572. Cascade of HIV Care of Newly Diagnosed Citizens in Israel 2011–2015: A Population-Based Cohort Study

The cascade of HIV care indicates a country’s progress toward optimal diagnosis and care. In Israel national health insurance covers all citizens. Treatment and follow-up are provided in specialized HIV centers. We assessed the linkage to care and treatment of Israeli citizens, newly diagnosed during 2011–2015. Annual estimates of new Israeli cases living with HIV was calculated by the Ministry of Health, and all newly diagnosed Israeli cases confirmed by the Central Virology Laboratory were included. Excluded were tourists, Israeli patients diagnosed abroad and non-Israeli migrants. Gender, age at diagnosis and linkage to care to HIV centers within 90 days was available for all adults (>16). Risk factors for infection, first CD4 and viral load, treatment start date, number of annual visits, last CD4 cell count and viral load (VL) in each year were available for 75% of the studied population (data from one center was missing). Included were1,538 newly diagnosed with HIV/AIDS in 2011–2015. No significant change was seen in proportions of unidentified people (~10%), link to care (~79%), or undetectability in those treated (~85% VL < 50). Proportion of patients starting treatment increased from 47.5% in 2011 to 89.9% in 2015, resulting in increase in undetectability (VL < 50) from 35% in 2011 to 71% in 2015 (figure). Median age at diagnosis was 36 (16–92); 15% were >50 years. 76.3% were men, 23.5% women and 0.2% transgender. Twenty-five patients (1.6%) died within 2 months of diagnosis, 62 (4%) were not linked to care for the entire follow-up period. Of 1,159 patients with detailed records, median CD4 at diagnosis was 342 cells/mL, (361 in men and 264 in women), CD4 below 200 cells/mL was found in 27.6%. CD4 at diagnosis did not improve over time (350, 362, 367,331, 283 in the years 2011–2015, respectively). By the end of 2015, 77.9% of the 1,159 patients were in care, 74% were treated and 67% had VL < 50 copies/mL. In multivariate analysis risk factors for lost to follow-up were: previous incarceration OR 4.56 (95% CI 1.8–11.5), and age OR 1.02 (95% CI 1.005–1.036). This is the first country-wide individual-based data cascade of care in Israel. In a small country with national health coverage, linkage to care should be improved. The low CD4 levels at diagnosis might imply for a higher rate of undiagnosed individuals. M. Chowers, GSK: Grant Investigator, Research grant.