CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Despite high awareness that ART eliminates HIV transmission risk, there is both a lack of in depth knowledge and conviction among health providers and PrEP users. New strategies to communicate U=U in a reliable and believable way are urgently needed. 1061 RESUPRESSION AFTER POINT-OF-CARE VIRAL LOAD TESTING TO GUIDE ADHERENCE COUNSELING Giovanni Villa 1 , Dorcas Owusu 2 , Marilyn Azumah 3 , Colette J. Smith 4 , Adam Abdullahi 1 , Dominic Awuah 3 , Laila Sayeed 5 , Apostolos Beloukas 1 , David Chadwick 5 , Richard Phillips 2 , Anna Maria Geretti 1 1 University of Liverpool, Liverpool, UK, 2 Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, 3 Komfo Anokye Teaching Hospital, Kumasi, Ghana, 4 University College London, London, UK, 5 South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK Background: Whilst implementation of virologic monitoring remains uneven across Africa, novel molecular platforms now facilitate adoption at point of care (POC). The OPTIMISE study explored POC viral load testing followed by immediate adherence counselling for its impact on rates of virologic resuppression in a programmatic care setting in Ghana. At the center, the second largest in Ghana, routine virologic monitoring is not yet available. Methods: Consecutive patients who were established on ART and accessed outpatient care over a 2-week period in February 2018 (T1) were invited to complete an adherence questionnaire and to self-report adherence via a visual analogue scale (VAS). HIV-1 RNA was quantified with Cepheid Xpert over 90 min. Patients with viremia (>40 copies/ml) received immediate adherence counselling by trained nurses over 15-20 min, and were invited to reattend 8 weeks later (T2), when adherence was re-assessed and viral load testing repeated. Results: At T1, 333 consecutive patients (74% females, median age 48 years, median CD4 count 626 cells/mm3) underwent POC viral load testing. Patients had received ART for a median of 9 years. Most (297/333, 89%) were on NNRTI- based ART (mainly efavirenz); 36/333 (11%) were on PI-based ART, mainly lopinavir/ritonavir. The NRTIs comprised mainly TDF/3TC (187/333; 56%) and ZDV/3TC (130/333, 39%). Overall, 164/333 (49%) subjects had viremia, with median levels of 423 copies/ml; 71/333 (21%) had levels >1000 copies/ml. By regression analysis, a self-reported history of ≥1 treatment interruption since first starting ART (usually due to unavailability of the dispensary) independently predicted viremia at T1 (adjusted OR 3.1; 95% CI 1.5-6.3; p<0.01). Of the 164 patients with T1 viremia, 150 (91%) attended at T2 and 32/150 (21%) showed resuppression. By multivariable analysis (Table 1), a T1 viral load >1000 copies/ ml independently predicted lack of resuppression at T2. Conclusion: In this programmatic HIV setting lacking access to routine virologic monitoring, half of the cohort had detectable viremia while on ART, and only a fifth achieved resuppression following adherence counselling. Patients established on long-term NNRTI-based ART who report a history of treatment interruption could benefit from viral load testing at POC regardless of current self-reported adherence. Those with a viral load >1000 copies/ml should be offered an immediate switch to alternative therapy.

for high-risk people living with HIV (PLWH) with comorbidities (e.g., substance use, homelessness, and mental health disorders) to improve viral suppression (VS) (<200 c/mL) through case management services. The present study aims to determine the odds of VS prior to and following MCC enrollment, and to compare trajectories by reported stimulant use, homelessness, and depressive symptom severity. Methods: Data were 52,138 observations from 6,269 PLWH from 12 months (m) prior to MCC enrollment to 36 m post-enrollment. Piecewise mixed effects logistic regression estimated trajectories of VS (1) 12 m pre-MCC, (2) 0-6 m post-enrollment, and (3) 6-36 m post-enrollment--cut-points based on locally weighted scatterplot smoothing. We compared VS trajectories by reported stimulant use (methamphetamine, cocaine, and crack), homelessness, and depressive symptoms (PHQ-9 score), adjusting for sociodemographic and HIV- related covariates. Results: At enrollment, 42.8% of the sample had VS. Reported stimulant use (OR=0.62, 95% CI [0.52, 0.74], p<.001) and pronounced depressive symptoms (OR=0.90, 95% CI [0.85, 0.96], p<.001) were associated with lower odds of VS, while homelessness was not. Odds of VS increased by a factor of 11 in the first 6 months in MCC (ΔOR=10.88, 95% CI [9.98, 11.87], p <.001), then did not significantly change 6-36 m post-enrollment (ΔOR=0.98, 95% CI [0.95, 1.00], p=.080). Post-enrollment changes in odds of VS did not differ by reported stimulant use. In the first 6 m in MCC, those reporting homelessness improved less in VS than those stably housed (ΔOR=0.42, 95% CI [0.34, 0.51], p<.001). In later months, those reporting homelessness improved more in VS than those stably housed (ΔOR=1.06, 95% CI [1.00, 1.13], p=0.035). Pronounced depressive symptoms were associated with greater improvement in VS 6-36 m post- enrollment (ΔOR=1.03, 95% CI [1.02, 1.04], p=0.001). Conclusion: MCC patients significantly improved and sustained their VS, with the greatest increase occurring within the first 6 m, likely attributed to improved access and adherence to HIV care as well as support services. While there were significant differences in time to VS among patients with comorbidities, these results suggest potential for this patient-centered program to address these disparities.

Poster Abstracts

1063 HIGH NCDs INCIDENCE AMONG PLHIV IN KENYA: LONGITUDINAL ANALYSIS OF TREATMENT OUTCOMES

Dunstan Achwoka 1 , Anthony Waruru 1 , Tai Ho Chen 1 , Kenneth Masamaro 1 , Evelyne Ngugi 1 , Irene Mukui 2 , Abraham Katana 1 , Thomas Achia 1 , Lucy Ng’ang’a 1 , Kevin M. De Cock 1 1 CDC, Atlanta, GA, USA, 2 National AIDS Control Council, Nairobi, Kenya Background: Over the last decade, the Kenyan national HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden in the country. There is limited data on the burden of NCDs among PLHIV in Kenya. We sought to characterize the burden of four major categories of NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) among adult PLHIV in Kenya.

1062 COMORBID CONDITIONS, VIRAL TRAJECTORIES, AND COORDINATED CARE IN LOS ANGELES COUNTY Michael J. Li 1 , Erica Su 1 , Wendy H. Garland 2 , Sona Oksuzyan 2 , Robert E. Weiss 1 , Uyen Kao 1 , Sung-Jae Lee 1 , Raphael J. Landovitz 1 , Steven Shoptaw 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Los Angeles County Department of Public Health, Los Angeles, CA, USA Background: In March of 2013, the Los Angeles County Division of HIV and STD Programs implemented a clinic-based Medical Care Coordination (MCC) Program

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