933 - Cured vs. Not Yet Treated: Population Differences for HIV/HCV Co-infected Patients Navigating the HCV Care Cascade in 11 Connecticut Clinics

Background: Hepatitis C (HCV) care cascades for persons with HIV/HCV co-infection are hampered by incomplete HCV surveillance data, lack of standardized matching algorithms, and incomplete ability to determine HCV treatment status from surveillance alone.  However, client-level data from individual clinics can be combined into multi-site cascades to assess progress toward micro-elimination goals.  To achieve these goals, characterization of treatment gaps is crucial.  Looking at trends in 11 HIV clinics, we examine correlates of not entering/initiating HCV therapy.

Methods: We established a partnership with CT Dept. of Public Health and 11 HIV clinics through a HRSA SPNS grant (047). Lists of HIV/HCV co-infected individuals obtaining care from these clinics from 1/2009-9/2018 were created using data from HIV (eHARS) and HCV (CTEDSS) surveillance, individual clinic rosters and a validated matching algorithm.  Clinic personnel reviewed these lists to determine who were treatment eligible (TE) and their current HCV treatment status (e.g. treatment initiated, SVR documented,   untreated but in clinical care).  Clinic lists were updated regularly to reflect changes in overall patient status (e.g. deceased, relocated, transferred care).  We performed bivariate analysis to identify correlates of treatment initiation including odds ratios with 95% confidence intervals.

Results: Of 7265 patients receiving HIV-related services, 2117 matched to HCV surveillance, representing 1496 unique patients.  As of 6/1/2020,  821 patients were TE, 727 (89% of TE) were in active care, 630 (77%) initiated treatment, 620 (76%) completed treatment, 584 (71%) achieved SVR.   Of the TE group, 77 (9%) had not yet initiated treatment. Compared to initiators of HCV therapy, patients not yet initiating treatment are more likely to be women (OR 1.7 95% CI 1.1-2.8), and black (OR 1.9 95% CI 1.1-3.1), with unsupressed HIV viral loads (OR 2.5, 95% CI 1.5-4.0).

Conclusion: This work capitalizes on the feasibility of creating a care cascade for HIV/HCV by Data to Care methods.  Patients in partner clinics  who had not yet initiated treatment were more likely to be women, black, and have poorly controlled HIV. Further efforts are needed to determine the barriers to treatment initiation among these groups.