Retention in care and viral suppression after same-day ART initiation: One-year outcomes of the SLATE I and II individually randomized clinical trials in South Africa

Introduction: Same-day initiation (SDI) of antiretroviral therapy (ART) for HIV consistently increases ART uptake, but concerns remain about higher attrition from care after initiation. We analysed twelve-month retention in the SLATE SDI trials. Methods: SLATE I and SLATE II were individually randomized trials at public outpatient clinics in Johannesburg that enrolled patients not yet on ART and administered the SLATE I or II algorithm, which included a symptom self-report, medical history, brief physical examination, and readiness questionnaire, to assess eligibility for SDI. ART uptake and early retention have been reported. Using routine clinic records, we conducted a pooled analysis of retention in care and HIV viral suppression 14 months after study enrolment. Results and discussion: We enrolled 1,193 study participants (standard arms, n=599, 50%; intervention arms, n=594, 50%) and analysed by originally assigned groups. By 14 months after study enrolment (equivalent to 12-month retention in care), 50% of intervention arm patients and 46% of standard arm patients remained in care at the initiating site (crude risk difference 4% (95% confidence interval -1% to 10%; crude relative risk 1.10 (0.97-1.23), with similar viral suppression between arms. Observed attrition from care at site by 14 months was high in both study arms, but we found no evidence that the offer of SDI led to greater overall attrition or lower rates of viral suppression one year after starting ART and may have led to small improvements. Same-day initiation may have shifted some attrition from before to after dispensing of the first dose of medication. Conclusions: An offer of same-day initiation of ART, following a carefully designed protocol to identify patients who are eligible and ready to start treatment, is not inherently associated with an overall increase in patient attrition from care.

The Food Anti-Microbials β-Phenylethylamine (-HCl) and Ethyl Acetoacetate Do Not Change during the Heating Process

β-Phenylethylamine hydrochloride (PEA-HCl) and ethyl acetoacetate (EAA) are anti-microbials with applications in food processing. As food anti-microbials, the compounds will have to withstand the cooking process without changing to toxic compounds. With this Communication, we address the question of whether PEA and EAA are altered when heated to 73.9 °C or 93.3 °C. A combination of gas chromatography and mass spectrometry was used to analyze solutions of PEA(-HCl) or EAA in beef broth or water. In addition, the anti-microbial activity of PEA-HCl and EAA was compared between heated and unheated samples at a range of concentrations. The gas chromatograms of PEA(-HCl) and EAA showed one peak at early retention times that did not differ between the heated and unheated samples. The mass spectra for PEA and EAA were near identical to those from a spectral database and did not show any differences between the heated and unheated samples. We conclude that PEA(-HCl) and EAA formed pure solutions and were not altered during the heating process. In addition, the anti-microbial activity of PEA-HCl and EAA did not change after the heating of the compounds. Regardless of temperature, the minimal inhibitory concentrations (MICs) for PEA-HCl were 20.75 mmol mL−1 for Escherichia coli and Salmonella enterica serotype Typhimurium. For EAA, the MICs were 23.4 mmol mL−1 for E. coli and 15.6 mmol mL−1 for S. enterica.

Early retention among pregnant women on ‘Option B + ’ in urban and rural Zimbabwe

Background In 2013, the World Health Organisation (WHO) recommended Option B+ as a strategy to prevent mother-to-child transmission (PMTCT) of HIV. In option B+ , lifelong antiretroviral therapy (ART) is offered to all HIV positive pregnant and breastfeeding women to reduce MTCT rate to less than or equal to 5%. Its success depends on retaining women on ART during pregnancy, delivery and breast-feeding period. There is limited data on early retention on ART among pregnant women in Zimbabwe. We therefore assessed early retention among women on Option B + from antenatal care (ANC) until 6 months post ANC booking and at delivery in Bulawayo city and Mazowe rural district of Zimbabwe. Methods We collected data for pregnant women booking for ANC between January and March 2018, comparing early retention among ART naïve women and those already on ART. The two cohorts were followed up for 6 months post ANC booking, and this was done in two districts. Data were collected from routine tools used at facility level which include ANC, delivery and ART registers. The Kaplan-Meier survival analysis was used to estimate retention probabilities at 1, 3 and 6 months post-delivery and for retention at delivery proportions were used. Poisson regression was used to investigate factors associated with non-retention at 6 months post ANC booking. Results A total of 388 women were included in the study with median age of 29 years (IQR: 25–34). Two-thirds booked in their second trimester. Retention at 3 and 6 months post ANC booking was 84% (95% CI 80–88) and 73% (95% CI 69–78) respectively. At delivery 81% (95% CI 76–84) were retained in care, 18% lost-to-follow-up and 1% transferred out. In this study we did not find marital status, gestation age, facility location, ART status at ANC booking, to be associated with loss to follow-up. Conclusion In this study, we found low retention at 3, 6 months and delivery, a threat to elimination of Mother-to-child Transmission of HIV in Zimbabwe. Our findings emphasize the need for enhanced interventions to improve early retention such as post-test counselling, patient tracing and visit reminders.

The Effect of Chronic Treatment with Lacosamide and Topiramate on Cognitive Functions and Impaired Emotional Responses in a Pilocarpine-induced Post-status Epilepticus Rat Model

Introduction: Epilepsy and antiepileptic drugs can affect negatively the cognitive abilities of patients. Aim: The present study aimed to evaluate the effect of topiramate (TPM) and lacosamide (LCM) on the emotional and cognitive re-sponses in naive animals and in animals with pilocarpine-induced status epilepticus.  Materials and methods: Male Wistar rats were randomly divided into 6 groups and status epilepticus was evoked in half of them by a single i.p. administration of pilocarpine (Pilo) (320 mg/kg): Pilo-veh, Pilo-TPM (80 mg/kg) and Pilo-LCM (30 mg/kg). Matched naive rats were treated with the same doses as follows: C-veh, C-TPM, and C-LCM. In a step-down passive avoidance test, the learning session was held for one day, the early retention test was conducted on day 2, and the long-term memory test - on day 7. Motor activity and anxiety were evaluated in an open field test.  Results: The Pilo-TPM and Pilo-LCM groups increased the time spent on the platform compared to Pilo-veh animals while the C-LCM animals decreased the time compared to C-veh animals during short- and long-term memory retention tests. TPM and LCM exerted an anxiolytic effect in naive rats. The two antiepileptic drugs were unable to alleviate the hyperactivity, but they alleviated the impulsivity associated with decreased anxiety level in epileptic rats. Conclusions: Our findings suggest that LCM and TPM have a beneficial effect on cognition both in naive and epileptic rats. While the two antiepileptic drugs can produce an anxiolytic effect in naive rats, they alleviate the impulsivity after pilocarpine treatment.

Changes in Human Fat Injected Alongside Hyaluronic Acid in the Backs of Nude Mice

Background Cross-linked hyaluronic acid (HA) is an active anti-ageing cosmetic filler. The combination of cross-linked HA and preadipocytes or adipose-derived stem cells has been previously investigated, but the effects of agglomerated cross-linked HA injection on the vascularization of fat grafts remain unclear. Objectives To explore the effects of agglomerated cross-linked HA injection on the vascularization of fat grafts. Methods The back of each nude mouse was divided into four regions that received different treatments: nothing (control group), agglomerated Biohyalux™ (HA group), agglomerated fat (FAT group), and lumps formed by the sequential injection of Biohyalux™ and fat (HA/FAT group). Samples were collected after 1 month for weighing and haematoxylin and eosin staining, immunohistochemistry, image analysis and western blotting. Results The mass weight of fat and the mean number of adipocytes in the HA/FAT group did not significantly differ from those in the FAT group. No living tissue was found in agglomerated HA. Some tiny HA particles were surrounded by tissue rich in blood vessels. The expression levels of CD31 and vascular endothelial growth factor (VEGF) in the HA/FAT group were higher than those in the FAT group, but the difference was only significant for VEGF expression. Conclusions Cross-linked HA had minimal effect on the early retention rate of surrounding fat grafts, but enhanced their vascularization. Fat grafts should be not injected into lumps of cross-linked HA. Therefore, agglomerated cross-linked HA should be dissolved before fat transplantation.

A Basic Formula for Effective International Student Services

The effective delivery of support services for international students has been the subject of professional discourse for nearly a century (Wheeler, King & Davidson, 1925). While scholars have long examined the problem of student attrition, early retention models (Spady, 1970; Tinto, 1988) applied anthropological, psychological and sociological theories in ways that mostly ignored the intuitional responsibility and capacity to serve culturally diverse individuals. Furthermore, an analysis of fifty years of student affairs research found that international students were mostly excluded (Pope, Mueller and Reynolds, 2009). It was not until the establishment of the Journal of International Students that international students began to receive regular attention within the academic literature. International student advisors have an important role to play in helping international students adjust to their host communities and institutions. However, changes to student immigration regulations has resulted in an increased emphasis on immigration compliance (Boyd, 2008; Rosser, Hermsen, Mamiseishvili, & Wood, 2007) and lowered the capacity of some international student offices to provide non-immigration services. The quality of international student services, whether immigration or not, is generally dependent on formal and informal processes of which multiple stakeholders are a part. Thus, a small change to one element has the potential to affect the whole. In order to maximize efficiency and effectiveness of services offered, international student advisors may benefit from applying a systems perspective as summarized by the following formula: ISS = [PM + (LM + I + V)] + CI International Student Services = [Process Mapping + (Lean Mindset + Intentionality + Value)] + Continuous Improvement Process Mapping Process mapping is a useful tool for understanding the interrelationships of all the specific elements that allow for a specific service. For instance, a process map may be used to visualize the series of steps, decisions and delays that begin when someone applies for admission as an international student and ends when that person receives the necessary documents to apply for a student visa. The elements are each mapped individually and their relationships to each other visually mapped to create a workflow diagram. This dynamic flowcharting activity makes it possible to understand how each part contributes to the whole and the downstream consequences of interventions. Lean Mindset International student advisors should strive to develop a lean mindset. This includes commitment to identifying and eliminating wastes from programs and services offered to international students. Such wastes may include requiring international students to complete actions that are unnecessaryor overly burdensome. For instance, requiring a student to obtain signatures on a paper form in order to request authorization for curricular practical training when free cloud-based solutions exist that would expedite and simply the process for all involved. As the workload of international student advisors increase due to additional immigration compliance requirements, it is critical to be able to maximize capacity by eliminating waste. Intentionality International student services should be considered an important part of the co-curriculum. While an orientation program for new international students may include a shopping trip to the local, an intentional approach to this service would be to leverage the activity as a means for teaching students how to use the local bus system. This would not only accomplish the basic goal of helping students obtain access to needed goods, but it would also help them acquire the knowledge and skills necessary to travel confidently around their host community. Value When analyzing components of international student services, it is important to assess parts of the process using the following criteria: 1. Adds value from the student’s perspective 2. Does not add value from the student’s perspective, but is required 3. Does not add value from the student’s perspective nor is it required The goal of assessing value is to ensure most, if not all, of the components that make up the process are viewed as valuable from the perspective of the student. This helps to ensure a higher level of satisfaction with the services offered and it keeps advisors from engaging in activities that detract from the overall mission of supporting international students. Continuous Improvement The work of enhancing international student services is never complete. Rather, the international student office staff should commit to regularly reviewing and refining the services they offer using the method summarized by the formula. Conclusion A systems perspective is helpful for understanding and ensuring the effectiveness of international student services. While international student advisors may be exceptional as individual contributors to a given process, failure to see the interdependencies between their work and the work of others who touch the process can result in misalignment in expectations and experiences on the part of the student.

Example Interventions Using Motivational Interviewing to Enhance Engagement in HIV Care

Chapter 8 provides examples of programs developed to optimize retention in HIV care that are based on principles of motivational interviewing (MI). Two programs are highlighted: iEngage, a recently evaluated intervention to promote early retention in HIV-care as part of a multi-site clinical trial, and 60-Mintues for Health, a piloted intervention approach for patients tenuously engaged in HIV-care. These programs, their theoretical underpinnings, and use of MI offer some importance insights about mobilizing MI in the context of HIV care. Consistent with MI, both programs are founded on patients’ autonomy and self-determination, with the interventionist acting as a guide to help patients achieve tailored goals while avoiding the righting-reflex and highlighting change talk.

1965. PrEP On the Go! Implementation Mobile PrEP, STI, and HIV Prevention Services in South Florida

Background Pre-Exposure Prophylaxis (PrEP) can reduce HIV incidence when implemented effectively for people who are at highest risk of HIV infection. However, access to and uptake of PrEP remains suboptimal among priority populations such as black and Hispanic/Latino men who have sex with men (MSM). We established mobile HIV prevention/PrEP services delivered with cancer screening services through the Sylvester Gamechanger vehicle. We describe demographics, utilization, and early retention in PrEP care delivered through this model. Methods We selected four local HIV high-incidence areas where PrEP services were lacking, to locate the clinic. The vehicle, staffed by a medical provider, HIV/PrEP counselor, and cancer educator, returned to each site regularly. In addition to self-referrals, Prevention305, a community-based organization, developed focused patient recruitment through social media. Services were provided at no cost. Normative demographics, risk behavior, sexually transmitted infections (STIs), and early-maintenance-in-care data were collected. Descriptive statistics were compiled using SPSS. Results From October 2018 to April 2019 services were provided to 229 clients. Of these, 168 (73.7%) sought PrEP. Of PrEP clients, 125 (74.4%) identified as White/Hispanic, 6 (3.5%) as Black/Hispanic, 6 (3.5%) as White/non-Hispanic, 11 (6.5%) as Black/non-Hispanic, and 19 (11.3%) as other; 124 (73.8%) were foreign-born; 159 (94.9%) of PrEP clients identified as MSM. Six (3.5%) PrEP-seeking clients were HIV positive at baseline. Of these, 2 were identified as acute/early infections. An initial PrEP prescription was filled by 166 (98.8%). Of the 77 clients seen within the initial 3 months of operation and due for follow-up assessment, 55 (71.4%) completed a follow-up visit. Overall, 45 (26.6%) PrEP clients had positive STI results (gonorrhea, chlamydia, or syphilis) at baseline. Nine (16.3%) clients returned positive STI results at their follow-up visit. Conclusion Implementation of mobile HIV prevention services including PrEP is feasible and is effective in engaging Hispanic/Latino immigrant MSM. High demand for services is noted and plans are underway to increase capacity and outreach to other highly affected groups. Disclosures All Authors: No reported Disclosures.