CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

blood drawn for HCV antibody testing. The study was approved by supervising IRB in Vietnam. Results: Enrolment included 532 participants; 521 (98%) completed two study visits and were included in the incidence analysis. The study population included 76% MSM and 24% TGW with a median age 27 (IQR 24-30). Three-quarters (75%) had high school education or above, with over half (58%) reporting at least some college education. Reported risk behaviors during the follow-up period included condomless anal/vaginal sex (47%), group sex (29%), and methamphetamine use (21%). Injection of methamphetamine appears to be a newly emerging risk in Vietnam; 3 individuals (0.6%) reported this risk at follow-up while none reported it at baseline. HCV prevalence at baseline was 3/523 (0.6%), all of whom were MSM. At 12 months, 7 new HCV infections were detected, for an incidence of 12.0 per 1,000 person years. All incident cases were among MSM participants. Restricting incidence analyses to only MSM (n=397), the incidence rate was 15.2 per 1,000 person years. In the multivariable logistic regression analysis, the only factor significantly associated with new HCV infection was participating in group sex (adjusted odds ratio (aOR) 13.8, 95% confidence interval 1.29-146.5). Conclusion: HCV incidence is significant among MSM living with HIV in southern Vietnam. HCV infection appears to be related to sexual activity, particularly group sex, which is also often associated with use of recreational drugs such as methamphetamine. Clinics that provide HIV care to MSM clients should provide prevention counseling to at-risk MSM and regular HCV screening for those with high-risk behaviors. Cost Savings Modeling of Telehealth Services for Hepatitis C Virus Infection, Cherokee Nation Jorge Mera 1 , Molly A. Feder 2 , Jeri Sawyer 3 , Gretchen Greene 3 , Brigg Reilley 4 , Ashley Wirth 4 , David Stephens 4 , Jessica Leston 4 1 Cherokee Nation Health Services, Tahlequah, OK, USA, 2 Cardea Services, Seattle, Washington, 3 Greene Economics, Battle Ground, Washington, 4 Northwest Portland Area Indian Health Board, Portland, OR, USA Background: American Indian and Alaska Native (AI/AN) people are disproportionately affected by hepatitis c virus (HCV) infection with the highest rate of acute HCV infection (2.7 per 100,000) and HCV-related mortality (10.17 per 100,000) compared with other races in the US. Telehealth programs using the Extension for Community Healthcare Outcomes (ECHO) Model® are effective in delivering HCV care. Cherokee Nation Health Services (CNHS) initiated ECHO to support HCV care in 2014, utilizing Indian Country ECHO's holistic, collaborative teleECHO model that emphasizes whole-person versus disease-specific care and treatment. Methods: This study assessed cost savings of implementing CNHS' HCV ECHO compared to conventional care. The conventional care scenario modeled the costs of the HCV care program prior to adoption of ECHO, in which a patient receives in-person treatment by a specialist via referral. The ECHO scenario modeled the costs of ECHO, including laboratory tests, personnel, and other direct program components. The total cost of HCV care for both scenarios was calculated on an annual basis and compared. Costs of care via ECHO and conventional care were estimated based on CNHS financial records and publicly available data. Projections on HCV prevalence, treatment, and outcomes were based on de-identified CNHS electronic medical record data among individuals with an HCV RNA test from 2016 through 2020. Demographic estimates of population and trends were taken from US Census data to model HCV treatment and outcomes by age and sex through 2040, 10 years beyond the 2030 US national HCV elimination goal. Results: Costs of HCV medical services per patient via ECHO were 69% lower than conventional care. ECHO was projected to have total cost savings of over $6 million in 10 years and nearly $10 million in 20 years based on $3,122 cost savings per patient. ECHO provided substantial short- and long-term cost savings for HCV services in CNHS. Conclusion: ECHO provided substantial cost savings for HCV care provision in Cherokee Nation. Clinical sites serving communities with limited healthcare access, including rural and AI/AN communities, may consider ECHO as a model for increasing treatment and achieving cost savings for delivering HCV care.

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Using County Notification Data to Characterize Recently Reported Hepatitis C Cases, Los Angeles Cassidy J Hernandez-Tamayo 1 , Lokesh Bhardwaj 1 , Riya Shah 1 , Chrysovalantis Stafylis 1 , Prabhu Gounder 2 , Mirna Ponce Jewell 2 , Jeffrey D. Klausner 1 , for the Hepatitis C Linkage to Care Team 1 University of Southern California, Los Angeles, CA, USA, 2 Los Angeles County Department of Public Health, Los Angeles, CA, USA Background: Hepatitis C remains a public health problem with continued incidence and a high proportion of individuals either unaware of their infection or untreated. Using the Los Angeles County hepatitis C registry of notified cases, the University of Southern California and the Los Angeles County Department of Public Health established a novel HCV case-management program. We describe the characteristics of contacted cases and the frequency and correlates of treatment. Methods: Volunteer study case-workers contacted Los Angeles County residents with a positive HCV RNA test result reported to the Department of Public Health between January 2021 and April 2022 to assess awareness of their infection status, verify treatment, and counsel untreated cases. We evaluated bivariate associations of race/ethnicity, age, biological sex, insurance status (private, public (Medicare, Medical), and none), and symptomatic status (symptoms vs no symptoms) with treatment status (treated vs. untreated) using a Pearson's Chi-Square Test. We created a multivariable logistic regression model to assess associations between demographic and clinical characteristics and treatment status. Results: Among 403 cases contacted, 227 (56%) had public insurance, 254 (63%) were male, 230 (57%) were 45+ years old, and 181 (45%) were Hispanic or Latino. Eighty-five percent were aware of their positive HCV result, yet 68% never received treatment. Untreated cases (N=295) were predominantly male (65%) and non-White (76%). No statistically significant differences between treatment status existed for race/ethnicity and sex. The multivariable logistic regression model showed public insurance status (vs private odds ratio [OR]: 0.56; 95% CI: 0.32, 0.98), older age group (vs young adults 18-29 years OR: 3.17, 95% CI: 1.23, 8.18), and the existence of symptoms (vs no symptoms OR: 3.70; 95% CI: 2.15, 6.64) were associated with treatment. Conclusion: HCV case registry data can be used to inform people about their infection, assess treatment status and counsel untreated cases. Those publicly insured, younger, and asymptomatic were less likely to be treated. Local health departments should use case registry data to help accelerate HCV elimination efforts. A Model to Eliminate Viral Hepatitis Infection in Migrants: A Prospective Study in Southern Italy Antonio Russo 1 , Mariantonietta Pisaturo 1 , Alessio Loredana 1 , Stefania De Pascalis 1 , Margherita Macera 1 , Vincenzo Messina 2 , Lorenzo Onorato 1 , Carmine Minichini 1 , Maria Stanzione 1 , Gianfranca Stornaiuolo 1 , Mario Starace 1 , Caterina Monari 1 , Caterina Sagnelli 1 , Nicola Coppola 1 1 University of Campania Luigi Vanvitelli, Naples, Italy, 2 Azienda Ospedaliera Sant'Anna e San Sebastiano di Caserta, Caserta, Italy Background: Migrants born in intermediate and high HBV and HCV-prevalence countries are likely to be at an increased risk for HBV and HCV infection. Data on HCV and HBV prevalence in migrants living in Italy are scanty and there are few screening and linkage-to-care programs for this target. Methods: A prospective, multicenter, based on the long-term active cooperation between two 3rd level units of Infectious Diseases and four 1st level clinical centers in southern Italy (Naples and Caserta) was designed. The

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Poster Abstracts

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CROI 2024 206