CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

870 OPIOID SUBSTITUTION THERAPY AND INITIATION INTO INJECTION DRUG USE IN SAN DIEGO, CA Maria Luisa Mittal 1 , Devesh Vashishtha 1 , Xiaoying Sun 1 , Sonia Jain 1 , Richard S. Garfein 2 , Steffanie A. Strathdee 2 , Dan Werb 1 1 Univ of California San Diego, La Jolla, CA, USA, 2 Univ of California San Diego, San Diego, CA, USA

Background: Opioid substitution therapy (OST) is the gold standard of care for the management of opioid use disorder. OST is also known to reduce HIV risk behaviors among people who inject drugs (PWID) by reducing the frequency of injecting. Given that data suggest that PWID play a key role in initiating others into drug injecting through exposing others to injecting behaviors, our objective was to explore whether an association existed between OST enrollment and initiating others into injecting among PWID. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01), is a multi-site cohort study assessing the impact of a range of socio-structural factors on the risk that PWID initiate others into injection. Preliminary results were drawn from a single participating cohort of PWID in San Diego ≥ 18 years old who reported injection drug use 6 months prior to baseline (STAHR-II; NIDA R01DA031074). PRIMER survey items were measured at 24-month follow up, and the outcome was defined as reporting ever initiating others into injecting; sustained OST enrollment was defined as being enrolled at 2 or more study visits (i.e., ≥1 year). Logistic regression modeling was used to identify associations. Results: Participants (N=360) were predominantly male (n=253, 71%), with a mean age of 47 (Interquartile Range [IQR]: 38-55), and a median of 24 years injecting (IQR: 13-35). Thirty-nine percent (n=139) of participants reported ever enrolling in OST and 19% (n=70) reported being enrolled in OST during the study period. Less than half of participants (n=135, 38%) reported ever initiating others into injecting. In multivariable models, males who reported sustained enrollment in OST had decreased odds of initiating others into injecting (Adjusted Odds Ratio [AOR]: 0.23, 95% Confidence Interval [CI]: 0.10-0.50; p<0.01). Additionally, each year increase in age was associated with decreased odds of initiating others (AOR: 0.94, 95% CI: 0.91-0.97; p<0.01), and a higher number of years injecting was independently associated with increased odds of initiating others into injecting (AOR: 1.03, 95% CI: 1.00-1.06, p=0.05). Conclusion: OST may improve community health and reduce HIV risk behaviors by reducing the incidence of injection drug use initiation. While preliminary, this study highlights the need to further investigate whether OST may, along with reducing injection-related harms, also impact the risk that individuals initiate injection drug use. 871 CHANGES IN PRESCRIPTION OPIOID, METH, AND COCAINE USE AMONG MSM IN 20 US CITIES Brooke Hoots , Dita Broz, Lina Nerlander, Gabriela Paz-Bailey CDC, Atlanta, GA, USA Background: Men who have sex with men (MSM) have higher rates of drug use compared with the general population and are at increased risk of contracting HIV. The United States is currently experiencing an opioid epidemic, but few studies have examined opioid use among MSM. Previous studies have focused on crystal meth, cocaine, and other drugs. We analyzed data fromMSM participating in the National HIV Behavioral Surveillance to determine the prevalence of non-injected use of prescription opioids, meth, and cocaine by key characteristics, and to evaluate changes from 2008 to 2014. Methods: Men were recruited using venue-based, time-space sampling in 20 US cities in 2008, 2011, and 2014. Non-injected use of meth, cocaine, and prescription opioids (e.g., Oxycontin, Vicodin, and Percocet) in the past 12 months were self-reported. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated from log-linked Poisson regression models to estimate the change in prevalence of drug use per three-year increase overall, and by demographic group. Results: Meth use was more frequent among MSMwho were white, had lower education and income, lived in Western cities, and were HIV-positive. There were no differences in meth use over time, with 7.8% reporting use in 2008, 6.6% in 2011, and 8.0% in 2014 (P=.76). Cocaine use was more frequent among MSM who were white and ‘other’ race and younger. Cocaine use was also stable over time, although much more frequent than meth use, with 18.6% reporting use in 2008, 16.9% in 2011, and 19.0% in 2014 (P=.75). Opioid use was on par with meth use and was more common among MSM who were white, younger, low education and income, and who lived in Western cities. Opioid use also did not increase overall, with 7.5% reporting use in 2008, 7.7% in 2011, and 7.8% in 2014 (P=.87). However, after adjusting for covariates, increases in opioid use were seen among black MSM (adjusted PR [aPR], 1.24, CI: 1.06-1.45) and those with less education (aPR 1.21, CI: 1.02-1.43) and low income (aPR 1.23, 95% CI: 1.02-1.49). Conclusion: Overall, there were no changes in reported use of meth, cocaine, and opioids among MSM from 2008 to 2014. Opioid use was as frequent as meth use and is increasing among black MSM and those of low socioeconomic status. HIV prevention interventions need to consider assessing use of opioids and other commonly abused drugs among MSM and offer early treatment for drug dependence to prevent transition to injection. 872 CHANGING PATTERN OF CRYSTAL METH USE IN BLACK &WHITE MSM, WASHINGTON, DC, 2008–2014 Irene Kuo 1 , Rudy Patrick 1 , Jenevieve Opoku 2 , Anthony Rawls 1 , Manya Magnus 1 , James Peterson 1 , Michael Kharfen 2 , Alan Greenberg 1 1 The George Washington Univ, Washington, DC, USA, 2 District of Columbia Dept of Hlth, Washington, DC, USA Background: Crystal meth use is associated with increased sexual risk behavior, particularly among men who have sex with men (MSM). Despite evidence of declining methamphetamine use among MSM, it is unknown whether this is occurring across different racial groups. We explored trends in crystal meth use between black MSM (BMSM) and white MSM (WMSM) in Washington, DC over time. Methods: Data from National HIV Behavioral Surveillance in 2008, 2011, and 2014 were used. MSM recruited via venue-based sampling completed an interviewer-administered survey regarding past year drug use and sexual behaviors and tested for HIV. The prevalence of self-reported past year crystal meth use was calculated for each data collection year by race; a chi-square test for trend assessed changes in prevalence over time. Multivariable logistic regression were stratified by race and identified independent correlates of crystal meth use, including year of data collection as a covariate.

Poster and Themed Discussion Abstracts

CROI 2017 376