CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

and time-to-event analyses. Among those initiating ART, we calculated the proportion retained on ART at 12 months, and explored its association with timeliness of ART initiation using multivariable logistic regression, with adjustment for socio-demographic and clinical variables and clustering by site. Results: Among the 148,680 patients diagnosed with HIV in our cohort, 61.7%were female, 66.5%were aged 25-54 years, and 83.5%were diagnosed within their home commune. The proportion of patients who never started ART dropped from 63.1% among those diagnosed with HIV before 2013 to only 9.4% for those diagnosed in the first calendar quarter of 2018. Among 8,429 patients who were first diagnosed with HIV after adoption of the T&S policy in July 2016, who started ART, and who had 12 months of time under observation in the cohort, 70.5%were retained on ART at 12 months. Retention was highest in patients with longer intervals between HIV diagnosis and ART start (64.3% retained for same day ART start, 66.9% for ART start within 2 weeks, and 75.7% retained for ART start after 2 weeks). In adjusted analysis, compared to the reference category of same day ART initiation, patients with longer intervals to ART start had likelihood of 12 month retention which was 1.24 – 2.01 times greater, a highly significant finding (p<0.001). Conclusion: Haiti has rapidly expanded ART coverage; however, there is room for improvement in ART retention for patients rapidly initiating ART under T&S. Enhanced post-test counseling, patient education, and support may help patients who rapidly start ART to remain on treatment.

the standard arm at 0 (70% vs 54%), ≤7 (86% vs 73%), ≤14 (90% vs 85%) and ≤28 days (94% vs 89%) (Table). In the intervention arm, 109 patients (45.4% of 240) screened out: 51 (47%) due to TB symptoms alone, 42 (39%) due to TB symptoms and ≥ 1 other reasons, and 16 for reasons other than TB. Among the 109 screened out and referred back to the clinic for further care, 36/109 initiated the same day and 64/109 initiated within 90 days; 9/109 patients did not start within 90 days. Conclusion: Use of the SLATE algorithm increased uptake of ART within 7 days-the WHO’s definition of “rapid” initiation-by 12.8%. Medical officers were able to implement it in routine care settings without additional equipment or clinical supervision. Current TB symptoms accounted for 3/4 of patients screened out. Early results suggest that a simple algorithm for treatment initiation procedures is feasible and can increase same-day and rapid ART uptake.

Poster Abstracts

1019LB WITHDRAWN/INTENTIONALLYUNASSIGNED 1020 IMPLEMENTING UTT IN AFRICAN CORRECTIONAL FACILITIES: A PROSPECTIVE COHORT STUDY

Michael Herce 1 , Christopher Hoffmann 2 , Katherine Fielding 3 , Steph Topp 4 , Harry Hausler 5 , Helene Smith 6 , Lucy Chimoyi 7 , Candice Chetty-Makan 7 , Rachek Mukora 7 , Mpho Tlali 8 , Abraham Olivier 5 , Monde Muyoyeta 6 , Stewart Reid 9 , Salome Charalambous 7 1 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Johns Hopkins University, Baltimore, MD, USA, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 James Cook University, Townsville, Australia, 5 TB/HIV Care Association, Cape Town, South Africa, 6 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 7 The Aurum Institute, Johannesburg, South Africa, 8 University of Cape Town, Cape Town, South Africa, 9 University of Alabama at Birmingham–CIDRZ, Lusaka, Zambia Background: Despite widespread HIV treatment and care scale up, corrections inmates continue to be left behind in the global HIV response. To provide inmates with the known benefits of universal test and treat (UTT) and to describe clinical outcomes for UTT delivery in southern African correctional facilities, we conducted an implementation research study enrolling a prospective cohort of HIV-positive inmates from Zambia and South Africa. Methods: We offered immediate ART to inmates ≥18 years with newly diagnosed HIV or previously diagnosed HIV not yet on ART (regardless of CD4 or WHO stage) who were expected to be incarcerated ≥30 days at 3 high-volume correctional facilities in Lusaka, Zambia and Johannesburg and Cape Town, South Africa. To enable UTT delivery at each site, we strengthened public, on-site HIV care programming by supporting: HIV testing and anti-retroviral therapy (ART); viral load (VL) monitoring; and corrections officer, health worker, and peer educator training on UTT. We collected clinical and socio-demographic data at study baseline and follow-up visits. We calculated summary statistics for variables of interest, and conducted an exploratory risk factor analysis for unsuppressed VL using logistic regression modelling. Results: From June 2016-March 2018, 1,562 HIV-positive inmates were identified across the study sites, of whom 1,022 (65%) met study eligibility criteria and 977 (96%) enrolled. Participants were mostly young men (n=824, 84%), with median age 32 years (interquartile range, IQR: 28–38) and 29% (n=287) having prior incarceration history. Of those enrolled, 835 (85%) started ART, and did so within 1 day (IQR: 0–17) of HIV diagnosis. Of 141 who did not start ART, most (n=113, 80%) were transferred or released prior to baseline evaluation. Among 384 (46%) participants with a documented 6-month post-ART VL, 74%, 89% and 91% achieved virologic suppression using thresholds of <50 copies(c)/mL, <400 c/mL, and <1,000 c/mL, respectively. Factors associated with VL ≥50 c/ml are reported in the table.

1018 SAME-DAY ART INITIATION IN THE SLATE TRIAL IN KENYA: PRELIMINARY RESULTS Alana T. Brennan 1 , Bruce Larson 1 , Isaac Tsikhutsu 2 , Margaret Bii 2 , Matthew P. Fox 1 , Willem D. Venter 3 , Mhairi Maskew 4 , Lungisile Vezi 4 , Sydney Rosen 1 1 Boston University, Boston, MA, USA, 2 Walter Reed Project–Kericho, Kericho, Kenya, 3 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 4 Health Economics and Epidemiology Research Office, Johannesburg, South Africa Background: WHO’s and Kenya’s HIV treatment guidelines recommend rapid initiation of ART (≤7 or ≤14 days of HIV diagnosis, respectively) and encourage same-day initiation. Identifying efficient procedures for determining same-day eligibility and readiness is a priority. The Simplified Algorithm for Treatment Eligibility (SLATE) trial is testing a clinical algorithm in Kenya and South Africa that allows clinicians to determine eligibility for immediate ARV dispensing at the patient’s first visit. We report early results from Kenya. Methods: SLATE is an individually randomized, pragmatic trial at 3 public hospital-based outpatient clinics in western Kenya. Ambulatory patients presenting for an HIV test or HIV care, but not yet on ART, were enrolled sequentially, consented, and randomized to intervention or standard care. Intervention arm patients were administered the SLATE algorithm, comprised of a symptom self-report, medical history questionnaire, brief physical examination, and readiness assessment, to identify patients eligible for immediate ART initiation (“screened in”) or requiring further care, tests, or counseling before starting treatment (“screened out”). Patients who screened in were dispensed ARVs immediately; those who screened out were referred back to the clinic for further routine care. Follow up was by record review. We report ART initiation within 0 (same-day), 7, 14, and 28 days of study enrollment. Results: From 12 July 2017 to 23 April 2018, we enrolled 477 adult, HIV+, non- pregnant patients. More patients initiated ART in the intervention arm than in

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