CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Methods: NHBS is a structured interview project conducted in high-risk populations utilizing respondent-driven sampling. Sharing any injection equipment in the past 12 months was the primary outcome. Predictor variables included race/ethnicity, age, education (< or > high school), primary drug (heroin, cocaine or both) and needle source (needle exchange program (NEP), dealer, multiple or other) were compared in the 2005, 2009, and 2012 NHBS in Philadelphia. Data were weighted based on respondent’s injection network size. A multivariate logistic regression model was constructed using predictors which were found to be significant in cycle specific models plus a variable for time. Additionally, a Cochran-Armitage test for trend was performed to determine significant changes in sharing behaviors over time. Results: 483, 525 and 554 participants were interviewed in cycles 1-3. There was no statistically significant trend over time with 47.6%, 64.4% and 54.4% of participants reporting any sharing in the last 12 months. Tests for trends showed that sharing increased significantly in IDUs age 18-34 years (p=0.018), females (p=0.004) and those who obtained their needles from a dealer only (p<0.001). In the final multivariate logistic regression, blacks (OR 0.39, 95%CI: 0.30-0.51) and Latinos (OR 0.64, 95%CI: 0.44-0.92) were significantly less likely to share compared to whites. IDU that used a NEP (<.0001) were less likely to share than IDU whose source of needles were a dealer or multiple sources. Year, education and primary injection drug were also found to be significant predictors of sharing (Figure).

Conclusions: Further increasing the utilization of NEPs in persons of all races, females and IDU age 18-34 may reduce the likelihood of sharing any injection equipment and may help to further decrease HIV transmission. Surprisingly, we did not observe a declining trend in the sharing of injection equipment in IDU despite a decline in HIV incidence over the course of the NHBS cycles. Further analysis should focus on barriers to the use of NEPs and other risk behaviors that may influence HIV transmission among IDU. 1029 Sexual Transmission of HIV and Possible Underreporting of Drug Use in Kazakhstan Anna Deryabina ; Padmaja Patnaik; Charon Gwynn;Wafaa M. El-Sadr ICAP at Columbia University, Almaty, Kazakhstan Background: National data in Kazakhstan suggest that ≥ 50% of new HIV infections occur in people who inject drugs (PWID) through contaminated needles. However, recent trends suggest an increasing role of heterosexual transmission of HIV, possibly among sex partners of PWID. To better understand these trends, we conducted a survey among sex partners of PWID in Kazakhstan. Methods: A cross-sectional survey was conducted in a convenience sample of sex partners of PWID to determine HIV and HCV seroprevalence and to identify factors associated with HIV. Sex partners were referred by PWID that were recruited through a nationally conducted integrated bio-behavioral survey or from NGOs in Karaganda, Temirtau, Ust- Kamenogorsk and Kostanai - cities with highest rates of sexually transmitted HIV. Recruitment was limited to sexual partners who did not report current injection drug use (IDU). Behavioral data were collected through semi-structured interviews. Dried-blood spots were tested for HIV and HCV using ELISA. Multivariate analyses were conducted using logistic regression modeling to identify factors independently associated with HIV. Results: Of 1,125 sex partners of PWID, 19%were men and 81%women, mean age 32. HIV prevalence in participants was 9.3% in men and 7.0% in women (p>0.05). Those having a PWID partner with known HIV-infection (OR=5.1, 95%CI=2.5-10.7) and those reporting past history of IDU (OR=4.8, 95%CI=2.4-9.6) had a higher likelihood of HIV infection. HIV prevalence was lower among those who reported no past history of IDU (5.2%; p<0.001). HCV prevalence (a possible surrogate for IDU) was high: 51.4% in men and 19.8% in women (p<0.001). Yet only 58.2% of HCV-positive men and 41.1% of HCV-positive women (p<0.001) reported prior history of IDU, suggesting under-reporting of injecting behavior. HIV prevalence was significantly lower (4.0%; p<0.05) in partners of PWID who reported no prior history of IDU and were HCV-negative. Conclusions: HIV prevalence was high in sexual partners of PWID in Kazakhstan. Sex with HIV-positive PWID was significantly associated with HIV infection. However, high HCV prevalence is those reporting solely current sexual contact with PWID suggests possible underreporting of previous or current IDU likely due to stigma, especially for women. Thus, increase in reported sexually-acquired HIV in the country may represent underreported IDU. Programs for prevention of sexual transmission of HIV should target PWID and their sex partners and address IDU in both groups.

Poster Abstracts

604

CROI 2015