CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1142 SEARCH TEST & TREAT INTERVENTION IMPROVES VIRAL SUPPRESSION AMONG HAZARDOUS DRINKERS Sarah B. Puryear 1 , Dalsone Kwarisiima 2 , James Ayieko 3 , Judith A.Hahn 1 , Atukunda Mucunguzi 2 , Sabina Ogachi 3 , Laura B. Balzer 4 , Vivek Jain 1 , Edwin D. Charlebois 1 , Craig R. Cohen 1 , Elizabeth A.Bukusi 3 , Maya L.Petersen 5 , Diane V. Havlir 1 , Moses R. Kamya 2 , Gabriel Chamie 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Infectious Diseases Research Collaboration, Kampala, Uganda, 3 Kenya Medical Research Institute, Nairobi, Kenya, 4 University of Massachusetts Amherst, Amherst, MA, USA, 5 University of California Berkeley, Berkeley, CA, USA Background: Hazardous alcohol use has been associated with poor HIV care cascade outcomes. We previously reported that hazardous drinkers had lower baseline viral suppression (VS) than non-drinkers in the SEARCH universal test and treat (UTT) trial. In this analysis, we sought to assess if gaps in VS persisted between hazardous drinkers and non-drinkers by arm in intervention and control communities after 3 years and to determine if the intervention improved VS compared to control among hazardous drinkers. Methods: SEARCH randomized 32 communities in Kenya and Uganda to a UTT intervention of annual testing and universal ART eligibility via streamlined care designed to decrease barriers to engagement in care and VS, or a control of baseline universal testing with ART eligibility and delivery by evolving country standards over 3 years (2013-17). We evaluated VS at year 3 in baseline HIV+ adults. We assessed baseline alcohol use by Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score: hazardous drinking was defined as a score 3 for women and 4 for men and non-drinking as a score of 0. Within each arm, associations between baseline alcohol use and year 3 VS were estimated using individual-level Targeted Maximum Likelihood Estimation (TMLE) to adjust for sociodemographic factors, mobility and clustering by community. Comparisons of year 3 VS between arms among hazardous drinkers were based on cluster- level TMLE. Results: Of 9,936 HIV+ adults with baseline AUDIT-C measures, 871 (9%) reported hazardous alcohol use. Men accounted for 75% of hazardous drinkers (655/871) and 29% (2655/9065) of non-drinkers. After adjustment for confounders, year 3 VS in the control armwas lower among hazardous drinkers (77%) compared to non-drinkers (83%, aRR: 0.93, 95%CI:0.86-0.99, p=0.04). In contrast, in the intervention arm, year 3 VS among hazardous drinkers (86%) was not significantly different than among non-drinkers (90%, aRR: 0.96, 95%CI:0.9-1.01, p=0.11). Hazardous drinkers in intervention communities were more likely to achieve VS than hazardous drinkers in control communities (RR 1.21, 95%CI: 1.1-1.3, p<0.001). Conclusion: The SEARCH intervention reduced the gap in VS between baseline hazardous drinkers and non-drinkers, achieving high prevalence of VS regardless of alcohol use, whereas a disparity in VS by alcohol use persisted in the control arm. These data suggest that the SEARCH intervention may have decreased barriers to HIV care and VS for hazardous drinkers.

Jonathan Feelemyer 4 , Vu H. Vinh 5 , Didier Laureillard 6 , Philippe Van De Perre 1 , Jean-Pierre Molès 1 , Don Des Jarlais 4 1 INSERM, Montpellier, France, 2 Center for Supporting Community Development Initiatives, Ha Noi, Vietnam, 3 Hai Phong Medical University, Hai Phong, Vietnam, 4 New York University, New York City, NY, USA, 5 Viet Tiep Hospital, Hai Phong, Vietnam, 6 CHU de Nimes, Nimes, France Background: The HIV epidemic among people who inject drugs (PWID) has been ended in many high-income countries, but no such achievement has been reported from the low-middle income countries (LMIC) where the epidemic has flared. In Vietnam, despite a persistent repressive policy regarding drug use, directly-observed methadone therapy and universal ART have been implemented, along with community-based organizations (CBO) to deliver harm reduction and assist PWID in accessing care. In this context, we assessed whether the HIV epidemic could be ended in this high-risk group, taking the case of Haiphong, a 2 million inhabitant city. Methods: After a feasibility phase which estimated the active PWID population size to 5500 in Haiphong, we implemented 3 community-based respondent driven sampling surveys (RDS) in October 2016, 2017 and 2018. We enrolled active PWID with recent injection skin marks and heroin detected in urine, recorded drug use behaviors, and tested them for HIV and plasma viral load. From each RDS, all HIV-positives and 200 to 400 HIV-negative PWID entered in two open cohorts with bi-annual follow-up. HIV incidence was calculated using follow-up accumulated from both the cohort (bi-annual HIV testing) and recaptured PWID between RDS. We also estimated the HIV cascade of care, recent infections and HIV viremia prevalence. Results: The 3 RDS recruited 1380, 1451 and 1443 PWID, representing 3146 distinct individuals; all of themwere injecting heroin, 23% for less than 5 years, and 11.8%, 32.4% and 41.5% reported being in the methadone program, respectively. Their mean age was 39 years, and 94.9%were male. Reported needles/syringes sharing was low at 3.9%, 3.2% and 3.6%, respectively. The HIV prevalence was 26.5%, similar across RDS. Overall, 1497 person-years of follow- up were accumulated with 1 HIV seroconversion, yielding a HIV incidence of 0.7/1000 person-years (95%CI: 0.02-4). At RDS1, the cascade of care was 87-93- 97, improving to 91-92-95 and 95-93-95 at RDS2 and RDS3. There was no recent infection among all HIV-positives. The viremia prevalence (threshold of 1000 copies/mL) decreased from 7.2% at RDS1, to 5.4% at RDS2 and 3.1% at RDS3. Conclusion: Ending the HIV epidemic among PWID in a LMIC setting can be reached, thanks to low sharing rate and high success of the HIV care program, much facilitated by an active CBO network. 1144 ENDING THE HIV EPIDEMIC AMONG PEOPLE WHO INJECT DRUGS: A COST- EFFECTIVENESS ANALYSIS Emanuel Krebs 1 , Xiao Zang 1 , Benjamin Enns 1 , Jeong E. Min 1 , Bohdan Nosyk 1 , for the Localized Economic Modeling Study Group 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Background: In the United States, people who inject drugs (PWID) continue to be disproportionately at risk of HIV infection. We aimed to determine the cost-effectiveness of expanded access to evidence-based prevention and care interventions for PWID and to identify the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in six US cities with diverse HIV microepidemics. Methods: We identified and estimated costs, effectiveness and previously- documented scale of delivery for 14 evidence-based interventions from the US CDC’s Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention and from the published literature. Using a dynamic, compartmental HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, we assessed combinations of evidence-based interventions implemented at either previously-documented, optimistic or ideal scale. We estimated averted HIV infections among PWID, quality-adjusted life-years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) for each combination and city compared to the status quo over a 20-year time horizon (healthcare perspective; 3% annual discount rate, 2018$US). Interventions were implemented for a 10-year period. In addition, we estimated health production functions, representing combination implementation strategies providing the greatest health benefits for incremental investment levels. Results: Strategies that maximized health benefits while remaining cost- effective according to international standards contained between six (Atlanta and Seattle) and twelve (Miami) interventions. The ICER values for these

Poster Abstracts

1143 END OF HIV EPIDEMIC AMONG PWID IN A LOW-MIDDLE INCOME COUNTRY: THE HAI PHONG CASE Nicolas Nagot 1 , Khuat T.Oanh 2 , Duong T. Huong 3 , Delphine Rapoud 1 , Hoang T. Giang 3 , Catherine Quillet 1 , PhamM. Khue 3 , Laurent Michel 1 , Roselyne Vallo 1 ,

CROI 2020 432