Abstract THDB1016 Treatment cascade of HIV-infected infants in the Thailand National Program: How close are we to the 90-90-90 target?   1 Thanyawee Puthanakit, 2 Pope Kosalaraksa, 3Witaya Petdachai, 4Rawiwan Hansudewechakul, 5Thitiporn Borkird , 6Rangsima Lolekha, 7Hansa Thaisri, 8Thanawan Samleerat , 9 Sarawut Boonsuk, 10Sumet Ongwandee2 on behalf of the ACC working group Related poster = TUPEE 483 Lolekha R.

Study Objective To describe the coverage of early infant diagnosis & treatment cascade of HIV-infected infants in the Thai’s National Program under “Active case management model” During 2008-2011: Cascade of 53% - 56%-47% HIV viral suppression Diagnosis Treatment Thailand has a generalized HIV epidemic with prevalence of HIV in pregnancy of 0.6%. The early infant diagnosis program using HIV DNA PCR was established in 2006. However, during 2008-2011 the coverage of HIV diagnosis was only 53% diagnosed 56% start Rx within the first year of life and 47% had HIV viral suppression. Therefore the Thai Ministry of Public health set up an active case management model aiming to promote early ART initiation among HIV-infected infants. The objective of this analysis is to describe the coverage of early infant diagnosis and treatment cascade of HIV-infected infants In the Thai National Program under Active case management model. The first 90 HIV diagnosis – based upon estimated number using % transmission rate of 1.9 to 2.1%. The second 90 HIV Treatment – number of children initiated treatment The third 90 HIV viral suppression – number of children achieved HIV viral suppression The definition that were used in this analysis include Diagnosis: number of HIV infected infants identified divided by the estimated number of HIV-infected infants calculated from the HIV transmission risk of 1.9-2.1% Treatment: number of HIV-infected infants received antiretroviral treatment HIV viral suppression: at month 6 and month 12 after treatment No. HIV infants identified Estimated No. No. infants initiated ART No. infected infants identified @ Month 6 & 12 HIV RNA <50 <400, <1000 c/ml Based on GARP/SPECTRUM Estimated there are 128 HIV-infected infants during Aug 2014-Dec 2015

Active Case Management to promote Early ART August 2014- June 2016 Blood samples from HIV-exposed infants for HIV DNA PCR HIV DNA PCR@Birth HIV DNA PCR @ 1,2-4 month 16 Laboratories 2 Laboratories HIV EID program manager PCR positive PCR positive Pediatric Treatment Coordinator Via Email + Line Since 2014, Active case management to promote early ART initiation has established with the main 2 components First, to have laboratory alert system when HIV DNA PCR test for HIV-exposed infants is positive the central laboratory manager Will informed and pediatric treatment coordinator who cover each Of the 5 regions (14-20 provinces) To contact local hospital to facilitate treatment initiation such as to help intepret HIV DNA result, to advice on antiretroviral reimen and dosing Second, add HIV DNA PCR at birth for infant with high risk of HIV transmission and might also have risk of loss along the cascade – mother received ART less than 4 weeks prior to delivery. North: Chiang Rai 18 province Northeast: Sri Nakarindh 20 provinces South: Hat Yai: 14 provinces Central: Prachomkloa 14 provinces Central: HIVNAT 14 provinces North Chiang Rai Northastern Srinagarind South Hat Yai Central Prachomklao Central HIVNAT

Results – Diagnosis and Treatment From Aug 2014 – Dec 2015 (period of 17 months) Diagnosis 79 % (95% CI 71-86) 128 Estimated HIV-infected infants 21,415 samples for HIV DNA PCR 101 HIV infected infants (13 cases by PCR @birth) Treatment 84 % (95% CI 76-91) 85 HIV infected infants initiate HAART (85% LPV/r-based) There were 101 infant identified of which is accounted for 79% of estimated number of infants during these period. Second 90 is treatment initiation 84% intiaite ART, the rest was died or loss to follow up. After 1 year of antiretroviral therapy 68% had HIV RNA < 1000 copies/ml, but if we used stringent critieria as in adult Only 52% had HIV RNA < 50 copies/ml At 1 year of treatment 52% HIV RNA < 50 c/ml 68% HIV RNA < 1000 c/ml HIV viral suppression 52-68%

Results – Treatment outcome 101 HIV-infected infants 10 6 85 infants initiated HAART @ mean age 2.9 months (1.9-4.9) Mortality rate = 15.8% (95% CI 9.3-24.4) Loss to follow up = 14.8% (95%CI 8.6-23.3) 5 73 infants at month 6 7 2 1 48 at month 12 *22 infants during 6 to <12 month of ART 85 infants received ART at mean age of 2.9 months; the median time to contact patient to come back to clinic is 15 days and 70% of infants had start ART on the same day that confirmatory HIV DNA PCR was done. 85% used LPV/r based regimen 1- year mortality rate = 15.8%. majority prior to start ART and 8 cases were the case that missed the cascade of PMTCT intervention, mother is an incident case during pregnancy-breastfed or infant did not received ARV infant prophylaxis. Pneumonia is the most common cause of death High rate of loss to follow-up either not come back to get HIV DNA result or loss after start few months after start ART. The overall mortality rate was 15.8 % (0.5% CI 9.3-24.4) 10 case who died 8 case missed the cascade presented as symptomatic HIV never received ARV prophylaxis, other 2 died prior to 2 months of life 3/13 of diagnosed from birth PCR – died 5 who died after start Rx – within the first 2 month of ART 1 who died after 6 month of treatment due to pneumonia Median age at death was 4.4 months (IQR 2.4-6.2) Pneumonia being the commonest cause of death. Lost to follow-up include 5 migrants (2+2+1) Chain of 14 infants diagnosis PCR at birth 3 dead (21%)+ 2 loss to follow up (14%)+ (VL suppression 5 <UD, 3 fail, 1 pending) = in utero 56-67% HIV RNA Month 6 (n=60) Month 12 (n=37) < 50 c/ml 31.7% (20-45) 51.4% (34-68) < 400 c/ml 51.7% (38-65) 59.5% (42-75) < 1000 c/ml 58.3% (45-71) 67.6% (50-82) During 2014-2015: Cascade of 79% - 84%-68%