CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

1 The Johns Hopkins Univ, Baltimore, MD, USA, 2 Rakai Hlth Scis Prog, Kalisizo, Uganda, 3 Columbia Univ, New York, NY, USA, 4 Makerere Univ, Kampala, Uganda Background: Higher HIV prevalence is commonly observed among migrant populations in Sub-Saharan Africa. However the extent to which migration is a cause or consequence of HIV infection is largely unknown. Here, we use population-based, longitudinal data to assess the association between duration of residence since migration into a community and HIV incidence in Rakai District, Uganda. Methods: We used prospective data from HIV-negative participants residing in thirty communities under continuous surveillance between 1999 and 2015 in the Rakai Community Cohort Study (RCCS), an open population-based census and cohort of adults aged 15-49 in rural south-central Uganda. Migrants were identified during census and classified as individuals who moved to a new community with intention to stay. Newly HIV-positive individuals were considered incident HIV cases if they had an HIV-negative test result at a prior survey. Poisson regression with generalized estimating equations was used to estimate incidence rate ratios (IRR) of HIV infection associated with years since arrival for migrants relative to long term-residents with adjustment for demographics, sexual risk behaviors, and calendar time. Results: HIV incidence was assessed among 13,991 HIV-negative individuals of whom 57% (n=8,049) were women and 34% (n=4571) were classified as migrants. Participants were followed for 85,654 person-years (pys) during which 802 incident HIV events were detected (n=313 in men; n=489 in women). Overall, incidence was 1.6/100pys in recent migrants (arrived <2 years), 0.97/100pys in non-recent migrants (>2 years), and 0.88/100pys among long-term residents. Among women, HIV incidence was significantly elevated in recent migrants relative to long-term residents before and after adjustment for potential confounders (IRR=1.86, 95%CI:1.43-2.41; adjIRR=1.60, 95%CI: 1.21-2.13) but not in non-recent migrants (IRR=0.89, 95%CI:0.71-1.12; adjIRR=0.97, 95%CI: 0.76-1.23). We observed no significant increases in HIV risk among recent (IRR=1.34, 95%CI:0.78-2.32; adjIRR=1.36, 95%CI:0.78-2.37) or non-recent migrant men (IRR=1.03, 95%CI:0.71-1.48; adjIRR=1.12, 95%C1: 0.77-1.64). Conclusion: These data suggest that the earliest years after migration are associated with increased risk of HIV acquisition in women but not men in rural East Africa. These findings highlight the need for timely interventions targeted to migrant populations, particularly women, to reduce HIV incidence in Sub-Saharan Africa. 1016 OUTCOMES ALONG THE HIV CARE CONTINUUM AMONG UNDOCUMENTED IMMIGRANTS IN CLINICAL CARE Jonathan Ross , Uriel Felsen, Chinazo Cunningham, Viraj V. Patel, David B. Hanna Albert Einstein Coll of Med, Bronx, NY, USA Background: HIV-infected undocumented immigrants face unique barriers to care yet little is known about clinical outcomes in this population. We compared outcomes along the HIV care continuum between undocumented and documented patients in a diverse, high HIV prevalence area where insurance and prescription medications are available to undocumented immigrants. Methods: We performed a retrospective cohort analysis of HIV-infected persons ≥ 18 years who were linked to care between 2006-2014 at a large academic medical center that is the largest provider of HIV care in the Bronx, NY. Undocumented status was assessed based on an algorithm incorporating Social Security number and insurance status and was verified through medical chart review. We used adjusted Poisson regression models with generalized estimating equations to compare undocumented patients and documented patients with respect to retention in care (≥ 2 CD4 count or viral load measurements ≥ 90 days apart), antiretroviral therapy (ART) prescription (≥ 3 active antiretroviral agents in a year) and viral load suppression (HIV RNA < 200 copies/mL for the last measured viral load) for each year in care. Results: A total of 7,551 eligible patients were followed for a median of 5 years (interquartile range 2-9). We classified 173 patients (2.3%) as undocumented. At entry to care, undocumented patients were younger (mean age 37.8 years vs 40.6 years, p<0.001), less likely to report injection drug use as their primary HIV risk factor (3% vs 18%, p<0.0001) and had lower median CD4 counts (in cells/mm3: 299 vs. 341, p<0.01). For each year of the analysis, higher proportions of undocumented immigrants were retained in care, prescribed ART and virally suppressed. After adjusting for age, race/ethnicity, sex, HIV risk factor, and comorbid substance use disorder, undocumented immigration status was associated with increased probability of retention in care (RR 1.05, 95% CI 1.01-1.10), ART prescription (RR 1.05, 95% CI 1.01-1.08) and viral load suppression (RR 1.13, 95% CI 1.08- 1.19) compared to documented status. Conclusion: Undocumented immigrants achieved retention in care, ART prescription and viral load suppression at modestly higher rates than documented persons, despite entering care with more advanced disease. When insurance and prescription medications are available to undocumented immigrants, similar outcomes along the HIV continuum of care may be achieved regardless of immigration status.

Poster and Themed Discussion Abstracts

1017 IMMIGRANTS AND BOTSWANA’S ART PROGRAM: POTENTIAL BARRIERS TO EPIDEMIC CONTROL Tafireyi Marukutira 1 , Mary Grace Alwano 1 , Stephanie Behel 2 , Joseph N. Jarvis 1 , Unoda Chakalisa 3 , Kathleen Powis 4 , William Bapati 5 , Gene Ussery 6 , Refeletswe Lebelonyane 7 , Pamela J. Bachanas 2 1 US CDC, Gaborone, Botswana, 2 CDC, Atlanta, GA, USA, 3 Botswana Harvard Partnership, Gaborone, Botswana, 4 Harvard Univ, Boston, MA, USA, 5 Tebelopele Voluntary Counseling and Testing Cntr, Gaborone, Botswana, 6 Northrop Grumman Corporation, Atlanta, GA, USA, 7 Botswana Ministry of Hlth, Gaborone, Botswana Background: Models suggest that universal HIV testing and immediate antiretroviral therapy (ART) combined with enhanced prevention approaches could achieve epidemic control of HIV in southern Africa. Botswana may be close to UNAIDS 90-90-90 targets according to baseline data from the Botswana Combination Prevention Project (BCPP).

CROI 2017 438