CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1109 ALCOHOL USE AND THE HIV CARE CONTINUUM IN ZAMBIA: NATIONALLY REPRESENTATIVE SURVEY Michael J. Vinikoor 1 , Izukanji Sikazwe 2 , Anjali Sharma 2 , Lloyd Mulenga 3 , John Mayeya 3 , Ravi Paul 4 , Geetanjali Chander 5 , Jenala Chipungu 6 , Laura Murray 5 , Jeremy Kane 5 1 University of Alabama at Birmingham, Birmingham, AL, USA, 2 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 3 Government of Zambia Ministry of Health, Lusaka, Zambia, 4 University of Zambia, Lusaka, Zambia, 5 Johns Hopkins University, Baltimore, MD, USA, 6 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia Background: Although increasing in sub-Saharan Africa (SSA), unhealthy alcohol use is not routinely screened for or treated within HIV prevention and treatment programs, in part due to lack of data on its intersection with the HIV epidemic. We evaluated the prevalence of unhealthy alcohol use among people living with HIV (PLWH) and its association with the HIV care continuum in Zambia. Methods: We analyzed de-identified data from the 2016 Zambia Population- Based HIV Impact Assessment (ZamPHIA), a nationally-representative household survey. ZamPHIA included an assessment of alcohol use with the consumption questions from a modified Alcohol Use Disorders Identification Test (AUDIT-C), and rapid point-of-care HIV testing. PLWH also took an HIV care history survey and provided blood for detection of antiretroviral therapy (ART) and HIV RNA quantification. Unhealthy alcohol use was defined as an AUDIT-C score of 3-12 for women and 4-12 for men, abstinence was 0, and other scores were considered moderate use.Using multivariable regression, we identified the correlates of unhealthy alcohol use in the overall sample including sociodemographic factors and HIV status. Among PLWH, we evaluated the association of unhealthy and moderate alcohol use (versus abstinence) with HIV diagnosis, current ART use, and viral suppression (VS; RNA <1,000 copies/ml) using multinomial regression. PLWH were assumed to be diagnosed and on ART if ARVs were detectable. Results: Among 18,796 participants included in the analytic sample, 11.9% were HIV-positive, and 15.3% (95% CI 14.6-16.1) reported unhealthy alcohol use. Male sex (relative risk ratio [RRR], 5.09), urban residence (RRR, 1.78), and HIV-positivity (RRR, 1.51) were independently associated with unhealthy alcohol use. Among PLWH, 71.4%were diagnosed, 87.1%were on ART, and 89.2% had VS. Unhealthy alcohol use (compared to abstinence) was associated with significantly lower odds of being diagnosed (adjusted odds ratio [AOR], 0.66; 95% CI, 0.49-0.87). We observed non-significant trends towards reduced odds of current ART use (AOR, 0.73; 95% CI, 0.48-1.10) and VS (AOR, 0.91; 95% CI, 0.57-1.44) among unhealthy users (versus abstainers). Conclusion: Urban men living with HIV reported increased prevalence of unhealthy alcohol use in Zambia. Unhealthy drinking was associated with reduced awareness of HIV infection. Efforts to achieve control of the HIV epidemic in SSA should include alcohol reduction activities. 1110 RCT OF EARLY REFERRAL OF HIV+ ADULTS STARTING ART TO COMMUNITY-BASED ADHERENCE CLUBS Jasantha Odayar 1 , Joanna Allerton 1 , Siti Kabanda 1 , Thoko Malaba 1 , Maia Lesosky 1 , Zodwa Mamanzi 1 , Cathy Kalombo 2 , Landon Myer 1 1 University of Cape Town, Cape Town, South Africa, 2 Western Cape Provincial Department of Health, Cape Town, South Africa Background: Differentiated models of service delivery (DSD) are widely recommended to provide ART services for HIV+ patients established on ART, but there are few data on how soon stable patients may be referred to DSD after ART initiation. Methods: We randomised adults 4 months after starting TDF+FTC+EFV in a large primary care service in Cape Town, South Africa, to either (a) immediate referral to the local DSD [‘adherence clubs’ (AC)] or (b) continued clinic-based care (NCT03199027). At randomisation all participants were eligible for ACs based on local criteria: VL<400 copies/mL with no reported adherence problems, TB or other comorbidities, or HIV/ART complications. In this setting ACs are based at community venues separate from the clinic with counsellor-led services, 2-4 monthly ART refills and annual nurse checks; clinic-based services are nurse-/doctor-driven with 2-monthly ART refills and 4-monthly clinical appointments. Using study follow-up visits conducted separately from routine care in either arm, we evaluated the primary trial outcome of VL<400 copies/mL at 12 months on ART (8 months after randomisation).

care, thereby providing support for the need to address HIV stigma in efforts to optimize retention in HIV care and virologic control. 1108 HOSPITALIZATIONS & MORTALITY DIFFER BY GENDER AMONG LONG- TERM ART PATIENTS IN UGANDA Golshan Massah 1 , Wendy W. Zhang 2 , Josephine Birungi 3 , Mastula Nanfuka 4 , Julia Zhu 2 , Stephen Okoboi 5 , Pontiano Kaleebu 3 , Baker Tibenganas 4 1 University of British Columbia, Vancouver, BC, Canada, 2 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, 3 Uganda Virus Research Institute, Entebbe, Uganda, 4 The AIDS Support Organization, Kampala, Uganda, 5 Infectious Disease Institute, Kampala, Uganda Background: We conducted an analysis to determine if differences in health- seeking behaviour may explain gender disparities in mortality among long-term survivors receiving antiretroviral therapy (ART) in rural Uganda. Methods: From June 2012 to September 2013, we enrolled patients receiving a first-line ART regimen for at least four years without previous viral load (VL) testing in Jinja, Uganda. We measured HIV VL at study entry. We switched participants to second-line therapy, if VL was ≥1000 copies/ mL on two measurements, and followed all participants for three years. We collected clinical and behavioral data at enrollment and every six months. We used Cox proportional hazards modeling to examine factors associated with hospitalization and mortality until September 2016. Results: We enrolled 616 participants or whom 75.3%were female. The median age was 44 years (interquartile range [IQR]39-50 years), the median duration of ART was 6 years (IQR 5-7 years) and the median CD4 count at enrollment was 523 cells/µL (IQR 362- 707). Of these, 113 (18.3%) had VLs≥1000 copies/mL at enrollment. Participants were followed for a median of 2.8 years (IQR 2.6-3.2) years during which hospitalizations occurred in 101 participants (7% of men vs. 20% of women; p<0.001). A total of 22 (3.6%) deaths occurred; 9% of men vs. 2% of women (p <0.001). Participants who were hospitalized had a lower risk of mortality in the univariate analysis (HR=0.22; 95% CI 0.03-1.63), but it was not statistically significant (p=0.138) and was not included in the final model. In the multivariate model, mortality was associated with age (adjusted hazard ratio (AHR) = 1.07 per year increase; 95% CI 1.01-1. 13), male gender (AHR = 2.57; 95% CI 1.06-6.23) and time-updated CD4 counts (AHR = 0.67 per 100 cell increment; 95% CI 0.52-0.88). Virologic failure at enrollment was not associated with mortality (AHR = 1.18; 95% CI 0.40 - 3.47). Conclusion: Female patients receiving ART for more than 6 years in rural Uganda were three times more likely to be hospitalized than men, but male mortality was nearly four times higher in the subsequent three years of follow- up. Facilitating care for acute medical problems may help to improve survival among male ART patients.

Poster Abstracts

CROI 2020 418