CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Medicaid coverage increased from 39% (CI: 32–46) to 51% (CI: 46–56). The percentage of patients receiving Ryan White services was 42% (CI: 39–45) in both NME and ME expansion states in 2012 but increased to 55% (CI: 49–62) in NME states in 2014 with no accompanying change in ME states. Prevalence of viral suppression was 77% (CI: 75–79) in both NME and ME states in 2012, increasing to 83% (CI: 81–85) among patients in ME states and non-significantly to 81% among patients in NME states (CI: 76–86) in 2014. Conclusion: Among patients in ME states, the percentage of persons in HIV care who were uninsured declined by nearly 50% from 2012–2014; this was driven by increases in Medicaid coverage. No decline in the percentage uninsured was found among patients in NME states. Viral suppression increased by 8% in ME states from 2012–2014. Future work will examine whether this increase in viral suppression is attributable to changes in health care coverage. 1013 HOUSING STABILITY IS ASSOCIATED WITH HIV VIRAL SUPPRESSION IN A HOUSING PLACEMENT RCT Yaoyu Zhong 1 , Ellen Wiewel 1 , Vivian L. Towe 2 , Rachel Johnson 1 , Laura McAllister-Hollod 1 , Joanne Hsu 1 , Sarah Braunstein 1 , John Rojas 1 1 New York City DHMH, Long Island City, NY, USA, 2 RAND Corporation, Arlington, VA, USA Background: Homeless or unstably housed people living with HIV (PLWH) may have low rates of retention in HIV care and viral suppression (VS). Providing stable housing is complex. A randomized controlled trial of rapid rehousing, Enhanced Housing Placement Assistance (EHPA), tested whether at-residence case management could improve housing stability and health outcomes among low-income, homeless PLWH in New York City (NYC). Methods: A total of 236 PLWH from 22 emergency housing facilities were randomly sampled and assigned to EHPA or usual housing placement assistance (HPA). Case managers visited EHPA persons at their emergency housing weekly up to 1 year, to help them find stable housing; HPA persons received in-office supportive services ≤3 months (the standard for housing placement). Housing status, engagement in HIV care (any viral load [VL] or CD4 count) and VS (last VL ≤200 copies/mL) were measured in 6-month increments from enrollment through 24 months. For each time increment, housing stability was classified as “low” for continuous residence in emergency housing, “medium” for transit between stable housing (i.e., permanent housing or independent living) and emergency housing, and “high” for continuous residence in stable housing. Chi-square measured the difference in housing stability between EHPA and HPA in each time increment. Multilevel logistic regression measured improvement in VS over time by using an interaction term of study arm by time, and housing stability’s impact on VS. Data came from surveys, the NYC HIV surveillance registry, and an emergency housing database. Results: Over 65% of participants were male, Black or Hispanic, ≥40 years old, disabled or unemployed, and chronically homeless. EHPA had more persons with medium and high housing stability than HPA at each time increment (at 6 and 12 months, p≤0.01). People with low housing stability were least likely to be engaged in care, but the proportion engaged in care decreased over time among high housing stability persons in EHPA. Half of variance in VS was due to within-subject differences (ICC=0.49). Compared to HPA, VS of EHPA persons increased by 4%monthly (aOR 1.04, 95% CI: 1.01-1.07; Table). People with medium and high housing stability were >50%more likely to be virally suppressed than those with low stability. Conclusion: Compared with HPA, enhanced housing stabilization services with at-residence case management were associated with improved housing and health outcomes for PLWH.

Poster and Themed Discussion Abstracts

1014 ADVANCING “TASP” USING A MEDICAL-CARE COORDINATION MODEL IN LOS ANGELES COUNTY Wendy H. Garland , Sonali P. Kulkarni Los Angeles County, Los Angeles, CA, USA

Background: Despite effective antiretroviral therapies, only 35% of persons living with HIV nationally achieve the full benefit of treatment and there is a paucity of evidence based interventions to increase viral suppression. To advance “treatment as prevention,” the Los Angeles County (LAC) Division of HIV and STD Programs evaluated the effectiveness of a Medical Care Coordination (MCC) model. Methods: MCC was adapted from chronic disease models in which HIV patients at highest risk for poor health outcomes are targeted for integrated medical and psychosocial support services. In 2013, MCC services were delivered by multidisciplinary teams (nurse, social worker, caseworker) co-located in 35 safety net HIV clinics in LAC. Patient acuity was assessed at enrollment and guided service intensity. Service effectiveness was evaluated using a pre-post prospective cohort design with patients as their own controls. The proportion of patients with suppressed viral load (last test in past 6m≤200 copies/mL) was compared at 12m pre-and post-enrollment in MCC using McNemar’s chi-square. Results: In 2013, 1,204 HIV+ patients were enrolled in MCC (49% Latino, 26% Black; 85%male; 54% aged 25-44; 78%≤federal poverty level; 38% ever incarcerated; 17% homeless in past 6m). Acuity at enrollment was 52%moderate, 30% high,18% low and >1% severe. Patients received 18.3 median service hours of MCC (interquartile range=23.6) over 12mwith higher acuity patients receiving significantly more hours (p<0.05). The proportion of virally suppressed patients increased significantly from 31% pre-MCC to 60% post-MCC (p<0.05) resulting in a relative improvement of 97%. The largest improvements in viral suppression pre-and post MCC were observed among patients who were high/ severe acuity (19% pre-MCC vs 49% post-MCC; p<0.05); patients aged 12-24 years (25% pre-MCC vs 58% post-MCC; p<0.05); transgender patients (31% pre-MCC vs 65% post-MCC; p<0.05); and, men who have sex with men (MSM) (28% pre-MCC vs 60% post-MCC; p<0.05). Conclusion: The results of this large scale intervention demonstrate that MCC model is effective at increasing the proportion of patients with viral suppression after 12 months. Significant improvements were also seen among vulnerable populations including those with highest acuity, youth, transgender and MSM. This promising strategy not only results in improved health status among patients but advances “treatment as prevention” by reducing the likelihood of forward HIV transmission. 1015 MIGRATION, GENDER, AND HIV INCIDENCE IN RAKAI, UGANDA Oluwasolape M. Olawore 1 , Aaron Tobian 2 , Fred Nalugoda 2 , Ronald H. Gray 1 , Maria Wawer 1 , Robert Ssekubugu 2 , John Santelli 3 , Larry W. Chang 2 , David Serwadda 4 , Kate Grabowski 1

CROI 2017 437