CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

892

Clinical Relevance of the CRAG Semiquantitative Scores in CRAG-Positive People with AIDS Thu T Nguyen 1 , Sruthi Venugopalan 1 , Khanh H. Dang 2 , Phuong L. Trinh 2 , Heera N. Sambath 1 , Matthew T. Burke 1 , Vo Trieu Ly 3 , H Rogier van Doorn 2 , Vu Quoc Dat 2 , Thuy Le 1 1 Duke University School of Medicine, Durham, NC, USA, 2 Oxford University Clinical Research Unit in Vietnam, Ho Chi Minh City, Vietnam, 3 Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam Background: High cryptococcal antigen (CrAg) titer is associated with higher mortality in patients with cryptococcal meningitis and in asymptomatic CrAg positive people in Africa. CrAg titer testing may improve patient management; however, titer testing is cumbersome and expensive. Here, we evaluate the diagnostic performance of IMMY CrAg semiquantitative (CrAg SQ) LFA and determine the association of CrAG SQ scores with CrAg titers and mortality in CrAg positive patients with advanced HIV disease (AHD) in Vietnam. Methods: This is a nested case control study using serum samples from 2 multi-center cryptococcal screening cohorts enrolling patients with AHD (CD4 count <100 cells/μL or WHO stage III/IV disease). Cohort 1 enrolled 1177 asymptomatic patients from 22 clinics across Vietnam between 2015 and 2019. Cohort 2 enrolled 900 hospitalized patients from 3 hospitals between 2021 and 2023. Cases (N=86) were all patients who were CrAg positive by CrAg LFA. Controls (N=30) were randomly selected CrAg negative patients. CrAg titer was tested for all CrAg-positive samples. We evaluated the sensitivity and specificity of the CrAg SQ LFA using CrAg LFA as the reference standard and the correlation between CrAg SQ score & CrAg LFA titer. We determined the association between CrAg SQ score and 12-month mortality using Cox regression modeling. The results of the CrAg SQ were interpreted by 2 double-blinded readers, and interrater reliability (IRR) was determined by intra-class correlation. Results: CrAg SQ demonstrated a sensitivity of 97.6% (95% CI: 90.9-99.6) and specificity of 94.8% (95% CI: 77.8-98.9). CrAg SQ scores were highly associated with CrAg titers, Pearson's correlation coefficient r = 0.89 (95% CI: 0.88 to 0.92; P < 0.001). The median CrAg titers that correspond to the CrAg SQ scores were 1:5 (IQR, 1:5-1:7) for 1+ score, 1:60 (IQR, 1:40-1:140) for 2+ score, 1:5120 (IQR, 1:320-1: 40960) for 3+ score, and 1:122880 (IQR, 1: 8960-1:327680) for 4+ score. Multivariate analysis revealed an average 29% increase in the odds of 12-month mortality for every one unit increase in the CrAg SQ score (OR 1.29 [0.77 – 2.28], P = 0.34). The IRR was excellent at 0.98 (95% CI: 0.96 - 0.99; P < 0.001). Conclusion: The CrAg SQ demonstrated excellent sensitivity and specificity compared to the CrAg LFA. There is excellent correlation between CrAg SQ score and CrAg titers, and a non-significant but positive association between CrAg SQ scores and 12-month mortality.

Conclusion: Invasive mycoses were detected in 25% of hospitalised and 14% of outpatients with AHD in Vietnam. Talaromycosis is the leading mycosis and together with histoplasmosis should be added to the WHO package of care for AHD in the Asia Pacific region.

891

Enhancing Advanced HIV Screening: Innovating With the "Hub and Spoke" Testing Model in Tanzania Nelson M Jonas 1 , Alexander Christopher 1 J. Christopher 1 , Amos Scott 2 , Julius Zelothe 3 , John Roman 4 , Aaron Tesha 1 , Frederick Ndossi 1 , Christopher Henjewele 5 , Josephat Francis 6 , Peter Mlacha 7 , Hosea William 8 , Andrea Mbunda 9 , Eva Matiko 1 , Redempta Mbatia 1 1 Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania, 2 Tanzania Health Promotion Support, Shinyanga, United Republic of Tanzania, 3 Tanzania Health Promotion Support, Kigoma, United Republic of Tanzania, 4 Tanzania Health Promotion Support, Pwani, United Republic of Tanzania, 5 Tanzania Health Promotion Support, Dar Es Salaam, 6 Ministry of Health and Social Welfare, Pwani, United Republic of Tanzania, 7 Ministry of Health and Social Welfare, Shinyanga, United Republic of Tanzania, 8 Ministry of Health and Social Welfare, Kigoma, United Republic of Tanzania, 9 US Centers for Disease Control and Prevention Tanzania, Dar es Salaam, United Republic of Tanzania Background: Despite the global adoption of the World Health Organization's 'test and treat' policy, the proportion of people living with HIV (PLHIV) presenting with advanced HIV disease (AHD) remains high at around 30% in Tanzania. Due to gaps in identification, recipients of care (RoC) with AHD face an elevated risk of mortality primarily because of opportunistic infections (OIs) such as tuberculosis and cryptococcal meningitis (CM). We demonstrated the implementation of AHD screening through CD4 testing to detect and manage OIs, particularly cryptococcal infection. Methods: In collaboration with the Kigoma, Pwani, and Shinyanga Regional and Council Health Management Teams, we revived CD4 testing for all newly diagnosed PLHIV along with reflex Cryptococcal antigen (CrAg) testing. We extracted data from the HIV Care and Treatment Clinic database, comparing the identification of AHD after the intervention through CD4 and Crag testing. In 2019, we integrated CD4 testing within the established viral load sample transportation system using a 'hub and spoke' model and point of care (PoC). Healthcare providers received training on AHD screening and management, including CD4 testing for all newly enrolled to care and laboratory-reflex CrAg testing at the laboratory for all samples with CD4 counts of <200 cells/μL. We used the client's recorded cards and care and treatment database as the main data source. The analysis focused only on newly enrolled RoC. Results: Enhancing sample transportation led to 167 (68%) supported facilities without CD4 machines to access CD4 testing and cryptococcal screening through CrAg tests at the hub sites. The number and proportion of newly enrolled RoC tested for CD4 at 245 supported facilities rose from 1,931 (7%) in 2020 to 9,900 (95%) in 2023. Simultaneously, the proportion of samples with CD4 counts <200 undergoing laboratory-reflex CrAg testing increased from 173 (36%) in 2020 to 1,474 (96%) in 2023, resulting in CrAg positive identification of 35 (20%) individuals in 2020, 89 (16%) in 2021, 102 (10%) in 2022, and 90 (6%) as of June 2023. CM cases identified increased from 5 in 2020 to 39 in 2023. Conclusion: The CD4 testing for newly diagnosed HIV-positive clients has substantially increased the identification of individuals with asymptomatic cryptococcal infection. The successful implementation of early AHD screening among newly diagnosed PLHIV in resource-constrained settings is feasible through sample transportation integration and expanding point of care CD4 testing

Poster Abstracts

893

Semi-Quantitative Cryptococcal Antigen Testing and Mortality in HIV-Related Cryptococcal Meningitis F Kathryn Boyd 1 , Olivia Maskill 2 , Ronan Doyle 1 , Kwana Lechiile 3 , Cecilia Kanyama 4 , Graeme A. Meintjes 5 , David B. Meya 6 , Mosepele Mosepele 7 , Conrad Muzoora 8 , Henry C. Mwandumba 9 , Chiratidzo Ndhlovu 10 , Thomas S. Harrison 11 , David S. Lawrence 1 , Joseph N. Jarvis 1 , for the AMBITION Study Group 1 London School of Hygiene & Tropical Medicine, London, United Kingdom, 2 London School of Hygiene & Tropical Medicine, Blantyre, Malawi, 3 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 4 University of North Carolina Project–Malawi, Lilongwe, Malawi, 5 University of Cape Town, Cape Town, South Africa, 6 Infectious Diseases Institute, Kampala, Uganda, 7 University of Botswana, Gaborone, Botswana, 8 Mbarara University of Science and Technology, Mbarara, Uganda, 9 Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, 10 University of Zimbabwe, Harare, Zimbabwe, 11 St George's University of London, London, United Kingdom Background: Cryptococcal meningitis (CM) causes 19% of HIV-related deaths, and 10-week mortality rates with current treatments are high (25-45%). Risk stratification at disease presentation with tailoring of treatment could reduce

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