CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

who have sex with men (MSM) in Baltimore who were classified with unrecognized HIV infection had evidence of recent antiretroviral (ARV) medication. The current study used ARV biomarkers to validate self-reported HIV infection in recent data collection waves among MSM and people who inject drugs (PWID) in Baltimore to assess changes in misrepresentation and obtain a better assessment of unrecognized HIV infection over time. Methods: Sera from HIV+ participants in National HIV Behavioral Surveillance-Baltimore MSM (2011, n=177 and 2014, n=121) and PWID (2012, n=132) was tested for the presence of ARVs using liquid chromatography-high resolution accurate mass (HRAM) mass spectrometry (Thermo Fisher Q-Exactive) which detects 20 antiretroviral (ARV) drugs. Factors associated with unrecognized infection and misreported HIV status were assessed. Results: Of participants originally classified with unrecognized HIV infection, 47.0% (55/117) of MSM in 2011, 52.5% (21/40) of MSM in 2014, and 58.3% (21/36) of PWID in 2012 tested positive for non-prophylactic ARV drugs. Compared to MSM who self-reported HIV+ status and ARV use, MSMmisreporters in 2011 and 2014 were more likely to be non-Hispanic Black, lowest income, bisexual, and report female sex partners. MSMmisreporters in 2014 also had less education, more social instability, and more substance use compared to those who disclosed HIV+ status. Among PWID, misreporters had lower education and employment and increased binge drinking. Recalculated prevalence of unrecognized HIV infection among HIV+MSM was 35.0% in 2011 and 15.7% in 2014. Recalculated prevalence of unrecognized HIV infection among HIV+ PWID was 11.4%. Conclusion: ARV testing reduced unrecognized HIV infection by half due to misreporting. This bio-behavioral approach across time points and populations highlights a set of persistent characteristics among those more likely to misreport HIV status. There is a critical need to enhance assessment of this important metric and to understand the role of economic and social factors such as perceived stigma and social desirability on self-report validity related to HIV status in epidemiological research. 905 SPATIAL VARIATION ALONG THE HIV CARE CONTINUUM IN WASHINGTON, DC, 2014–2015 Arpi Terzian 1 , Naji Younes 1 , Jenevieve Opoku 2 , Johnathan Hubbard 1 , Rena R. Jones 3 , Princy Kumar 1 , Amanda D. Castel 1 , for the DC Cohort Executive Committee 1 The George Washington Univ, Washington, DC, USA, 2 District of Columbia Dept of Hlth, Washington, DC, USA, 3 NCI, Bethesda, MD, USA Background: Neighborhood level features have been found to influence a person’s ability to connect to a HIV care provider and remain in care. The objective of this analysis was to: 1) identify clusters of geographic areas with poor outcomes along the HIV care continuum and 2) assess person-level factors associated with residing in clusters among persons living with HIV (PLWH) enrolled in the DC Cohort study, a city-wide clinical cohort in Washington, DC. Methods: Among PLWH with ≥ 1 year of follow-up in the DC Cohort, retention in care (RIC), prescribed antiretroviral therapy (ART), and viral suppression (VS) were estimated by residential ZIP code from June 2014 to June 2015. RIC was defined as evidence of ≥ 2 HIV-related encounters ≥90 days apart in 12 months. ART prescription was among those RIC. VS was defined as VL <200 copies/mL at last visit among those RIC and on ART. Clusters of adjacent ZIPs with similar outcomes were identified using Moran’s I and Getis-Ord Gi*. χ2 statistics were used to assess differences in person-level attributes by cluster status. Results: Among 4,413 PLWH, they resided in 20 ZIP codes. Median RIC was 71% (range: 41-79%) with clustering of low RIC ZIPs in the West (p<0.05). Median percentage on ART was 97% (range: 85-100%) with no clustering. Median VS was 89% (range: 75-100%) with clustering of low VS ZIPs and high VS ZIPs in the SE and NW, respectively (p<0.05). RIC in PLWH living in clusters of low RIC was 10% lower than in other ZIPs, though the difference was not significant (64% vs74%; P>0.05). This group was less likely to be non-Hispanic (NH) black (18% vs 83%), more likely to be employed (47% vs 19%), permanently housed (90% vs 78%), and privately insured (55% vs 20%). VS in PLWH living in clusters of high VS was 19% higher (100% vs 84%; P<0.05, Figure 1); this group was less likely to be NH Black (40% vs 83%), more likely to be employed (29% vs 20%), permanently housed (83% vs 78%), privately insured (37% vs 20%) and older (median: 57 vs 50 years). Conclusion: Consistent with prior research, person-level and neighborhood-level retention may relate to yet not fully predict VS – even in the setting of high ART coverage. Clinically stable PLWH may see their HIV providers less often thus, while they may be virally suppressed, they may not meet current definitions of retention in care. Spatial analyses may inform the development of geographically targeted interventions to reduce drop offs along the continuum. 906 TRENDS AND DISPARITIES IN ART USE AMONG PERSONS WITH HIV IN SAN FRANCISCO, 2006–2015 Ling Hsu , Sandy Schwarcz, Susan Scheer San Francisco Dept of Pub Hlth, San Francisco, CA, USA Background: Early entry in care and initiation of antiretroviral therapy (ART) among persons diagnosed with HIV is essential to achieve optimal treatment outcomes. However not all people with HIV receive ART and some delay initiation. In 2010, SFDPH recommended universal treatment for all persons with HIV regardless of stage of disease. We used SFDPH HIV surveillance data to examine ART use among persons diagnosed with HIV before and after the City’s universal ART policy. Methods: San Francisco residents aged ≥ 13 years diagnosed with HIV between 2006 and 2015 were divided into two time periods (2006-2010, 2011-2015). ART use and reasons for not starting ART were obtained frommedical chart review. Persons whose medical records were unavailable but were virally suppressed (<200 copies/mL) were assumed to have received ART. Sociodemographic and risk characteristics of persons diagnosed in each time period who received ART were compared to those who did not using the Chi- Square test. The Kaplan-Meier product limit method was used to calculate time from HIV diagnosis to ART initiation. Logistic regression was used to identify factors associated with delayed ART initiation, defined as not starting ART within 6 months of diagnosis. Results: Eighty-seven percent of the 2529 persons diagnosed with HIV in 2006-2010 and 88% of the 1902 diagnosed in 2011-2015 received ART. Lower ART use was observed in both time periods among persons who injected drugs (PWID), homeless, without health insurance at diagnosis, and diagnosed at counseling and testing sites. ART use was significantly lower among African Americans compared to other races in 2011-2015. Median time from diagnosis to ART initiation was 9 months in 2006-2010 and 1 month in 2011- 2015. Median days from diagnosis to ART initiation decreased from 77 days in 2011 to 18 days in 2015. The most frequently documented reasons for not initiating or delaying ART were patient refusal (19%) and asymptomatic (13%). Factors independently associated with delayed ART initiation in both time periods were being African American (OR 0.74, 95% CI 0.6-1.0; OR 0.57, 95% CI 0.4-0.8, respectively) and MSM-PWID (OR 0.57, 95% CI 0.4-0.7; OR 0.60, 95% CI 0.4-0.9, respectively). Conclusion: Overall treatment uptake after HIV diagnosis is high in San Francisco and time from diagnosis to ART significantly reduced in the last 10 years. However disparities remained. Efforts to improve timely linkage to care and treatment should target identified underserved populations. 907 CARE CONSTANCY AND VIRAL SUPPRESSION AMONG ADULTS IN HIV CLINICAL CARE, UNITED STATES Heather Bradley , Kate Buchacz, Yunfeng Tie, Oluwatosin Olaiya, R. L. Shouse CDC, Atlanta, GA, USA Background: It is important to assess the frequency of HIV laboratory testing for monitoring ART efficacy to describe patterns of care usage and to improve our understanding of how care constancy is associated with viral suppression. Clinical HIV care guidelines recommend patients receive at least 1 viral load test every 6 months and 1 CD4 test every 12 months. Methods: We used 2013–2014 data from the Medical Monitoring Project, a surveillance system producing nationally representative information about adults receiving HIV care in the US These data include 24 retrospective months of medical record data for 8,787 participants. We calculated weighted prevalence estimates of care constancy, defined as receiving 1 viral load test in each 6-month period and 1 CD4 test in each 12-month period. Using bivariate and multivariate logistic regression, we examined the association between care constancy and viral suppression (<200 copies/mL) at last test. Analyses were stratified by first CD4 count during the 24-month period (<350 vs. >350 cells/µL2). Results: Overall, 52% [95% confidence interval (CI): 50–54] of patients met the care constancy definition over 24 months, though patients had a median of 7 clinical visits. Those with a lower first CD4 count were less likely than those with a higher first CD4 count to meet care constancy [48% (CI: 45–52) vs. 54% (CI: 52–56)] and to achieve viral suppression [74% (CI: 71–76) vs. 87% (CI: 85–89)]. Among patients with a lower first CD4 count, 83% (CI: 81–85) of those meeting care constancy were virally suppressed at last test compared to 65% (CI: 61–68) of those not meeting care constancy. Those with a higher first CD4 count who met care constancy were also more likely to be virally suppressed than those not

Poster and Themed Discussion Abstracts

CROI 2017 393