CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

reporting the location of their last HIV test, 21% tested at the community outreach center/SSP, 15% at jail/prison, 15%were tested by a professional at home, and the remaining persons reported utilizing 1 of 7 other testing options. Sixty-six (33%) and 21 (11%) participants reported having heard of PrEP or PEP, respectively. Of those who had heard of PrEP, 3 were taking it; no one reported taking PEP. Of those reporting the location of their last HIV test, 53% of those who last tested at the SSP expressed knowledge of PrEP, compared to 32% of those whose last HIV test was not at the SSP (p=0.023). Conclusion: Enhanced HIV testing efforts following an HIV outbreak among PWID in Indiana were associated with increased HIV testing and diagnoses. Awareness and use of PrEP and PEP were low, but PrEP awareness was significantly higher among those whose last HIV test was at the SSP. These findings indicate a need for increased education and access to PrEP and PEP, and suggest that SSPs may offer a useful forum for PrEP/PEP education. 963 AN OUTBREAK OF HIV ASSOCIATED WITH SHARING OPIATE INJECTION PREPARATION EQUIPMENT Sharon Koivu, L Ball, K Gupta, C Venner, R Tirona, Eric Arts, B Hallam, Ryan Wong, Klajdi Puka, M Speechley, G Hovhannisyan, Michael Silverman University of Western Ontario, London, ON, Canada Background: London, Canada is experiencing a HIV outbreak among People Who Inject Drugs (PWID) despite a very extensive needle and equipment distribution campaign, opiate substitution therapy program and local HIV clinic. Hydromorphone hydrochloride time-release capsules (HMC)(Hydromorph Contin®); a controlled release prescription opioid, is the local opiate of choice. Injection of HMC is associated with frequent sharing of injection drug preparation equipment [(IDPE) filters and cookers] with multiple needle insertions into the IDPE. Methods: We conducted a nested case control study of local PWID. Cases (HIV+) (n=35) and controls (HIV neg)(n=84) completed an extensive questionnaire regarding attitudes and behaviors associated with injection drug use. We assessed the presence of residual HMC or immediate release hydromorphone (IRH) in the IDPE following initial injection, and the effects of heating the preparation (using a cigarette lighter) via liquid chromatography– tandemmass spectrometry. The persistence of HIV reverse transcriptase activity (RT) and Infectivity (Tzm-bl cells) was assessed after adding virus to IDPE in the presence or absence of HMC or IRH. Results: Logistic regression analysis demonstrated that sharing IDPE in the absence of needle/syringe (NS) sharing was strongly associated with HIV infection [aOR=22.12; p<0.001], sharing both IDPE and NS was also associated with HIV infection [aOR=23.9, p=0.007], while there was no association with sharing only NS [aOR=0.91; p=0.92] (likely due to NS sharing being very infrequent and only with sero-concordant partners vs IDPE sharing being highly repetitive, often several times/day). The belief that heating the HMC preparation in the IDPE was unnecessary or harmful was also associated with HIV infection (p<0.05). We demonstrated that 45% of HMC (but not IRH) remained in the IDPE following initial injection, with no significant change to the quantity of extracted or residual hydromorphone after heating. HIV RT activity and infectivity was preserved in the IDPE by the presence of HMC but not IRH. Heating the IDPE rapidly inactivated HIV even in the presence of HMC. Conclusion: We demonstrated a high risk for HIV transmission associated with sharing of IDPE. Time released hydromorphone encourages IDPE sharing, and the drug excipients can preserve HIV viability. Messaging “don’t share IDPE, but cook it if you do”, may be an effective (i.e. reducing infection) and safe (i.e. not contributing to overdose) harm reduction strategy.

964 IDENTIFYING UNDIAGNOSED HIV-INFECTED PWID IN INDIA USING RESPONDENT-DRIVEN SAMPLING Allison M. McFall 1 , Shruti H. Mehta 1 , Aylur K. Srikrishnan 2 , Santhanam Anand 2 , Canjeevaram K. Vasudevan 2 , Gregory M. Lucas 1 , Sunil S. Solomon 1 1 The Johns Hopkins University, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: Globally, people who inject drugs (PWID) have a high HIV burden yet many are not self-referring for HIV testing or engaged by outreach, resulting in awareness levels well below the 90% UNAIDS target. Respondent-driven sampling (RDS), a type of chain-referral sampling, is an efficient way to reach PWID and other hidden populations. We examined if recruiter characteristics could predict recruitment of undiagnosed HIV-infected PWID. Methods: In 2013, a cross-sectional sample of 14,481 PWID across 15 Indian cities (~1000/city) was accrued using RDS. Each sample was initiated by two well-connected PWID (seeds) with each seed and subsequent recruit given 2 coupons to recruit other PWID. Participants underwent a blood draw, HIV testing, and completed a survey. We evaluated predictive accuracy of combinations of recruiter characteristics in recruitment of undiagnosed HIV- infected PWID by calculating areas under receiver operating characteristic (AUC) from logistic regression models, focusing on easy-to-collect predictors. Results: Median age was 30 and most were men (94%). 58% injected daily and 20%were HIV-infected, of whom 58%were previously undiagnosed; 40% were HCV-infected. 57% recruited at least one person and 10% recruited an undiagnosed HIV-infected PWID. People with HIV/HCV mono and co-infection were more likely to recruit an undiagnosed PWID (odds ratio [OR] vs. HIV and HCV uninfected, HIV: 1.9 [95% confidence interval CI: 1.5-2.4]; HCV: 1.6 [1.4-1.8]; co-infection: 2.1 [1.8-2.4]; AUC=0.714). Recruiting an undiagnosed PWID was associated with larger network size (OR ≥50 vs. ≤10: 1.7 [1.4-1.9], AUC=0.707) and harm reduction use (OR needle exchange: 1.5 [1.3-1.6]; OR opiate agonist therapy: 1.2 [1.1-1.5]; combined AUC=0.706). Age, gender, marriage, and education were not independently associated and together had an AUC=0.700. HIV/HCV infection with the addition of network size resulted in an AUC=0.718, significantly higher than HIV/HCV infection alone or combined other predictors. Among those with HIV/HCV co-infection and a large network (≥50 PWID), 1 in 5 (22%) recruited an undiagnosed PWID. Conclusion: Recruitment patterns suggest PWID with HIV/HCV infection and who are central in their network are more likely to recruit PWID with undiagnosed HIV. These easily obtainable characteristics could be used to target an RDS in order to identify undiagnosed infections more efficiently, potentially useful in other high-burden populations or outbreaks when rapid case finding is vital.

Poster Abstracts

CROI 2018 368