CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Payments for care for PLWH remain high, particularly in PLWH with the lowest CD4 counts, emphasizing the importance of effective treatment and immune reconstitution. Payments for older individuals are high and will likely continue to grow as PLWH live longer. Finally, rising ART costs have been offset by lower inpatient and outpatient costs. 1066 Proportionately More Gay Men in Seattle Insured Following the Affordable Care Act

Julia E. Hood 1 ; Susan E. Buskin 1 ; Elizabeth A. Barash 1 ; Julia C. Dombrowski 2 ; Matthew R. Golden 2 1 Public Health–Seattle & King County, Seattle, WA, US; 2 University of Washington, Seattle, WA, US

Background: The Affordable Care Act (ACA) was established to improve the quality, accessibility, and cost of health care in the United States. Washington ranked among the top 10 states on two ACA implementation metrics: proportion of uninsured selecting an insurance plan through exchange, and percent increase in Medicaid enrollment. We assessed the extent to which ACA impacted men who have sex with men (MSM) in Seattle. Methods: We analyzed cross-sectional survey data collected annually at the Seattle Pride Parade between 2009 and 2014 (n=2095). Parade spectators who self-identified as a ‘man who has sex with men’ were eligible to complete a self- or interviewer-administered survey. Respondents were asked if they had health insurance, a regular medical provider, and been impacted by ACA. They were considered ‘high risk’ if they reported an STD diagnosis, methamphetamine or popper use, 10+ sex partners, or non-concordant condomless anal sex in last year. This analysis excludes self-reported HIV-positive respondents (n=240). We summarize survey responses using descriptive statistics and used multiple logistic and linear regression to identify factors associated having health insurance. Results: Controlling for age, race, education, income, and HIV risk, respondents in 2014 were significantly more likely to be insured than respondents in prior years (aOR= 3.3, 95% CI= 2.3-4.7, p<0.0001). The income disparity in insurance status narrowed considerably. The percent insured among respondents with an annual income <$30,000 increased from 59% in 2013 to 86% in 2014. Sixteen percent of respondents reported having used the Washington HealthPlanFinder (State ACA) Website, and 12% enrolled in an insurance plan via the website. In 2014, 18% of respondents reported that their health care had improved as a result of ACA; 6% reported that their health care had worsened. After controlling for age and HIV risk level, health insurance status was significantly associated with STD testing in the prior 12 months (aOR=2.1, 95% CI=1.1-4.0, p=0.03) but was unassociated with HIV testing in the prior 2 years (p=0.25). The percent of insured and uninsured respondents without a regular medical provider was 17% and 53%, respectively.

Poster Abstracts

Conclusions: The proportion of low-income Seattle MSM with health insurance increased dramatically with institution of the ACA. Despite this, nearly a quarter of MSM reported not having a regular medical provider, highlighting the need to link all MSM to medical care. 1067 Characteristics and Outcomes of Patients Seeking Care at a New“Co-Pay”Convenience Clinic Established to Explore Sustainable Funding Models in Uganda Rosalind M. Parkes-Ratanshi 1 ; Gerald Mukisa 1 ;Tom Kakaire 1 ; Faridah Mayanja 1 ; AdellineTumikye 1 ; Brenda Mitchell 1 ; Shadia Nakalema 1 ;Walter Schlech 2 1 Makerere University College of Health Sciences, Kampala, Uganda; 2 Dalhousie University, Halifax, Canada Background: 80% of funding for HIV services in Uganda is from international funders but this has plateaued and may now decrease. At the Infectious Diseases Institute we provide free of charge HIV care for 8000 patients, therefore we are exploring models of care to provide HIV services with a focus on long term sustainability. HIV prevalence in Uganda increases with socio-economic status. We explored if HIV patients would be interested in paying for services which are more convenient and if their HIV outcomes could be improved with a more convenient service. Methods: A routine customer care survey at the IDI clinic revealed that 60% of patients would be willing to pay for more convenient services. We established a physician led co-pay clinic in November 2013 which provided more private HIV services in the evenings for patients at a charge of around US$16 for consultation, with routine drugs and tests for free. In February 2014 we started a junior doctor led out of hours clinic (charge = UD$8). We present the preliminary results of an observational study based on patients attending this clinic. Results: By end of September 2014, 419 patients had ever attended the co-pay clinics at IDI. 50.6% are female, compared to 63.2% in the general clinic. 22 patients were ART naive and eligible for ART when at time of enrolment (CD4 count <350cells/mm3) and 18 (81%) have started ART. 52 patients are new to IDI services, of these 25 had tested HIV positive in the last 6 months, 25 were receiving ART from other clinics and 2 had been lost to follow up from another clinic. 27 (49%) of the new patients enrolled reported missed appointments or poor adherence to ART prior to joining the clinic. 52 patients had a viral load;13 (25%) were detectable (VL >400 copies/ml). Of these 11 switched to an intensified regimen (with a protease inhibitor+/-raltegravir). Of those switched 5 had an increase in CD4 count, 1 CD4 was stable, 5 have not reached 6 months.

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CROI 2015