CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1114 COMMUNITY PRIVATE PHARMACY ANTIRETROVIRAL THERAPY REFILL IN KAMPALA, UGANDA Martin Ssuuna 1 , Shamim Nakade 1 , Joseph Kabanda 2 , Sarah Zalwango 3 , Daniel A. Okello 3 , Christopher Mugara 1 , Donna Kabatesi 2 , Alice Namale 2 , Alex Muganzi 1 , Nelson Kalema 1 , Joanita Kigozi 1 1 Infectious Disease Institute, Kampala, Uganda, 2 CDC Uganda, Kampala, Uganda, 3 Ministry of Health Uganda, Kampala, Uganda Background: Of the 1,000,000 (72%) persons living with HIV (PLHIV) on antiretroviral therapy (ART) in Uganda, 20% received care in Kampala, the capital, and its surrounding areas between April and June, 2019. The number of PLHIV attending Kampala’s mid-level public health facilities has grown four times in the last 10 years, resulting in high patient-provider ratios, congestion, and long waiting times. The Kampala private community pharmacy ART refill model is a differentiated care approach that was introduced in 2017 for stable clients to address these challenges. Here, we describe the model and evaluate its effectiveness Methods: The Infectious Diseases Institute in partnership with the Kampala Capital City Authority selected 6 private pharmacies to serve as community ART refill points for stable PLHIV from 4 high-volume public health facilities (8000–13,000 PLHIV on ART at each site). Virally suppressed adults on first- line ART were enrolled in this model by their primary care providers. They received ART refills at the pharmacy and attended semi-annual follow-up appointments at the primary health facility per national guidelines. A nurse- dispenser per pharmacy supported free ART refills, symptomatic opportunistic infection screening, patient referrals, tracking and follow-up, ART inventory management, and reporting. Program data from pharmacy and facility records has been summarized and analysed. Results: Over a 30-month period (Jan 17 - June 19), 9921 (29%men) PLHIV enrolled in the pharmacy refill model, representing 30% of clients at the 4 facilities. Of these, 96% had received ART refills as scheduled, and the average waiting time at the pharmacy was <10 minutes. The 12-month retention in care rate was 98%, and >99% of enrolled clients remained virally suppressed. Conclusion: Rapid enrolment and good retention rates indicate high acceptability of this model among urban PLHIV in Uganda. Structured public- private partnerships present opportunity for delivery of simplified ART refill services for PLHIV in resource-limited settings. 1115 COMMUNITY-BASED SERVICE DELIVERY OF HIV TREATMENT IN ZAMBIA: COSTS AND OUTCOMES Brooke E. Nichols 1 , Refiloe Cele 2 , Lise Jamieson 2 , Lawrence Long 1 , Zumbe Siwale 3 , Patrick Banda 4 , Crispin Moyo 4 , Sydney Rosen 1 1 Boston University, Boston, MA, USA, 2 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 3 EQUIP Health Zambia, Lusaka, Zambia, 4 Ministry of Health, Lusaka, Zambia Background: There are 1 million Zambians receiving antiretroviral treatment (ART) for HIV, severely straining existing healthcare infrastructure and human resources. To address this challenge, community-based differentiated service delivery (DSD) models of care have been implemented to reduce provider workload and improve quality of care. The costs and impact of these DSD models have not yet been evaluated in routine settings. Methods: We conducted a cost and outcomes analysis of ART patients whom entered into DSD models in Zambia between 2015-2017 to estimate the average cost per patient per year. We evaluated the former standard of care (SOC), in which stable patients received care and medication refills at healthcare facilities every 3 months, and four out-of-facility models of care (which, per country guidelines, require two clinical facility-based visits per year): community adherence groups (CAGs), urban adherence groups (UAGs), home ART delivery, and mobile ART services. Using patient-level data, we captured individual resource utilization in each model over the first 12 months of model participation, then estimated the cost/patient by assigning unit costs to each resource. Retention in care at 12 months was defined as attending a clinic visit at 12 months +/- 3 months. We then used percentage of patients retained in care after 12 months to estimate an average cost/outcome for each model. To account for missing patient-level data in the number of DSD visits for three of the models, we also considered high and low visit utilization scenarios. Costs are reported in 2018 USD. Results: Differentiated models of service delivery cost more per patient/year than the standard of care for all models assessed, as illustrated in Table 1. Costs ranged from as little as an annual $116 to $199 for the DSD models, compared

1113 PROSPECTIVE STUDY ON IMPACT OF DIFFERENTIATED CARE ON HIV RETENTION IN KEY POPULATION George Eluwa 1 , Lung Vu 1 , Scott Geibel 1 , Isa Iyortim 2 , Abiye Kalaiwo 2 , Osasuyi Dirisu 1 , Ellen Weiss 1 , sylvia B. Adebajo 1 1 Population Council, New York, NY, USA, 2 USAID Nigeria, Abuja, Nigeria Background: MSM and FSWs are prone to stigma and discrimination which may affect their retention in treatment. Key population (KP) designated facilities, termed One-stop shops (OSS) have shown promise in providing culturally appropriate care and treatment to KPs. We assessed the effect of different models of OSS on linkage to and retention in treatment in Nigeria. Methods: Between December 2017 and June 2018, newly diagnosed MSM and FSWwere enrolled into treatment at two OSS models and followed prospectively for one year. Model 1 was a fully integrated OSS with all clinical services while Model 2 was a prevention site with treatment needs supported by a different implementing partner in the state. Retention was estimated from drug pick records and was defined as being on treatment within 90 days one-year post ART initiation. Cox regression was used to identify the independent effect of the OSS models on retention while probability of being retained in treatment at 1-year was estimated with Kaplan-Meier product limit. Results: A total of 605 newly diagnosed clients were enrolled into the study (340 in Model 1 and 265 in Model 1; 342 were FSW, while 263 were MSM). Median age was 26 years for MSM and 30 years for FSW. A majority of MSM had completed secondary level education in both M1 and M2 (54% vs. 67%) while most of FSW had completed primary level education (49% vs. 45%). Linkage to treatment was similar in both models (67%). Among those linked to treatment, retention was higher in M1 than in M2 (65% vs. 52%; p=0.007). Among those not retained, mean days to be lost-to-follow up (LFTU) was 60 days. Controlling for educational level, population type and age, clients who received treatment in M2 were 6 times more likely not to be retained in treatment at the end of 1 year (Hazard ratio 5.89; 95% CI: 1.04 – 33.16). The Kaplan Meier estimates of the probability of being retained in 6 months, 9 months and 12 months was 0.97, 0.92, 0.80 and 1.00, 0.96, 0.91 for M2 and M1 respectively. Conclusion: Linkage to treatment was suboptimal across both models with less than 90% of newly identified positives initiated on treatment. Retention was higher and more likely among those who received care at model 1 compared to model 2. Mean time to be lost was two months requiring intensive monitoring within this period. This has implications for programs and policies that support one stop shops for HIV care and treatment.

Poster Abstracts

CROI 2020 420