CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

(CoRECT) tests a Data to Care strategy that aims to establish a collaborative approach between health departments and HIV clinics to identify, re-engage, retain and virally suppress PLWH recently out-of-care. Methods: The CT DPH, Yale University School of Medicine and 23 HIV clinics conducted the study. Using the DPH eHARS surveillance database and individual clinic level data, “recently out of care patients” were further investigated by clinic personnel to assess eligibility for randomization to either clinic standard of care (SOC) vs DPH field workers(DIS) who were trained to locate, assess barriers to care, and facilitate re-linkage to care within 90 days of randomization. Clinic visit status was collected and compared between DIS and SOC. Additional data on linkage status and barriers to care were collected by DIS. We report this data on patients who completed 90 days post randomization. Results: There were 655 patients randomized: DIS (N=333) vs. SOC (N=322), of which 588 were at 90 days post randomization. Demographics showed: Black (39.80%); Hispanic (38.10%); white (20.20%); male (62.41%); age <30 (16.84%); there was no difference between DIS and SOC arms. Comparison of successful attendance at scheduled clinic visits: DIS (42.6% ) vs SOC (32.3% ) (p<0.001). Clinic outcomes for patients randomized to DIS showed: returned to clinic by DIS (32.83%); unable to locate (22.80%); located but refused to return to clinic (14.89%). Demographic comparison showed that those who were unable to be located by DIS were not statistically different than those successfully returned to clinic. Last viral load recorded was significantly greater for those not returned to care vs those who did return to care ( p<.0001); last CD4 was lower, (p<.0001). Among those randomized to DIS with successful linkage, the most common identified barriers to care were life issues (92.5%) and mental/physical health issues (38.3%). Conclusion: 1)The DIS intervention was successful in returning recently OOC pts to care 2)Among OOC PLWH linked by DIS, the most common barriers were “life issues” and “mental/physical health issues” 3)Patients whom DIS were unable to locate were more likely to have higher viral loads and lower CD4 counts 4)This intervention can be used to improve the HIV Care Continuum 1029 DEVELOPMENT OF AN EMR-BASED ALGORITHM TO IDENTIFY PATIENTS LOST TO HIV CARE Jason Zucker 1 , Jacek Slowikowski 2 , Kenneth Ruperto 2 , Peter Gordon 1 1 Columbia University Medical Center, New York, NY, USA, 2 New York Presbyterian Hospital, New York, NY, USA Background: Ending the HIV epidemic requires optimizing primary and secondary prevention. After diagnosis, many HIV positive patients drop out of the care cascade but continue to “touch” the hospital in a variety of settings. Identifying individuals out of care in real time allows for care coordination to engage in secondary prevention efforts, reaching out for re-linkage and restarting antiretroviral therapy. We used a novel EMR based algorithm to develop a dashboard that identifies all HIV positive patients who interact with our institution as well as their linkage and viral load status. Methods: We identified all individuals with an International Statistical Classification of Diseases (ICD) code for HIV, positive HIV antibody, HIV RNA viral load, and the date of visit in any of our clinic locations that routinely provide HIV care. We developed an algorithm to highlight patients as a potential new diagnosis, unlinked to care, unsuppressed viral load, and most recent HIV visit in the past 6 months, 9 months, or longer. To evaluate accuracy, we created a reference standard to replicate a clinician’s review of the chart and performed a review on a random 20% (128) of patients identified from 8/1/18 to 9/15/18. Results: The algorithm correctly categorized 95% of HIV positives, 86% of patient’s linkage to care status, and 91% of viral load status. Causes of errors were false positive HIV screening tests, perinatal HIV exposure, and individuals documented as receiving care at an outside hospital. In the validation cohort, 8/1/18 – 9/15/18, the algorithm identified 639 patients with a diagnosis of HIV, 78%who were linked to care in the past 9 months, and 66%who were virally suppressed. Of the 22%who were not linked to care 47% (66) were not virally suppressed. Over the prior year, 9/15/2017 – 9/15/2018. the algorithm identified 2851 patients with a diagnosis of HIV, 29% of who were categorized as out of care of the past 9 months Conclusion: Population-level HIV care cascade tools can be developed that are accurate and efficient. Our algorithm has a high accuracy for identifying HIV positive individuals and individuals not linked to care. EMR based algorithms have the potential to provide an efficient method for care coordinators, reducing their workload but still allowing them to identify HIV patients requiring services. This algorithm is generalizable and has the potential to be

1 London School of Hygiene & Tropical Medicine, London, UK, 2 Africa Health Research Institute, Mtubatuba, South Africa, 3 Heidelberg University, Heidelberg, Germany, 4 Brighton and Sussex Medical School, Brighton, UK, 5 University College London, London, UK Background: South Africa has the largest HIV treatment programme globally, with 7 million people living with HIV and 4 million on antiretroviral therapy (ART). However, HIV incidence remains high, particularly among young women. In addition, persistent excess HIV-related mortality in men compared with women suggests that reaching men and young women with HIV testing and ART for those who test positive is a priority for HIV prevention. South Africa introduced universal test-and-treat (UTT) in 2016. We report on linkage to HIV care after the 2017 introduction of home-based HIV counselling and testing (HBHCT) and telephone-facilitated support for linkage in a demographic surveillance area in rural KwaZulu-Natal, where antenatal clinic HIV prevalence is around 40%. Methods: All residents aged ≥15 years(y) were eligible for HBHCT. Those who tested positive and were not in care were referred for ART at one of the 11 public-sector clinics in the surveillance area. Individuals who did not attend the clinic within 2 weeks were sent an SMS reminder; those who had not attended after a further 2 weeks were contacted by telephone by a trained nurse counsellor, to discuss their concerns and encourage them to attend the clinic. Kaplan-Meier methods were used to estimate the proportion linking to care in the first 6 and 12 months(m), stratified by age group and sex. Results: Among the 41,815 individuals who were contacted in 2017, 26% accepted HBHCT. Uptake was higher in women than men (29% vs 20%), but similar in people aged <30y and ≥30y (27% vs 25%). 1210 (11%) tested HIV positive, of whom 783 were in care (65%). The proportion in care was higher in women than men (68% vs 52%) and in ≥30y than <30y (73% vs 48%). Of the 427 not in care, only 18% and 31% of men and women <30y, respectively, had linked to care at 6 months(m), compared with 39% and 41% of those ≥30y (Figure 1). At 12m, 30% and 45% of men and women <30y had linked to care, vs. 45% and 50% of those ≥30y. Conclusion: Our results suggest that both uptake of HBHCT and linkage to care, despite telephone follow-up and support, was low, particularly in young men and women in this hyper-endemic HIV setting. This shows that HBHCT and telephone-facilitated linkage to care may not be sufficient to obtain the desired effects of UTT on reducing HIV incidence in young women, or reducing HIV mortality in men.

Poster Abstracts

1028 PROJECT CORECT: PRELIMINARY RESULTS OF DATA TO CARE WITH CT DPH AND HIV CLINICS Merceditas Villanueva 1 , Janet Miceli 1 , Constance Carroll 1 , Suzanne Speers 2 , Lisa Nichols 1 , Frederick Altice 1 , Heidi Jenkins 2 1 Yale University, New Haven, CT, USA, 2 Connecticut Department of Public Health, Hartford, CT, USA Background: A significant portion of PLWH remain incompletely engaged in care resulting in poor individual health outcomes, as well as ongoing HIV transmission. The CDC sponsored Cooperative Re-Engagement Controlled Trial

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