CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

594 ACTIVE-C: A COMMUNITY-BASED PROGRAM TO TEST AND CURE HEPATITIS C IN ALABAMA

no prior treatment. A second patient had a new diagnosis of HCV which had spontaneously cleared. The third patient had been previously diagnosed with HCV, and successfully treated. Conclusion: At NYCSHC’s, HCV prevalence among HIV-negative MSM initiating PrEP and PEP is 0.26%. This prevalence is lower than the prevalence estimated in the general population of NYC and the U.S. The PrEP/PEP programs at sexual health clinics provide a good opportunity for monitoring trends in sexually transmitted HCV.

Ricardo A. Franco , James W. Galbraith, Ashley Gilmore, Anthony Lee, Ashutosh Tamhane, Ronada Anderson, DeAnn Jones, Brendan McGuire, Ashwani K. Singal, E. Turner Overton, Omar Massoud, Michael Saag University of Alabama at Birmingham, Birmingham, AL, USA Background: Limited data exist about the effectiveness of community-based programs in achieving key goals of the National Viral Hepatitis Action Plan. We report results of ACTIVE-C (Alabama Coalition for Testing, Interventions and Engagement in Hepatitis C Care), a state-wide, community-based test and treat program focused on disease awareness, testing, patient navigation and hepatitis C treatment co-location in Primary Care. Methods: The University of Alabama at Birmingham (UAB) Center for AIDS Research, the UAB Liver Center, the Alabama Department of Public Health (ADPH) and 12 community centers across 7 cities in Alabama engaged in formal partnerships. Clinics provided aggregate hepatitis C antibody screening data from 2013 through March 2017. Nine on-site coordinators assisted clinics with patient navigation, prior authorizations and de-identified, individual-level data collection of positive cases in the community. Primary care providers (PCPs) attended overview lectures and case-based discussions. We analyzed testing trends over time before and after launching ACTIVE-C. We compared patient characteristics and the care cascade of community sites with the UAB’s tertiary center. Results: Starting in July 2015, ACTIVE-C distributed 655 continued medical education credit-hours to 242 providers, and achieved state-wide reach within the first year. By June 2017, quarterly community hepatitis C antibody testing and diagnosis had a cumulative increase of 2.7 and 2.2 fold respectively and 70 PCPs had prescribed direct-acting antivirals (DAAs) in Primary Care setting. Comparative analysis of the proportion of patients moving downstream care cascade steps are shown in the table attached. PCPs in community clinics compared to specialists at UAB achieved similar SVR rates (table). Compared to specialists at UAB, PCPs treated with DAAs significantly higher proportions of persons who were uninsured (55% versus 3%, p < 0.0001), African Americans (47% versus 28%, p < 0.0001), living in urban counties (83% versus 64%, p < 0.0001) and in low income zip codes (69% versus 46%, p < 0.0001). Conclusion: ACTIVE-C interventions were in alignment with key goals of the National Viral Hepatitis Action Plan, resulting in effective state-wide expansion of hepatitis C testing and treatment access to vulnerable groups within primary care clinics. We verified comparable results to what is observed in our academic medical center, confirming that treatment via community clinics is feasible and effective.

593 ASSESSING DIFFERENCES IN HISTORIC AND RECENT HIV/HCV COINFECTION IN PHILADELPHIA Dana Higgins , Danica Kuncio, Kathleen Brady, Coleman Terrell Philadelphia Department of Public Health, Philadelphia, PA, USA

Background: In Philadelphia, 17% of people living with HIV (PLWH) are coinfected with hepatitis C virus (HCV). Historically, the burden of coinfection in Philadelphia has been greatest among males, Non-Hispanic (NH) Blacks and Hispanics, people who inject drugs (PWID) and those >50 years old. More recently reports of coinfection in populations different fromwhat was historically observed have been seen. The purpose of this analysis was to assess risk factors and compare historic HCV coinfection to recent HCV coinfection to understand if recent trends, including sexual acquisition of HCV, are occurring among PLWH in Philadelphia. Methods: HIV and HCV surveillance information, including a subset of recently identified HCV seroconversion cases, was matched on first and last name, date of birth, and social security number. Patients with historic coinfection were defined as those living with HIV through December 31, 2016 with an HCV diagnosis date prior to January 1, 2012. Patients with recent coinfection were defined as those living with HIV as of December 31, 2016 with an HCV diagnosis after January 1, 2012. Chi-square analysis and multivariable logistic regression were used to assess demographic, clinical, and risk factor differences among the two groups. Results: In 2016, 3,219 PWLH in Philadelphia were coinfected with HCV. From 2012 -2016, 58 confirmed HCV seroconversions occurred among PWLH. The majority of HCV seroconversions occurred in MSM (50%) and Heterosexuals (16%), respectively. Overall, compared to HIV monoinfections, a significantly greater proportion of HIV/HCV coinfected individuals were Hispanic, PWID, >50 years old, and diagnosed with HIV >10 years ago. When stratified by historic versus recent HCV coinfection, the odds of recent coinfection were increased among younger patients and those diagnosed with HIV <5 years ago. In comparison to PWID, the odds of recent HCV coinfection were also significantly increased among MSM and Heterosexuals. Conclusion: This study highlights a shifting trend in coinfection in Philadelphia. Overall, the majority of coinfection occurs in those >50 years old and PWID. However, recent HCV coinfections highlight that younger MSM and Heterosexual PWLH may be at increased risk for sexual acquisition of HCV. As HIV providers strive to eradicate HCV in PWLH, prevention and treatment strategies, including updated HCV screening guidelines for emerging at-risk populations, need to be prioritized as well.

Poster Abstracts

595 MASSACHUSETTS HEPATITIS C CARE CASCADE, 2007-2015

Quynh Vo , Shauna Onofrey, Daniel Church, Kevin Cranston, Alfred DeMaria, Monina Klevens Massachusetts Department of Public Health, Boston, MA, USA Background: Despite the high mortality and morbidity burden, the population impact of effective treatment for hepatitis C virus (HCV) infection has not been fully characterized due to under-ascertainment of screening and retention in care. We examined state-level reports of the number of HCV-infected persons who received key services along the continuum of HCV care. Methods: Data from 76,825 Massachusetts residents who were reported to the state HCV surveillance system and received an anti-HCV antibody test

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