CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

bivariate analysis to test the associations between hypothesized correlates and uptake of ART and the Generalized Linear Model (GLM) to estimate the risk ratios associated with ART uptake Results: The average difference in proportions of ART use between AYA and adults was 18.4% (CI; 13.7, 22.9; P<0.01). In 2013, 12.8% of the AYA were on ART compared to 28.9.1% for adults, and by 2018, the proportions were 49.7% and 71.2%, respectively. In multivariate models, risks of not being on ART among AYA were increased in males (RR: 1.21; CI 1.01- 1.44), never married compared to married (1.19; CI 0.99, 1.41), and one and 2+ sexual partners compared to those with none (RR: 1.39; CI 1.00- 1.95); (RR: 1.50; CI 1.07- 2.11, respectively). Conclusion: There is an increase in ART uptake among AYA over time, but still remains lower than the UNAIDS 95-95-95 goals. AYA with multiple sexual partners and fishing occupations were less likely to use ART. We recommend targeted efforts to promote ART initiation and retention among adolescents in order to achieve epidemic control.

Poster Abstracts

1124 ENGAGEMENT IN CARE AND VIRAL SUPPRESSION AMONG NEWLY DIAGNOSED HIV-INFECTED PERSONS Kashif Iqbal 1 , Maria Mendoza 1 , Anne Patala 1 , Robyn N. Fanfair 1 , Gary Marks 1 1 CDC, Atlanta, GA, USA Background: Achieving and maintaining viral suppression (VS) in persons living with human immunodeficiency virus (HIV) protects their own health and prevents new infections. An important step to achieving and maintaining VS is being engaged in care. This study describes how newly diagnosed HIV-infected persons are engaging with their provider and achieving VS over a 24-month period. Methods: Persons newly diagnosed with HIV infection from June 30, 2012- December 31, 2014 who presented at one of six HIV clinics (Birmingham, AL; Boston, MA; Houston, TX; Miami, FL; San Diego, CA; Seattle, WA) were included in the cohort. All participants had an unsuppressed viral load on their first viral load (VL) test at the clinic and observed for up to 24 months from the date of their first VL test. We examined patterns of VS (<200 copies/mL) across time and the percentage of persons who had VS on their latest VL test during the 24-month follow up period. We used chi-squared statistics to compare persons with VS and not virally suppressed (nVS) by proportion of kept HIV care visits and by clinic, age, sex, race/ethnicity, and insurance. Results: Overall, 76% (1111/1469) of all newly diagnosed HIV-infected patients were VS at their latest VL test with an average of 149 days to achieve VS. Examining the cohort across time revealed that after achieving VS, 69% remained VS on all subsequent VL tests and 19%were nVS on any of their tests. The percentage VS varied by clinic, race/ethnicity, age, insurance, and proportion of kept visits with their provider (Table). Notably, as the proportion of clinic visits increase, the proportion of VS patients increase with 90% of those who kept >50% of their clinic visits being VS on their latest test. We also see differences in distribution of VS by race/ethnicity, with Non-Hispanic Blacks having significantly smaller proportion being VS. Conclusion: A large proportion of newly diagnosed HIV-infected patients achieved and maintained VS however nearly 20% never achieved suppression. There is a need for close clinical monitoring and identification of barriers impacting some newly diagnosed patients, particularly the unmet needs of minorities to increase the number who achieve stable suppression.

1125 FREQUENT DETECTION OF UNDIAGNOSED HIV WITHIN EMERGENCY DEPARTMENTS IN BOTSWANA Jillian Pintye 1 , Katrina F. Ortblad 1 , Shreshth Mawandia 2 , Odirile Bakae 2 , Lenna Tau 2 , Matias Grande 2 , Goabaone Mogomotsi 3 , Esther Mmatli 3 , Modise Ngombo 3 , Laura Seckel 1 , Renee Heffron 1 , Jenny Ledikwe 1 1 University of Washington, Seattle, WA, USA, 2 International Training and Education Center for Health, Gaborone, Botswana, 3 Ministry of Health and Wellness, Gaborone, Botswana Background: Botswana has a severe generalized HIV epidemic (23% adult HIV prevalence) with a high annual HIV incidence (1.3%). In 2004, Botswana became Africa’s first country to routinize “opt out” provider-initiated HIV testing and counseling (PITC) at health facilities, though it is rarely implemented in Emergency Departments (EDs). EDs provide episodic, unplanned care to large volumes of undifferentiated patients. Thus, EDs provide an opportunity to capture patients with undiagnosed HIV infection missed by other facility-based HIV testing. Methods: We evaluated the frequency of detecting undiagnosed HIV infection in the ED using data from a national HIV testing program in Botswana. From January 2018 to September 2019, HIV testing was conducted by program counselors at 149 facilities in 16 districts, including 55 EDs. Electronic data captured demographic information (age, sex, citizenship) and testing date, location and result. Data were included from individuals’ first HIV test during the programwithin ED, voluntary counseling and testing (VCT), or other PITC settings. We excluded data from risk-based testing strategies (e.g., index testing, STI or TB clinics) and antenatal clinics. Observations were excluded if test results were unavailable or if the individual previously tested HIV-positive. Results: In total, 130,161 individuals were tested in ED (9,695; 7%), VCT (12,760; 10%), or other PITC (107,706; 83%) and were included in the analysis; median age was 30 years (IQR 24-30), 29%were <25 years, 53%were male, and 57% were tested in urban centers. Compared to individuals who tested in VCT or other PITC, individuals who tested in the ED differed in age, sex, and urbanicity (Table 1). Overall, frequency of detecting undiagnosed HIV infection was 3.4%; 2.2% in VCT, 3.4% in other PITC, and 4.7%, in ED, respectively. Frequency of HIV detection in EDs was 2-fold higher than in VCT (prevalence ratio[PR]=2.2, 95% CI 1.4-3.3, p<0.001) and 1.4-fold higher than in other PITC (OR=1.4, 95%

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