CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

retention in care (RIC) result in failure to achieve and sustain VS, impacting personal health outcomes and onward HIV transmission. Methods: The NIH-funded iENGAGE trial (NCT01900236) enrolled PLWH within 14 days of their initial outpatient HIV care visit at 4 CFAR-affiliated academic HIV clinics. Participants were randomized to an intervention or standard of care (SOC) control arm (1:1). The intervention integrated and adapted 2 evidence- based approaches with demonstrated efficacy for RIC and ART adherence; enhanced personal contact/reminders and a 4 session counseling program based on Motivational Interviewing and grounded in a situated information, motivation and behavioral skills (sIMB) framework. Participant baseline and 48-week computer assisted surveys were done using validated instruments. A sample size of 400, with 10% attrition, provided >80% power to detect a 15% difference in 48-week VS, with 60% VS estimated in the SOC arm based upon historical data. Results: Between 12/13 and 06/16, 371 participants enrolled (62% black, 19% women, 24% uninsured, 60%MSM, 25% CD4<200). Baseline psychosocial co- morbidities included: 31% depression, 30% anxiety, 35% high-risk alcohol use, 18% active substance use. Roughly half the sample (49%) reported unmet need for supportive services (e.g. housing, employment, food and transportation). Overall, 86% of participants achieved 48-week VS; 86% intervention, 87% SOC; p=0.87. Median time to VS was 63 days (IQR 42-101) and did not differ between the two study arms (HR=0.94, 95%CI=0.75-1.19). Conclusion: Among new to care iENGAGE participants with substantial co-morbid psychosocial illness and unmet need for supportive services, 86% achieved 48-week VS in a median time of 63 days with no differences between study arms. Similar findings by study arm and the higher than expected VS rate in the SOC group likely reflects a rapidly evolving HIV treatment landscape, which emphasizes the care continuum, rapid ART initiation and the emergence of integrase inhibitors as first-line therapies. Sustaining care engagement and VS among new to care PLWH beyond the first year is imperative to maximize the individual and population health benefits afforded by modern HIV treatment. 1051 INCREASES IN KNOWLEDGE OF HIV POSITIVE STATUS, ART, AND VIRAL SUPPRESSION IN BCPP Refeletswe Lebelonyane 1 , Pamela J. Bachanas 2 , Mary Grace Alwano 3 , William Abrams 3 , Lisa Block 4 , Gene Ussery 5 , James A. Miller 5 , Huisheng Wang 5 , Lisa A. Mills 3 , Tafireyi Marukutira 3 , Faith Ussery 2 , Shenaaz El Halabi 1 , Michelle Roland 3 , Kathleen Wirth 6 , Janet Moore 2 1 Botswana Ministry of Health, Gaborone, Botswana, 2 CDC, Atlanta, GA, USA, 3 CDC Botswana, Gaborone, Botswana, 4 Intellectual Concepts, Atlanta, GA, USA, 5 Northrop Grumman Corp, Atlanta, GA, USA, 6 Harvard University, Boston, MA, USA Background: Botswana approached the UNAIDS 90-90-90 targets at the onset of the Botswana Combination Prevention Project (BCPP). In this context, we examined the feasibility of further increasing HIV testing, ART coverage, and viral suppression through community-based HIV testing campaigns and universal ART. Methods: BCPP is a community-randomized trial evaluating the impact of HIV testing and universal treatment on HIV incidence. The BCPP HIV testing campaigns included community-wide home, mobile and targeted outreach HIV testing. HIV testing was offered to all individuals who did not have documentation of positive HIV status. All HIV-positive community residents age 16-64 who were citizens were tracked to determine linkage to care, ART initiation, retention in treatment, and viral suppression. Electronic medical records were examined for clinical outcomes. We used household enumeration and community HIV prevalence data from BCPP in combination with 2011 census information to estimate the total number of adult residents living with HIV (PLHIV). Results: A total of 15,093 estimated PLHIV resided in the 15 intervention communities. BCPP identified 13,676 (91% of estimated PLHIV) HIV-positive persons in these communities (Figure 1). Among these, 11,214 (82%) were known HIV-positive while 2,462 (18%) were newly-diagnosed through BCPP, a 22% increase in knowledge of positive status. Among the 11,214 who knew their HIV status, 9,621 (86%) were already on ART. Of those not on ART (newly and previously diagnosed; n = 4055), 3413 (84%) initiated ART, increasing the treatment coverage among all identified HIV-infected individuals from 70% (9621/13,676) at baseline to 95% (13,034/13,676) at study end. Among the 13,034 persons known to have taken/started ART, 191 (1.5%) people died and 11,998/12,843 (93%) were retained on ART at end of study. Viral load tests were

available on 12,235/12,843 (95%) of persons on ART, and 11,946 (98%) of those had HIV-1 RNA <400 copies/mL. Conclusion: Despite high levels of HIV testing, ART coverage and viral suppression at baseline, knowledge of HIV positive status, treatment uptake, and viral suppression increased substantially with enhanced testing, linkage interventions and universal ART.

Poster Abstracts

1052 SUCCESSFUL VIRAL OUTCOMES AFTER IMPLEMENTING “TREAT ALL” IN SOUTH AFRICAN CLINICS Jienchi Dorward 1 , Yukteshwar Sookrajh 2 , Kelly Gates 3 , Nigel Garrett 1 1 CAPRISA, Durban, South Africa, 2 Prince Cyril Zulu Communicable Disease Centre, Durban, South Africa, 3 University of KwaZulu-Natal, Durban, South Africa Background: There is little data to determine the impact of WHO ‘Treat All’ guidelines on retention in care and viral load (VL) suppression in low and middle income countries. Methods: We analyzed routinely collected TIER.net and National Health Laboratory Service data from 8 public clinics in rural and urban KwaZulu- Natal, South Africa, where ‘Treat All’ was implemented in September 2016. Non-pregnant patients aged >15 years and initiating ART between September 2014-February 2017 were included in this analysis. We assessed the relationship between time period of ART initiation, initiation CD4 count and the outcomes of retention in care and VL suppression using logistic regression. Results: Of 9526 patients, 57% (95% CI 56-58) were female, median age was 33 years (IQR 28-41) and median CD4 count was 288 cells/mm 3 (IQR 151-429). At 12 months post ART initiation, 75% (95% CI 74-76%) were retained in care, 25% transferred care or were lost to follow up, and 0.5%were confirmed dead. In multivariable analysis, age >35 years (adjusted odds ratio [aOR] 1.54, p<0.001), female gender (aOR 1.42, p<0.001), not having TB at initiation (aOR 1.29, p=0.002) and initiation CD4 count >200 cells/mm 3 (p<0.001) were associated with retention in care at 12 months. Among the 7132 with VL and initiation CD4 results, 94% (95% CI 93-94) had VL suppression at <1000 copies/ ml, at median 356 days (IQR 307-377) post ART initiation. In multivariable analysis, age >35 years (aOR 1.53, p<0.001), female gender (aOR 1.35, p=0.003) and not having TB at initiation (aOR 1.39, p=0.009) were associated with VL suppression. Patients with initiation CD4 count >500 cells/mm 3 had over 5 times higher odds of VL suppression compared to those with CD4 counts <200 cells/ mm 3 (p<0.001). Retention in care (aOR 1.03, p=0.494) and VL suppression (aOR 1.03, p=0.811) did not differ between those initiated before and after ‹Treat All›, even among those with initiation CD4 >500 cells/mm 3 (p for interaction 0.654 and 0.465 respectively) Conclusion: Implementing ‘Treat All’ in South African public clinics did not reduce retention in care or VL suppression. Furthermore, patients newly eligible for ART with CD4 counts >500 cells/mm 3 had the best viral outcomes. Overall retention in care was moderate, but amongst those retained with VL results, VL suppression was high. Efforts to implement ‹Treat All› and to improve retention in care should continue in order to acheive 90-90-90.

CROI 2019 413