CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

the highest hazard ratios for LTFU were observed among pregnant females (aHR 1.90, 95% CI 1.50-2.42) and non-pregnant females (aHR 1.57 95% CI 1.19-2.08), when compared to males. OA had lower hazard of LTFU if enrolled at health facilities which provided group adherence counselling (aHR 0.61, 95% CI: 0.53-0.70), and if they attended tertiary health facilities vs. primary health facilities (aHR 0.64, 95% CI: 0.46-0.90). Availability of adolescent-specific clinics and outreach services were not statistically significantly associated with LTFU after ART initiation. Conclusion: Older adolescents enrolling in care experienced higher risk of LTFU compared to younger adolescents and adults, and should be targeted with supportive interventions such as group counselling. Specific retention interventions are needed for teenage girls, especially those who are pregnant at enrolment into HIV care.

Poster and Themed Discussion Abstracts

838 IMPACT OF SUBSTANCE USE, MENTAL HEALTH, AND AGE ON RETENTION AND VIRAL SUPPRESSION Brian C. Zanoni 1 , Sara Lammert 1 , Jessica Haberer 1 , Gregory K. Robbins 1 , Heidi M. Crane 2 , Michael J. Mugavero 3 , Katerina Christopoulos 4 , Kenneth H. Mayer 5 1 Massachusetts General Hosp, Boston, MA, USA, 2 Univ of Washington, Seattle, WA, USA, 3 Univ of Alabama at Birmingham, Birmingham, AL, USA, 4 Univ of California San Francisco, San Francisco, CA, USA, 5 Fenway Hlth, Boston, MA, USA Background: Adolescents and young adults living with HIV in the United States have lower retention in care and viral suppression rates than older adults. The extent to which modifiable factors such as substance use, mental health and lack of insurance contribute to these outcomes has not been fully characterized. Methods: We evaluated the correlation of self-reported current substance use, moderate to severe anxiety and/or depression and lack of health insurance on retention in care and viral suppression among individuals initiating antiretroviral therapy (ART) between January 1, 2010 and September 30, 2014 at 6 centers in the United States as part of the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. We used univariable and multivariable logistic regression to evaluate the association between current substance use, moderate to severe anxiety and/or depression, insurance status, and categorical age (18-24, 25-49, 50+ years) on retention in care (2 visits within first year separated by ≥90 days) and viral suppression (viral load <200 copies/ml after 6 and 12 months on ART). We included interaction terms to evaluate for effect modification based on age. Results: Among the 3,465 individuals in the CNICS cohort with self-reported outcomes, we found higher rates of current substance use, moderate to severe anxiety/depression and lack of health insurance in younger compared to older adults (Table). Current substance use was associated with lower retention in care (AOR=0.53; 95% CI 0.36 – 0.78; p<0.001), lower 6-month (AOR=0.51; 95% CI 0.28 – 0.93; p=0.029;) and 12-month (AOR=0.38; 95% CI 0.19 – 0.72; p=0.003) viral suppression rates. Despite these differences, there was no difference in retention in care, 6-month, or 12-month viral suppression rates among younger compared to older adults. Adjusting for substance abuse, anxiety/ depression, and insurance status, age was not associated with lower retention in care or viral suppression. In addition, there was no effect modification based on age. There were no significant differences in primary outcomes when adjusting for baseline CD4 or time from initial linkage to ART initiation. Conclusion: HIV programs such as the CNICS network which incorporate routine screening for mental health disorders and substance use show no difference in retention in care and viral suppression among youth compared to older adults. Incorporating screening may improve outcomes for HIV-infected youth in other settings.

CROI 2017 363