CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

C virus infection living in British Columbia (BC), Canada in 2017, stratified by history of injecting drug use to compare progress in care and treatment. Methods: The BC Testers Cohort (BC-HTC) was used for this analysis. BC-HTC includes all individuals tested for HCV in BC since 1990, linked to date on all prescription drugs, medical visits, hospitalizations and mortality data. We defined six cascade of care stages: 1) anti-HCV positive (diagnosed); 2) RNA tested; 3) RNA positive; 4) genotyped; 5) initiated treatment; and 6) achieved post-treatment sustained virologic response (SVR). People diagnosed with HCV infection were stratified by history of injecting drug use (recent PWID, people who injected drugs <3 years; past PWID, >3 years ago; or never PWID) and progression through care cascades compared among these groups. Results: In 2017, there were 52,987 individuals diagnosed with HCV infection (anti-HCV positive) in BC. Among those diagnosed, 22% (11806/52987) were recent PWID, 17% (9118/52987) past PWID and 61% (32063/52987) never PWID. Confirmation of infection by RNA or genotype testing was highest among recent PWID, and lowest among never PWID (Figure 1). Of people with genotype testing, HCV treatment initiation was lowest among recent PWID, with 38.1% (2698/7081), compared to 46.3% (2016/4350) among past PWID, and 60.4% (10162/16812) among never PWID. Among both past and never PWID, a higher proportion of individuals were born before 1965, whereas among recent PWID a higher proportion of individuals were born after 1965. Conclusion: Through integration of provincial testing, treatment, mortality, medical visits and hospitalization datasets, it is possible to assess population- level HCV prevention and care cascades among PWID, which is essential to monitoring progress towards HCV elimination goals. Overall, progression through the HCV cascade of care in BC has improved since DAAs were available, but it remains lower among recent PWID. Treatment uptake may improve with the recent removal of fibrosis restrictions on treatment eligibility; however, factors associated with treatment uptake among PWID should be further investigated to help identify strategies to enhance HCV treatment uptake among this group.

581 DEMOGRAPHIC TRENDS IN HCV DIAGNOSIS AND LINKAGE TO HCV CARE AMONG JAIL DETAINEES Ank E. Nijhawan 1 , Jacqueline Sullivan 2 , Merilyne Aguwa 2 , Esmaeil Porsa 2 1 University of Texas Southwestern, Dallas, TX, USA, 2 Parkland Health and Hospital Systems, Dallas, TX, USA Background: The changing epidemiology of hepatitis C infection (HCV) has important implications for screening and prevention. However, HCV surveillance is limited as chronic hepatitis C is not a reportable illness and acute hepatitis C is under-reported to public health departments. The criminal justice system, which houses a large number of individuals at risk for HCV, is a key venue to identify hepatitis C infection, evaluate HCV epidemiology and initiate linkage to HCV treatment. Methods: Opt-out HCV antibody (Ab) testing was offered at the time of routine blood draw for individuals incarcerated at the Dallas County Jail beginning in June 2015 and occurring in three separate testing cycles. HCV RNA testing was added in 2017. Demographics and testing results were extracted from electronic medical records; HCV risk factor and health insurance status were self-reported. Patients with a positive HCV RNA were initiated in a linkage-to-care protocol beginning in 2017 including disease education, prevention counseling, and information about linkage to HCV care including a hotline number routed to a navigation specialist. Post-release, the navigation specialist followed up by phone to facilitate linkage to community HCV care. Data analyses were completed using SAS v. 9.4. Results: The prevalence of HCV Ab positivity remained stable over the three testing cycles 16.4% (500/3042), 16.5% (708/4260) and 15.9% (421/2635). The number of younger individuals (born after 1965) with HCV Ab + increased over time, from 48% to 57% to 63%, as did the proportion of women with HCV Ab+, from 20% to 24% to 25%. Injection drug use was more commonly cited as a risk factor from year 2 to 3 (39% to 56%). Education was provided to 85% of individuals with HCV RNA+ in both years 2 and 3. In years 2/3, 198 HCV RNA+ individuals were released to the community, 149 were called at least once after release, 21 called the hotline after release and 17/21 had scheduled or pending appointments in liver clinic. Conclusion: A larger proportion of women, younger individuals and injection drug users tested positive for HCV infection over consecutive years of an opt-out HCV testing program at the Dallas County Jail. Rates of HCV education were high during incarceration. Successful linkage to community HCV care was characterized by a combination of: (a) nurse navigator initiatives of education and outreach both during and after incarceration and (b) patient activation through post-release, patient-initiated engagement with healthcare. 582 HEPATITIS C CASCADE OF CARE AMONG PEOPLE WHO INJECT DRUGS IN BRITISH COLUMBIA IN 2017 Sofia Bartlett 1 , Stanley Wong 1 , Amanda Yu 1 , Maria Alvarez 1 , Terri Buller- Taylor 1 , Zahid A. Butt 1 , Maryam Darvishian 1 , Carmine Rossi 1 , Margo Pearce 1 , Jason Wong 1 , Mark Gilbert 1 , Mark W. Tyndall 1 , Mel Krajden 1 , Naveed Z. Janjua 1 1 BC Centre for Disease Control, Vancouver, BC, Canada Background: New short course well-tolerated direct acting antivirals (DAAs) are expected to increase treatment rates among people living with hepatitis C virus (HCV), particularly among People Who Inject Drugs (PWID). We constructed the HCV cascade of care among people diagnosed with hepatitis

Poster Abstracts

583 A COMMUNITY INTERVENTION INCREASED HCV SCREENING AND TREATMENT IN KING COUNTY, WA John D. Scott 1 , Meaghan Munn 2 , Atar Baer 2 , Sara N. Glick 1 , Elizabeth Barash 2 , Hilary Armstrong 2 , Kris Kowdley 3 , Matthew Messerschmidt 4 , Pallavi Patel 5 , Michael Ninburg 6 , Matthew R. Golden 1 , Jeff Duchin 2 1 University of Washington, Seattle, WA, USA, 2 Public Health–Seattle & King County, Seattle, WA, USA, 3 Swedish Medical Center, Seattle, WA, USA, 4 HealthPoint, Auburn, WA, USA, 5 Kaiser Permanente Washington, Seattle, WA, USA, 6 Hepatitis Education Project, Seattle, WA, USA Background: Hepatitis C virus (HCV) infection is common in HIV+ patients and in the general US population, leading to significant morbidity and mortality, and the incidence of HCV-related chronic liver disease and cancer continues to increase. However, simplified screening recommendations and highly effective direct acting antivirals for HCV present an opportunity to reverse this trend. We report the results of a community-based program to increase the testing, linkage to care, treatment and cure of persons with HCV infection.

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