CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

and Chi-square to compare the proportion of respondents with <1000 copies/ ml and those that achieved untransmitable viral load level of < 200 copies/ml before and after start of TLD. We used ANOVA to determine difference in means between the different KP groups. We set P-value at P < 0.05, being statistically significant. Results: 64.7% (n=2153) females and 35.3% (n=1174) males were enrolled (FSW 55.9% (n=1861); MSM 24% (n=797); PWID 14.3% (n=476); sexual partners of key population 5.6%; (n=190); People in prisons 0.1%; (n=3)). Mean age of clients is 31.19 ±2.82. Lower viral load achieved when on TLD (mean= 6924.71, SD = 65687.079) than when on TLE (mean= 17059.85, SD= 118859.603). Paired sample t-test found this difference to be significant (t = 4.572, p<0.005). Chi square reveals more clients achieved viral load <1000copies and <200 copies/ml while on TLD than while on TLE (X2 = 217.491, p< .005; X2 = 175.722, p< .005 respectively). ANOVA showed no significant difference in the mean of the viral load between the groups before and after start of TLD (f (4) = 1.113, p=0.35 for viral load results before start of TLD: f (4) = 0.665, p=0.62. for viral load results after start of TLD). Conclusion: DTG-based regimen significantly suppressed viral load of KP PLHIV following transition from Efavirenz based regimen. Virologic suppression and untransmitable viral levels achieved were superior with the use of TLD. Mvandaba 3 , Yandisa Nyanisa 3 , Victoria Chen 2 , Pamela Mda 3 , Roshen Maharaj 3 , David Stead 3 , John Black 3 , Steven J. Reynolds 1 , Jean B. Nachega 4 , Thomas Quinn 1 , for the WISE Study Group 1 Johns Hopkins University, Baltimore, MD, USA, 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Walter Sisulu University, Mthatha, South Africa, 4 University of Pittsburgh, Pittsburgh, PA, USA Background: Despite efforts to extend HIV services cross South Africa a significant number of persons living with HIV in the Eastern Cape remain either untested or unengaged. Even though Emergency Departments (EDs) were designed to address acute medical issues, they may also represent an under-utilized gateway for identification and engagement of HIV positive individuals at high risk for disease progression as well as onward transmission. We therefore sought to examine the feasibility and acceptability of universal HIV testing in the ED and subsequent linkage to treatment. Methods: We conducted a prospective cohort study across four EDs in the Eastern Cape province of South Africa, for a period of six weeks each, from July 2016 to July 2018. All adult (over 18yrs) non-critical patients presenting were systematically offered HIV testing. HIV+ patients were further consented to participate in a follow up study to ascertain linkage to care (LTC) via; 1) Telephone follow-up and/or; 2) Tracking in the National Health Laboratory System (NHLS) database. LTC at one-year was defined as self-reporting linkage (telephonic) or evidence of repeated CD4/viral load testing (NHLS). All patients followed the usual down referral care pathway (follow up in local clinic near their home after receiving a letter stating their results). Results: Over the study period 5900 patients were enrolled, of which 4846 (82.1%) accepted testing, of which 1172 (24.2%) were HIV positive of which 949 consented to participate in a LTC follow up study. Of these 633 (66.7%) had a known diagnosis of HIV and 316 (33.3%) had a new diagnosis of HIV infection. Of the known HIV positive patients, 30.9% had evidence of LTC via NHLS (72/233) and 48.6% confirmed via phone (71/146). Among newly diagnosed patients, 27.6% (40/145) had evidence of LTC in the NHLS database, and 38.4% confirmed via phone (28/73). There was no significant difference in linkage to care between those with known HIV versus those with HIV diagnosed in the ED. Conclusion: ED-based HIV testing in South Africa identified individuals with new HIV diagnoses and those out of HIV care. Overall LTC in this population was extremely poor. While the ED is a critical venue to identify HIV individuals not on ART there is a need to deploy novel, targeted LTC interventions in the ED. 1122 LINKAGE TO CARE AND VIRAL SUPPRESSION FASTER OVER TIME AMONG NEW HIV DIAGNOSES IN DC Rupali K. Doshi 1 , Jenevieve Opoku 1 , Adam Allston 1 1 District of Columbia Department of Health, Washington, DC, USA Background: Treatment for all people with HIV and improved antiretroviral therapy and care infrastructure are expected to have improved health outcomes 1121 POOR LINKAGE TO CARE AMONG HIV+ PERSONS IN EMERGENCY DEPARTMENTS IN SOUTH AFRICA Bhakti Hansoti 1 , Aditi Rao 2 , Elizabeth Hahn 2 , Sofia Ryan 2 , Nomzamo

in the US. We aimed to describe changes in initial care outcomes for people diagnosed with HIV in the District of Columbia (DC) over time. Methods: We used DC HIV surveillance data for people ages 13 and older diagnosed with HIV in DC in 2009-2017 to calculate linkage to care (LTC, presence of CD4 or viral load after HIV diagnosis) and viral suppression (VS, HIV RNA <200 copies/ml) as continuous variables (time from diagnosis to outcome) and dichotomous variables (LTC-30, or LTC within 30 days, and VS-90, or VS within 90 days of diagnosis). Chi square tests were used to compare demographics and CD4 at diagnosis between those diagnosed in 2009-2012 (DX09-12) vs. 2013-2017 (DX13-17). For DX13-17, multivariable (MV) logistic regression was used to calculate adjusted prevalence ratios (aPR) for LTC-30 and VS-90, adjusted for age at diagnosis, gender, race/ethnicity, mode of transmission, year of diagnosis, and CD4 at diagnosis. Results: Compared to DX09-12 (n=3124), DX13-17 (n=2119) were more likely to be men (75.2% vs. 71.3%), Latino (10.9% vs. 7.5%), MSM (50.1% vs. 43.0%), and younger (all p<0.001). There were no differences by LTC-30 between the groups. The proportion never virally suppressed declined (22.7% DX09-12 vs. 19.8% DX13-17, p<0.0001). Median time from HIV diagnosis to initial VS declined from 250 days (DX09-12) to 137 days (DX13-17) (p<0.0001); among those with CD4>350 cells/µl at HIV diagnosis, median time from HIV diagnosis to initial VS declined from 235 days (DX09-12) to 129 days (DX13-17) (p<0.0001). Among DX13-17, achievement of VS was lowest among transgender people (TG, 67.9%), PWID (58.6%), and adolescents 13-18 (69.2%). MV analysis (Table) demonstrated that non-White races, MSM/PWID, ages 25-39, dx year 2014, and CD4>500 were less likely to achieve LTC-30. Black race and MSM/PWID (aPR 0.45, 95% CI 0.22-0.91) were less likely to achieve VS-90, and women, TG, dx years 2015-2017, and those with CD4>500 (aPR 1.47, 95% CI 1.13-1.90) were more likely to achieve VS-90. Conclusion: Time from HIV diagnosis to LTC and VS have significantly improved from 2009 to 2017 for people diagnosed in DC, but gender, race, and risk factor-based disparities were found. Results can guide interventions for focus populations, including men, MSM/PWID, Black individuals, and those with lower CD4 counts. Future research may elucidate reasons for delays.

Poster Abstracts

1123 TRENDS IN LINKAGE INTO CARE AFTER "TEST AND START" AMONG ADOLESCENTS AND YOUNG ADULTS Darix S. Kigozi 1 , Philip Kreniske 2 , Ivy Chen 2 , Fred Nalugoda 1 , Susie Hoffman 2 , Godfrey Kigozi 1 , Gertrude Nakigozi 1 , Robert Ssekubugu 1 , Edward Kankaka 1 , Ronald H. Gray 3 , Maria Wawer 3 , Larry W. Chang 4 , Steven J. Reynolds 5 , Tom Lutalo 1 , Joseph Kagaayi 1 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 Columbia University, New York, NY, USA, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 5 NIAID, Bethesda, MD, USA Background: There is underutilization of anti-retroviral Therapy (ART) among HIV positive adolescent and young adults (AYA: 15–24 years) compared to adults (25-49 years). We examined trends and factors associated with ART uptake after the test and start program in a community-based cohort in Rakai, Uganda. Methods: We analyzed data from the Rakai Community Cohort Study (RCCS) for 10,827 HIV positive participants collected between 2013 and 2018 and compared 1,669 AYA (15-24 years) to 9,158 adults (25-49years). Covariates included: gender, marital status, religion, occupation, alcohol consumption, family size, education and number of sexual partners. In addition, we used

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