CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: The Medical Monitoring Project (MMP) is a surveillance system that collects interview and medical record data from a probability sample of adults with diagnosed HIV in the United States. Using weighted data collected 6/2015-5/2016 from 3560 persons taking prescription drugs, we examined the prevalence of 6 strategies used to reduce prescription drug costs, including 3 involving nonadherence (skipping doses, taking less medicine, delaying filling a prescription). Because nonadherence can affect health and transmission, we compared the prevalence of cost-saving related nonadherence by sociodemographic groups, and clinical outcomes among those who did and did not report cost-saving related nonadherence. We used prevalence ratios with predicted marginal means to evaluate significant (P<0.01) differences between groups. Results: In all, 13% of persons reported using any cost-saving strategy and 8% reported any cost-saving related nonadherence; 8% asked a doctor for lower cost medicine, 1% bought drugs from another country, 2% used alternative medicine, 4% skipped doses, 4% took less medicine, and 6% delayed a prescription. Cost-saving related nonadherence was not associated with age, gender, race/ethnicity, poverty, or homelessness. Cost-saving related nonadherence was significantly higher among persons with a disability, private insurance, and unmet need for medications from the Ryan White AIDS Drug Assistance Program (ADAP), and lower among persons with Medicaid (Table). Persons reporting cost-saving related nonadherence were less likely to be virally suppressed and engaged in care, and more likely to have visited an emergency room or been hospitalized more than once. Conclusion: Persons with diagnosed HIV in the United States used various strategies to reduce prescriptions drug costs. Cost-saving related nonadherence was relatively low, but was associated with poorer clinical outcomes. Increasing access to ADAP and Medicaid coverage may help to decrease nonadherence due to cost concerns among persons with diagnosed HIV.

LA-ART compared to oral ART under both scenarios that would be considered cost-effective, using $500/DALY averted as the cost-effectiveness threshold. Results: Assuming adherence similar to oral ART, we project LA-ART would avert 10,439 HIV infections and 4,159 HIV-related deaths over 10 years compared to standard of care. With higher adherence (94%), LA-ART would prevent 52,971 infections and 18,433 deaths over 10 years. To have an incremental cost- effectiveness ratio (ICER) below the $500/DALY averted threshold, the annual per-person cost of LA-ART administration can be at most $191 and $266 USD higher than oral ART administration ($169 per year) for the similar and higher adherence scenarios, respectively. Conclusion: Providing LA-ART to AYA could be cost-effective for reducing HIV burden in Kenya if it is low-cost. Increases in drug resistance due to non- adherence to LA-ART would decrease health benefits and should be evaluated in future analyses. 1077 COST-EFFECTIVENESS OF LONG-ACTING MULTIPURPOSE PREVENTION TECHNOLOGY IN SOUTH AFRICA Marjolein M. van Vliet 1 , Cheryl J. Hendrickson 2 , Brooke E. Nichols 3 , Charles Boucher 1 , Remco P. Peters 4 , David van de Vijver 1 1 Erasmus University Medical Center, Rotterdam, Netherlands, 2 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 3 Boston University, Boston, MA, USA, 4 Anova Health Institute, Johannesburg, South Africa Background: Although preexposure prophylaxis (PrEP) is an efficacious HIV prevention strategy, its preventive benefit has not yet been shown among young women in sub-Saharan Africa likely due to non-adherence. Adherence may be improved with the use of injectable long-acting PrEP methods currently being developed. We hypothesize that targeting long-acting PrEP to women already using injectable contraceptives, the most frequently used contraceptive method in sub-Saharan Africa, could improve adherence to PrEP, result in a reduction of new HIV infections, and be a relatively easy-to-reach-target population. In this modelling study we assessed the epidemiological impact and cost-effectiveness of targeting long-acting PrEP to injectable contraceptive users in Limpopo, South Africa. Methods: We developed a deterministic mathematical model calibrated to the HIV epidemic in Limpopo. Long-acting PrEP was targeted to 50% of HIV negative injectable contraceptive users in 2018 and scaled-up over 2 years. We estimated the number of HIV infections that could be averted by 2030 and the drug price of long-acting PrEP for which this intervention would be cost-effective over a time horizon of 40 years, from a third-party payer perspective. In the base-case scenario we assumed long-acting PrEP is 75% effective in preventing HIV infections and that 85% of infected individuals are on antiretroviral drug therapy (ART). In sensitivity analyses we adjusted PrEP effectiveness and ART coverage. Costs between $519-$1119 per disability-adjusted life-year (DALY) averted were considered potentially cost-effective, and <$519 as cost-effective. Results: Without long-acting PrEP, 220,000 (interquartile range 182,000– 265,000) new infections will occur by 2030; use of long-acting PrEP could prevent 27,000 (21,000–32,000) or 11.9% (11.0%–13.0%) new HIV infections by 2030 (including 7000 (6000-8000) in men). Long-acting PrEP would prevent 40,000 (33,000-45,000) or 13,000 (9,000-18,000) at 75% and 95% ART coverage by 2030, respectively. To be considered potentially cost-effective the annual long-acting PrEP drug price should be <$28 and the ART coverage remains at most 85%. PrEP is not cost-effective at a ART coverage of 95%. Conclusion: Targeting long-acting PrEP to injectable contraceptive users in Limpopo is only potentially cost-effective when long-acting PrEP drug prices are low and ART coverage below 95%. If low prices are not feasible, targeting long- acting PrEP only to women at high risk of HIV infection will become important. 1078 NONADHERENCE DUE TO PRESCRIPTION DRUG COSTS AMONG US ADULTS WITH HIV, 2015-2016 Linda Beer, Yunfeng Tie, John Weiser, Christine Agnew-Brune , R. L. Shouse, for the Medical Monitoring Project CDC, Atlanta, GA, USA Background: The United States spends more per capita on prescription drugs than other countries, and one-fifth of this cost is paid out-of-pocket by patients. Cost-saving strategies, including nonadherence to medications due to cost concerns, have been documented among U.S. adults, which can affect morbidity and, in the case of persons living with HIV, transmission. However, population- based data for persons with HIV are lacking.

Poster Abstracts

1079 HEALTH CARE UTILIZATION AND COSTS OF ACCESSING HEALTH CARE IN SOUTH AFRICA AND ZAMBIA Sarah Kanema 1 , Ranjeeta Thomas 2 , Lawrence Mwenge 1 , Justin Bwalya 1 , Nomtha Mandla 3 , Helen Ayles 1 , Peter Bock 3 , Sarah Fidler 2 , Richard Hayes 4 , Katharina Hauck 2 , for the HPTN071-PopART 1 Zambart, Lusaka, Zambia, 2 Imperial College London, London, UK, 3 Desmond Tutu TB Centre, Western Cape, South Africa, 4 London School of Hygiene & Tropical Medicine, London, UK Background: In much of Africa, accessing essential healthcare services is associated with costs to patients, even if there are no user fees. Patients need to pay for travel, and possibly accommodation, and they have a loss in earnings in travel time to and waiting at the facility. These costs can constitute substantial barriers to utilization of healthcare. User fees were abolished in public healthcare facilities in South Africa and Zambia to improving access, but patients may still incur costs. This study sought to determine costs of accessing care in the two countries and elicit factors affecting utilization of outpatient healthcare. Methods: As part of the HPTN071(PopART) study, baseline data from a random sample of the general adult population aged 18-44 years in 21 communities (all Arms of the study) in South Africa and Zambia were collected between November 28, 2013 and March 31, 2015. Respondents were asked whether they had accessed outpatient healthcare within the past 3 months, and what costs they incurred at the facility, in form of fees for services and pharmaceuticals, costs for accommodation and travel, and howmuch time they took to travel

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