CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

individualized ART decision-support. We hypothesized that trainees with access to HIV-ASSIST would be more likely to select appropriate ART for diverse HIV patient scenairios, compared to those using DHHS HIV guidelines alone. Methods: We conducted a randomized study of medical students and residents at Johns Hopkins University, in which participants were asked to select an ART regimen for 10 HIV case scenarios through an electronic survey. Participants were randomized to receive either DHHS guidelines alone (with a video tutorial), or DHHS guidelines and HIV-ASSIST (with a video tutorial) to support their decision-making. ART selections were graded ‘appropriate’ if consistent with DHHS guidelines, or concordant with ART regimens selected by HIV experts at three major academic institutions. Results: Among 118 trainees, participants randomized to receive HIV-ASSIST had significantly higher percentage of appropriate ART selections compared to those receiving DHHS alone(% appropriate responses in DHHS vs HIV-ASSIST arms: median 40% [Q1, Q3: 30%, 50%] vs 90% [80%, 100%], p<0.001). This difference was consistent among both medical students (median 40% vs 90%, p<0.001) and residents (median 40% vs 90%, p<0.001). The effect was seen for all case-types, but most pronounced for complex cases involving ART-experienced patients with ongoing viremia (DHHS vs HIV-ASSIST: median 0% [0%, 33%] vs 100% [66%, 100%]). In qualitative feedback, 61% commented on difficulty navigating or interpreting DHHS guidelines; by contrast 82% commented that HIV-ASSIST was user friendly, with 85 and 98% agreeing or strongly-agreeing that HIV-ASSIST was useful for making ART selections for ART-naive and experienced patients, respectively. Conclusion: Trainees using HIV-ASSIST were significantly more likely to choose appropriate ART regimens compared to those using guidelines alone. Interactive decision-support tools may be important and necessary to ensure appropriate interpretation and implementation of HIV clinical practice guidelines.

1118 PATIENTS EXPERIENCING VIRAEMIA IN ADHERENCE CLUBS: IS BACK-TO- CLINIC ALWAYS BEST? Tali Cassidy 1 , Jonathan Euvrard 1 , Claire Keene 2 , Erin Roberts 3 , Rodd Gerstenhaber 4 , Andrew Boulle 1 1 University of Cape Town, Cape Town, South Africa, 2 Medecins Sans Frontieres, Cape Town, South Africa, 3 Western Cape Department of Health, Cape Town, South Africa, 4 Médecins Sans Frontières, Cape Town, South Africa Background: ART adherence clubs have proven a successful model for many stable patients to receive peer support and convenient ART refills while utilizing fewer clinic resources. In the Western Cape, South Africa, patients are eligible to join a club after 6 months on ART, provided they are clinically stable, with a suppressed viral load (VL) and are not pregnant. Current guidelines, requiring viraemic patients to leave clubs and return to clinic care, are not strictly implemented. We describe the implementation of guidelines and 12-month outcomes of club patients who experience viraemia. Methods: We included data on all patients ever in a club at three large primary healthcare clinics in Khayelitsha, a high HIV-prevalence, low-income, peri-urban area in Cape Town, South Africa. We identified patients with viraemia (VL>1000 copies/mL) that occurred after joining the club, before they first exited the club (<3 months after last club visit), and before 1 October 2017. We describe characteristics of these patients at the time of the unsuppressed VL test result, subsequent 12-month outcomes, and we performed multivariate logistic regression to identify predictors of 12-month VL resuppression. Results: Of 8680 total club patients with a median time of 29.8 months in clubs (IQR:20-51) and VL testing data available, 503 (6%) experienced viraemia. Of the 494 patients who had any ART visits >2 months after viraemia, 345 (70%) returned to clinic care. Those who remained in clubs had the same chance of remaining in ART care 12 months later (93%), higher resuppression rates, similar VL completion rates, and a similar yet slightly lower median first high VL, compared to those returning to clinic (Table 1). A multivariate logistic regression showed 12-month VL resuppression was associated with remaining in clubs after one high VL result, compared to returning to clinic (OR:1.39; 95%CI:0.93- 2.06), and the log of the first high VL (OR:0.84; 95%CI:0.75-0.93). Conclusion: Inconsistent application of guidelines may result from clinical oversight or deliberate decisions based on patient-specific factors. Regardless, promising resuppression rates among those remaining in clubs suggest that there is scope to adapt adherence club guidelines to give patients and providers more flexibility, while providing safe clinical management of viraemic patients. http://files.aievolution.com/prd/cro2001/abstracts/abs_3358/table1_croi.PNG' 1119 RANDOMIZED TRIAL OF HIV-ASSIST VERSUS GUIDELINES FOR ART SELECTION BY TRAINEES Jesus Ramirez 1 , Manoj Maddali 2 , Saman Nematollahi 3 , Jonathan Z. Li 4 , Maunank Shah 3 1Johns Hopkins University, Baltimore, MD, USA, 2University of California San Francisco, San Francisco, CA, USA, 3Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4Brigham and Women's Hospital, Boston, MA, USA Background: Support for primary care clinicians in HIV medicine is critical in light of national HIV-provider shortages. Department of Health and Human Services (DHHS) guidelines are comprehensive but complex to apply for antiretroviral therapy (ART) selection. HIV-ASSIST (www.hivassist.com) is a free, online tool providing

Poster Abstracts

1120 TRANSITION TO DOLUTEGRAVIR-BASED REGIMEN: NIGERIAN EXPERIENCE AMONG KEY POPULATIONS

Moses Katbi 1 , Adefisayo Adedoyin 1 , Kent Klindera 1 , Bartholomew Ochonye 2 , Iyiola Faturiyele 3 , Michele Russell 1 , Oluwatosin Adeoye 4 , Adeoye Adegboye 5 , Tolu A. Alamu 6 1 USAID Nigeria, Abuja, Nigeria, 2 Heartland Alliance international, Abuja, Nigeria, 3 USAID Washington, Washington DC, WA, USA, 4 Save The Children International, Lagos, Nigeria, 5 Institute of Human Virology Nigeria, Abuja, Nigeria, 6 Heartland Alliance International, Federal Capital Territory, Nigeria Background: Following the release of the preliminary results of the largest ever HIV/AIDS indicator and Impact survey in Nigeria, the government of Nigeria and PEPFAR launched an aggressive effort towards improving virologic supression among PLHIV. We transitioned clients from efavirenz to dolutegravir based regimen. We examined the viral load among key population groups transitioned from TLE to TLD in three high burden states. Methods: A descriptive observational study that compared the routine viral load result of 3,327 key population (KP) clients from three high burden states who were transitioned from Tenofovir-Lamivudine-Efavirenz (TLE) to Tenofovir-Lamivudine-Dolutegravir (TLD). We carried out a repeat viral load tests on clients 1 to 3 months after transitioning to TLD using the Roche (C6800 & C8800) and Abbott PCR analyzers. We analyzed data using SPSS version 21. Paired sample t-test was used to compare the means of the viral load test results

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