CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

the 3-year outcomes of this cohort, the largest group of initially hospitalized HIV+ substance-using individuals with uncontrolled HIV infection followed prospectively. Methods: Project Hope recruited 801 patients from 11 hospitals in the U.S. from 7/10/2012 until 9/10/2014 and followed for a year. Of the 711 patients alive at 12-months, 686 had consented to contact for long-term follow-up, which was completed between 2/18/2016 and 1/30/2017. Differences by study arm in treatment success (viral suppression) versus failure (non-suppression or death) were tested with mixed models for binary outcomes. Results: There were 650 of 686 patients located, with 117 of 686 (17%) having died between the last and long-term follow-up and 422 of the 569 alive (74%) enrolled yielding follow-up assessment on 539 of 686 (79%). The median time to the long-term follow-up was 3.3 years [IQR=2.9, 3.6]. There was no difference in the rates of treatment success at long-term follow-up across study arm (PN=33%, PN+FI=33%, TAU=36%, p=.181). Blacks (OR=.42, 95%CI[.23,.77]), those recruited from the South (OR=.27, 95%CI[.16,.47]), and stimulant users (OR=0.43, 95% CI[0.27,0.70]), were all less than half as likely as Whites, those not from the South, and non-stimulant users, respectively, to be virally suppressed. Of 801 patients, 207 (26%) have died since randomization into Project Hope with no differences in rates of deaths across study arm (PN=28%, PN+FI=24%, TAU=25%, p=.681). Rates of viral suppression for those who survived to follow-up were 50%. There were no significant differences in long-term substance use across study arm (PN=71%, PN+FI=70%, TAU=69%, p=.646). Conclusion: Despite intensive time-limited intervention, the long-term rate of success with hospitalized substance-using patients was only 33%, with lower rates for Blacks, those using stimulants and those recruited in the South. The high rates of death (26%) and high rates of viral non-suppression among survivors (50%) highlight the cost of this public health failure. This coupled with the continued high rates of substance use point to the need for ongoing intervention with this population.

contacts) for HIV and, regardless of their HIV status, assessed risk behaviors and elicited contacts (2nd-generation contacts). We also tested and interviewed 2nd-generation contacts. Results: Of 45 persons diagnosed in 2017, 87%were male, 60%were 20–29 years old, 67%were white, and 60% likely acquired HIV through male-to-male sexual contact. Only 27% had lab-confirmed viral suppression (<200 copies/ mL). Persons diagnosed in 2017 named 190 unique 1st- and 2nd-generation contacts; 14%were diagnosed with HIV before 2017, 27% tested HIV-negative, and 59% had unknown status (Figure 1). We interviewed 84 persons: 38 diagnosed in 2017 and 46 1st- (n=30) or 2nd-generation (n=16) contacts. Overall, 13/84 (15%) injected drugs in the past year, including 4 diagnosed in 2017, 4 1st-generation contacts, and 5 2nd-generation contacts. Among those diagnosed in 2017 who were interviewed and not virally suppressed, 63% (n=17/27) had ≥1 sexual or IDU contact with negative or unknown HIV status. Of those, 3 (18%) injected drugs and shared equipment in the past year, and 2 (12%) others had ≥1 partners who reported injecting drugs and sharing equipment in the past year. Conclusion: While most 2017 HIV diagnoses in these rural WV counties were attributable to male-to-male sexual contact, we identified potential for HIV transmission through IDU risk behavior. In the context of the rural opioid epidemic in the US, timely public health response to clusters of HIV infection in low prevalence populations is critical to prevent HIV outbreaks.

Poster Abstracts

976LB HIV TRANSMISSION POTENTIAL DUE TO INJECTION DRUG USE IN RURAL WEST VIRGINIA, US, 2017 Vicki Hogan 1 , Brooke Hoots 2 , Christine Agnew-Brune 2 , Dawn Broussard 2 , Kate Buchacz 2 , Bridget Rose 1 , Scott Cope 2 , Erica Dawson 2 , William Hoffman 1 , Shacara Johnson 2 , Sheryl Lyss 2 , Laura Quilter 2 , Paul J. Weidle 2 , Brunilis White 2 , Heather Bradley 2 1 West Virginia Department of Health and Human Resources, Charleston, WV, USA, 2 CDC, Atlanta, GA, USA Background: In 2017, WV diagnosed 45 HIV infections in 15 largely rural, geographically contiguous counties with historically low HIV prevalence. Based on population characteristics associated with high levels of injection opioid use, CDC identified these counties as highly vulnerable to rapid dissemination of HIV. Nearly all are among the most vulnerable 5% of U.S. counties, and 3 are among the 20 most vulnerable. Initial case review indicated most 2017 diagnoses were attributable to male-to-male sexual contact; we investigated potential for bridging of HIV transmission to persons who inject drugs. Methods: From October 16–November 9, 2017, we intensified contact tracing efforts in the 15 counties by eliciting an expanded network of contacts and asking detailed questions about current injection drug use (IDU) behavior. First, persons diagnosed in 2017 were interviewed about past year risk behaviors and contacts (sexual, IDU, and social). We then tested their contacts (1st-generation

977 EVALUATING THE USE OF SYPHILIS PARTNER SERVICES FOR HIV CASE FINDING IN MISSISSIPPI Tigran Avoundjian 1 , James Stewart 2 , David Peyton 2 , Christie Lewis 2 , Kendra Johnson 2 , Sara N. Glick 1 , Matthew R. Golden 1 , Christine M. Khosropour 1 1 University of Washington, Seattle, WA, USA, 2 Mississippi State Department of Health, Jackson, MS, USA Background: Mississippi (MS) has one of the highest rates of new HIV infections in the United States. HIV incidence in MS has continued to increase since 2012 despite national decreases. Health departments throughout the US routinely provide partner services (PS) to persons with early syphilis, and many integrate partner HIV testing into those efforts. We evaluated the HIV case- finding effectiveness of syphilis PS in MS. Methods: We used MS Department of Health (MSDH) STD surveillance data to identify new cases of early syphilis (primary, secondary, and early latent) reported from July 1, 2014 through December 31, 2016, excluding cases with a new HIV diagnosis at the time of syphilis diagnosis. MSDH routinely contacts sexual partners of early syphilis cases to conduct interviews, provide syphilis and HIV testing, and link to treatment. A partner was considered a new case of

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