CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

with increased odds of HCV testing. Of those tested, 7,499 (33.4%) were HIV/ HCV coinfected. Blacks and those with detectable VL were less likely to be co- infected. Of the coinfected patients at HCV treating sites; 10.2%were prescribed DAA. MSM (AOR 0.65 (0.43, 0.98)), Whites (AOR 0.50, (0.36, 0.70)) and Hispanics (AOR 0.49 (0.32, 0.73) and those with HIV-1 RNA >200 (AOR 0.35 (0.26, 0.58)) were significantly less likely to be prescribed DAA than blacks or those with undetectable VL. Of those prescribed DAA, 95.5% successfully achieved SVR. Conclusion: While providers appear to be targeting PWH who are more likely to be HCV coinfected for testing, clinical guidelines indicate that all PWH be tested for HCV, and there is opportunity to increase HCV testing rates. Only 10% of HIV-HCV patients were prescribed DAA in the first two years of market availability, despite high rates of treatment success. Higher rates of HCV screening and treatment are needed among HIV/HCV co-infected patients.

599 OPERATIONALIZING ELIMINATION: CURING HEPATITIS C IN THE PATIENT- CENTERED MEDICAL HOME Sarah Rojas , Lisa Asmus, Christopher Cavanaugh, Maureen Khasira, Stephanie Constantino, Christian B. Ramers Family Health Centers of San Diego, San DIego, CA, USA Background: Given current methods to assess and treat HCV, the AASLD and IDSA have encouraged primary care providers (PCPs) to join in efforts to eradicate Hepatitis C (HCV). Recent studies demonstrate PCPs’ efficacy in treating single HCV genotypes or non-cirrhotic patients, but can PCPs treat complex disease in diverse, vulnerable and medically complicated patients? If so, than FQHC’s, with the PCMH model and accessible locales, can be important resources for eradicating HCV. The current study describes the experience of a single FQHC center in expanding HCV treatment. Methods: In 2013, we developed an HCV treatment programwithin an urban FQHC in San Diego. With support from the CDC and a state-funded initiative, a single infectious disease doctor (ID MD) trained and supported several PCPs annually, starting in 2015. These PCPs practice in five surrounding clinics, and participate in weekly telehealth sessions, using the ECHO model. They are supported by an interdisciplinary teamwhich performs rapid point-of-care testing, links HCV+ individuals to care, and guides patients through complex barriers to care, i.e. health insurance authorization, linkage to drug/alcohol or mental health services. Fibrosis assessment was non-invasive and patients were treated according to published guidelines. Results: Between 1/1/13 and 9/20/17, 799 individuals tested positive for active HCV infection; 797 received further evaluation, 610 completed HCV treatment, 91 are currently on treatment. In 2013-4, a single ID MD treated 42 pts. Since 2015, he trained 5 NPs and 3 PMDs. In 2016, ID MD initiated 124 therapies, while PCPs initiated 155 (2.35x the initiations of ID MD alone; see Figure). 65% of evaluated patients were baby boomers; 43%white; 70%male. 97% had federal or state-sponsored insurance; 58% (N=459) had stage F3 or F4 fibrosis. 47 (6%) were HIV/HCV co-infected; 60% had Genotype 1A. Of those treated, 520 were >12 weeks post therapy; 393 had labs 12 weeks post-treatment. Cure rates (SVR12) were 71% (ITT analysis) and 94% (per protocol). Twelve patients had 14 treatment failures, 10 of which had cirrhosis; one patient was re-infected. Eleven of these initiated a second regimen: 6 initial failures achieved cure, while 4 are being treated. Conclusion: PCPs trained and supported by an ID MD, along with an interdisciplinary staff, can double HCV treatment capacity and decentralize resources, reaching vulnerable populations without sacrificing cure rates.

598 HEPATITIS C CARE CASCADE IN JAIL: IMPLICATIONS FOR HARD-TO-REACH POPULATIONS Caroline Abe 1 , Esmaeil Porsa 2 , Ank E. Nijhawan 1 1 University of Texas Southwestern, Dallas, TX, USA, 2 Parkland Health and Hospital Systems, Dallas, TX, USA Background: Drug development for Hepatitis C virus (HCV) has lead to well- tolerated treatments for HCV with high rates of cure. However, identifying and treating HCV in hard-to-reach and vulnerable populations remains a challenge to the eradication of HCV. We determined the prevalence of HCV, factors associated with HCV infection and evaluated the HCV care cascade among jail inmates. Methods: Opt-out HCV antibody (Ab) testing is offered at the time of routine blood draw for individuals incarcerated at the Dallas County Jail. Demographics and testing results were extracted from electronic medical records from April-August 2017; self-reported HCV risk factor and health insurance status were recorded by nursing staff. If the HCV Ab was positive, an HCV ribonucleic acid (RNA) test was completed. Patients with a positive HCV RNA were initiated in a linkage-to-care protocol that started with in-house disease education, prevention counseling, and information about linkage to HCV care including a hotline number routed to a navigation specialist. Post release, the navigation specialist would follow-up by phone to encourage linkage to HCV care. Data analyses were completed using SAS v. 9.3. Results: Of 3174 unique individuals tested for HCV, 553 (17.4%) had a positive HCV antibody (Ab). 446/553 completed RNA testing, 301/446 (67%) tested positive for HCV RNA. Disease notification and education were provided to 266/301 (88.4%) (Figure 1). The 301 with confirmed HCV infection were 79% male, 48% non-Hispanic black, 37% non-Hispanic white, 15% Hispanic, with a median age of 50. Over half (51%) reported a history of injection drug use, 17% reported tattoos and 53%were sent to prison from jail. 186/240 (78%) had no insurance/charity care, 10%Medicaid, 5%Medicare, 5% Veterans affairs and <1% had private insurance. Among HCV+ individuals released to the community who were contacted by phone, 2/23 were scheduled with an HCV provider, 3 were planning an appointment, 2 did not desire HCV treatment, 17 were unable to be reached. Conclusion: HCV is prevalent among jail inmates, and the most common risk factors for infection are injection drug use and tattoos. Proximal steps in the HCV care cascade, including antibody testing and RNA confirmation of infection, as well as education and risk reduction counseling were feasible in this setting. Half of HCV+ inmates were transferred to prison and the majority were uninsured, highlighting challenges to continuity of care and completion of HCV treatment in this population.

Poster Abstracts

CROI 2018 220