CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Screening for acute HCV infection with HCV-cAg test provides an effective tool for early detection of HCV in high-risk populations. HCV-cAg tests are cheaper with a quicker turnaround time than HCV-RNA tests. The addition of ALT testing to a screening strategy based on HCV-cAg maybe a cost-effective method to reliably detect acute HCV cases.

and practices will need to adapt to changing universal screening guidelines, especially given the demographics and burgeoning of the opioid epidemic. 587 TRANSFORMING PRIMARY CARE PRACTICES FOR HEPATITIS C TREATMENT CENTERS Risha Irvin 1 , Boatemaa Ntiri-Reid 2 , Mary Kleinman 2 , Alexander J. Millman 3 , Lauren Canary 3 , Tracy Agee 1 , Jeffrey Hitt 2 , Onyeka Anaedozie 2 , Hope Cassidy- Stewart 2 , Oluwaseun Falade-Nwulia 1 , Mark Sulkowski 1 , Noele Nelson 3 , David L. Thomas 1 , Michael Melia 1 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA, 3 CDC, Atlanta, GA, USA Background: It is estimated that 80,000 persons in Maryland are chronically infected with hepatitis C virus (HCV). The clinical infrastructure and specialist workforce are insufficient to provide HCV treatment access to all HCV infected persons. In 2014, we developed Sharing the Cure, a provider training program and practice transformation model, with support from the CDC-funded Maryland Department of Health’s Community-based Programs to Test and Cure Hepatitis C to improve treatment access. Methods: Sharing the Cure is composed of a one-day workshop, mini- preceptorship, and teleconference for primary care clinicians. The program runs from January-September each year. A 20 question HCV knowledge exam developed by a faculty educator and reviewed by a cohort of national faculty experts is administered at the end of each training period to certify the clinicians as HCV providers. Partner site medical staff are trained in HCV education and treatment monitoring through a lunch lecture series. Treatment outcomes have been described through July 2018. Results: Thirty-five primary care clinicians from eight partner sites completed the program in cohorts 1-3. Nineteen clinicians (cohort 4) are currently completing training. Thirty-two clinicians (91%) passed the exam (score ≥ 70%). Of the 3 clinicians that did not achieve a passing score, 2 passed on second attempt which included a different subset of 20 questions and 1 clinician did not pass the second exam and was denied certification. The providers have started HCV treatment in 702 individuals with treatment ongoing in 71 patients (10%), complete in 598 (85%) patients, and discontinued in 33 (5%) patients. Notably, 592 patients are currently at least 12 weeks post treatment. Of the 462 patients with virologic data reported, 449 (97%) have documented sustained virologic response/cure. Despite providers evaluating an additional 665 patients with chronic HCV infection, treatment was not started. Barriers to treatment initiation in primary care were failure to meet prior authorization criteria in 370 (56%) patients (criteria for Maryland Medicaid includes liver fibrosis of ≥ F2), lack of patient follow-up in 81 (12%) patients, and specialist referral in 73 (11%) patients. Conclusion: Primary care practices can effectively be transformed into HCV treatment centers to expand HCV treatment access. However, prior authorization criteria by insurance providers remains a major barrier to HCV treatment access. 588 DECENTRALIZATION AND TASK-SHIFTING FOR HEPATITIS C: SYSTEMATIC REVIEW & META-ANALYSIS Background: Worldwide, 71 million persons are HCV infected but only a small proportion have been diagnosed and treated. Increasing access to care in low and middle income countries (LMICs) will require adoption of simplified service delivery models such as decentralization and task shifting to non-specialists. The evidence base for their effectiveness in HCV care remains limited. We conducted a systematic review and meta-analysis to establish the effectiveness of decentralization and task-shifting on outcomes across the continuum of HCV care in different populations. Methods: Bibliographic databases and conference abstracts were searched for English language clinical trials or observational studies published between 01/2008 to 02/2018 that evaluated these interventions. Outcomes were testing and HCV viral load uptake, linkage to care, treatment uptake, and cure (SVR12)) in PWID, prisoners, PLHIV, and general population. Decentralisation was defined as either full (FD) (testing and treatment at same primary care or harm reduction site), or partial (PD) (testing at decentralized site and referral for treatment) and task-shifting as HCV treatment by non-specialists (primary care Ena Oru 1 , Steve Kanters 2 , Rohan Shirali 2 , Philippa J. Easterbrook 1 1 WHO, Geneva, Switzerland, 2 Precision Xtract, Vancouver, BC, Canada

Poster Abstracts

586 DIVERSE OBSTETRICIAN HCV-SCREENING PRACTICES IN A LARGE REGIONAL HEALTH CARE SYSTEM Dawn Fishbein 1 , Ariunzaya Amgalan 2 , Eshetu Tefera 1 , Shari Sawney 1 , Nicole Brown 1 , Emily Paku 1 , Hala Deeb 1 , Stephen Fernandez 1 , Rachel K. Scott 1 1 MedStar Health Research Institute, Hyattsville, MD, USA, 2 Georgetown University, Washington, DC, USA Background: Given the onslaught of the opioid epidemic, the incidence of HIV and Hepatitis C (HCV) infection is increasing in reproductive age women. Unlike recommendations for universal HIV screening, HCV testing in pregnancy has been risk-based. Recent AASLD/IDSA guidelines recommend universal HCV screening. We hypothesized that prior to revised screening recommendations there was diversity in HCV testing practices amongst obstetrical practices. Methods: We extracted HCV testing (HCV antibody/RNA) and reactivity data from the EHR for the first outpatient prenatal visits at MedStar Health, a large regional healthcare system, from January 2017 through April 2018. We used Chi-square, Fisher’s Exact and Student’s t-tests, as appropriate for the bivariate analyses, and multivariate logistic regression to determine predictors of HCV screening and antibody positivity. Variables included age, race, ethnicity, HIV screening and infected, HBV infected, insurance, birth outcome, delivery method, and location. SAS statistical software was used for the analyses. Results: There were 10,415 women who met study eligibility; 3,081 (29.6%) were HCV tested, and 44 (1.4%) were HCV antibody positive. Pregnant women were more likely to be screened for HCV if they were older (ORadj 1.02, CI95 [1.01-1.02]), African American or other race as compared to Caucasian (2.24 [2.02-2.49]; 1.74 [1.53-1.98]), HIV tested (4.25 [3.65-4.94]), HIV infected (8.37 [4.77-14.70]), and had private insurance (1.51 [1.37-1.66]). Pregnant women were more likely to be HCV antibody positive if they were Caucasian as compared to African American (ORadj 11.44 [CI95 3.99-32.82]), HBV infected (15.27 [2.32-100.46]) and living in Maryland vs. DC (2.93 [1.17-7.32]). There was no difference in the latter analysis for age, ethnicity, HIV status, birth outcome or insurance. Conclusion: Universal HCV testing has not yet been fully deployed in pregnant women at this large healthcare system, which includes urban, suburban and rural practices. However, the 30% screening rate is higher than other published reports. There appears to be racial discordance in screening practices, with more African Americans tested; however, more Caucasians were HCV antibody positive. This could be due to prior universal testing adoption in the urban vs. the suburban/rural environment and requires further exploration. Providers

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