CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1234 Cost-Effectiveness of Integrated Multi-Month Dispensing for HIV and Hypertension in South Africa Youngji Jo 1 , Sydney Rosen 2 , Brooke Nichols 2 , Robert Horsburgh 2 1 University of Connecticut, Farmington, CT, USA, 2 Boston University, Boston, MA, USA Background: In the current era of universal antiretroviral treatment (ART), health systems have the dual challenge of a growing number of people living with HIV and on ART who are also receiving chronic, life-long treatment for non-communicable diseases. Current evidence suggests that multi-month dispensing (MMD) for HIV can maintain at least equivalent clinical outcomes to conventional care and reduce costs, but little evidence exists when integrating MMD for multiple conditions. We examined the cost-effectiveness of integrated MMD for people living with HIV and hypertension. Methods: Using an age and sex-specific hybrid decision tree and Markov state-transition model, we constructed a 100,000-person simulated population cohort who may develop HIV and hypertension and initiate treatment at clinics in South Africa over a 10-year time horizon. We assessed the incremental costs and effectiveness of MMD versus conventional care from a health system perspective under different conditions of care seeking, eligibility, and uptake of MMD for clinically stable patients. Model inputs were sourced from previously published literature. MMD was defined as reducing the frequency of clinic visits by increasing the number of medications dispensed to stable patients at each visit from 3 to 6 months. For the integrated MMD, we assumed that comorbid patients receive both HIV and hypertension drugs at the same facility on the same day. Results: Our study demonstrates that integrated MMD for HIV and hypertension in South Africa can avert between 0.08 and 0.11 DALYs and save between $166 and $208 health systems costs per patient per year. Across all scenarios, HIV prevalence, care seeking level, mortality rate and LTFU rate were key drivers in DALYs averted; HIV prevalence, outpatient costs per visit and ART cost were key drivers in health systems cost. Overall, greater MMD integration, higher care seeking and a greater proportion of well-controlled patients in care led to greater cost savings or better (lower) ICER values. Conclusion: Integrated MMD is likely cost-saving (or highly cost-effective at ≤$30 per DALY averted) in various care-seeking scenarios and proportions of patients in care. Scale-up of MMD strategies is most effective when multiple conditions are addressed simultaneously. The benefit of integrated MMD may be greater than what we have estimated here through the potential for greater care-seeking and disease control among patients already in care with less LTFU and fewer deaths through high-quality care.

suppressed PLWH (Gandhi et al., CROI 2023), carefully selected viremic patients were also offered treatment, using a monthly dosing schedule. These were generally PLWH who were struggling with adherence but who maintained consistent care engagement, and who were verified to have no relevant resistance mutations. We conducted a cross-sectional analysis comparing virologic suppression in patients on CAB-RPV LAI with patients prescribed oral ART, recognizing the presence of selection bias. The two groups were similar across age, sex, gender identity, insurance status, and baseline CD4 count. Results: To date, we have 133 PLWH receiving CAB-RPV LAI, who have received a total of 715 doses of which 96% have been given within the appropriate treatment window. Navigators track to ensure injection visits are scheduled at the correct time intervals and work with medical providers to reschedule quickly for missed appointments. Most CAB-RPV LAI patients (86%,114/133) had a VL <50 copies/mL on most recent assay, compared to 74% (2367/3176) of PLWH receiving oral HIV medication, Χ2 (1, N=3309) = 8.7, p<.01. Twenty- one patients were started on CAB-RPV LAI with a VL ≥ 50 copies/mL who had a VL drawn at least one month after their initial dose. This group's median baseline VL was 100 copies/mL, and 76% (16/21) have subsequently achieved VL <50 copies/mL. Of the five patients who remain non suppressed, median VL has dropped from 140 copies/mL to 60 copies/mL. Conclusion: We successfully developed a robust cohort of PLWH on CAB-RPV LAI in an FQHC setting. These patients have maintained viral suppression at a high rate. We also provide further evidence suggesting efficacy of CAB-RPV LAI in non-suppressed PLWH who struggle with adherence to oral ART. Research focused specifically on this at-risk population is urgently needed.

Poster Abstracts

1236 Injectable Cabotegravir/Rilpivirine Reach and Effectiveness in a South Side Chicago HIV Clinic Geoffroy Liegeon 1 , Chris Kaperak 1 , Eleanor Friedman 1 , Alicia Dawdani 1 , Paul Djuricich 1 , Kane Stafford 1 , Jessica Schmitt 1 , Aniruddha Hazra 1 , Katerina Christopoulos 2 , John Schneider 1 , Moira McNulty 1 1 University of Chicago, Chicago, IL, USA, 2 University of California San Francisco, San Francisco, CA, USA Background: Long-acting injectable (LAI) cabotegravir (CAB) and rilpivirine (RPV) represent a new treatment option for people with HIV (PWH). We sought to understand early reach and effectiveness outcomes in an academic Ryan White clinic serving a primarily Black/African American patient population. Methods: We conducted a retrospective cohort analysis of all PWH referred for LAI CAB/RPV at the University of Chicago HIV clinic from January 1, 2021 to May 31, 2023. We described the socio-demographic and clinical characteristics of the referred PWH. We compared the initiation rate categorized by viral suppression (VS), defined as a viral load <50 copies/mL, using a Fisher's exact test and described early clinical outcomes. Per guidelines, PWH without VS initiated LAI CAB/RPV after VS on oral antiretrovirals. Results: Of the 829 PWH in the program, 119 (14%) were referred for LAI CAB/ RPV with median age 34, 65% cisgender male, 30% cisgender female, 5% transgender or non-binary, 85% Black, 56% sexual minority men, 32% with psychiatric illness, 8% with substance use, and 61% Medicaid insured. Half of referred PWH had comorbidities, 69% took other pills daily, and 37% had a BMI >30kg/m 2 . At referral, the median time living with HIV was 7 years, 78% received an integrase inhibitor (INSTI)-based regimen, and 12/119 (12%) did not have VS. After a median period of 1 month (IQR 0-3), 78 PWH (66%) started LAI CAB/RPV, of whom 57% had no prior HIV drug resistance test available, 24% received an oral lead-in, and 77% initiated with a bimonthly dosing schedule. The reasons for non-initiation are detailed in Figure 1. PWH without VS at referral were less likely to start treatment (P<0.001). After a median of 5 injections (IQR 3 to 7) and a median follow-up time of 8 months (IQR 5-12 months), all maintained VS except for one virologic failure, with 11/78 (14%)

1235 Implementing Long-Acting ART in a Community Health Center: Insights and Early Outcomes David Fessler , Erin Kelley, Rachel McLaughlin, Erin Loubier, Robert Bangert, Tasliym Adams, Amanda Fuchs, Lexeii Alves, Jessica Estrada, Jonathon Rendina, Sarah Henn Whitman-Walker Health, Washington, DC, USA Presenting Author: Dr David Fessler Background: Long-acting injectable Cabotegravir-Rilpivirine (CAB-RPV LAI) offers people living with HIV (PLWH) a safe and effective alternative to daily oral ART. In 2021, Whitman-Walker Health, a Federal Qualified Health Center (FQHC), began scaling up implementation of CAB-RPV LAI in appropriate patients. Methods: A multidisciplinary working group developed a protocol for providers and a workflow to streamline processes involving insurance authorizations, coding/billing, and patient and medication tracking. Most patients were consistently virologically suppressed at baseline, consistent with FDA guidance and trial protocols. However, with early promising data in treating non

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