offer ART to any PLWH regardless of CD4 count. These two indicators can guide our efforts to improve HIV care among NDP.

Poster Abstracts

1105 A FIELD-BASED SAMPLING STRATEGY TO REVISE HIV TREATMENT PROGRAM RETENTION ESTIMATES Theodora Savory 1 , Masuzyo Chitala 1 , Paul Elish 2 , Jake Pry 2 , Cynthia Lupenga 2 , Jacob Mutale 1 , Walusiku Muyunda 1 , Mwansa Lumpa 2 , Kaala Moomba 2 , Carolyn Bolton Moore 2 , Izukanji Sikazwe 1 , Michael Herce 2 1 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia Background: Loss to follow-up (LTFU) in Zambia’s national treatment program threatens progress toward achieving HIV epidemic control. With CDC/PEPFAR funding, the Centre for Infectious Disease Research in Zambia (CIDRZ) supports the national program in Lusaka Province where a drop in 12-month retention was noted from 76% in FY17 to 65% in FY18. The recent CIDRZ BetterInfo study used a multi-stage sampling approach to generate revised, regionally representative estimates for mortality and LTFU in the national program. We adapted the study methodology to create a field ready “BetterInfo lite” sampling approach to ascertain true program status for patients apparently “LTFU” and drivers of retention decline. Methods: Using routine data, we selected 10 high-volume facilities in Lusaka for “BetterInfo Lite” based on the largest net drop in program retention between Q3 and Q4 FY18. We randomly selected 15% of newly “LTFU” clients between Q3 and Q4 in each facility to be traced by phone or in person and to complete a brief vital status and retention questionnaire. Leveraging existing CIDRZ platforms, trained peer educators contacted patients or their contacts

1104 MONITORING PROGRESS OF CARE IN PERSONS NEWLY DIAGNOSED WITH HIV IN SPAIN, 2004-2018 Belen Alejos 1 , Cristina Diez 2 , Maria J. Galindo 3 , Ana Delgado 4 , Santiago Moreno 5 , Federico Pulido 6 , Victor Asensi 7 , Vicente Estrada 8 , Gloria Samperiz 9 , Ines Suárez-García 1 , Angeles Castro 10 , Robert Muga 11 , Inma Jarrin 1 , Juan Berenguer 2 , for the CoRI S 1 Institute de Salud Carlos III, Majadahonda, Spain, 2 Hospital General Universitario Gregorio Marañón, Madrid, Spain, 3 Hospital Clinic of Valencia, Valencia, Spain, 4 La Paz University Hospital, Madrid, Spain, 5 Hospital Ramón y Cajal, Madrid, Spain, 6 Hospital Universitario 12 de Octubre, Madrid, Spain, 7 Hospital Universitario Central de Asturias, Oviedo, Spain, 8 Hospital Universitario Clí¬nico San Carlos, Madrid,

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