(P163) THE PROVISION OF A LABORATORY-BASED HIV RNA ASSAY DID NOT INCREASE LINKAGE-TO-CARE IN THOSE WITH HIV OR AT RISK OF HIV IN BALTIMORE, MD: RESULTS OF A RANDOMIZED CONTROL TRIAL

Background:
Rapid linkage-to-care (LTC) for antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) is essential to curbing the HIV epidemic. We evaluated the impact of providing HIV RNA testing on LTC.

Methods:
People with HIV (PWH) not virally suppressed and persons with risk factors for HIV infection not on PrEP were recruited from Johns Hopkins Emergency Department (JHED), social media, and other sources, then randomized 1:1 to receive either standard-of-care (SOC) HIV testing plus HIV RNA testing (cobas® HIV-1 Test, Intervention) or SOC HIV testing alone (Elecsys® HIV combi PT and Geenius™ HIV-1/2 Supplemental test, Control). The primary outcome was LTC (ART or PrEP) 12-weeks post-enrolment. Descriptive analyses, adjusted and unadjusted Cox model hazard ratios (HR) with 95% confidence intervals (CI), and Kaplan-Meier survival curves were generated.

Results:
From 08/21–01/23, 191 participants were enrolled (64%, 27%, and 9% from the JHED, social media, and other sources, respectively; 18% aged <25 years, 38% female sex, 58% African-American, 65% heterosexual, 74% reported condomless sex, 20% reported illicit drug use, 16% were PWH). Turnaround time for RNA testing was 26.3 (standard deviation 12.2) hours. In multivariable analysis, female sex (HR=2.6, 95%CI=1.1–6.1, p=0.030), post-high school education (HR=2.2, 95%CI=1.0–4.6, p=0.04), and social media recruitment (HR=2.7, 95%CI=1.3–6.7, p=0.03) were significantly associated with overall LTC; being in the intervention arm was not (HR=1.9, 95%CI=0.9-3.9, p=0.09).  LTC for PrEP was associated with social media recruitment (HR=4.5, 95%CI=1.4-14.0, p=0.01) and having health insurance (HR=4.6, 95%CI=1.0-20.7, p=0.05). There were no factors associated with LTC for ART. There was a significant reduction in time to LTC in PWH in the intervention arm (Log-rank p=0.04) but not overall, or in PrEP LTC.

Conclusion:
Laboratory-based HIV RNA testing did not improve LTC for ART or PrEP. Further studies are required to assess differences using HIV viral load platforms with shorter turnaround times.