CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

by the rural landscape, lack of standardized training, and competing clinical care priorities. This study sought to characterize the HIV care cascade within the Eastern Cape, by conducting an assessment of emergency department (ED) patients. Methods: We conducted a prospective observational study in three Hospitals in the Eastern Cape region of South Africa, from June 2017 to September 2018. All adult, non-critical patients presenting to the ED during this period, were systematically approached by trained HIV counselling and testing staff and offered a point-of-care test in accordance with South Africa’s 2015 National HIV Testing guidelines. All HIV positive individuals were further tested for ARV presence and viral suppression. A pooled analysis is presented; no significant differences were observed across the three sites. Results: Over the study period a total of 3,537 patients were approached in all sites, of which HIV status was determined in 2,901 patients. Of these, 794 (27.4%) were HIV positive, of which 216 had a new diagnosis. Of the 578 patients with a known positive diagnosis, blood samples were collected for 409 (70.8%) patients, of which 293 (75.9%) tested positive for the presence of ARVs. Of those in care with ARVs detected, 233 (80.6%) demonstrated viral suppression with a VL ≤1,000 (copies/ml). The majority of HIV positive ED patients were female (62.7%) and between the ages of 25-34 years (35.1%) and 34-44 years (29.3%). Males were significantly less likely to know their HIV status (60.5%) compared to females (80.1%). However, the remainder of the care cascade was similar in both groups with 51.4%-50.4% on ARVs and 80.4%-79.1% of those patients achieving viral suppression. In contrast attrition across the care cascade was greatest in younger patients (<25 years) compared to older patient populations (>45 years). Conclusion: This study demonstrates a high prevalence of HIV (27.4%) among ED patients in the Eastern Cape. For those with known HIV infection and in care, viral suppression was high, but a significant proportion of patients were unaware of their HIV status emphasizing the need for innovative measures, particularly among young males, to improve access to HIV testing, the first critical step to meeting the 90-90-90 target.

smoking status closest to the drinking index date; linkage to care (≥1 visit within 90 days following a new HIV diagnosis); retention up to 12 months after alcohol screening (2 or more HIV care visits 60+ days apart); and HIV RNA control (<75 copies/mL) between 3 months prior and 12 months post alcohol screening. Unadjusted and adjusted odds ratios (OR) from logistic regression models (see Table for covariates in adjusted models). Results: The overall sample had mean age 47.1 years and was 91.2%male; 53.3%white, 18.0% Latino, and 15.3% black; and 70.5%men who have sex with men. Sample size varied due to availability of lab data and because linkage analyses were restricted to those new to KPNC care: linkage to care (n=1,949), retention in care (n=9,397), HIV RNA control (n=8,758). In adjusted analyses, current smoking was associated with worse HIV RNA control (compared with not smoking at index date; OR=0.62 [95% CI 0.54-0.71], p<0.001), with some evidence of associations with worse retention (0.88 [0.77-1.01], p = 0.076) and worse linkage to care (0.6 [0.34-1.06], p=0.080). There was little evidence that unhealthy drinking at these thresholds was associated with linkage to care, retention in care or HIV RNA control. Conclusion: Both unhealthy drinking and smoking were associated with worse retention in care and HIV RNA control among PWH, but only the effect of smoking on HIV RNA control remained in adjusted analyses. Future analyses will examine effects of higher levels of unhealthy drinking and changes in drinking, as well as unhealthy drinking in combination with smoking. Clinicians should make a particular effort to help PWH quit smoking.

Poster Abstracts

1045 VIRAL LOAD MONITORING AND FIRST-LINE FAILURE CASCADE OF CARE IN RURAL SOUTH AFRICA Collins C. Iwuji 1 , Maryam Shahmanesh 2 , Olivier Koole 2 , Kobus Herbst 2 , Deenan Pillay 2 , Mark J. Siedner 2 , Kathy Baisley 2 1 Brighton and Sussex Medical School, Brighton, UK, 2 Africa Health Research Institute, Mtubatuba, South Africa Background: Reports have demonstrated prolonged duration of virologic failure (VF) among patients in care across sub-Saharan Africa, and that drug resistance is more likely to develop in those without frequent monitoring. We investigated the patterns of viral load (VL) monitoring in the first 24 months on ART, and adherence to guidelines after detection of VF in public ART clinics in the Hlabisa sub-district of South Africa. Methods: We analysed data from all patients initiating ART in 17 public sector clinics in the sub-district during 2010-2016, using the national HIV care electronic patient records system (TIER.Net). VL results are entered into TIER. Net manually. We first estimated the completion rate for VL monitoring at 6, 12, and 24 months. We then described the cascade of care for those with any VL measurement ≥1000 copies/mL after at least 20 weeks on ART, including the proportion with a repeat VL within 6 months, the proportion who re- suppressed, and the proportion who changed to a second-line regimen if a repeat VL remained ≥1,000 copies/mL. Results: We analysed data from 31,493 individuals who initiated ART during the study period (69% female, median age 31 years (IQR 25-39). Of those in care at 6, 12, and 24 months, we found that 41% (10,518/25,690), 33% (7,553/22,730),

1044 SMOKING AND UNHEALTHY DRINKING AND THE HIV CARE CONTINUUM Derek Satre 1 , Tory Levine-Hall 2 , Amy C. Justice 3 , Margaret May 4 , Jonathan Sterne 4 , Matthias Cavassini 5 , Jennifer O. Lam 2 , Stacey Alexeeff 2 , Stacy Sterling 2 , Kendall J. Bryant 6 , Paul Volberding 1 , Constance Weisner 2 , Michael A. Horberg 7 , Michael J. Silverberg 2 1 University of California San Francisco, San Francisco, CA, USA, 2 Kaiser Permanente Northern California, Oakland, CA, USA, 3 Yale University, New Haven, CT, USA, 4 University of Bristol, Bristol, UK, 5 Lausanne University Hospital, Lausanne, Switzerland, 6 National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA, 7 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA Background: Smoking and unhealthy drinking can adversely impact HIV care continuum benchmarks (linkage to care, retention, and HIV viral control). Methods: We examine associations between smoking and unhealthy drinking with linkage to care, retention and HIV RNA control among 9,397 people living with HIV (PWH) receiving care in the Kaiser Permanente Northern California (KPNC) integrated health care system, screened for unhealthy drinking (index date) and for smoking by providers between 07/01/2013 and 12/31/2017. Measures, derived from the electronic health record, included any self-reported unhealthy drinking in the prior 90 days (one or more days of 4+/5+ drinks per occasion and/or 7+/14+ drinks per week for women or men, respectively);

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