CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

964 Effective Disease Intervention Is Key Component to Acute HIV Detection JoAnn D. Kuruc 1 ; SarahWillils 1 ; Nicole Dzialowy 2 ; Jason Maxwell 3 ; John Barnhart 2 ;Victoria Mobley 3 ; Cynthia Gay 1 ; Erika Samoff 2 1 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2 North Carolina Division of PH, Raleigh, NC, USA; 3 North Carolina DHHS, Raleigh, NC, USA Background: North Carolina (NC) performs statewide testing for acute HIV (AHI) with expedited partner services (PCRS) and referral to care. AHI consistently represents 2.4% of new diagnosis and reflects populations most at risk. We sought to assess if use of the HIV Ag/Ab assay led to increased AHI detection. Methods: In 2013, the NC State Laboratory of Public Health (SLPH) implemented HIV Ag/Ab combination testing on all samples from publicly funded sites. As of 2013, HIV and STI results and PCRS data were combined in the NC Electronic Disease Surveillance System (NCEDSS), improving availability of data for Disease Intervention Specialists (DIS) who perform PCRS for HIV, AHI and early syphilis diagnoses in the state. We compared case data on AHI and other HIV cases diagnosed through the SLPH versus other settings since the implementation of HIV Ag/Ab testing by SLPH. We evaluated the yield of PCRS with AHI cases. We compared age, race, and gender of AHI cases, mode of case detection and links between AHI and STI cases on data from NCEDSS. Results: NC had a notable increase in the number of syphilis cases from 2012 to 2014 with 564, 688, and 1,113 cases per year respectively. AHI cases at the SLPH increased from 2013 to 2015, with 23 AHI cases in 2013, 23 cases in 2014 and 27 in only the first six months of 2015 compared to non-SLPH testing with 17, 27 and 23 cases, respectively. All AHI cases at the SLPH were detected the HIV Ag/Ab assay, but accounted for <50% of non-SLPH cases. AHI cases detected at the SLPH vs non-SLPH sites were similar; both were young (70% vs 57%, respectively), Black (75%, 58%) and MSM (79%, 70%). In 2014, co-infection with a STI prior to AHI diagnosis was common (22/50; 44%) and more frequent than established HIV cases (44% vs 20%); p<0.0001). PCRS resulted in AHI detection in 39/140 (28%) cases detected as part of a PCRS-prompted testing. More than half of AHI cases (78/140, 56%) were part of a sexual or social network including others with STIs. Conclusions: In the first half of 2015, AHI detection at the SLPH doubled compared with prior years while cases detected in the community were stable. It remains unclear if the HIV Ag/Ab assay increased case detection rates given the delay from implementation. The focus on rapid interview of new AHI cases allows DIS to interview persons closer to the testing event, possibly increasing yield of new HIV cases from PCRS. HIV testing in persons with recent STIs results in the detection of AHI. 965 Late HIV Diagnosis and Missed Opportunities for HIV Testing in South Carolina SharonWeissman 1 ; Kristina Kintziger 2 ; Helmut Albrecht 1 ;Terri Stephens 3 ; Babatunde Edun 1 ;Wayne Duffus 1 1 Univ of South Carolina, Columbia, SC, USA; 2 Dept of Med, Georgia Regents Univ, Augusta, GA, USA; 3 South Carolina Dept of Hlth and Environmental Control, Columbia, SC, USA Background: Previous studies, prior to routine HIV testing guidelines, showed that 43.4% individuals diagnosed with HIV in South Carolina (SC) between 2001-2005 were late testers, of these 73.4% had visited a SC healthcare (HC) facility in the years preceding their HIV diagnosis, representing missed opportunities for early diagnoses. The current study sought to re-visit the previous investigation to determine if there has been a reduction in missed opportunities for early diagnosis and evaluates predictors of late testing.

Methods: The SC enhanced HIV/AIDS Reporting System and a statewide all payer HC data base that includes inpatient (IP), outpatient (OP), and emergency department (ED) visits made to a SC facilities were linked. Analysis includes individuals diagnosed with HIV in SC from 2006-5/2015 and HC visits made from 2006 to date of HIV diagnosis. HC visits were categorized as likely to prompt an HIV test [sexually transmitted infections (STI), acute retroviral syndrome (ARS), HIV related, and intravenous drug use (IDU)] and not likely to prompt an HIV test. Individuals were classified as late testers (AIDS ≤1 year of HIV diagnosis) or early testers. Descriptive statistics and logistic regression analyses were conducted to determine associations with late testing. Results: From 1/2006-5/2015, 7,109 individuals were diagnosed with HIV in SC. Almost one-third were late testers (2,244; 31.6%). Of the total, 4,843 (68.1%) visited a SC HC facility prior to their HIV diagnosis. These 4,843 individuals made 29,969 HC visits prior to the HIV diagnosis, including 24,121 (80.5%) ED, 2,956 (9.9%) IP, and 2,039 (6.8%) OP visits. The mean number of visits was 6.1 (SD 9.1; range: 1-183). Among HC visits, 21,929 (73.2%) were for diagnoses unlikely to prompt an HIV test. The remaining 8,040 (26.8%) visits included diagnoses related to STI [851 (2.8%)], ARS [5,495 (18.3%)], HIV related [2,390 (7.9 %)], and IDU [641 (2.1%)]. The Table shows predictors of late HIV testing. Individuals with at least one HC (or missed opportunity for testing) were more likely to be late testers than those with no HC visits. Individuals residing in rural areas were more likely to be late testers. Older individuals were also more likely to be late testers (p-value for trend: <0.0001). Conclusions: Despite the recommendations for routine HIV screening, late testing and missed opportunities for early diagnosis continue to be a problem in SC. Continued emphasis on implementing routine screening in HC facilities statewide is needed. 966 Missed Opportunities for HIV Testing During Routine Doctor Visits, BRFSS, 2011-2013 Michelle Van Handel ; Patricia Dietz CDC, Atlanta, GA, USA

Poster Abstracts

Background: The Centers for Disease Control and Prevention and the United States Preventive Services Task Force (USPSTF) recommend HIV screening in clinical settings for all adolescents and adults regardless of risk. Yet, many people have never been screened for HIV. We estimated the number of adults never tested for HIV who had a recent routine doctor visit (past year) to identify state differences in and characteristics associated with missed opportunities for HIV screening. Methods: We analyzed 2011-2013 Behavioral Risk Factor Surveillance System data to estimate, nationally and by state, the number and percent of persons aged 18-64 years who had never been screened for HIV and who had a recent routine doctor visit (missed opportunities). Logistic regression models assessed trends in the percent never tested and with missed opportunities; year as a continuous variable; p<0.01 considered significant. Persons with missed opportunities for HIV screening were described by sociodemographic and health care characteristics. Results: During 2011-2013, the percent never tested did not change significantly and the percent with missed opportunities increased from 61.8% in 2011 to 63.7% in 2013 (p<0.0001). In 2013, an estimated 96.9 million (95% confidence interval (CI): 96.1–99.7 million; 56.6%; 95% CI: 56.2–56.9%) adults aged 18-64 years had never been tested for HIV; 59.7 million (95% CI: 59.1–60.4 million) of whom had a recent routine doctor visit. By state, the percent never tested ranged from 22.8% in the District of Columbia to 71.7% in Utah. Missed opportunities ranged from 50.5% in Oregon to 75.7% in Rhode Island. The highest percent of persons with missed opportunities were female (52.5%), aged 45-64 years (56.4%), non-Hispanic white (69.8%), and had health insurance coverage (88.6%). In 2012 (most recent year available), 12.4 million (95% CI: 12.1–12.7 million) persons with missed opportunities received a flu vaccine in a clinical setting.

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CROI 2016