CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

920 DEPRESSION AND ART INITIATION AMONG HIGH-RISK HIV SERODISCORDANT COUPLES IN AFRICA Jennifer Velloza 1 , Connie L. Celum 1 , Haberer Jessica 2 , Kenneth Ngure 3 , Elizabeth Irungu 3 , Nelly Mugo 3 , Jared Baeten 1 , Renee Heffron 1 , for the Partners Demonstration ProjectTeam 1 Univ of Washington, Seattle, WA, USA, 2 Cntr for Global Hlth, Massachusetts General Hosp, Boston, MA, USA, 3 Kenya Med Rsr Inst, Nairobi, Kenya Background: Depression is known to reduce antiretroviral therapy (ART) adherence and HIV care engagement, especially among women. Less is understood about the impact of depression on ART initiation, a key upstream factor on the HIV treatment cascade. Methods: We analyzed data from 1013 Kenyan and Ugandan HIV-infected participants in the Partners Demonstration Project, an open-label study of integrated pre-exposure prophylaxis (PrEP) and ART delivery for HIV serodiscordant couples. Participants completed quarterly visits over two years; depression and stigma were assessed at enrollment, 12-month, and 24-month visits. Depression was measured with the 16-item Hopkins Symptom Checklist (HSCL; mean score ranges from 1-4; scores >1.75 indicate “probable depression”). Stigma was measured with the sum from the 6-item Internalized HIV-Related Stigma Scale (score ranges from 0-6). Using multivariable Cox proportional hazards regression, we determined whether time-varying depressive symptoms and internalized stigma independently affected ART initiation among ART-eligible participants. Results: Most participants were female (67.0%), the median time since learning of HIV serodiscordancy was 1 month (IQR: 0.8-3 months), and the median age was 28 years (IQR: 23-35 years). At enrollment, 162 (16.0%) participants experienced probable depression and this proportion decreased during follow-up. The median stigma score was 2.0. Women were more likely to experience probable depression than men (12.8% vs. 7.5% of visits; RR=1.18; 95% CI=1.14-1.22; p<0.001) and reported higher levels of internalized HIV-related stigma across all visits (mean score of 2.4 vs. 2.0; p<0.001). Greater depressive symptom severity was associated with a higher ART initiation rate after adjustment for gender, stigma, HIV viral load, and CD4 count (aHR=1.32; 95% CI=1.01-1.73; p=0.04). This association was similar for men and women and remained when somatic items were removed from the HSCL in sensitivity analyses. Internalized stigma had no effect on ART initiation after controlling for gender, viral load, and CD4 count (aHR=0.97; 95% CI=0.93-1.02; p=0.11). Conclusion: In this demonstration project for HIV serodiscordant couples, depression and stigma were infrequently reported although women had significantly greater risk of depression and stigma than men. Depression and stigma did not hinder ART initiation and depressive symptoms should not prevent providers from encouraging all HIV-infected individuals to initiate ART. 921 HIV STIGMA, DEPRESSION, ADHERENCE, AND VIRAL LOAD AMONG HIV+ AFRICAN-AMERICAN WOMEN Lauren Lipira 1 , Emily C. Williams 1 , David Huh 1 , Patrick J. Heagerty 1 , Audrey French 2 , Susan E. Cohn 3 , Janet M. Turan 4 , Michael J. Mugavero 4 , Deepa Rao 1 1 Univ of Washington, Seattle, WA, USA, 2 Ruth M. Rothstein CORE Cntr, Chicago, IL, USA, 3 Northwestern Univ, Chicago, IL, USA, 4 Univ of Alabama at Birmingham, Birmingham, AL, USA Background: African-American women are disproportionately affected by HIV, have high levels of HIV stigma, and poor HIV outcomes. The purpose of this cross-sectional study is to explore relationships between HIV stigma, depressive symptoms, adherence to antiretroviral treatment (ART), and viral load among a sample of African-American women living with HIV. Methods: From 2013-2015, African-American women living with HIV in Chicago and Birminghamwere recruited for a stigma-reduction intervention. Baseline data fromwomen on ART were included in this analysis. Using logistic regression, the association between stigma (14-item Stigma Scale for Chronic Illness) and viral suppression at baseline (< 200 copies/mL) was estimated. Then, depressive symptoms (PHQ-8) and adherence (missed doses in last 30 days) were tested as mediators using the Karlson, Holm and Breen method for comparing coefficients of nested nonlinear probability models. Finally, a generalized path analysis evaluated a model of 1) stigma predicting depressive symptoms (linear regression), 2) depressive symptoms predicting adherence (negative binomial regression), and 3) adherence predicting viral suppression at baseline (probit regression). Models were adjusted for study site, age and education. Results: Among 194 African-American women, mean stigma score was 33.2 (SD=13.4), mean PHQ-8 score was 7.73 (SD=6.2), mean number of missed ART doses was 1.8 (SD=3.9), and 81%were virally suppressed at baseline. Higher stigma was associated with decreased odds of being virally suppressed at baseline (OR = 0.97, 95% CI: 0.94 – 1.00, p=0.03). This association did not appear to be mediated by depressive symptoms or adherence. However, when estimated simultaneously, higher stigma was associated with higher depressive symptoms (β = 0.27, 95% CI: 0.22 – 0.33, p<0.001); higher depressive symptoms were associated with a higher rate of missed ART doses (IRR = 1.04, 95% CI: 1.00 – 1.10, p =0.04); and a higher number of missed doses was associated with decreased odds of being virally suppressed at baseline (OR = 0.93, 95% CI: 0.88 – 0.99, p = 0.02). Conclusion: These results suggest that HIV stigma is negatively associated with psychosocial and disease outcomes among African-American women living with HIV in urban settings. Longitudinal analysis of similar measures may provide important causal insights. 922 THE CAUSAL EFFECT OF DEPRESSION ON VIRAL SUPPRESSION AMONG ADULTS IN HIV CARE Alison Hughes , Susan Scheer

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