CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

to an annual $100 for SOC. CAGs and UAGs increased retention by 2% and 14%, respectively. All DSD models also cost more per patient retained at 12 months than the standard of care. The CAG had the lowest cost/patient retained for DSD models ($140-157) followed by the UAG ($155-$169). Conclusion: Though they achieve equal or improved retention in care, out-of- facility models of ART delivery should be expected to be more expensive than traditional, facility-based care. Future studies should focus on comparison of these models of care to newer facility-based models of care currently implemented in Zambia, such as fast-track ART refills and 6-month ART scripting and dispensing.

1117 OUTCOMES OF COMMUNITY-BASED ANTIRETROVIRAL TREATMENT PROGRAM IN NAMIBIA Naemi Shoopala 1 , Andrew L. Baughman 2 , Assegid T. Mengistu 3 , Kiren Mitruka 2 , Godfrey Woelk 4 , GrahamMutandi 5 , Michael B. De Klerk 5 , Isaac Zulu 2 , Steven Hong 5 , Nicholus Mutenda 3 , Linea Hans 5 , Simon Agolory 5 , Leigh Ann Miller 5 , Eric J. Dziuban 5 , Ndapewa Hamunime 3 1 Centers for Disease Control and Prevention, Windboek, Namibia, 2 Centers for Disease Control and Prevention, Atlanta, GA, USA, 3 Ministry of Health and Social Services, Windhoek, Namibia, 4 Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, USA, 5 Centers for Disease Control and Prevention, Windhoek, Namibia Background: Namibia is a sparsely populated country of 2.5 million people, with an HIV prevalence 12.6% (persons aged 15-64 years). About 52.1% of the population lives in rural areas, having to travel, on average, 25-59 km for HIV care. During 2007–2014, communities and health care facilities (HCF) in two high HIV burden districts in northern Namibia collaborated to establish Community-Based Antiretroviral Treatment (C-BART) services. Community members constructed basic structures close to their homes where healthcare workers visited quarterly to provide HIV clinical assessment, viral load (VL) and CD4 specimen collection, and antiretroviral (ARV) refills. We evaluated clinical outcomes at these C-BART sites to inform program expansion. Methods: We conducted a retrospective cohort review of patients who were down-referred from HCFs to C-BART sites for continued HIV care during January 01, 2007–July 31, 2017, in Okongo (16 sites) and Eenhana (18 sites) Districts. We abstracted data on demographics, clinical encounters, ARV dispensation, and VL results from electronic and paper records. We measured C-BART retention (3-60 months), defined as being alive and on ART with a documented visit within 90 days of appointment date, and viral suppression (VS) (<1000 copies/ml) on a VL test at least 3 months after down-referral and closest to data abstraction date (November 30, 2017). Results: Of the 1031 patients (909 adults and 122 children) included in the analysis, 100% of patients were retained in C-BART at 3 months and 99% of adults (n=522) and children (n= 71) were retained at 12 months (Table). In Okongo District, 91% of adults (n=141) and 96% of children (n=28) were retained at 60 months. Overall, 98% of adults (n=568) and 87% of children (n=77) retained at CBART sites for ≥3 months had viral suppression; 98% of adults (n=427) and 84% (n=58) of children in CBART ≥12 months, and 98% of adults (n=121) and 83% (n=23) of children in CBART ≥60 months (Okongo) had VS. VS did not differ by the time on ART in CBART (range: 3 months−10 years) (p=0.49 and p=0.81, respectively). Conclusion: The C-BART program demonstrates high retention and VS among patients and alleviates concerns about providing community-based ART to children. High retention rates were sustained up to 60 months after down- referral to C-BART, demonstrating the utility of C-BART as a long-termmodel for managing patients on ART, particularly in rural settings.

1116 HIV+ PATIENTS RECEIVING ANTIRETROVIRAL DRUGS THROUGH HOME DELIVERY: A CAUSAL ANALYSIS Rory F. Leisegang 1 , Keri Calkins 2 , Susan Cleary 3 , Sumanth Karamchand 1 , Felix Hammann 4 , Poobalan Naidoo 5 , Mark Cotton 1 , Jane Ball 3 , David Dowdy 2 , Jean B. Nachega 6 1 Stellenbosch University, Cape Town, South Africa, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 University of Cape Town, Cape Town, South Africa, 4 Uppsala University, Uppsala, Sweden, 5 Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA, 6 University of Pittsburgh, Pittsburgh, PA, USA Background: Differentiated service delivery (DSD) models, which focus more on individual patient preferences and the needs of vulnerable subpopulations, are key to meeting the UNAIDS 90-90-90 goals for 2020 and beyond. Courier delivery of chronic medication by to a patient's home (home refill) is an attractive and scalable intervention to potentially improve antiretroviral therapy (ART) adherence and viral suppression; data, however, remains limited and is found predominantly in real-world settings with electronic health record (EHR). Methods: Building on a previous study, we conducted a retrospective analysis of ART naïve HIV-infected adults in Aid for AIDS (AFA) cohort, an HIV health management scheme for the private sector in South Africa who initiated first line NNRTI based ART between January 2002 and July 2013. The primary endpoint was all-cause mortality; secondary endpoints included CD4 and viral load (VL) response, loss to follow-up (LTFU), and switching to home-refill. Statistical analyses included descriptive, baseline (propensity-score) model, and time-updated (marginal structural) models (MSM). Results: 40,939 patients, contributing over follow-up 66,000 years were evaluated. In a baseline analysis only, courier was associated with improved survival (adjusted hazard ratio = 0.90 [95% CI: 0.84-0.96], p-value for log-rank test < 0.001) after adjusting for baseline differences. Within an MSM framework, which addresses time-varying aspects, courier was associated with higher benefit (adjusted hazard ratio = 0.66 [95% CI: 0.55-0.78]). LTFU and switching were positively associated with lower CD4 and higher VL, explaining the improvement in the adjusted hazard ratio; CD4 response and VL suppression rates were superior for home-refill (including cases in which patients switched to home-refill). Finally, hospitalisation days and average costs, and CD4/ VL monitoring were higher in home-refill compared to the self-refill groups (p<0.00.1) despite improved survival, CD4 and VL responses (see figure 1), which suggests that that home-refill promotes better health-seeking behaviour and better outcomes. Conclusion: Our findings support the adoption of home-refill (courier) within the DSD models to facilitate the UNAIDS 90-90-90 targets, for HIV programs in both resource-poor and -rich settings. Further research is needed on the potential impact of home-refill in vulnerable groups with known transportation barriers such as postpartumwoman and adolescents.

Poster Abstracts

CROI 2020 421