CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Results: The true target concentrations for the 4 samples were estimated by applying a standard VL assay to pre-dilution aliquots of the source plasma samples (VL 20 to 339 cp/mL), and dilutions calculated to range from 9 to 0.2 cp/mL had VL estimates generated via the 45-rep Poisson analysis that ranged from no underestimation to underestimation of the target concentrations by up to 3-fold. On initial 9-rep testing of 110 samples from 59 ART-treated adults followed in the RAVEN cohort, 63 samples (57%) from 37 individuals (63%) had detectable VL. An additional 36 reps were performed on a subset of 19 samples, 7 of which were initially undetectable. Four of seven (57%) initially undetectable samples had positive results when tested with the additional reps. The Poisson-derived estimates in the 19 samples tested with 45 total reps ranged from 0 [95% confidence interval (CI) 0 – 0.18] to 2.197 [95% CI 1.52 – 3.21] cp/mL. Conclusion: The Aptima HIV-1 Quant Assay provides a high throughput means to quantify VL to <1 cp/mL with large volume plasma specimens which allows detection and quantitation of VL in most ART-suppressed patients. Given the assay’s performance characteristics, its lack of reliance on specialized specimen handling and the highly automated approach, this assay is well-suited to early- and late-phase clinical trials of HIV curative interventions. 576 EFFECTIVENESS OF BEST PRACTICE ALERT AND PROVIDER EDUCATION FOR HEP C SCREENING Mamta K. Jain 1 , Joanne Sanders 1 , Lisa Quirk 1 , Brian Adamson 1 , Barbara J. Turner 2 , Amit G. Singal 1 1 University of Texas Southwestern, Dallas, TX, USA, 2 University of Texas at San Antonio, San Antonio, TX, USA Background: Hepatitis C is a curable disease and effective screening and treatment of hepatitis C virus (HCV) among baby boomers, born between 1945-1965, can significantly reduce the burden of liver complications in this population. We examined the effectiveness of a simple best-practice alert (BPA) within our electronic medical record coupled with provider education to increase HCV screening and linkage rates among baby boomers in a safety-net hospital system. Methods: We implemented a BPA in June 2015 coupled with provider education at a large urban safety net health system. We compared baby boomers without prior HCV screening and an outpatient appointment between 6/1/13-5/31/15 to a group of unscreened baby boomers with an outpatient appointment between 6/1/15-8/26/17. Comparison of rates for HCV antibody (Ab), HCV RNA, and linkage-to-care (i.e. completing a liver clinic appointment after HCV diagnosis) were performed using generalized estimating equations controlling for gender, race/ethnicity, insurance, and clinic. Results: Of 56,727 at-risk baby boomers seen prior to BPA implementation, 10.3% had HCV screening performed. HCV RNA confirmatory testing was performed in 54.2% of the 1117 HCV Ab-positive patients, and 43.1% (n=201) of patients with confirmed HCV infection (RNA positive) were linked to a liver clinic appointment. Among the 39,351 baby boomers seen after BPA implementation, the BPA was not acknowledged in most (52.7%) cases; providers ordered HCV Ab in 36.3%, and opted to not order HCV testing in 11%. HCV RNA confirmatory testing was performed in 74.7% of the 1205 HCV Ab-positive patients, and 45.7% (n=289) of patients with confirmed HCV infection (RNA positive) were linked to a liver clinic appointment. The intervention including BPA and provider education was associated with significantly increased odds of HCV antibody screening (AOR 5.42; 95%CI 5.22-5.62), confirmatory testing with HCV RNA (AOR 2.38; 95%CI 1.95-2.90); however, linkage to care rates were not significantly improved (AOR 1.61; 95%CI 0.88-1.54) (see Table). Conclusion: Implementation of a simple BPA and provider education significantly increased hepatitis C screening; however, linkage to care rates are still not adequate at only 50%. Further interventions to improve linkage to care of patients with HCV infection are needed to eradicate hepatitis C.

577 CHANGES IN HEPATITIS C VIRUS (HCV) TESTING AWARENESS IN MASSACHUSETTS, 2015-2016 Monina Klevens , Monica Morrison, Liisa Randall, H D. Fukuda, Daniel Church, Shauna Onofrey, Kevin Cranston, Alfred DeMaria Massachusetts Department of Public Health, Boston, MA, USA Background: Identification of infected persons who are unaware of their status is essential to eliminate HCV infection. In March 2015, the Massachusetts Department of Public Health (MDPH) implemented universal HIV and HCV antibody testing at funded integrated HIV, HCV, and sexually transmitted infection (STI) screening sites. Methods: There were 189 sites contracted by MDPH to conduct HIV, HCV, and STI testing and linkage to care. Anti-HCV enzyme immunoassays were conducted at the Massachusetts State Public Health Laboratory on all serum specimens submitted for HIV and HCV testing. Persons with positive antibody test results are referred for supplemental testing to diagnose current HCV infection and assessed for treatment. We compared number of tests, history of testing and results from all anti-HCV tests conducted in 2015 and 2016 and tested differences using the Chi-square test. Results: The number of HCV tests overall increased from 25747 in 2015 to 29490 in 2016, and the proportion of clients with no reported previous test decreased from 32.6% (8394/25747) to 27.1% (7982/29490; p<0.01). HCV seroprevalence increased from 12.4% (3194/25747) to 17.2% (5080/29490; p <0.01), as did the proportion of new positives among persons reporting a previous negative test, from 5.8% (646/11046) to 6.5% (963/14787; p<0.05). The proportion of newly positive persons among those reporting no previous test also increased from 4.7% (393/8394) to 6.7% (532/7982; p<0.05). The proportion of persons testing positive who were aware of their infection increased from 57.4% (1820/3173) to 65.4% (3316/5074; p<0.01). Conclusion: Implementation of universal HCV antibody screening in public health integrated infectious disease screening and referral programs yielded an increase in seroprevalence, including new positives. HCV antibody positive persons were more frequently aware of their status in 2016 than 2015; still, about a third of infected remained reportedly unaware. To eliminate HCV infection, awareness of infection and linkage to care must increase. 578 LINKAGE TO CARE FOR PREVIOUSLY DIAGNOSED HCV-INFECTED EMERGENCY DEPARTMENT PATIENTS Yu-Hsiang Hsieh , Anuj Patel, Danielle Signer, Erica Shelton, Jacob Cohen, Mustapha Saheed, David L. Thomas, Richard Rothman Johns Hopkins University, Baltimore, MD, USA Background: With up to 15% of HCV seroprevalence in urban emergency department (ED) patients, the burden of HCV infections in EDs remain high. Although highly effective, oral HCV treatment has been available since 2014, most of those previously diagnosed patients have not been treated. An ED-based linkage-to-care (LTC) program for those patients with chronic HCV infection was implemented in 2015 to improve treatment outcomes. Methods: FromMarch 2015 to May 2016, ED-based HCV LTC program staff identified patients with HCV RNA-positive from an electronic medical record system for HCV LTC services. Eligible patients were approached and were provided LTC services to on-site viral hepatitis clinic for HCV care if they were not already in care. On the same day, clinic staff met patients in the ED. Reminder phone calls were made regarding the first scheduled clinic appointment as well as phone calls for rescheduling that appointment if missed. Demographic and

Poster Abstracts

CROI 2018 212