P-70 Two decades plus delivering private HIV care and treatment in a predominantly public sector developing country setting: The Guyana experience

Methods: Demographic, drug treatment, treatment response and viral monitoring data were extracted from patients’ charts of a private clinic and entered into an excel data extraction tool. Descriptive and inferential data analysis were conducted using SPSS version 25. The Chi-square test was used to determine association between categorical variables. Statistical significance was set at p<0.05, with 95% confidence interval.

Results: A total of 101 patients, 57 (56.4%) females, 44 (43.6%) males), mean age 46.8 and standard deviation (SD) 13.367 years (mean age 47.09 years in males, 46.09 in females), were seen during a 23-year period. Majority (79.2%) were Afro-Guyanese. 34 (33.6%) were alive, 12 (10.5%) were dead, 23 (20.2%) were lost to follow up and 32 (31.7%) were either transferred or had migrated. Of the 34 living patients, all of whom were using dolutegravir, 33 (97.05%) were virally suppressed. Overall, 11(10.9%) experienced side effects, (5/44 [11.4%] had lipodystrophy while on fixed-dose combination Lamivudine+Stavudine+Nevirapine and 3/44 [6.8%] developed a generalized skin rash). While on fixed-dose Tenof ovir+Emtricitabine+Nevirapine, 3/35 (8.6%) developed renal impairment with decreasing eGFR. Overall, more females than males survived longer on treatment (55 vs 43), p = 0.058 (not significant). Mean length of survival after ARV treatment for the 34 living patients was 122.05 months (min 13, max 279.8). Of the 34 living patients, statistically significant more females than males (18 vs 15) survived longer on treatment, p=0.044.

Conclusion: Longstanding private HIV care is effective in predominantly public health care settings (in Guyana), with substantial lengths of survival and excellent rates of viral suppression, especially when using dolutegravir-based regimens. Living patients achieved the UNAIDS 95/95/95 target.