566. Earlier Linkage and ART Initiation Via Fast Track Referral System for New HIV Patients Leads to Stronger Engagement and Better Outcomes

Abstract

BackgroundTo 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).MethodsWe retrospectively reviewed the medical records of all new patients who were referred for HIV care at this single academic center from 2014 to 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.ResultsForty-seven 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 2947Age (median [IQR])50.00 [42.00, 55.00]31.00 [26.50, 39.50]<0.001Sex (%)0.367Female6 (20.7)5 (10.6)Male23 (79.3)41 (87.2)Race (%)0.583Asian/Pacific Islander0 (0.0)1 (2.1)Black, non-Hispanic17 (58.6)23 (48.9)Hispanic4 (13.8)6 (12.8)White, Hispanic1 (3.4)0 (0.0)Other0 (0.0)1 (2.1)White, non-Hispanic7 (24.1)16 (34.0)HIV risk group (%)0.011Heterosexual sex9 (31.0)12 (25.5)Injection drug use6 (20.7)1 (2.1)Men who have sex with men12 (41.4)34 (72.3)Time to first HIV clinic visit (median [IQR])N/A9.00 [0.00, 19.00]0.016Retained in care (≥2 visits in >90 days) (%)22 (75.9)43 (91.5)0.122Prescribed antiretroviral therapy (%)18 (62.1)43 (91.5)0.005HIV viral suppression at 1 year (%)20 (69.0)37 (78.7)0.495Initial CD4 counts at baseline (ave)3404140.334CD4 count change at d365+53+2300.004ConclusionImplementation 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.Disclosures All authors: No reported disclosures.