CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

San Francisco Dept of Pub Hlth, San Francisco, CA, USA Background: Depression has been associated with lower adherence to antiretroviral treatment (ART) and lower likelihood of viral suppression. We sought to use causal inference methods to quantify howmuch the proportion of viral suppression may increase if current depression could be eliminated among HIV-positive adults in HIV care in San Francisco, California. Methods: The causal effect of current depression on subsequent sustained viral suppression was estimated using causal inference methods. Data from the 2012-2014 cycles of the San Francisco Medical Monitoring Project (MMP) were collected from June 2012 through May 2015. Current depression was measured during the patient interview using the Patient Health Questionnaire Depression Scale-8 (PHQ-8) scale and was defined as a score ≥10. Sustained HIV viral suppression, which was defined as all reported viral loads within 12 months after interview being suppressed (≤200 copies/mL or “undetectable” result) was obtained through the HIV surveillance registry. Targeted minimum loss estimation (TMLE) was utilized to estimate the difference in the counterfactual proportion of HIV-positive adults virally suppressed if all adults in HIV care in San Francisco did not have current depression compared to the proportion of HIV-positive adults virally suppressed with the current level of depression. Non-parametric bootstrap was used to obtain 95% confidence intervals. Results: There were 692 adults in our sample. The prevalence of current depression was 20.1% and 87.7% of adults in HIV care had sustained viral suppression for the 12 months after interview. The counterfactual proportion of adults virally suppressed would increase by 4.6% (95% CI: 3.4%-5.8%) if current depression could be eliminated from its current prevalence in adults in HIV care in San Francisco. Conclusion: The results from this analysis highlight that current depression has a causal effect on sustained viral suppression among adults in HIV care in San Francisco. The percentage of adults virally suppressed at the current prevalence of depression fell short of the UNAIDS 90-90-90 goal, which aims to get 90% of persons living with HIV virally suppressed by 2020. If depression could be eliminated, through effective treatment, the proportion of adults virally suppressed in HIV care in San Francisco would increase from its current level of 87.7% to 92.3% (95% CI: 91.1%-93.5%), which exceeds the 90-90-90 target. 923 SOCIAL ECOLOGICAL FACTORS ASSOCIATED WITH SEX WORK AMONG TRANSGENDER WOMEN IN JAMAICA Carmen H. Logie 1 , Ying Wang 1 , Nicolette Jones 2 , Uzma Ahmed 1 , Kandasi Levermore 2 , Tyrone Ellis 2 , Ava Neil 2 , Annecka Marshall 3 , Ashley A. Lacombe-Duncan 1 , Peter A. Newman 1 1 Univ of Toronto, Toronto, Canada, 2 Jamaica AIDS Support for Life, Kingston, Jamaica, 3 Univ of the West Indies, Mona Campus, Kingston, Jamaica Background: Transgender women are disproproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non sex work involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study aimwas to examine social ecological factors associated with sex work involvement among transgender women in Jamaica. Methods: In 2015 we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. Results: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n=71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n=64; 47.06%); survival needs (n=27; 19.85%); and drugs/alcohol (n=6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement. Conclusion: Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non sex workers. Findings can informmulti-level interventions to advance the social determinants of health and HIV prevention and care cascades with transgender women in Jamaica. 924 SEXUAL ORIENTATION DIFFERENCES IN HEALTH AND WELLBEING AMONG WOMEN WITH HIV IN CANADA Carmen H. Logie 1 , Ashley A. Lacombe-Duncan 1 , Ying Wang 1 , Angela Kaida 2 , Alexandra de Pokomandy 3 , Kath Webster 2 , Tracey Conway 4 , Mona Loutfy 4 1 Univ of Toronto, Toronto, Canada, 2 Simon Frasier Univ, Vancouver, Canada, 3 McGill Univ, Montreal, Canada, 4 Women’s Coll Rsr Inst, Toronto, Canada Background: Scant research has examined wellbeing among sexual minority women (SMW) living with HIV despite well-documented sexual minority health disparities. The study objective was to examine sexual orientation differences in clinical, psychosocial and structural outcomes among women living with HIV (WLH) in Canada. We hypothesized that SMW living with HIV would experience poorer health and wellbeing than heterosexual WLH. Methods: Cross-sectional baseline data was analyzed from a national Canadian cohort study conducted with WLH between August 2013 and May 2015. This included 1,420 participants (SMW: n=180; heterosexual: n=1240). SMW participants (median age: 38 years, IQR: 13) included bisexual (58.9%), lesbian (17.8%) and other sexualities (gay, queer, Two-spirit) (23.3%). We assessed sexual orientation differences in clinical, psychosocial and structural outcomes. Univariate and multivariate logistic regression analyses were conducted to determine the adjusted risk ratio for sexual orientation. Results: SMWwere younger than heterosexual participants (median age 38 years vs. 43 years; p<.001). Caucasian was the highest reported ethnicity category for both heterosexual (40.4%) and SMW (46.1%) participants; the second most frequent ethnicity was African, Caribbean or Black among heterosexuals (31.9%) and Indigenous among SMW (35.6%). A higher proportion of SMW (73.5%) compared to heterosexuals (64.3%, p<0.05) reported an annual household income of < $20,000. Multivariate logistic regression analyses controlling for age, poverty, education, and ethnicity revealed that compared to heterosexual WLH, SMW living with HIV reported clinical (<80% ARV adherence vs. 100% ARV adherence [AOR: 2.57, 95% CI: 1.45-4.56]), psychosocial (childhood abuse history [AOR: 2.93, 95% CI: 1.83-4.70], sex work [AOR: 2.87, 95% CI: 1.71-4.81], current injection drug use [IDU] vs. never IDU [AOR: 4.54, 95% CI: 2.70-7.61], prior IDU vs. never IDU [AOR: 2.35, 95% CI: 1.51-43.65], depression [AOR: 1.06, 95% CI: 1.03-1.08], lower resilience [AOR: 0.96, 95% CI: 0.95-0.98]), and structural (barriers to HIV support services [AOR: 1.76, 95% CI: 1.15-2.69], unstable housing [AOR: 1.72, 95% CI: 1.11-2.69], gender discrimination [AOR: 1.04, 95% CI: 1.02-1.06], racial discrimination [AOR: 1.03, 95% CI: 1.02-1.05]) outcome differences. Conclusion: SMWwith HIV experience social and health disparities relative to heterosexual WLH. Tailored multi-level interventions are needed to promote health equity among SMWwith HIV. 925 HEALTH OUTCOMES ASSOCIATED WTIH GENDER-BASED VIOLENCE AMONG WOMEN WITH HIV IN CANADA Carmen H. Logie 1 , Angela Kaida 2 , Alexandra de Pokomandy 3 , Erin Ding 4 , Nadia O’Brien 3 , Uzma Ahmed 1 , Tracey Conway 5 , Val Nicholson 2 , Mona Loutfy 5 1 Univ of Toronto, Toronto, Canada, 2 Simon Frasier Univ, Vancouver, Canada, 3 McGill Univ, Montreal, Canada, 4 BC Cntr for Excellence in HIV Rsr, Vancouver, Canada, 5 Women’s Coll Rsr Inst, Toronto, Ontario Background: Gender-based violence (GBV) is a global epidemic that disproportionately impacts women living with HIV (WLWH). We aimed to assess factors associated with experiencing GBV among WLWH in Canada.

Poster and Themed Discussion Abstracts

CROI 2017 400