CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: LTFU varied across age groups and point of entry in care. Barriers to retention faced by young women initiating ART through PMTCT programs and recent initiators need further investigation. Similarly tracing studies may inform if high LTFU rates are partially driven by unreported deaths and silent transfers.

to determine patient mortality and true program status (i.e. alive in care, transferred, disengaged from care, dead, or LTFU). Results: 1,023 of 6,968 LTFU patients (15%) were randomly selected for tracing. Tracing was attempted in 1,001 (98%), with 604 of these (80%) reached by phone or in person. 397 (40%) could not be reached. Of the 604 contacted, 491 (81%) were found alive and in care at their original clinic or a neighboring satellite health post, 80 (13%) were “silent” transfers, 17 (3%) disengaged from care and 16 (3%) were deceased (figure 1). Conclusion: It is feasible to adapt a rigorous sampling-based strategy used in a research context for routine program use to revise HIV treatment program retention estimates. We observed a high proportion of patients alive in care at the facility where they were flagged as “LTFU”, suggesting data quality issues, likely due to increasingly decentralized ART distribution and data collection. We also observed numerous “silent” transfers after ART initiation and identified 16 missed deaths, resulting in a mortality underestimation and LTFU overestimation. Scale up of electronic data systems to decentralized ART dispensation points, use of unique identifier tools such as biometrics, and enhanced early patient support and follow-up are needed to improve, and better monitor, program retention.

Poster Abstracts

1107 HIV STIGMA PREDICTS RETENTION IN CARE AMONG US PATIENTS IN CARE Catherine Pearson 1 , Mallory Johnson 1 , Torsten B. Neilands 1 , Samantha E. Dilworth 1 , John Sauceda 1 , Michael J. Mugavero 2 , Heidi M. Crane 3 , Rob Fredericksen 3 , W. C. Mathews 4 , Richard D. Moore 5 , Sonia Napravnik 6 , Kenneth H. Mayer 7 , Katerina A. Christopoulos 1 1 University of California San Francisco, San Francisco, CA, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of Washington, Seattle, WA, USA, 4 University of California San Diego, San Diego, CA, USA, 5 Johns Hopkins University, Baltimore, MD, USA, 6 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 7 Fenway Health, Boston, MA, USA Background: HIV-related stigma is a known barrier to engagement in care yet no large-scale, nationally representative studies have prospectively evaluated the effect of stigma on retention for those in HIV care in the United States (US). Methods: The Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort integrates medical record and survey data from patients in primary care at 7 academic HIV clinics across the US. We added a yearly, validated 4-item assessment of internalized HIV stigma (response scale 1=strongly disagree to 5=strongly agree, α=0.91) into patient surveys administered every 4-6 months at primary care visits. We used multivariable logistic regression models to evaluate associations between mean stigma and two common prospective retention in care outcomes: keeping the next primary care appointment after stigma assessment and keeping all scheduled primary care appointments in the year following the stigma assessment. We controlled for age, gender, race/ethnicity, sexual orientation, time since CNICS enrollment, and CNICS site. We checked for interactions between stigma and these covariates. We addressed missing covariate data under the missing at random assumption via direct maximum likelihood estimation using Mplus. Results: From 4/16 – 10/17, 5,825 patients completed the stigma assessment. Median age was 49 (IQR 39-56), 80%were male, 39%were black, 15%were Hispanic, and 32% identified as heterosexual. Median (IQR) time since CNICS enrollment was 6 (3-11) years. Mean stigma was 1.9 (SD 1.08). Each unit increase in mean stigma was associated with decreased odds of keeping the next primary care appointment (aOR=0.93, 95% CI 0.87-0.99, p 0.015), as well as decreased odds of keeping all primary care appointments (median of 3 appointments, IQR 2-5) in the subsequent year (aOR=0.91, 95% CI 0.86-0.96, p < 0.001). In both models, younger age, black race, and non-cis gender identification were associated with suboptimal appointment attendance. There were no statistically significant interactions between stigma and covariates. Conclusion: In one of the first multi-site, clinic-based studies of stigma in the US, internalized HIV stigma had a modest statistically significant independent effect on the likelihood of subsequent appointment attendance. This is the first study to demonstrate prospectively the effect of stigma on retention in

1106 LOSS-TO-FOLLOW-UP RISK FACTORS AFTER ANTIRETROVIRAL THERAPY INITIATION IN UGANDA Barbara Castelnuovo 1 , Frank Mubiru 1 , Grace Banturaki 1 , Joseph Musaazi 1 , Joseph Kabanda 2 , Michelle Adler 2 , Alice Namale 2 , Rhoda Mwondha 1 , Joanita Kigozi 1 , Agnes Kiragga 1 1 Infectious Disease Institute, Kampala, Uganda, 2 CDC Uganda, Kampala, Uganda Background: In sub-Saharan Africa published data seem to indicate that loss to follow-up (LTFU) is higher in men and young individuals. We described the proportion of LTFU by age and gender, and explored gender differences in different age groups. We also identified risk factors for LTFU in patients on antiretroviral therapy (ART) in urban Uganda. Methods: This was a retrospective analysis of routine data of patients aged ≥15 years who initiated ART in 6 clinics in Kampala (2005–June 2018). Patients defined LTFU if they did not return for >90 days at any time, and did not transfer. Confirmed deaths and transfers were not included. We compared LTFU by gender, age groups (young adults [YA], 15–25 years; adults [AD], 26–50 years; and older adults [OA], >50 years), point of entry into HIV care, and year of ART initiation. We used Cox proportional hazards models to determine factors associated (P<0.05) with LTFU. We imputed missing (33%) CD4 count using multiple imputation chained equation with 30 imputations. Results: Of the 56,304 patients: 41,847 (74.3%) were women, median age 30 years (IQR, 25–36 years), 17.2% had WHO stage 3/4 disease, median CD4 count at ART start 271 cells/µL (IQR, 147–426 cells/µL), and 80.3% started efavirenz- based ART. Overall, 20,203 (35.9%) were LTFU; LTFU was higher in women (36.6%) than men (34.5%; P<0.001). LTFU declined across age groups: 45.8% in YA, 33.1% in AD, and 31.4% in OA. In YA, LTFU was higher among women (46.5%) than men (37.9%), but lower in women AD (32.6% vs 34.3%) and OA (29.9% vs 33.0%; all P<0.001). LFTU was higher among recent ART initiators. One quarter (25,5%) women entered care through prevention of mother-to- child transmission (PMTCT) programs; LTFU among pregnant women was 55.2% among YA, 45.1% among AD, and 35.7% among OA (P<0.001). On multivariate analysis, we found that men, women who entered care through PMTCT services, recent ART initiators were at higher risk of being LTFU. OA and AD were less likely to be LFTU than YA. Other factors are shown in Table 1.

CROI 2020 417