CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

assessed demographic characteristics, differences in drug injection behaviors by time period, and use of the SSP overall and by HIV status. Percentages and medians, with interquartile ranges (IQRs), were reported for categorical and continuous variables, respectively. We assessed differences in injection drug behaviors by time period using McNemar’s test. Results: Of the 124 PWID who reported injecting in both time periods, 72 (57%) were male, 115 (93%) were non-Hispanic white, and median age was 35 years (IQR: 28, 43). Self-reported HIV status was HIV-positive for 48 (39%), HIV-negative for 65 (52%), and unknown for 11 (9%) PWID. Compared with before outbreak detection, the percent of persons using only sterile syringes for injection increased from 12% to 64%, using a medical waste sharps container for used syringes increased from 18% to 82%, and sharing syringes decreased from 74% to 22% after outbreak detection. Compared with before outbreak detection, syringe sharing after outbreak detection decreased from 90% to 9% among HIV-positive persons and from 66% to 30% among HIV-negative persons. Overall, 107 (86%) persons used the SSP; 98% of HIV-positive persons and 85% of HIV-negative persons used SSP services. Among those who used the SSP, 85% of HIV-positive and 67% of HIV-negative persons reported never sharing needles after outbreak detection. Conclusion: High-risk injection practices among a sample of PWID in southeastern Indiana decreased dramatically after detection of an HIV outbreak and establishment of an SSP. Use of the SSP was high, and almost all self-reported HIV-positive persons used the SSP, minimizing HIV transmission risk. The SSP played a key role in decreasing behaviors associated with HIV transmission.

detectable HVL declining from 0.9 to 0.8 over time. The frequent MA use group’s conditional probability of detectable HVL was 0.7 (95% CI: 0.49-0.90), compared to 0.4 (95% CI: 0.21-0.59) in the no MA use group and 0.38 (95% CI: 0.15, 0.61) in the occasional MA use group. GBTM using incomplete 18-month follow-up data suggested a fourth small group with consistent daily MA use, but there was too much missing data for a valid model. Conclusion: Frequent MA use over time was associated with a longitudinal pattern of detectable HVL. Those who reported occasional MA use had similar HVL trajectories to those who reported no MA use, suggesting that pattern of MA use has ongoing implications for HIV viral load. To improve treatment outcomes for those living with HIV, frequency of use of substances such as MA needs to be addressed.

Poster Abstracts

969 TRANSACTIONAL SEX AMONG MEN WHO HAVE SEX WITH MEN: WHAT’S DRUGS GOT TO DO WITH IT? Marjan Javanbakht , Amy Ragsdale, Steven Shoptaw, Pamina Gorbach University of California Los Angeles, Los Angeles, CA, USA Background: The objective of this study was to examine the prevalence and correlates of transactional sex among men, the role of substance use and sexual risk behaviors, and how transactional sex may impact the use of STI/HIV biomedical prevention strategies. Methods: Participants included those recruited as part of an NIH/NIDA funded cohort, with 422 participants recruited between August 2014 and May 2017 in Los Angeles, CA. Eligible participants were: (1) ≥18 years of age; (2) male; and (3) if HIV negative reported condomless anal intercourse with a male partner in the past 6-months. By design, half were HIV-positive and half HIV-negative. At baseline and semi-annual visits, computer assisted self-interviews were used to collect information on sexual behaviors and laboratory testing was conducted for current STI/HIV status. Factors associated with transactional sex were evaluated using regression analysis with generalized estimating equations in order to account for within subject correlations. Results: The average age of participants was 31.4 years with 43% identifying as African American, followed by 36% as Hispanic/Latino. Prevalence of recent transactional sex across the 1,081 study visits was 18% (n=190), with 73% of this group reporting exchanging sex for drugs. Transactional sex was higher among those who reported unstable housing (32% vs. 11%; p value <.01), concurrent sexual partnerships (27% vs. 9%; p value<.01), and transgendered sex partners (38% vs. 16%; p value=0.02). Reciprocal sex work was also high with those who reported receiving money, drugs, or shelter for sex, also more likely to give money, drugs, shelter for sex (76% vs. 11%; p value <.01). HIV viral load was independently associated with transactional sex such that every log 10 increase in HIV-1 RNA was associated with a 40% increase in the odds of transactional sex [adjusted odds ratio (AOR)=1.4; 95% confidence interval (CI) 1.1-1.7). Additionally, those testing positive for an STI were nearly twice as likely to report transactional sex as compared to those without STIs (AOR= 1.9; 95% CI 1.0-3.7). ... Conclusion: The prevalence of transactional sex among this cohort of high risk HIV-negative and HIV-positive MSM was relatively high. These findings highlight that the intersection of drug use, poverty, and HIV among young LA MSMmay require different approaches to HIV prevention and care in order to reduce poorly controlled HIV disease and the practice of HIV transmission behaviors.

968 JOINT TRAJECTORIES OF METHAMPHETAMINE USE AND HIV VIRAL LOAD Chelsea L. Shover 1 , Heather A. Pines 2 , Steven Shoptaw 1 , Marjan Javanbakht 1 , Robert Bolan 3 , Pamina Gorbach 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 University of California San Diego, La Jolla, CA, USA, 3 Los Angeles LGBT Center, Los Angeles, CA, USA Background: Methamphetamine (MA) is highly addictive, interfering with adherence to HIV treatment and care. To identify effects of use patterns, we characterized the trajectories of MA use and HIV viral load (HVL) over 12 months in a cohort of HIV-positive men who have sex with men (MSM) of color aged 18-45. We hypothesized that there would be a strong association in the trajectories of both having a detectable HVL and MA use. Methods: The study included 137 HIV-positive men who enrolled in the NIDA- funded mSTUDY cohort between August 2014 and July 31, 2016 and had at least one follow-up visit. MA use and HVL were assessed at baseline and visits every six months. Past six-month frequency of MA use was assessed via computer- assisted self-interview as never, once, less than monthly, monthly, weekly, daily (recoded as 0-5). HVL was assessed via PCR test; under 40 copies/mL defined as undetectable. Group-based trajectory models (GBTMs) were constructed using a censored normal distribution to model trajectories of MA use and a binomial distribution to model trajectories of HVL (detectable vs. undetectable). A joint trajectory model was specified to determine conditional probabilities of membership in the identified groups. Results: GBTMs identified three MA use trajectory groups: 1) no use (34% of participants), 2) occasional and declining use (25%), and 3) frequent and declining use (42%). A Two HVL trajectory groups were identified: 1) consistently undetectable (53%), with probability of detectable HVL declining from 0.2 to 0.1 over time, 2) consistently detectable (48%), with probability of

CROI 2018 370