CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

909 The Impact of HIV on Mortality in Nairobi, Kenya Catherine N. Kiama 1 ; PeterW.Young 2 ; Aandrea Kim 3 ; JoyceWamicwe 1 ; Kevin M. De Cock 2 ; Johansen Oduor 1 ; Emily Rogena 4 ; Julius Oyugi 4 ; Marie Downer 5 ; MartinW. Sirengo 6 1 Ministry of Hlth, Nairobi, Kenya; 2 CDC, Nairobi, Kenya; 3 CDC, Atlanta, GA, USA; 4 Sch of Med, Univ of Nairobi, Nairobi, Kenya; 5 Cntrs for Disease Control & Prevention-Kenya, Nairobi, Kenya; 6 Natl AIDS and STI Control Prog, Nairobi, Kenya Background: Declines in HIV prevalence and increases in ART coverage have been documented in Kenya, but mortality associated with HIV has not been directly measured. Adult HIV prevalence in Kenya’s capital city of Nairobi is 4.9%. We piloted a surveillance system to monitor HIV-related mortality at two mortuaries in Nairobi, the largest referral hospital and largest county mortuary, which accounted for two-thirds of registered deaths in Nairobi in 2014. Methods: Cadavers from Kenyatta National Hospital (KNH) mortuary and Nairobi City mortuary from Jan 29 – Mar 3, 2015 aged 15 years or older were sampled consecutively for percutaneous cardiac blood collection prior to autopsy. Plasma was screened using the national HIV rapid testing algorithm. Viral load was quantified using the Abbott m2000 Real Time HIV-1 assay. We reviewed medical records for KNH deaths for history of HIV testing. Model-based estimates from Spectrum of people living with HIV (PLHIV) for Nairobi were used to calculate a standardized mortality ratio (SMR) and population-attributable fraction for mortality among the infected vs. uninfected population. Results: Among 610 cadavers tested, the overall HIV prevalence was 19.5% (95% confidence interval [CI] 16.4-22.9%) which differed significantly by sex: 14.6% for males and 29.7% for females (p<0.001), and by mortuary: 12.6% at City and 23.2% at KNH (p=0.002). Of 81 specimens with viral load results, 51.9% (95% CI: 40.5-63.1%) had unsuppressed viral load (>= 1000 copies/ml). Of 48 HIV-infected KNH deaths with available medical records, 87.5% (95% CI: 74.8-95.3%) had a documented HIV diagnosis. The SMR for HIV infection was 4.12 (95% CI 3.47-4.90), the attributable fraction in PLHIV was 0.753 (95% CI: 0.707-0.792) and the population attributable fraction was 0.148 (95% CI: 0.119-0.177). Conclusions: In spite of a recent reduction in HIV prevalence and 73% of adult PLHIV receiving ART in Nairobi, their risk of death is four-fold greater than in the uninfected, while 14.8% of all adult deaths in the city can be attributed to HIV infection. Higher prevalence at KNH may result from its referral hospital status. Poor viral suppression may indicate many PLHIV who die have not accessed ART or had treatment failure. Routinely estimating the impact of HIV on mortality is feasible and will contribute to understanding the public-health impact of ART. 910 Access to HIV Care in Health Districts Affected by Ebola Epidemic in Sierra Leone Jacques D. Ndawinz 1 ; Kenneth Katumba 2 ;Victor Kamara 3 ;Wogba Kamara 3 ; Lamin Bangura 4 ;Victoria Kamara 4 ; Umu N. Nabieu 4 ; Etienne Guillard 1 1 Solthis NGO, Paris, France; 2 Solthis NGO, Conakry, Guinea; 3 Natl AIDS Secretariat, Freetown, Sierra Leone; 4 Natl AIDS/VIH Control Prog, Freetown, Sierra Leone Background: The frequency of deaths caused by the current EVD epidemic among health-care workers severely disrupted supply and quality of routine health activities in West Africa. In addition, cultural beliefs and the fear of being contaminated by the EVD made patients reluctant to seek treatment from health facilities, particularly in areas where EVD cases were diagnosed. In Sierra-Leone, the effect of the current EVD epidemic on the continuity of HIV care has not yet been documented. Methods: The National AIDS Control Programme (NACP) is the specialized programme in charge of monitoring and evaluation of HIV programmes in Sierra Leone. NACP manages a nationwide database including the number of ART patients ‘currently on care’. During 2014, 126 HIV facilities reported data to NACP. Missing data for HIV facilities that were still functional during the period was imputed using the multiple imputation method. To assess the impact of the EVD epidemic on the continuity of HIV care during 2014, we first calculated the rate of change (ROC) between successive months of the numbers of ART-patients ‘currently in care’. Secondly, we calculated the proportion of the number of months (PNM) in which the ROC was negative during the post-outbreak period. PNMwith negative ROC was used to make comparisons between and within health districts. All analysis was made using Stata11. Results: During the year 2014, the number of ART-patients ‘currently in care’ increased from 10,300 in January to 11,750 in July followed by a slow decline until October (11,400), and a slow increase until December (11,660). The period of July to October corresponds to the peak of the EVD epidemic. The PNM with negative ROC varied within facilities from 0% to 80% and the median PNM with negative ROC was 33% (interquartile range: 17%-50%). The highest PNMwith negative ROC was found in 8 HIV facilities located principally in Port Loko, Tonkili, Western rural and Kono, the most affected Ebola health districts. The highest median PNM with negative ROC within health district was at Port Loko health district. Conclusions: Our results support the hypothesis that the decline of ART-patients that were ‘currently in care’ during 2014 was attributable to the EVD epidemic in Sierra Leone. The impact of Ebola on the continuity of HIV care was variable between and within health districts. This study will contribute to improve future epidemics preparedness.

Poster Abstracts

911 Effect of Alcohol on All-Cause and Liver-Related Mortality Among Individuals With HIV Chelsea Canan 1 ; Bryan Lau 1 ; Mary McCaul 2 ; Richard Moore 3 ; Geetanjali Chander 2

1 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 2 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 3 Johns Hopkins Univ, Baltimore, MD, USA Background: We examined the association between hazardous drinking, all cause and liver-related mortality among HIV-infected individuals. Methods: Study participants included HIV-infected individuals in Baltimore, MD from July 2000 to March 2013. We ascertained alcohol use by two methods: 1) self-report on an Audio Computer Assisted Self Interview (ACASI), and 2) medical record abstraction of a provider documentation of hazardous alcohol use. Self-reported (SR) alcohol consumption was categorized using the NIAAA definition as hazardous (men: >4 drinks/day or >14 drinks/week; women: >3 drinks/day or >7 drinks/week), moderate (any alcohol consumption less than hazardous), and non-drinking. Cause of death was ascertained using national registries. Analyses were conducted using inverse probability weighted survival models. We fit cause-specific regression models and obtained a cumulative incidence of liver-related mortality to account for competing risks. We adjusted analyses for age, sex, race, diabetes, illicit drug use, smoking, HIV transmission risk factor, nadir CD4, ART use, HIV suppression and hepatitis C coinfection.

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CROI 2016