CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Patients were interviewed to ascertain understanding of the transfer process and identify STF reasons. Although the majority of patients (n=27/30) believed it necessary to inform staff of the intent to transfer, more than half suggested challenges in requesting a transfer, including fear of negative staff attitudes (n=11), emergencies and life events (n=5) and long transfer documentation waiting times (n=3). HCPs acknowledged patients STF due to challenges with the transferring process and fear of repercussions when defaulting treatment. HCPs stated they would not prevent patients from requesting a transfer nor turn STF patients away who had interrupted treatment or arrived without adequate documentation. The HCPs’ open acceptance of transferring patients is inconsistent with patients’ perceptions that staff negatively react to patients requesting transfer or those transferring to another facility without request. Conclusions: Our study showed that incorrect reporting of STF patients negatively affects RIC data and RIC in the ART program could be underestimated by as much as one third. Operational service challenges and staff attitudes contribute to STF. Cumbersome transfer documentation processes hinder HCPs’ ability to effectively manage a STF. The ART program needs to review current transfer guidelines and develop processes that ease the burden on staff and are conducive to the needs of patients to prevent STF. Understanding the STF process will improve the quality of RIC data and the continuity of patient care. 1023 Countries With Lower HIV Prevalence Have Lower ARV Coverage: UNAIDS 2015 Database AndrewM. Hill 1 ; Anton N. Pozniak 2 ;Thomas Dauncey 3 ; Jacob Levi 3 ; Katherine Heath 4 ; Shaffiq Essajee 5 ; Carmen Perez Elias 6 1 Liverpool Univ, Liverpool, UK; 2 Chelsea and Westminster Hosp NHS Fndn Trust, London, UK; 3 Imperial Coll London, London, UK; 4 Univ of Oxford, Oxford, UK; 5 WHO, Geneva, Switzerland; 6 UNITAID, Geneva, Switzerland Background: Countries with a higher prevalence of HIV (at least 5% infected) have been prioritized in PEPFAR and Global Fund sponsored antiretroviral treatment programmes. However 50% of HIV-infected people live in countries with lower HIV prevalence (<5% infected). The aimwas to compare uptake of HIV testing and treatment in adults and children between countries with higher or lower HIV prevalence. Methods: The UNAIDS 2015 database includes country-level information on epidemic size, prevalence of HIV infection, antiretroviral treatment coverage, Antenatal Clinic (ANC) visits and Early Infant Diagnosis (EID). The analysis included results from 52 low and middle income countries with at least 50,000 people infected with HIV included. Least squares linear regression was used to correlate national adult HIV prevalence HIV with estimated rates of treatment coverage (adults, pregnant women and children), ANC, and EID. The analysis was weighted by epidemic size and controlled for GDP/capita and region (African vs non-African countries). Results: Of the 52 low or middle income countries in this analysis, 40 had a lower prevalence of HIV <5% (total 16 million HIV infections), while 12 had a prevalence of at least 5% (total 16.1 million HIV infections). As shown in the summary Table, the lower prevalence countries had significantly lower rates of treatment coverage in adults, pregnant women and children (p<0.01 for each comparison). In addition, lower prevalence countries had a smaller percentage of women attending antenatal clinic visits and Early Infant Diagnosis (EID) for infants (p<0.01). The annual death rate for people with HIV was 4.5% in the lower prevalence countries versus 2.5% in the higher prevalence countries. The HIV transmission rate (total new infections divided by HIV epidemic size) was 6.2% in lower prevalence countries versus 5.4% in higher prevalence countries. Conclusions: In this analysis of the UNAIDS 2015 database, including 32.1 million HIV infected people in 52 low or middle income countries, lower prevalence countries had significantly lower treatment coverage in adults, pregnant women and children, lower rates of Antenatal Clinic Visits and Early Infant Detection, and higher annual death rates. Countries with lower HIV prevalence need to upscale HIV and testing and treatment further, to meet the UNAIDS 90-90-90 targets by 2020.

Higher prevalence (≥5% HIV+) N=12 Total HIV+: 16.1 million

Countries

Lower prevalence (<5% HIV+) N=40 Total HIV+: 16.0 million

Mean HIV prevalence HIV+ adults on ART HIV+ children on ART

1.6%

14.6% 48.3% 48.3% 89.1% 72.3% 68.1%

31.7% 22.4%

HIV+ pregnant women on ART 46.7%

Early Infant Diagnosis At least 4 ANC visits

20.1% 55.3%

Death rate /year

4.5%

2.5%

1024 Feasibility of the Third 90-90-90 Target: Viral Load Coverage and Outcomes in Rwanda Muhayimpundu Ribakare 1 ; Jean d’Amour Ndahimana 1 ; Byiringiro Rusisiro 1 ; Gad Niyibizi 1 ; Jean Paul Uwizihiwe 2 ; Catherine Kirk 3 ; Sabin Nsanzimana 1 1 Rwanda Biomed Cntr, Kigali, Rwanda; 2 Inst of HIV/AIDS Disease Prevention and Control, Rwanda Biomed Cntr, Kigali, Rwanda; 3 Partners In Hlth, Kigali, Rwanda Background: UNAIDS set the ambitious 90-90-90 targets to end the AIDS epidemic by 2020. To reach the third “90”, viral load (VL) monitoring needs to be reinforced as many of resource-limited setting continue to use CD4 to monitor success or failure of ART. As HIV services have expanded in Rwanda, annual VL monitoring was added to the guidelines in 2007 and the number of VL machines increased from X to X. This study aimed to assess the number of patients with a VL test over one-year in Rwanda, proportion of patients with treatment failure, and the healthcare provider’s (HCP) response. Methods: A cross-sectional, mentorship activity was completed countrywide in 2015 in all health facilities (HF) providing ART. A doctor and nurse pair of mentors visited HF and supported them through onsite coaching. During mentorship, mentors collected data from the VL register between 1 Jan and 31 Dec 2014 and recorded: number of VL samples taken, VL results received and coded as <20 copies/ml (undetectable VL), 21-999 copies/ml, ≥1000 copies/ml (treatment failure) and missing results. For samples with VL ≥1000, mentors reviewed their medical files to assess whether the HCP responded based on the national HIV guidelines (if ≤10 files, all files were assessed; if >10 files, a random sample was selected). Results: Data were collected from 485 HF representing 96.4% of all HFs in the country. 117,226 VL samples taken from Jan-Dec 2014. Results received for 89.1% (n=104,546), however 5.0% (n=5,274) were inconclusive due to insufficient/inappropriate samples. Majority of patients with results had an undetectable VL 86.6% (n=85,969) and 9.7% (n=9,606) had treatment failure. The remaining 3.7%(n=3,697) had a VL between 21 and 999 copies/ml. Among patients with treatment failure, 3,164 (32.9%) patient files were reviewed. Concerning the decision of HCP, 31.7% (n=1,003) were counseled for medication adherence, 19.6% (n=620) reinforced with adherence and control VL in three months and 12.2% (n=386) shifted to the next regimen. However, 36.5% (n=1155) of files of patients assessed with treatment failure, HCP did not intervene at all. Conclusions: VL test is feasible to monitor patients on ART in resource-limited countries. More than 85% of patients who performed VL suppressed their VL. However, more efforts still needed to reach all patients in need of VL, reinforce adherence to reach the suppression rate as set by UNAIDS and to strengthen capacity of HCP in treatment failure management.

Poster Abstracts

437

CROI 2016