CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We selected PWH from the NYC HIV Surveillance Registry who died during 2007-2015, resided in NYC at death, and died due to OD (classified as accidental (AOD (ICD10 codes X40-X44)) or intentional (IOD (ICD10 codes X60- X64))). We compared the demographics of PWH who died of AOD versus IOD, and analyzed CD4 and viral load (VL) tests from surveillance to evaluate retention in care and viral suppression (VS) (VL≤200 cc/mL) in the 12 months prior to death as markers of care-seeking. Results: From 2007-2015, 670 PWH died of either AOD or IOD in NYC (Table 1). While the rate of OD deaths in PWH declined during the full period, from 64 per 100,000 in 2007 to 47 per 100,000 in 2015 , it increased from 2013 (36 per 100,000) to 2015 (47 per 100,000). Decedents during 2007-2015 were predominantly male (70.6%), black (37.3%) or Latino/Hispanic (36.3%), aged 40-59 years (74.1%), and persons who inject drugs (PWID) (53.5%). Over three- quarters (76.1%) of decedents were retained in HIV care in the 12 months prior to death, and 51.0%were VS. Of the total, 626 (93.4%) deaths were classified as AOD and 44 (6.6%) as IOD. AOD decedents were also predominantly male (69.2%), black (39.0%) and Latino/Hispanic (37.9%), aged 40-59 years (75.6%), and PWID (48.2%). However, IOD were nearly all male (90.9%), mostly white (70.5%), older (22.7% aged 60+) and men who have sex with men (MSM) (65.9%). Three-quarters of both AOD and IOD decedents were retained in care prior to death, but more IOD decedents were VS (79.5% vs. 49.0%). Conclusion: A sizeable number of NYC PWH died of OD in the last decade, and OD death rates in recent years increased. Pre-death care patterns reveal frequent interaction with the health care system, underscoring missed opportunities for harm-reduction and suicide prevention interventions for PWH. Differences in the demographic profiles of AOD and IOD decedents warrant further exploration. Interventions for PWID and MSM who are long-term survivors may need to be further tailored to prevent OD-associated mortality in the context of HIV care.

973 NEW DIAGNOSES OF HIV AMONG INJECTING DRUG USERS, NEW YORK CITY 2006-2016 Lucia V. Torian 1 , Jasmine Abdelnabi 1 , Lisa A. Forgione 1 , Joel O. Wertheim 2 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 University of California San Diego, La Jolla, CA, USA Background: Unintentional drug poisoning and overdose deaths in New York City have increased each year between 2010 and 2016. One contributing factor has been the transition of users of medical and non-medical opioid analgesics to non-injection heroin use, with rapid (median 6 months) transition to heroin injection. This has led to concern that a resurgent HIV epidemic among injecting drug users would follow, as has been seen elsewhere in the US. Methods: We analyzed new diagnoses reported to surveillance to ascertain the trajectory, demographics and risk factors of the HIV epidemic among NYC IDU, focusing on trends among the 2,037 new HIV diagnoses with IDU as a risk factor that occurred in 2006-2016. Pairwise concordance analysis, a genetic distance- based clustering tool, was used to construct transmission networks. Results: Most injection-related cases in the history of the NYC epidemic have occurred in two distinct waves. The first wave began prior to 1981, is 97% black and Hispanic, 68% aged 40+ at diagnosis, and concentrated in northern Manhattan, the South Bronx, and central Brooklyn. Its survivors occupy genetic transmission networks populated primarily by older diagnosis dates. The second wave is more recent, involves persons with the dual risk of MSM and IDU, and is more evenly distributed by race/ethnicity (40%white) and neighborhood, younger, (47% aged 20-29 and 30% aged 30-39 years), and belongs to transmission networks populated primarily by young, non-injecting, more recently diagnosed MSM. There is minimal overlap between the networks of the two waves. To date, the new heroin injectors, whose numbers and demographics are unknown, have made no discernible impact on HIV rates. In fact, during 2006-2016 new diagnoses declined 88.0% among IDU and 64.6% among MSM/IDU. Conclusion: Unlike other jurisdictions, NYC has not seen an increase in HIV diagnoses attributable to IDU. However, it has a large population of people living with HIV, including more than 16,000 IDU and more than 2,600 MSM/ IDU, and any bridge between the risk sharing networks of new injectors and the survivors of the first and second waves has the potential to spark a third wave of injection-fueled HIV. NYC syringe exchange programs, which reduced incidence in previous waves, as well as New York State legislation that in 2000 legalized over-the-counter syringe sales in pharmacies, may mitigate risk by facilitating safe injection among future new injectors. 974 DRUG OVERDOSE DEATHS AMONG PERSONS WITH HIV IN NEW YORK CITY, 2007-2015 Sarah L. Braunstein , Rebekkah S. Robbins, Demetre C. Daskalakis New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: Preventable deaths, including those due to drug overdose (OD), are a significant public health concern in New York City (NYC). The rate of unintentional drug OD death in NYC increased 143% between 2010 and 2016; trends in drug OD death among persons with HIV (PWH) in NYC have not been described. Care-seeking by PWH presents an opportunity to avert preventable deaths, including OD deaths.

Poster Abstracts

975 3-YEAR OUTCOMES OF PATIENT NAVIGATION+FINANCIAL INCENTIVES FOR HIV+ SUBSTANCE USERS Daniel Feaster 1 , Carlos del Rio 2 , Abigail Matthews 3 , Lauren Gooden 4 , Tim Matheson 5 , Maxine Stitzer 6 , Mamta K. Jain 7 , Allan Rodriguez 1 , Wendy S. Armstrong 2 , Gregory M. Lucas 6 , Mari-Lynn Drainoni 8 , Carmen L. Masson 9 , David C. Perlman 10 , Petra Jacobs 11 , Lisa Metsch 4 1 University of Miami, Miami, FL, USA, 2 Emory University, Atlanta, GA, USA, 3 Emmes Corporation, Rockville, MD, USA, 4 Columbia University Medical Center, New York, NY, USA, 5 San Francisco Department of Public Health, San Francisco, CA, USA, 6 Johns Hopkins University, Baltimore, MD, USA, 7 University of Texas Southwestern, Dallas, TX, USA, 8 Boston University, Boston, MA, USA, 9 University of California San Francisco, San Francisco, CA, USA, 10 Icahn School of Medicine at Mt Sinai, New York, NY, USA, 11 National Institute on Drug Abuse, Rockville, MD, USA Background: Project Hope (CTN0049), a previously reported 3-arm RCT, tested 6 months of Patient Navigation (PN) and PN+Financial Incentives (PN+FI) versus treatment as usual (TAU) in increasing viral suppression rates in HIV+ substance-using hospitalized patients. Results showed PN+FI had higher rates of viral suppression than TAU at 6 but not 12 months. We report on

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