CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

HCV testing. Screening was fully integrated into ED care using opt-out consent; antibody positive tests were followed by reflex RNA testing. Outcomes included newly diagnosed HCV (RNA-detected) and elements of the HCV care continuum through 12 months of follow-up. Analyses: Intention-to-treat, chi-square, and risk ratios (RRs) with 95% confidence intervals (CIs). Results: From 11/19/2019 through 8/4/2022, 147,498 eligible patients were randomized with excellent balance of characteristics. Of the 73,651 allocated to targeted screening, 23,339 (31.9%) were identified as high risk, 7,110 (30.4%) accepted testing and 4,634 (65.3%) completed testing, resulting in 114 (2.5%) new diagnoses. Of the 73,847 allocated to nontargeted screening, 16,516 (22.5%) accepted testing and 9,825 (59.5%) completed testing, resulting in 154 (1.6%) new diagnoses. Compared to targeted screening, nontargeted screening was significantly associated with new diagnoses (RR 1.35, 95% CI 1.06-1.72, p=0.02). Small proportions had treatment appointments, initiated and completed treatment, or attained SVR12 (Figure). Conclusion: Nontargeted HCV screening was superior to targeted screening for identifying newly diagnosed HCV in the ED. The significant decay from diagnosis to SVR12 suggests innovative models of HCV treatment from the ED are needed.

study started in June 2018, was stopped in February 2020, and was resumed in February 2021 until November 2021. All migrants > 18 years old consecutively evaluated for clinical consultation at one of the first-level centers were enrolled. An anonymous serological screening was offered to seek HIV, HBV and HCV. The participants who were positive for a virus hepatitis infection and or for HIV were referred for linkage to cure at one of the tertiary units. Results: In the study period we observed 3,501 migrants; 3,417 (97.6%) agreed to be screened. Of the 3,417 subjects screened 185 (4.7%) were anti-HCV positive, 334 (10%) were HBsAg positive, 61 (1.7%) HIV Ab positive. Of the 334 HBsAg positive subjects (figure 1), 116 (55%) had HBV DNA over than 2000 UI/ ML. Of the 116 subjects with HBV DNA over than 2000 UI/ML, 111 (96%) had chronic hepatitis, 3 (2%) had cirrhosis and 2 (1.7%) had HCC; all subjects with HBV DNA over than 2000 UI/ML were linked to cure but 3 (2%) lost to follow up. Eight subjects (2%) were HDV Ab positive, but only one were HDV RNA positive, genotype 1 and was linked to cure. Of the 185 HCV ab subjects, 53 (29%) were HCV-RNA-positive. Of the 53 HCV-RNA-positive-subjects, 48 (90%) were linked to cure, 5 (10%) refused. Of these 48, 16 (33.3%) harboured HCV genotype 1b, 11 (22.9%) genotype 1a, 16 (33.3%) genotype 3, 3 (6.3%) genotype 4 and 2 (4.2%) genotype 2. All the 48 HCV-RNA-positive patients started DAA-regimen with sofosbuvir/velpatasvir and completed the 12 weeks of treatment. Of these 48 subjects, 47 (97.9%) showed a sustained virologic response (SVR) at 12 and at 24 weeks after treatment and one dropped-out in follow-up after finishing the DAA treatment. Conclusion: After an educational phase on the route of transmission and treatment availability, nearly 98% of subjects agreed to be screened and evaluated for hepatitis virus infections, so our model seems useful in the viral hepatitis screening, linkage-to-care and treatment in a difficult to manage population.

Poster Abstracts

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Navigation is Superior to Clinician Referral for Linkage to HCV Care from the Emergency Department Sarah E Rowan 1 , Jason Haukoos 1 , Kevin Kamis 1 , Emily Hopkins 1 , Matthew Minturn 1 , David Higgins 2 , Erika Becerra-Ashby 2 , Carolynn Lyle 1 , Stephanie Gravitz 1 , Robert McGoey 1 , Meghan Bellamy 1 , Alia Al-Tayyib 1 , Edward Gardner 1 , David L. Wyles 1 , for the DETECT Hep C Linkage-to-Care Trial Investigators 1 Denver Health and Hospital Authority, Denver, CO, USA, 2 University of Colorado Denver, Denver, CO, USA Background: Emergency departments (EDs) serve as important clinical settings for hepatitis C (HCV) screening and care, yet optimal methods of linkage-to-care for HCV-diagnosed individuals remain unknown. The goal of this study was to test the effectiveness of linkage navigation (LN) and clinician referral (CR) among ED patients identified with untreated HCV with a primary hypothesis that LN plus CR is superior to CR alone. Methods: We performed a prospective two-arm parallel-group comparative effectiveness randomized trial at Denver Health Medical Center among ED patients with untreated HCV. Participants were randomized in a concealed fashion to CR alone or CR plus LN. All participants provided informed consent. Individuals in the CR arm were educated about HCV by their primary ED clinician and given information on how to access HCV care verbally and in discharge instructions. Individuals in the LN arm met with a linkage navigator in the ED or by phone after the visit. The LN reiterated basic HCV education and helped schedule and facilitate HCV treatment appointments. Pre-specified outcomes, collected in a blinded manner, were initiation of HCV treatment (primary), appointment with an HCV clinician, completion of treatment, and sustained virologic response 12 weeks after treatment (secondary) at 6 months post enrollment. Analyses were performed using intention-to-treat with differences, precision estimates, and bivariate hypothesis testing. Results: From November 2019 through January 2023, 280 individuals were randomized with excellent balance in baseline characteristics, including individuals <40 years of age or with recent injection drug use (IDU). Individuals in the LN arm were significantly more likely to link to care (Δ = 18%, p=0.0004) and initiate treatment (Δ = 11%, p=0.01). More individuals in the LN arm

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Hepatitis C Screening in the Emergency Department: The Multi-Center DETECT Hep C Clinical Trial Jason Haukoos 1 , Sarah E. Rowan 1 , Emily Hopkins 1 , James Galbraith 2 , Richard E. Rothman 3 , Yu-Hsiang Hsieh 3 , Stephanie Gravitz 1 , Kevin Kamis 4 , Carolynn Lyle 1 , Michael S. Lyons 5 , Douglas White 6 , Alia Al-Tayyib 4 , Edward Gardner 1 , David L. Wyles 1 , for the DETECT Hep C Screening Trial Investigators 1 Denver Health Medical Center, Denver, CO, USA, 2 University of Mississippi Medical Center, Jackson, MS, USA, 3 The Johns Hopkins University, Baltimore, MD, USA, 4 Denver Health and Hospital Authority, Denver, CO, USA, 5 The Ohio State University, Columbus, OH, USA, 6 Highland Hospital, Oakland, CA, USA Background: Testing for hepatitis C (HCV) is the first step toward ultimately curing HCV infection and preventing transmission. Emergency departments (EDs) are key clinical settings for screening given that they serve at-risk patients who commonly do not access healthcare elsewhere. Determining the best approach to HCV screening in ED settings is imperative to maximize the benefit of this public health intervention. The goal of this study was to evaluate the effectiveness of HCV screening in EDs with the hypothesis that nontargeted screening is significantly associated with identification of new diagnoses when compared to targeted screening. Methods: Design & Setting: Prospective multi-center randomized pragmatic trial in EDs in Denver, CO, Baltimore, MD, and Jackson, MS. Population: Patients ≥18 years of age presenting for ED care. Exclusions: critical illness, inability to consent, prior HCV diagnosis. Interventions: Eligible patients underwent concealed randomization as part of routine care to either nontargeted screening, where all were offered HCV testing, or targeted screening, where all were asked risk questions and any affirmative response led to an offer for

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