CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

HCV (liver) evaluation, receiving an offer of HCV medications, initiating HCV medications, completing HCV treatment, and achieving sustained viral response at 12 weeks (SVR12). Power analyses called for a sample of 100-125 to have adequate power. The outcome was assessed using a Poisson regression. Results: Of the 517 CTN-0049 participants alive as of Feb 2016, 485 (94%) were contacted and 381 (79%) enrolled for HCV testing. Of those enrolled, 268 were ineligible, with 244 HCV negative. There were 113 participants randomized (61 to TAU, 52 to CF). Participants were mostly male (58%), mean age 50 (SD=8), 14% Hispanic, 71% Black, 20%White, and 76% had insurance. CF participants achieved, on average, 2.8 steps along the HCV care cascade while TAU participants achieved approximately 2 steps (p=.018). Participants in CF had higher rates of receiving HCV viral load (94% vs 54%), liver evaluation (42% vs 28%), an HCV treatment offer (21% vs 11%) and SVR12 (12% vs 8%). Men had a larger response to the CF intervention (CF=3.3 steps, TAU=1.9) than women (CF=2.1, TAU=2.3; p=.015). Women in TAU received HCV viral load results significantly more than did men in TAU (74% vs 42%, p=.016). Conclusion: A strengths-based care facilitation intervention significantly increased progress along the HCV care cascade, with a greater effect on men than women. Rates of sustained viral response were low within the 12 months of follow-up. ClinicalTrials.gov # NCT02641158

drugs. Of the 189 patients with detectable viral loads, 142 (75.1%) were linked to care either by education or attending their first HCV medical appointment. Of these patients, 9 (4.8%) were cured of HCV. Conclusion: The high rate of patients with chronic HCV (6.8%) in the trauma surgery service suggests that trauma surgery patients are at risk for HCV and should be routinely screened. Reflex HCV antibody to RNA testing increased the identification of patients living with chronic HCV. This program linked 75% of patients and cured 5% of HCV. The trauma surgery setting has significant potential to screen, diagnose, link to care and cure a vulnerable population that may not engage in routine medical care.

580 A RANDOMIZED TRIAL OF HIV/HCV NURSE CASE MANAGEMENT FOR LINKAGE TO HCV CARE Laura Starbird 1 , Hae-Ra Han 1 , Mark Sulkowski 2 , Chakra Budhathoki 1 , Nancy Reynolds 1 , Jason Farley 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: The opportunity to eliminate hepatitis C virus (HCV) is at hand, but challenges across the care continuum persist. These challenges are particularly poignant for persons co-infected with HIV, who are a high-priority to cure but historically not well engaged in HCV care. Case management interventions have shown success in linking patients to HIV care. We hypothesized that a strengths-based nurse case management intervention (Care2Cure) adapted from evidence-based HIV studies could improve HCV care continuum outcomes for persons with HIV/HCV co-infection. Methods: We conducted a prospective, single-blinded, randomized controlled trial to test the effect of Care2Cure in 68 adults (intervention n=35 and control n=33) with HIV/HCV co-infection. The Care2Cure intervention consisted of nurse-initiated referral to HCV care, scheduling assistance in the HCV practice, and HCV education. The comparison group (usual care) received an HCV fact sheet only. Primary outcomes included 1) linkage to HCV care (i.e., attendance at an HCV clinic appointment within 60 days of enrollment) and 2) time to DAA initiation (number of days from enrollment to first dose of DAAs). Study participants were followed for 6 months. Results: Our sample was predominantly Black/African American (81%) and low income (85%Medicaid). Nearly half (46%) reported illicit drug use and 43% had an undetectable HIV viral load. There were no demographic differences between groups at baseline. At day 60, a greater proportion of participants in the Care2Cure arm linked to HCV care (47%) compared to the comparison arm (25%) (p=0.036 by z test for difference in proportions; 95% confidence bound=3.2-40.9%). Among participants who initiated HCV treatment (n=12), the median time to DAA initiation was 100 days (interquartile range 69.5-118.5 days), with a median of 72 days for participants in the Care2Cure arm and 98 days for those in the comparison arm. This did not result in a significant difference in time to treatment initiation between the two arms at 6 months by logrank test (p=0.192). Conclusion: Our results support provision of nurse case management as a successful strategy to link persons co-infected with HIV to HCV care. Nonetheless, linking to care alone is not sufficient to cure HCV in those who remain untreated. Interventions that address the intersection of HCV and HIV that continue from linking to care through treatment initiation and cure are needed to achieve HCV elimination in this high-priority population.

Poster Abstracts

579 HEPATITIS C TESTING OF TRAUMA SURGERY PATIENTS: INCIDENCE, PREVALENCE, & CARE CASCADE Jenna M. Wick, Josue Oyola-Jimenez, Davone Singleton, Samantha Webster, David M. Fleece, Jill Volgraf, Amy J. Goldberg, Gina M. Simoncini Temple University, Philadelphia, PA, USA Background: Trauma surgery patients often miss opportunities to engage in routine healthcare, including Hepatitis C (HCV) screening. We developed a HCV screening and linkage program to assess the incidence, prevalence, linkage to care rates, and HCV cure rates among this vulnerable population. Methods: From August 2016 to March 2018, HCV screening was performed on patients evaluated at an urban Level I trauma center. Data were collected including HCV antibody status, HCV RNA status, sex, race, age, year of birth, and history of intravenous drug use (IVDU). Midway through the study (May 2017), a reflex HCV screening test was introduced, in which a HCV antibody positive sample would automatically undergo the HCV RNA test without an additional blood draw and/or return visit. Patients with a positive test result were linked to care or re-engaged in care by the navigator. Follow-up was performed to assess the cascade of care among patients who tested HCV RNA positive. Results: There were 2,953 patients eligible for HCV screening and 2,782 were screened (94.2%). There were 366 patients with HCV antibodies (13.2%) and 189 (6.8%) with detectable HCV RNA and 36 (1.3%) patients were newly diagnosed. Of the patients with a positive HCV antibody, 292 (79.8%) underwent a confirmatory HCV RNA test. Before the reflex test, there were 0.21 positive HCV RNA tests per day compared to 0.41 positive HCV RNA tests per day after the reflex test was introduced. Men comprised 148 (78.3%) of the chronic HCV patients. The average age was 47 (22-87). There were 70 (37%) Black, 65 (34.3%) White, and 42 (22.2%) Hispanic patients. There were 85 (44.9%) patients born between 1945-1965 and117 (61.9%) patients with a history of IVDU, but 28 (14.8%) were neither a baby boomer nor a person who injected

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