CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

health services. Five-year age distribution trends were used to project the number of RWHAP clients aged ≥50 by 2030. Results: In 2016, 44% of RWHAP clients were aged ≥50, an increase from 32% in 2010. A higher proportion of older than younger clients were White, lived above the poverty level, had stable housing, and accessed food-related services. Among older clients, women and transgender clients had higher housing instability and poverty compared to men. Variation was seen by race/ethnicity. In 2016, VS among older clients was 90% compared to 81% among younger clients. VS increased across all subpopulations of older clients from 2010 to 2016; however, clients with unstable or temporary housing had lower percentages compared to other key subpopulations. By 2030, a projected 66% of RWHAP clients will be aged ≥50 years. Conclusion: Older PLWH receiving care and treatment through RWHAP have high percentages of VS. However, social and structural factors, such as housing stability, may impact HIV outcomes. In addition, aging PLWH may have unique needs, such as food insecurity, long-term HIV medication effects, behavioral health needs, and age-related comorbidities. As the population of older PLWH continues to grow, so too will the importance of further assessing and planning for the needs of this emerging population. 1066 CASCADES TO EVALUATE THE CERVICAL CANCER SCREENING PROGRAM IN A ZIMBABWEAN ART CLINIC Katayoun Taghavi 1 , Ardelle Mandiriri 2 , Eliane Rohner 1 , Tinei Shamu 2 , Cleophas Chimbetete 2 , Tsitsi M. Magure 2 , Serra L. Asangbeh 1 , Matthias Egger 1 , Margaret Pascoe 2 , Julia Bohlius 1 1 University of Bern, Bern, Switzerland, 2 Newlands Clinic, Harare, Zimbabwe Background: The cascade approach, which is utilized for assessment of HIV care, might also be useful to strengthen cervical cancer (CC) screening programs for women living with HIV (WLHIV). We defined cascade indicators and piloted this approach in an antiretroviral therapy (ART) clinic in Harare, Zimbabwe. Methods: We defined eligibility for inclusion into the study as women aged ≥ 18 years enrolled into the Newland’s ART clinic between 06/2012 and 06/2017, and followed them up until 06/2018. We identified the number of women eligible for the study; screened and their screening results; receiving treatment; and the number of women receiving re-screening. We extracted data from routinely collected electronic data; some variables were extracted manually from electronic free text records into an EpiData database. The different steps of the Cascade were calculated, using the same denominator throughout the cascade. Results: A total of 1,651 WLHIV were eligible for the study at enrolment into the ART clinic (median age 37 years (IQR 30 – 44)). At enrolment, 70.6% (1166) were HIV WHO stage 1 or 2, while 23.7% (391) were WHO stage 3 and 4, this data on the remaining 5.7% (94) was missing. Overall, 75.3%WLHIV (1244/1651) were screened within the first year of enrolment into the ART clinic. Of these, 935 (56.6%) were re-screened within 18 months and 747 (45.2%) were free from cervical disease at first follow-up (Figure Panel A). Most women (99.7%, 1241/1244) were screened using visual inspection with acetic acid and cervicography (VIAC), and 0.3% (3/1244) received a PAP smear. Of the 407 women who were not screened, 21.6% (88/407) reported that they were not yet sexually active and 9.3% (38/407) were pregnant at the time of enrolment into ART clinic. Of women who were screened within one year of enrolment, 29% (357/1244) were VIAC positive. Of these, 308 (78.2%) received treatment within 3 months, 278 (70.6%) were followed up within 12 months after treatment and 191 (48.5%) were free from cervical disease at follow-up (Figure Panel B). Conclusion: In our pilot study, 75% of WLHIV were screened for CC within one year of enrolment into the ART clinic and about half of the women enrolled were known to be free from cervical disease at follow-up screening. The proposed cervical cancer prevention and care cascade allows monitoring patient flow through essential screening steps and identification of targets for interventions to further improve CC screening outcomes.

Poster Abstracts

1067 EARLIER AGE OF ONSET AND HIGHER PREVALENCE OF COMORBIDITIES IN PEOPLE LIVING WITH HIV Ni Gusti Ayu Nanditha 1 , Martin St-Jean 1 , Hiwot M. Tafessu 1 , Michelle Lu 1 , Kate Salters 1 , Julio S. Montaner 1 , Silvia Guillemi 1 , Robert S. Hogg 1 , Viviane D. Lima 1 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Background: As people living with HIV (PLWH) are living longer, premature morbidity and mortality from age-associated comorbidities are more common. Our objective was to compare prevalence trends and age of onset of comorbidities between PLWH and the general population in British Columbia (BC). Methods: This retrospective cohort study used longitudinal data from the Comparative Outcomes and Service Utilization Trends study, a population-based cohort of PLWH and 10% random representative sample of BC population. Eligible participants were ≥19 years old and followed for ³1 year between 2000 and 2012. PLWH were antiretroviral therapy (ART) naïve. Age-related comorbidities were identified from hospital and physician billing provincial databases using the International Classification of Disease versions 9/10. Selected comorbidities included cardiovascular, kidney, lung, and liver diseases, non-AIDS-defining cancers, diabetes, osteoarthritis and hypertension. Generalized non-linear models (assuming a beta distribution and a logit link) modeled the prevalence trends, and the Mann-Whitney U test compared the distribution of age of onset of comorbidities between both populations. Results: The study included 4,223 PLWH and 454,092 HIV-negative individuals (median age 37 vs. 39 years, 80% vs. 50%men, median follow-up 5 vs. 13 years, respectively). Yearly prevalence of diabetes, kidney, liver, and lung diseases were significantly higher among PLWH, while the remaining comorbidities were significantly higher among HIV-negative individuals. The gap in prevalence of kidney and liver diseases between the two populations is considerably wide, while for cardiovascular diseases and diabetes, it is rapidly narrowing. PLWH experienced all comorbidities at a significantly younger age than their counterparts, ranging between 8 years earlier for hypertension and 22 years for kidney diseases. See figure for an example of trends of prevalence and age of onset of two key comorbidities in these populations.

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