POSTER PRESENTATIONS

Models of Care
P327 Modelling the cost-effectiveness of HIV care in Poland shows clear benefits, while
transmission risk is considered in the calculations
Kowalska, J*; Wójcik, G; Rutkowski, J; Ankiersztejn-Bartczak, M; Siewaszewicz, E (Warsaw, Poland)
P328 Targeting HIV testing at a population level: cost-effectiveness of three approaches
Gomez Ayerbe, C*; Muriel, A; Reverte, C; Perez Elias, P; Del Campo, S; Vivancos, M; Santos, C;
Calonge, M; Uranga, A; Moreno, A; Moreno, S; Casado, J; Perez Elias, M (Madrid, Spain)
P329 HIV linkage to care: impact of a proactive intervention in a health area of Spain
del Campo, S*; Gómez Ayerbe, C; Vivancos Gallego, M; Moreno Zamora, A; Casado Osorio, J;
Loza de Bobadilla, E; Galán Montemayor, J; Rodriguez Dominguez, M; Dronda Nuñez, F;
Sanchez Conde, M; Moreno Guillén, S; Pérez Elías, M (Madrid, Spain)
P332 Efficiency of antiretroviral therapy in Russia
Pokrovskaya, A*; Kozyrina, N; Guschina, U; Suvorova, Z; Yurin, O; Pokrovskiy, V (Moscow, Russian
Federation)
P333 Closing the gap of perinatal HIV infection in Hong Kong
Wong, C*; Lin, W; Wong, K (Hong Kong, Hong Kong)
P334 ‘The first 90’: how close can we get with home-based HIV testing? First results from
recruitment for the CASCADE trial in rural Lesotho
Labhardt, N*; Ringera, I; Lejone, T; Muhairwe, J; Fritz, C; Klimkait, T; Glass, T (Basel, Switzerland)
P335 Characterisation of an inmate population followed in an infectious diseases department in
the centre of Portugal
Casella, M*; Ascenção, B; Goes, A; Pinto Luís, N; Messias, A; Brito, A; Joana, S; Poças, J (Setúbal,
Portugal)
P338 Reasons for transferring HIV care in London
Ahmed, N; Scott, D; Waters, L*; Matin, N; Whitlock, G (London, UK)
P339 Atmosphere of risk or family-like support? Alternative patient experiences of decentralized
care in North Central Nigeria
Kolawole, G*; Gilbert, H; Dadem, N; Agaba, P; Genberg, B; Agbaji, O; Okonkwo, P; Ware, N
(Jos, Nigeria)

*Indicates presenting author.

 HIV Drug Therapy Glasgow 2016
Abstract Nr P 327
jdkowalska@gmail.com

Modelling the cost-effectiveness of HIV care in Poland shows clear

benefit while transmission risk is considered in the calculations
Justyna D. Kowalska 1, Grzegorz Wójcik 2, Jakub Rutkowski 2, Magdalena Ankiersztejn-Bartczak 3, Ewa Siewaszewicz 4
1. Hospital for Infectious Diseases, Medical University of Warsaw 2. HTA Consulting, Krakow, Poland 3. Foundation of Social Education (FES) 4. Gilead Sciences, Poland

Background Methods

 Cost-effectiveness analyses of HIV treatment are usually based on
individual benefits quantified by CD4+ counts and morbidity, but
avoided transmission events are rarely considered
 Here we evaluate the impact of sexual HIV transmission due to
delayed cART on the cost-effectiveness of HIV treatment
 For the input data Test and Keep in Care (TAK) project cohort pre-
clinical and clinical information was used [15].
 Analysis was performed from the public payer perspective therefore
costs were based on real expenditures of Ministry of Health, National
Health Fund (NFZ), available studies [16–18] and expert’s opinion.

Methods  Costs and effects were discounted at rates of 5% and 3.5%,

respectively.
 A lifetime Markov model (1-month cycle) was developed to estimate
 Cost-effectiveness threshold for incremental cost-utility ratio (ICUR)
lifetime costs, clinical outcomes, and cost per quality adjusted life
was set to 125 955 PLN (29 312 EUR) according to Ministry of Health
years (QALY) gained for 1 and 3 year delay in starting cART (as
requirements.
compared to starting immediately at linkage to care).

 Health states included >20 illnesses/events into the model grouped Results
as: asymptomatic HIV, AIDS defining condition (mild, moderate,
severe) [1], Hodgkin’s Lymphoma, non-AIDS defining condition.  Input data were available for 141 patients form TAK cohort.

 Mortality rates and utility values were obtained from published
literature [2-13].
 Number of new infected persons was estimated based on sexual
orientation, number of sexual partners per year, number of sex acts
per month, frequency of condom use and use of cART [14].
 For viral suppression we assumed that patients had HIV RNA <50
copies/ml immediately after starting cART and for a lifetime.
 Transmission risk was presented for three scenarios: low, medium,
high. (see Figure 1 for definition)
 Costs of care, cART and potential life-years lost were based on
estimated total costs and the difference in expected QALY gained
between HIV-positive and average person in Polish population.
 Parameters for the model were: female gender 4.3%, mean age 36.1
(SD 7.6) years, mean CD4 count 413 (SD 196) cells/µl , median HIV RNA
4.4 (IQR 3.7-5.0) log copies/ml, transmission mode: homosexual
83.7%, heterosexual 9.9%, bisexual 5.7%, drug use 0.7%.
 If additional costs of treatment and potential life-years lost due to new
HIV infections were not taken into account, initiating cART immediately
at linkage to care was not cost-effective irrespective of cART delay.
When additional costs and QALY lost were included immediate cART
initiation was dominant (cheaper and more effective) regardless of the
chosen scenario (Figure 1).
Conclusions
 Accounting for HIV transmission in cost–effectiveness analysis
provides further evidence supporting immediate initiation of HIV
treatment from a public payer perspective.

References:
1. Mocroft A. Clinical Infectious
Diseases 2013; 57(7):1038–1047.
2. Mocroft A. Clinical Infectious
Diseases: 2009; 48(8):1138–1151.
3. Worm SW. BMC infectious diseases.
2013; 13:471.
4. Hasse B. Clinical Infectious Diseases.
2011; 53(11):1130–1139.
5. Ryom L. AIDS. 2014; 28(2):187–199.
6. Friis-Møller N. European Journal of
Preventive Cardiology. 2016;
23(2):214–223.
7. Petoumenos K. Journal of the
International AIDS Society. 2012;
15(2):17426.
8. Sterne JAC. Lancet. 2009;
373(9672):1352–1363.
9. Kovari H. Journal of Hepatology.
2015; 63(3):573–580.
10. Hleyhel M. International Journal of
Cancer. 2015;137(10):2443–2453.
11. Tengs TO. 2002;22(6):475–481.
12. Bayoumi AM. AIDS. 1998;
12(12):1503–1512.
13. Golicki D. Advances in Medical
Science. 2015;125(1-2):18–26.
14. Lasry A. AIDS 2014;28(10):1521–
1529.
15. Ankiersztejn-Bartczak M. HIV
medicine. 2015;16(2):88–94.
16. Amarowicz J. Ortopedia,
Traumatologia, Rehabilitacja. 2015;p;
17(1):59–69.
17. Rak płuc z perspektywy NFZ 2002-
2010. http://hospicjum.tarnow.pl/
Cost-effectiveness for ICUR is below 125 955 PLN (29 312 EUR) according to Polish Ministry of Health requirements. news/1301039672011_06_02_rak_pluc
_koszty.pdf.
18. Kinalska I. Diabetologia Praktyczna.
 P-328

Targeting HIV Testing at a Population level: Cost-effectiveness of three Approaches.

C.  Gómez  Ayerbe1,  A.  Muriel2,  C.  Reverte1,  P.  Pérez  Elías3,  S.  Del  Campo1,  M.J.  Vivancos1,  C.  Santos3,    M.E.  Calonge3,  A.  Uranga3,  A.  
Moreno1,  S.  Moreno1,  J.L  Casado1,  M.J.  Pérez  Elias1,  DRIVE  Study  Group  

1  InfecJous  Diseases  Dep.,  Ramón  y  Cajal  Hospital,  Madrid,  Spain;    2  StaJsJcs  Dep.,  Ramón  y  Cajal  Hospital;  3  Garcia  Noblejas  Primary  
Care  Centre,  Madrid  
BACKGROUND and OBJECTIVE
Targeted  HIV  TesJng  has  been  proposed  as  the  most  efficient  strategy  to  diagnose  HIV  infected  subjects  in  low  prevalence  populaJons.    

•  However,  idenJfying  these  people  at  risk  of  HIV  InfecJon  can  be  someJmes  difficult  and  takes  many  Jme.  

In  DRIVE  01  Study  we  proved  that  a  Targeted  HIV  TesJng  strategy,  filling  a  self-­‐administered  Risk  Exposure  &  Clinical  Indicators  (RE&CI)  QuesJonnaire  and  then  tesJng  
for  HIV  InfecJon  only  subjects  with  a  posiJve  QuesJonnaire  (≥1  afirmaJve  answer),  could  idenJfy  the  same  number  of  New  HIV  Diagnoses  (NHD)  as  a  non-­‐targeted  
strategy  (RouJne  HIV  TesJng  strategy).    
•  Moreover,  this  Targeted  HIV  TesJng  strategy  reduced  cost.  

Compare  cost-­‐effec.veness  of  three  different  HIV  Tes.ng  Targeted  Approaches,  previously  validated  to  predict  HIV  infec.on.      

METHODS
DRIVE  01  Study  is  a  non-­‐Targeted  HIV  TesJng  Programme    performed  in  Emergency  Department  and  Primary  Care  Centre  (PCC).  All  parJcipants  were  tested  for  HIV  
(Rapid  Test)  and  filled  out  the  self  administered  RE&CI-­‐QuesJonnaire.  

The  3  tools  considered  were:  

• RE&CI-­‐QuesJonnaire,    consisted  on  6  quesJons  to  evaluate  Risk  of  Exposure  to  HIV  infecJon  and  14  other  to  asses  HIV  associated    
Clinical  Indicators  (from  HIDES  Study).  One  afirmaJve  item  was  considered  as  posiJve  (Medicine).  
• Denver  HIV  Risk  Score,  is  a  validated  tool  to  target  HIV  tesJng  to  people  with  the  highest  risk,  includes  only  demographics  (age,  sex,  race/
ethnicity),2  risk  behaviors  (injecJon  drug  use),  and  the  history  of  HIV  tesJng,  a  cut  off  >  30  was  considered  (Haukoos  et  al.  2013;)  
• and  HIDES  Study  using  14  Clinical  Indicators,  one  clinical  condiJon  is  considered  (Sullivan).  
We  calculated  SensiJvity  (Sn),  Specificity  (Sp),  PosiJve  PredicJve    Value  (PPV)  and  NegaJve  PredicJve  Value  (NPV)  of  the  three  tools,  considering  the  gold  standard  
confirmed  cases  of  HIV  InfecJon  with  EIA/WB  

Number  of  Missed  HIV  InfecJons  (MHI),  Test  avoided  and    number  of  test  to  obtain  a  posiJve  result  were  calculated  

Provider  perspecJve  directed  costs  of  HIV  tesJng  and  confirmaJon  plus  RP&CC  quesJonnaire  were  considered  to  calculate  Incremental  costs/effecJveness  raJo  

RESULTS
 DRIVE  01  Popula.on
Accuracy  of  three  HIV  Targeted  Tes.ng  Strategies:  RE&CI  Ques.onnaire,  Denver  HIV  Risk  Score  and  
N 5,329 14  IC  of  HIDES  Study  
Sex  Women 50.36% Number  of  test  
Median  age  (IQR) 37   Number  of  
Sn   Sp   PPV   NPV   NHD/MHI  
test  avoided  
to  obtain  one  
(28-­‐47) posiJve  
OrigIn     Non-­‐Targeted  
22/0   0   242  
       Spain   74.92%   Strategy  
       LaJn-­‐Americans   20.12%   RE&CI   100%   49%   0.80%   100%  
       East  Europeans               2.53%   22/0   2,601   124  
QuesJonnaire   (84.6-­‐100%)   (47.7-­‐50.4%)   (0.5-­‐1.2%)   (99.9-­‐100%)  
       Others 2.42%
DHRS   72.7%   60.41%   0.76%   99.8%  
LocaJon     16/6   3,212   132  
(54.1-­‐91.3%)   (59.1-­‐61.7%)   (0.39-­‐1.1%)   (99.6-­‐99.9%)  
       PCC   69.3%   14  CI  HIDES   91%   74.4%   1.4%   99.9%  
       Emergency  Dep. 30.7% 20/2   3,948   69  
(70.8-­‐98.9%)   (73.2-­‐75.6%)   (0.88-­‐2.2%)   (99.8-­‐100%)  
POSITIVE  RE&CI   52.1%
QuesJonnaire
The  cost  for  one  HIV  Diagnosis  was:  552  €  (HIDES),  992  €  (RE&CI  QuesJonnaire)  and  1,058  €(Denver  HIV  Risk  Score).  
DENVER  HIV  Risk   39.7%  
INCREMENTAL  COST:  
Score  >30
The  save  per  HIV  Diagnosis  was  66  €  in  RE&CI  QuesJonnaire  Strategy  and  506  €  in  HIDES  Strategy  respect  Denver  HIV  Risk  Score  
≥1  CI  of  HIDES 26.7%     Strategy.  

CONCLUSIONS
Working  group    Primary  Care  Center  García  Noblejas:  Esmeralda  Alonso,  Arancha  Alonso,  Josefa  Araujo,  
Alberto  Barbado,  Fernando  Barcala,    Rafael    Barea,    Rosario  Blanco,  Raquel  Blázquez,  Mª  Eugenia  

ü All  three  tools  avoided  HIV  Tests,  but  only  the  RE&CI  Ques.onnaire  captured  all   Calonge,  AgusJna  Cano,  Fuencisla  Consuegra,    Lino  Cota,  Mª  Teresa  Cuenca,    Maria  Escribano,  
Concepcion  Falcón,  Mercedes  Fernández,  Mercedes  Fraile,    Pilar  García  ,Rocio  Garrido,  Mª  Isabel  
González,  Juan    Jose  González,  Mª  Jesus  González,  Pilar  González,  Carmen  GuJérrez,  Adelaida  Iglesias,  

HIV-­‐Infected  subjects  detected  by  the  non-­‐targeted  strategy.  

Victoria  Izquierdo,  Juan  Jose  Jiménez,  Eduardo  Llamazares,    Rafaela  Lerín,  Mª  Jose  López  Bonillo,  Luisa  
Lorente,  Antonia  MarJn,    Eva  MarRn  Gracia,    Jose  Luis  MarRnez,  Silvia  Medrano,  Lucia  Naranjo,  Juana  
Pascual,    Jose  Parra,  Rosa  Pavo,  Pilar  Pérez  Elías,    Lidia  Polo,  Rosario  Ruíz  Giardín,  CrisJna  Santos,    
Alberto  Serrano,  Luis  Miguel  Serrano,  Pilar  Sanz,  Rosario  Sobrino,  Isabel  Susaeta,  Mariano  Torres,    
Araceli    Treceño,  Julio  Turrientes,  Almudena  Uranga.  Working  group  Hospital  Ramón  y  Cajal:  SanJago  

ü A  selecJon  of  HIDES  list  presented  a  high  sensiJvity,  and  was  able  to  avoid  the   Moreno,  CrisJna  Gómez-­‐Ayerbe,  Alberto  Diaz,  Ana  Moreno,  Alfonso  Muriel  Beatriz  Hernandez,    
Carolina  GuJerrez,  Jose  Luis  Casado,  Angela  Trueba,  Ana  Arizcorreta,  Fernando  Dronda,  Gema  
Robledillo,  Marta  Fernandez,  Sandra    Ibarra  Lorenzo,  Beatriz  Sanz  Arias,    Rocio  Curiel  Serradilla,  CrisJna  
Fernández  San  Pedro,    M    Bueno  Pozo,    Mª  Teresa  sanchez  leiva,  Mª  Dolores  López  Pérez,  Carmen  

highest  number  of  tests.   Quereda,  Paloma  MarR-­‐Belda,  Isabel  Hornero,  Laura    Etxeberria,  Juan  Carlos  Galán,  Jose  María  
Gonzalez-­‐Alba,  Dolores  pastor  Pinilla,  Pilar  Regojo  Dans,  Ana  Belen  Sanchez  Rubio,  Marta  Gonzalez  
Gómez,  Serafina  Perez  Figueroa.    
   

ü Cost  of  each  NHD  obtained  using  RE&CI-­‐QuesJonnaire  compared  to  HIDES  list  is  
This  study  was  financiated  with  two  compeJJve  grants:  ISCIII  
low  with  respect  to  the  benefit  obtained.   (FISS),  PI12/00995  parcialmente  financiada  por  FEDER  ,  MSSSI  
EC11/144  .  
 HIV linkage to care:

Impact of a proactive intervention in a Health Area of Spain.

S. del Campo1; C. Gómez Ayerbe1; MJ. Vivancos Gallego1; A. Moreno Zamora1; JL. Casado Osorio1; E.
Loza de Bobadilla2; JC. Galán Montemayor2; M. Rodriguez Dominguez2; Mateos M2 F. Dronda Nuñez1; M.
Sanchez Conde1; S. Moreno Guillén1; MJ. Pérez Elías1.
1. Hospital Ramón y Cajal Infectious Diseases IRYCIS Madrid Spain; 2. Hospital Ramón y Cajal
Microbiology Madrid Spain
P-349

BACKGROUND RESULTS
Overall 21,049 HIV tests were requested (9,969 and 11,072 in 1st
Ø Early identification of people living with HIV (PLHIV), timely initiation of
antiretroviral therapy (ART) and lifelong care are key elements towards and 2nd periods).
achieving universal access to HIV treatment and therefore ending the Table 1: baseline and outcome results (overall and according to period)
epidemic.
Ø The full benefits of HIV Testing are the continuum of care for PLHIV, which 1st PERIOD 2nd PERIOD
extends from HIV Testing through enrollment in HIV care, ART initiation and Overall P value
2015 2016
retention in life-long ART and chronic care. For different reasons many
patients are lost in some of these steps, and do not complete the whole 1st HIV tests 21,049 9,669 11,072
cascade.
NHIVD 108 (0.51%) 60 (0.56%) 48 (0.44%) p=0.16
Ø We think that linkage to care is one of the essential steps in HIV cascade of
care, and failure to retain PLHIV on life-long treatment after treatment Sex (Women) 18 (17%) 12 (20%) 6 (12%) p=0.3
initiation is another reason for loss of PLHIV and for the failure to achieve
and sustain viral load suppression. Age 36 (28-42) 38 37 P=0.6
(years mean RIQ)
OBJETIVE Setting
37 (34%) 35% 35%
PHA p=1
Ø The objective of this work, is to evaluate the impact of an active 71 (66%) 65% 65%
HD
intervention aimed to shorten time from first HIV EIA result to first HIV
outpatient clinic visit. Linkage to care
96 (89%) 50/60 (83%) 46/48 (96%) p=0.062
(yes)
METHODS
Time to be linked
77 (46-108) 104 (54-157) 30 (20-39)
(Mean estimated) p=0.410
Days Days Days
log-Rank
qThis is a first interim analysis of Infectious Diseases and Microbiology
Services linkage to care intervention.
Figure 1: Time to linkage in the two periods of study.
qPeriod of study: From 1st of January to 30th of June 2015 (1st period) and
same dates 2016 (2nd period) we identified all first positive HIV EIA (HIV)
results obtained in the Microbiology Laboratory Department (MlabD) of Ramón Probability to be linked at 93 days was
82.5% vs. 97% for the first and second
y Cajal Hospital (RyC). periods, respectively p=0.41

qAll Samples came from two main settings: Hospital Departments (HD), or .
Primary Health Area (PHA).

qIn 2015 period, HIV+ results were electronically informed and when
possible prescriber physician was alerted by phone, that a second sample
needs to be sent to confirm serology. In the 2016 period addition to the
above mentioned, all HIV + results were weekly identified and we phoned the
requesting physician informing the HIV+ result and recommending that the
confirmation and the first HIV visit should be done as soon as possible at the
HIV outpatient Clinic.
Figure 2: Time to linkage according to sex.
qNumber and result of HIV tests, linkage to RyC HIV clinic or other clinic and
time (days) to first HIV visit of HIV+ cases where compared between the two 1,0

periods. Categorical variables were compared with the Chi-squared or the Probability to be linked at 97days was 73%
Fisher’s exact test using contingency tables, whereas continuous variables vs. 90% for women and men respectively, SEX
Probability to be linked according to sex

were compared with the Student’s t-test. Regression analysis models, and 0,8 time to be linked in women was 156 (48- Women

log-Rank test along with Cox regression models were also used for time to 267) vs.61 (32-90) days p=0.041 Male
W-censored
M-Censored
event variables
0,6

Interventions 0,4

HIV EIA were electronically informed in Both periods

0,2

1st period (2015) 2nd period (2016)

0,0

0,00 100,00 200,00 300,00 400,00 500,00 600,00

Time to first HIV clinic visit , according to sex

Personal call to physicians Weekly review of all HIV + Serologies

when possible and phone/email comunication to
requesting physician In a regression model, we found a trend towards a better linkage rate
during second period, in an unadjusted model, OR 4.6 95% IC (0.95-22.1),
this effect attenuated by sex OR 4.3 95% IC(0.88-20.9), while men have a
trend towards a better linkage rate, in an unadjusted model 2.9 95% IC
Confirmation by Primary (0.77-11.04), and this effect was also attenuated by the period of
Confirmation in Hospital HIV
Care Physicians observation 2.59 95% IC (0.67-10.13).
outpatient clinic.

Conclusions
High rates of linkage to care were observed in both periods studied, near or higher than UNAIDS objectives
In this preliminary analysis a trend towards a higher rate of and less time to linkage to care were observed in the
intervention period, but the effect was attenuated by sex .
 hiv Drug Therapy Glasgow 2016
23-26 October 2016 1
Central Research institute of Epidemiology, Russian Federal
P332 AiDS Centre, Moscow, Russia
RUDN University, Moscow, Russia
EfficiEncy
2

3
Regional AiDS Centers, Russia

of antirEtroviral A.V. Pokrovskaya1,2 Z.K. Suvorova1 Portrait of the

N.V. Kozyrina1 O.G. Yurin1 Patient study
thErapy in russia U.S. Guschina2 V.V.Pokrovskiy1 group3

Background: art combinations prescribing for naïve patients

pic.2

ART is available for free in Russia for PLh, who visit special in russia in 2009-2014 years
AiDS centers. According current guidelines ART is eligible Female
Other 26,9%
for all PLh, but for patients with CD4 <350cells/ml is priority. Male
ABC + 3TC + EFV 2,6% All
At the beginning of the year 2015 more than 200.000 PLh were ZDV + 3TC + DRV/r 3,0%
on ART. The aim of this study was to characterize th basic Ф-АЗТ + 3TC + LPV/r 3,1%
aspects of antiretroviral therapy among PLh who visited AiDS ABC + 3TC + LPV/r 3,4%
centers in Russia in order to develop recommendations for new ZDV + 3TC + NVP 3,8%
treatment guidelines. ZDV + 3TC + ATV/® 8,9%
ZDV + 3TC + LPV/r 21,7%

Methods:
ZDV + 3TC + EFV 26,6%
0,0% 5,0% 10,0% 15,0% 20,0% 25,0% 30,0% 35,0% 40,0%

Multicenter, open-label study with the inclusion of a retrospective
model. We analyzed medical records and questionnaires of 7,000
adult patients, who visited AiDS centers and signed an informed
consent form in 27 regions of Russia in April — July 2014. Funding
support for this study was provided by Bristol-Myers Squibb.
Results:
3,406 (49%) of all recruited participants were females,
1  was transgender. Mean age — 35, median — 34 (18-79)
years. The majority of females were infected through sex
(77.4%), more males reported iDU in the past (57.4%). 10%
of participants were current drug addicted. 4445 (60%) of
all participants were on ART which was initiated at mean
CD4 — 224.6±138.9; median — 216 (1-1400) cells/ml (pic.1).
pic.1
cD4-cells level at the start of art
Median CD4 — 216 cells/ml
Mean CD4 — 224.6±138.9 cells/ml
ZDv+3TC+ATv/(r) (8.9%) — pic.2. The average duration of ART
was 34 months (max — 16 years), 18.7% of study participants
were on ART over 5 years — pic.3. 52.3% of patients received
the first ART combination, 29.1% — the second (max — 9 ART
regimens in patient). The main causes of treatment regimens
change were adverse events — 43.3%, simplification (reducing
the number of pills and multiplicity) — 27%, pregnancy — 11.2%.
The most frequent adverse events of the first ART regimens
were: gastrointestinal disorders (33.7%), CNS disorders (22.3%),
anemia/leukopenia (14.8%), rush/dermatitis/allergic reaction
(10.15%). virologic failure was the cause of ART change only
in 3% of patients. 83.9% of patient in the study reached hiv
RNA<1000 copies/ml and 69.1% — less 400 copies/ml at the
end of the first year of treatment. Among patients, who have
segodiscordant regular sexual partner, only 66.7% were on
ART. We noted substantial improvements over time in the
proportion of individuals on ART. The proportion of hiv
diagnosed patients who received ART increased from 18%
in 2011 to 23% in 2013.

43,4 34,9 9,4 3,7 8,5

% % % % %
pic.3
Duration of art in study participants
50,0%
CD4 < 50 50 — 200 201 — 350 351 — 500 > 500 45,0%
cells/ml cells/ml cells/ml cells/ml cells/ml
40,0%
35,0% 32,1%
Termination of therapy in  the time of the study was recorded 30,0%

in 10.1% of patients. Brand name ART drugs were mainly used 25,0% 20,6% 18,7%
20,0%
17,9%
in the period of the study. The most commonly prescribed 15,0% 10,7%
10,0%
ART combinations for naive patients in period 2009-2014 5,0%
0,0%
years were: ZDv+3TC+EFv (26.6%), ZDv+3TC+LPv/r (21.7%), < 6 months 6 months
– 1 year
1 – 3 years 3 – 5 years > 5 years

Conclusion: the majority of patients receiving art in russia have not yet a very long treatment experience.
cD4 level at the moment of art initiation was low. though old-fashioned art combinations
were effective and tolerable in a part of the patients, the number of adverse effects were
significant. Measures are needed to encourage earlier art initiation and use drugs with
lower toxicity.
 P333

Wong, Chun Kwan Bonnie, Lin, Wai Chi Ada, Wong, Ka Hing
Special Preventive Programme, Centre for Health Protection, Department of Health
Hong Kong Special Administrative Region

Background Results
•  To achieve the ultimate goal of eliminating perinatal •  UATP has high coverage rate of >98% in recent
transmission, we reviewed and identified gaps of the years
current public health programme for the prevention of •  From 2001 to 2014, 3 perinatal infections were
mother-to-child transmission (PMTCT) of HIV in identified out of 72 infants born to HIV-infected
Hong Kong, a region with low HIV seroprevalence of mothers. All three were detected before 2007, two of
<0.01% in the antenatal population which were due to late presentation to antenatal care
•  The Universal Antenatal HIV Testing Programme without participation in UATP. The others was due
(UATP) was introduced in 2001, with an aim to to failure of intra-partum and post-partum
interrupt MTCT through timely diagnosis and intervention when the mother presented 6 days prior
management of infected expectant mothers to her pre-term delivery (Table 1)
•  The programme was strengthened with implementation •  The incorporation of Rapid HIV Testing in 2008
of Rapid HIV Testing component in 2008 to offer had filled the gap for late-presenting pregnant
rapid HIV test in labour wards for women who did not women so that interventions could be offered to
receive testing in early antenatal period HIV-infected women not identified by UATP (Fig. 1)
•  Since 2008, the percentage of women with HIV test
results known prior to delivery remained above
98.6%; and 97% of HIV positive mothers and their
Methods babies had received either 3-part or 2-part ART
•  However, five cases of HIV-infected children born
•  We reviewed the programme performance, and to their infected mother who were tested negative by
matched with perinatal infections reported UATP in the early antenatal period were reported in
2009 to 2015. Unprotected sex during pregnancy was
the common risk factor. All 5 mothers and all but
one of the spouses/partners were either non-Hong
Kong residents or originated from Asian or African
countries where the HIV prevalence was higher than
Hong Kong, highlighting this unique epidemiological
pattern.

Figure  1    

Table  1.  Three  cases  of  perinatal  HIV  infec6ons  due  to  late  
presenta6on  to  antenatal  care  prior  to  introduc6on  of  Rapid  HIV  
Tes6ng  in  labour  units  

Conclusion
•  The gap in PMTCT in Hong Kong lies in the HIV-infected women who seroconverted after they were
tested negative in the early antenatal period
•  Partner counselling and testing, enhancement of safer sex, targeted HIV retesting at third trimester for
pregnant women based on their epidemiological and behavioural risks are options to close the gap

International Congress on Drug Therapy in HIV Infection , 23-26 October 2016, Glasgow, UK
 The first “90” Poster Number: P334

How close can we get with ‘door-to-door HIV testing’? –

Preliminary results from recruitment for the CASCADE-trial in rural Lesotho

1 Clinical Research Unit, Medical Services and

Niklaus Daniel Labhardt1,2 Diagnostic, Swiss Tropical and Public Health
Isaac Ringera3 Institute, Basel, Switzerland
2 University of Basel, Switzerland
Thabo Ishmael Lejone3 3 SolidarMed, Swiss Organization for Health in
Josephine Muhairwe3 Africa, Maseru, Lesotho
4 SolidarMed, Swiss Organization for Health in
Christiane Fritz4 Africa, Lucerne, Switzerland
Thomas Klimkait5 5 Molecular Virology, Department of Biomedicine,
Basel, Switzerland
Tracy Renee Glass1,2

Background 100%

Person not encountered at

The first of the UNAIDS 90-90-90 aims at 90% coverage of HIV 90% Person not encountered at home
testing and counselling (HTC) [1]. Studies on HTC at the homes of home 3313
4893
individuals report HTC uptake (individuals tested / individuals 80% Person present, declines
encountered at home) of >90%[2]. However, HTC coverage testing
1925
(individuals knowing their status / individuals living in targeted 70% Person present, declines
testing
area) remains below 90% because of persons absent during home- 1925
+ 8%
60%
based HTC[3]. This study assesses the HTC coverage achieved in
Persons who know
Lesotho after two consecutive home-visits in order to achieve their HIV status
Person present, tests HIV-negative
50%
maximal coverage and to cover presence during the week and on 10782

weekends. 40%
Person present, tests HIV-negative
9240

Materials and Methods 30%

The study was conducted in Lesotho, Southern Africa. Data derive

20%
from home-based HTC campaigns serving to recruit HIV-infected Person present, tests HIV-positive Person present, tests HIV-positive
301 329
individuals for the CASCADE-trial (NCT02692027). Assessment of 10%
HTC coverage after two home visits is a nested study in the published Person present, known HIV Person present, known HIV
positive; 1371 positive; 1381
CASCADE-trial protocol[4]. The primary outcome of interest was the 0%
HTC coverage in targeted areas after two visits. Counsellors visited After 1st visit After 2nd visit
randomly selected villages or urban areas moving door-to-door and
Figure 1: HIV testing coverage after first and second household visit
offering HTC to all household members. Each area was visited twice,
once during the week and once during a weekend day. Household-
members were defined as spending at least one night at least twice a Total n (%) Odds-ratio (95%CI) p-value
month in that household. The duration of the HTC campaigns was Encountered at home
from February 22 to July 3, 2016. Data were captured on tablet - Women ≥15 years 8115 7211 (88.9) 1
computers and synchronized daily[5]. - Men≥ 15 years 5209 3668 (70.4) 0.30 (0.27 – 0.33) <0.001
- Children <15 years 4393 3534 (80.5) 0.52 (0.47 – 0.57) <0.001
Results
HTC Uptake
From February 22 to July 3, 2016 counsellors visited 6429 occupied
- Women ≥15 years 7211 6204 (86.0) 1
households with 17,887 household members in 60 rural villages and
- Men≥ 15 years 3668 3116 (85.0) 0.92 (0.82 – 1.03) 0.13
17 urban areas; 1988 (30.9%) households were revisited because of
members absent at first visit. Among individuals encountered at - Children <15 years 3534 3048 (86.3) 1.02 (0.91 – 1.14) 0.77
home, 1381 (9.5%) were already known to be HIV-infected. Among HTC coverage
the 13,193 with unknown HIV-status, 11,268 (85.4%) accepted HTC. - Women ≥15 years 8115 6204 (76.5) 1
HTC coverage in visited areas increased from 62.7% after the first to - Men≥ 15 years 5209 3116 (59.8) 0.46 (0.43 – 0.49) <0.001
70.5% after the second visit (figure 1). Table 1 shows HTC uptake
- Children <15 years 4393 3048 (69.4) 0.70 (0.64 – 0.76) <0.001
and HTC coverage after two visits, stratified by age and gender. HTC
uptake was similar among men and women, but coverage was lower
Table 1: Logistic regression for endpoints according to age and gender
among men due to a lower proportion encountered at home.

Conclusion
A second catch-up visit on a weekend increased the proportion of
persons knowing their HIV status by 8%, but home-based HTC still
fell short of the targeted 90% coverage. Future strategies need to
combine home-based HTC with approaches specifically tailored to
frequently absent household members, such as testing at the work-
place or school-based HTC or self-testing.
References
(1) 90-90-90 an ambitious treatment target to help end the AIDS epidemic. UNAIDS / JC2684 (accessed October 30th 2014 at
Www.unaids.org) 2014, Oct.
(2) Labhardt ND, Motlomelo M, Cerutti B, Pfeiffer K, Kamele M, Hobbins MA, Ehmer J. Home-Based versus mobile clinic HIV
testing and counseling in rural lesotho: A cluster-randomized trial. PLoS Med 2014, Dec;11(12):e1001768.
(3) Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing
to address linkage to care gaps in sub-saharan africa. Nature 2015, Dec 3;528(7580):S77-85.
(4) Labhardt ND, Ringera I, Lejone TI, Masethothi P, Thaanyane T, Kamele M, et al. Same day ART initiation versus clinic-
based pre-art assessment and counselling for individuals newly tested hiv-positive during community-based HIV testing
in rural lesotho – a randomized controlled trial (CASCADE trial). BMC Public Health 2016, Apr;16(1):1.
(5) https://visibleimpact.org/projects/1197-cascade-trial
 CHARACTERIZATION OF AN INMATE POPULATION FOLLOWED IN AN
INFECTIOUS DISEASES DEPARTMENT IN THE CENTER OF PORTUGAL
Casella, MI1; Ascenção, B1; Goes, AT2; Luís, NP1; Gonçalves, AC1; Brito, AP1; Sá, J1; Poças, J1
1. Infectious Diseases Department, Hospital de São Bernardo – Centro Hospitalar de Setúbal, Setúbal, Portugal
2. Internal Medicine Department, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal

Introduction:
The elevated prevalence of HIV and HCV infections among inmates has been
closely linked to intra-venous drug use (IVDU) and the sharing of injection
equipment. [1]
The prevalence of HIV in the general population in Portugal is one of the highest
of Western Europe (~0.6%), and although the prevalence in IVDU is decreasing
in general population, this is not the rule in the incarcerated population. [2]
Approximately 20% of convictions in Portugal are due to drug-related crimes,
which emphasizes the expected role of drug injection behavior in the
transmission of these infections among the imprisoned population. [3,4] http://www.rd.com/wp-content/uploads/sites/2/2016/02/march-2016-the-moth-small-town-prisoner.jpg

Materials and Methods:

The HIV and HCV prevalence was estimated among inmates of two male prisons in the center of Portugal (Pinheiro da
Cruz and Setúbal), followed in the Infectious Diseases Department between 2014 and 2016.
Data was obtained from the hospital medical records. Collected information included variables such as age, country of
birth, transmission risk, serological status, and adherence to consultation and therapy. Patients were considered as
refractory to consultation if they had fewer than two consultations per year.

Results:
Approximately 1000 men were incarcerated in those prisons at the time of data collection [4]. 82 (8%) were under follow
up in our hospital.

Fig.1 Distribution by infection status Fig.2 Distribution by transmission

Fig.5 Distribution by adherence to follow-up and therapy

62% SVR

Fig.3 Distribution by HIV Classification (CDC Atlanta) Fig.4 Distribution of HCV patients by treatment

Conclusions:
HIV and HCV prevalence in the inmate population was 5 to 13 times higher than the general population, which represents
a major public health issue. Compliance to HAART is higher, probably due to controlled medication distribution in prison
facilities.
The prevalence of patients undergoing treatment for HCV is approximately the same as in general population.
National data on HIV and HCV prevalence among inmates, and the characterization of this population, might be a useful
measure to study the epidemiological situation, implement prevention interventions and to improve screening and
treatment for these two chronic conditions, as well as to implement measures to increase adherence to follow up. Recent
studies on this topic are sparse in Portugal and other European countries.
References:
1. Calzavara L, Ramuscak N, Burchell AN et al. Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities. CMAJ 2007; 177: 257–261.
2. Martins H, Shivaji T. Infecção VIH/SIDA: a situação em Portugal a 31 de Dezembro de 2014. National Programme for HIV/AIDS infections. Available on www.insa.pt [in
Portuguese]. ISBN (ebook): 978-989-8794-10-9.
3. Barros H, Ramos E, Lucas R. A survey of HIV and HCV among female prison inmates in Portugal. Cent Eur J Public Health 2008;16 (3): 116-120.
4. 2016 Statistics, in Direcção Geral Reinserção e Serviços Prisionais. Available on www.dgsp.mj.pt [in Portuguese].
 Reasons for transferring
HIV care in London
Ahmed, Nadia1 ; Scott, Duncan2* ; Waters, Laura1 ; Matin, Nashaba2 ; Whitlock, Gary3
1Mortimer Market Centre, CNWL London; 2Barts Health NHS Trust, London; 356 Dean Street, London.

Background Materials and Methods

• In England people living with HIV (PLWH) can access care at any • Patients transferring their HIV care to one of three London clinics
centre, regardless of geographical location. between December 2015 to June 2016, were asked to fill in a
• Non-UK born and individuals without residency are also entitled questionnaire:
to free HIV care at any service. • Bloomsbury clinic at Mortimer Market Centre
• There is no data currently available on reasons patients transfer • Graham Hayton Unit at Barts Health Trust
their HIV management and care from one service to another. • 56 Dean Street of Chelsea and Westminister Hospitals.
• We aimed to investigate reasons for transfer amongst PLWH • The questionnaire was designed to explore reasons for leaving
transferring their care to one of three London HIV units in London, their previous centre and reasons for choosing the new service.
UK.
Results
• 111 patients completed the questionnaire. • The main reasons for choosing the service patients transferred to
• 47% (n=52) transferred from services abroad (see figure 1), 37% shown in figure 2. Other reasons included: Figure 2. Venn
(n= 41) within London and 16% (n=18) transferred from outside of • recommendation by a third party including diagram showing
London. previous clinic, doctor, charity (n=6); reasons for choosing
Figure 1. Map showing countries patients have transferred from. • service specific to the clinic including the service patients
Canada (1)
specialist clinic, particular doctor, patient transferred to
Spain (6),
France (4) ,Poland (4),
Ireland (3), Italy (3),
representative support, weekend care (n=6);
• previously attending that clinic (n=5); 16 (14%)
Moldova (2), Portugal (2), Sweden (2),
Bulgaria (1), Cyprus (1), Denmark (1),
USA (2)
Friend/ family
• via the internet (n=1).
Germany (1), Netherlands (1),
Greece (1), Switzerland (1).
Hong Kong (3) attending
Bermuda (1)
Figure 2 Key: service
Turkey (2) Lebanon
(1)
Friend/family attending service
Friend/family attending service 3 (3%) 10 (9%)
AND good reputation 3 (3%)
Brazil (3) Thailand (1) Good reputation
Good reputation AND location 34 (31%) 22 (20%)
India (1) Location Location
5 (5%) Good
Australia (4)
Location AND friend/family attending service reputation
Friend/family attending service
AND good reputation AND location

• Current BHIVA guidelines recommend a medical summary should

be received within two weeks of transferring to a new a service.
• Reasons for leaving the previous HIV clinic is shown in table 1 • 27% (26/95) of patients were aware of the summary being
• Other services offered include specialist hepatitis C, received at the time of their first appointment of whom 10/26 had
cardiovascular, neurology and oncology. transferred their care within the UK. 35/95 stated it had not been
• Financial reasons included private insurance finishing and cost of received and 53/95 did not know. Figure 3 summarises this data.
medication being to expensive.
Figure 3. Bar graph showing whether patients were aware if their
Table 1. Reasons for leaving the previous HIV clinic medical summary had been received
50
Location 83 (75%)
Yes No Don’t know
Problems at the clinic 12 (11%) 38
Confidentiality 5 (5%)
Services offered 4 (4%) 25
Financial reasons 2 (2%)
Employments 2 (2%) 13
Lost to follow-up 2 (2%)
Other not specified 1 (1%) 0
Transfer from abroad Transfer within London Transfer from outside London

Conclusions
• Most patients transferred their care to another HIV service for geographical reasons.
• Reasons for choosing their new clinic included a combination of location, reputation or a friend/partner already attending the service.
• Reassuringly a minority cited problems at their old clinic as a reason to transfer care. However, this could have been due to sampling bias,
patients with problems may have been less likely to complete the questionnaire.
• In the age of digital media it is also interesting that only one patient found their chosen clinic via the internet.
• Patients seem to base their choice on recommendation.
*Our co-author Duncan Scott died in September 2016. Our thoughts are with his family.
 Atmosphere of Risk or Family-like Relationship?: Alternative Patient Experiences
of Decentralized Care in North Central Nigeria
Kolawole GO1, Gilbert HN, Dadem NY1, Agaba PA1, Genberg BL2, Agbaji OO1, Okonkwo P3 Ware,NC4
1Jos University Teaching Hospital, Infectious Diseases Unit, AIDS Prevention Initiative, Nigeria
2 Brown University, Providence, RI, USA
3 AIDS Prevention Initiative, Nigeria Ltd., Nigeria
4 Harvard Medical School, Boston, Massachusetts, USA

Background Results
Figure 1. For many patients, receiving care at decentralized sites resulted in (a) heightened
Decentralization of care and treatment for HIV Map of Africa Showing Nigeria risk of unwanted disclosure and (b) the development of family- like atmosphere.
infection in sub-Saharan Africa aims to make Factors explaining the negative effect of heightened risk of disclosure include: i)
treatment services available in local health holding the HIV clinic on specific, predictable days of week ii) the physical layout
facilities, closer to people’s homes. This effort has of the clinic, with waiting areas visible to the public, and iii) lapses in patient
played a critical role in scaling up treatment confidentiality by staff. Factors that contributed to the positive effect of a family-
services across the region. To better understand like atmosphere within the clinic include: i) the development of social
the impact of decentralized care from the patient relationships among patients, ii )the re-enforcement of social interactions among
perspective, we conducted a qualitative study that patients by staff, and iii) active efforts by staff to keep patients involved in care by
examined how patients experienced receiving care promoting a sense of caring.
close to their home communities. Nigeria
Study participants expressed a preference for decentralized care, emphasizing the
importance of easy access to care in terms of proximity and lower cost of
transportation as reasons for their preferences.
Methods
Study data were purposefully collected at one public and government, three faith-
Conclusion
based and one private hospitals (N=5). Ninety-three (N=93) male (N=22) and female Decentralized clinics embedded within communities can pose the risk of
(N=71) adults receiving decentralized HIV care and ART at the five participating sites unwanted disclosure. However, with patient-centered staff management, clinics
took part in individual, open-ended interviews and focus group discussions. The can use local positioning to promote family-like relationships and impact
Plateau State, decentralized HIV care program centers on a large tertiary health care
positively on patient perceptions of quality of care, and on retention.
facility, surrounded by associated general hospitals. Multiple primary health care
facilities are linked to each participating hospital. The entire sample had transferred
from the central Plateau State or another large HIV and AIDS care and treatment site.
Atlas.ti was used for organizing qualitative data. The interviews covered access to
care, services received, and experiences of stigma. Resulting data were content-
analyzed with the goal of inductively deriving a set of descriptive categories and
Acknowledgement
linking them together to tell a larger “story” about patient experiences of Funding: U.S. National Institute of Mental Health (K24MH090894, NC Ware, PI)
decentralized care.