566. Earlier Linkage and ART Initiation Via Fast Track Referral System for New HIV Patients Leads to Stronger Engagement and Better Outcomes
Session: Poster Abstract Session: HIV: Linkage to Care and Viral Suppression in the Care Cascade
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • VirataIDWeek18posterfinal.pdf (1.6 MB)
  • Background:

    To reach the 90-90-90 target goals for HIV care, clinical service requires a coordinated strategy to overcome barriers that prevent patients' sustained wellbeing. Earlier initiation of antiretroviral therapy (ART) improves desired outcomes yet it can be a difficult task. With the help the Early Intervention Service (EIS) from our local Health Department in Connecticut, our academic clinic implemented a Fast-Track Linkage (FTL) and ART process for clients new to HIV care by providing services within 10 days of diagnosis. The aim of our study was to compare this new system with the standard of care (SOC).

    Methods:

    We retrospectively reviewed the medical records of all new patients who were referred for HIV care at this single academic center from 2014-2016. Only patients not on ART at the initial visit were included. We divided them into two groups. One with patients that were newly diagnosed and utilized the FTL vs. all others. We compared the demographic and outcome data including retention in care, viral suppression (VS) and CD4 differences.

    Results:

    47 were referred via the FTL system. See Table 1. Our analysis did not identify any significant barrier to care. FTL patients were significantly younger. Retention, ART, VS and CD4 recovery were better in the group that was treated earlier.
    Table 1

    SOC

    FTL

    p

    n

    29

    47

    Age (median [IQR])

    50.00 [42.00, 55.00]

    31.00 [26.50, 39.50]

    <0.001

    Sex (%)

    0.367

    Female

    6 (20.7)

    5 (10.6)

    Male

    23 (79.3)

    41 (87.2)

    Race (%)

    0.583

    Asian/Pacific Islander

    0 (0.0)

    1 (2.1)

    Black, non-Hispanic

    17 (58.6)

    23 (48.9)

    Hispanic

    4 (13.8)

    6 (12.8)

    White, Hispanic

    1 (3.4)

    0 (0.0)

    Other

    0 (0.0)

    1 (2.1)

    White, non-Hispanic

    7 (24.1)

    16 (34.0)

    HIV risk group (%)

    0.011

    Heterosexual sex

    9 (31.0)

    12 (25.5)

    Injection drug use

    6 (20.7)

    1 (2.1)

    Men who have sex with men

    12 (41.4)

    34 (72.3)

    Time to first HIV clinic visit (median [IQR])

    N/A

    9.00 [0.00, 19.00]

    0.016

    Retained in care (>=2 visits in >90 days) (%)

    22 (75.9)

    43 (91.5)

    0.122

    Prescribed antiretroviral therapy (%)

    18 (62.1)

    43 (91.5)

    0.005

    HIV viral suppression at one year (%)

    20 (69.0)

    37 (78.7)

    0.495

    Initial CD4 counts at baseline (ave)

    340

    414

    0.334

    CD4 count change at d365

    +53

    +230

    0.004

    Conclusion:

    Implementation of FTL systems that include EIS can lead to successful and sustained high rates of VS and improved CD4 recovery. Larger scale initiatives could prove to be highly beneficial from a public health perspective.

    Michael Virata, MD, Medicine, Yale University, New Haven, CT, Carlo Comia, BA, Economics, University of Pennsylvania, Philadephia, PA and Patrick Cudahy, MD, Division of Infectious Diseases, Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT

    Disclosures:

    M. Virata, None

    C. Comia, None

    P. Cudahy, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.