CROI 2024 Abstract eBook

Abstract eBook

Oral Abstracts

204

What Are the Outcomes for Established Clients Enrolled in DSD During the First 3 Years on ART? Amy N Huber 1 , Lise Jamieson 1 , Musa Manganye 2 , Lufuno Malala 2 , Thato Chidarikire 2 , Matthew P. Fox 3 , Sydney Rosen 3 , Sophie Pascoe 1 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 National Department of Health, Pretoria, South Africa, 3 Boston University, Boston, MA, USA Background: Replacing routine clinic visits with differentiated service delivery (DSD) models for HIV treatment could benefit DSD clients and the health system, but its value depends on maintaining or improving patient outcomes. South Africa's DSD models include facility pick-up points, external pick-up points and adherence clubs, which facilitate easier access to medication. We conducted a prospective record review to compare outcomes of DSD clients to those eligible but not enrolled in DSD in South Africa. Methods: Among adults initiating ART between 2016-2021 at 18 primary healthcare facilities, we compared retention and viral suppression for DSD clients to those DSD eligible but not enrolled using TIER.Net records. For reference we also included those not DSD eligible. DSD eligibility was defined per guidelines (2016-2019: 2 suppressed viral load (VL) (<400c/mL) and ≥12 months ART; 2020-2021: 1 suppressed VL (<50c/mL) and ≥6 months ART). DSD enrollment was defined as any DSD interaction in the previous 12 months before the 12, 24, or 36 month time point. DSD eligibility and enrollment were reclassified every 12 months. Outcomes were assessed at 12, 24, and 36 months after ART initiation. 12, 24 and 36 month retention was defined as attending a visit 13-24 months, 25-36 months and 37-48 months after ART initiation, respectively. Outcomes after 12 months were conditional on being retained in the previous period. Results: 59,118 clients (67% female, 17% age 18-24) initiated ART during the study period. Proportion enrolled in DSD was 2% (N=1,431), 23% (N=7,238), 37% (7,845) by 12, 24 and 36 months; eligible but not enrolled was 12% (N=7,339), 48% (N=15,087), 46% (N=9,761) by 12, 24 and 36 months. Retention and viral suppression at 12 months were lower for those in DSD vs eligible. Retention at 24 and 36 months was higher for those in DSD vs eligible (relative risk: 1.10 [95% confidence interval 1.07-1.13]; 1.09 [1.06-1.13]). Viral suppression among those with a VL at 24 and 36 months was similar between those in DSD vs eligible. There were no differences in outcomes by gender or age group. Conclusion: South African DSD clients had higher retention and similar viral suppression at 24 and 36 months after ART initiation. The observed decrement to outcomes for DSD clients at 12 months requires further examination, particularly as new guidelines allowing DSD enrollment ≥4 months on ART. There was a missed opportunity for DSD enrollment as most of those eligible were not enrolled ≤ 3 years on ART.

egg at baseline. 28-day follow-up was high (SOC: 1519 [87.0%]; PE: 1450 [86.0%]; PDE: 1559 [87.8%]). Outcomes are shown in Table 1. ART initiation or VMMC booking was higher in the PE arm (PE vs SOC: aRR:1.16; 95%CI:0.99; 1.37; p = 0.069) whereas the PDE arm was associated with significant reduction in active Schistosomiasis compared to eSOC (aRR:0.80; 95%CI:0.69; 0.94; p = 0.005). Conclusion: Peer educators marginally increased uptake of ART and VMMC, whereas the addition of HIVST kit distribution, significantly reduced the prevalence of active Schistosomiasis. Combining HIV and Schistosomiasis services using beach clinics is feasible and would improve current policy and practice.

Oral Abstracts

203

Improving Posthospital Outcomes in People With HIV: A Multicenter Randomized Trial in Tanzania Robert Peck 1 , Benson Issarow 2 , Godfrey Kisigo 3 , Elialilia Okello 2 , Severin A. Kabakama 2 , Thomas Rutachunzibwa 4 , Sean Murphy 1 , Heiner Grosskurth 3 , Lisa Rosen-Metsch 5 , Daniel Fitzgerald 1 , Philip Ayieko 3 , Myung Hee Lee 1 , Saidi Kapiga 3 1 Weill Cornell Medicine, New York, NY, USA, 2 Mwanza Intervention Trials Unit, Mwanza, United Republic of Tanzania, 3 London School of Hygiene & Tropical Medicine, London, United Kingdom, 4 Ministry of Health, Dar es Salaam, United Republic of Tanzania, 5 Columbia University, New York, NY Background: In spite of the widespread availability of antiretroviral therapy (ART), people living with HIV (PLWH) still experience poor outcomes with high mortality during and after hospital admissions. Delayed linkage to HIV care after hospital discharge is a major risk factor. We tested a linkage case management intervention ("Daraja" = "Bridge" in Kiswahili) to address barriers to HIV care engagement after hospital discharge. Methods: We conducted a single-blind, individually randomized trial to evaluate the effectiveness of the Daraja intervention (NCT03858998). PLWH who were either ART-naïve or ART defaulters were recruited from 20 hospitals in northern Tanzania. Participants were randomized before hospital discharge to receive either the Daraja intervention or standard of care. The Daraja intervention consisted of 5 sessions conducted by a social worker over a 3 month period. The primary outcome of all-cause mortality at 12 months was confirmed by death certificates, hospital records, or verbal autopsies. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Results: We enrolled 500 hospitalized PLWH between March 2019 and February 2022. The mean age was 37 years, 77% were female, 35% had CD4 counts <100 cells/μL, 75% were ART naïve, and characteristics were similar between arms. Intervention uptake was high with 86% of expected sessions successfully completed; 496 participants completed 12 months of follow-up (2 withdrew consent; 2 lost-to-follow-up). Eighty-five (17%) participants died; mortality did not differ by study arm (43 vs. 42 deaths, p=0.96). Half of deaths occurred within 30 days after discharge. By contrast, the Daraja intervention reduced time to HIV clinic attendance and ART initiation (p<0.0001). Intervention participants also achieved higher rates of HIV clinic retention (87% vs. 76%, p=0.005), ART adherence (81% vs. 68%, p=0.002), and HIV viral load suppression (79% vs. 67%, p=0.01) at 12 months. Conclusion: In hospitalized PLWH, a linkage case management intervention was effective in accelerating the HIV continuum of care but did not reduce mortality. Intervention recipients who survived to 12 months had higher rates of ART adherence and viral load suppression. Our trial highlights the need for earlier diagnosis of HIV infection and for continued improvement of hospital and post-hospital care in the global effort to get to zero AIDS-related deaths.

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CROI 2024