CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Results: A total of 2197 participants were enrolled from Aug 2013-Nov 2014 and followed for 12 months. Median age was 32 years (IQR 26-40); 59%were female. Participants in CIS versus SOC had significantly lower undisclosed HIV+ status at M1 and M12. Among all participants, undisclosed HIV+ status decreased 61.5% fromM1 to M12; only 5.7% reported undisclosed HIV+ status at M12. There were no associations between undisclosed HIV+ status at M12 and sex, marital status, education, employment, number of close friends, mental health, stigma, or HIV knowledge. In adjusted analysis, undisclosed HIV+ status at M12 was more than four-fold higher among 18-24 year olds vs persons 50 years and older and more than two-fold higher among those very concerned vs not concerned with unintended disclosure at baseline. Among 18-24 year olds with undisclosed HIV+ status at M12, half reported being very concerned about unintended disclosure. Those with undisclosed HIV+ status at M1 [aRR 1.5, 95% CI 1.2-1.7] and M12 [aRR 1.7, 95% CI 1.4-2.2] were significantly less likely to achieve the primary outcome. Among 18-24 year olds with undisclosed HIV+ status at M12, 84.4% failed to achieve the primary outcome. Conclusion: Undisclosed HIV+ status may hinder linkage and retention in care. Interventions are needed to assist HIV+ persons in disclosure. Screening for disclosure fears and addressing disclosure concerns among 18-24 year olds is particularly important.

health services and patient navigation intervention on viral suppression. Patients in the integrated intervention did have reduced psychological distress after completing the intervention. Despite more SUT in the RC arm, both groups declined equally in substance use. Interventions that improve retention in care and viral suppression are needed for this population.

1079 SINGLE-PILL ART AND RETENTION IN CARE: A REGRESSION DISCONTINUITY STUDY IN S. AFRICA

Sheryl Kluberg 1 , Matthew P. Fox 1 , Michael LaValley 1 , Denise Evans 2 , Kamban Hirasen 3 , Mhairi Maskew 2 , Lawrence Long 1 , Jacob Bor 1 1 Boston University, Boston, MA, USA, 2 University of the Witwatersrand, Johannesburg, South Africa, 3 Health Economics and Epidemiology Research Office, Johannesburg, South Africa Background: Single-pill fixed-dose combination (FDC) antiretroviral therapy (ART) is recommended by the World Health Organization (WHO) because of its potential to improve patient quality of life, as well as adherence and retention on therapy. However, the causal effect of FDCs on clinical retention in sub- Saharan Africa has not been investigated. In April 2013, South Africa adopted WHO recommendations to use FDCs for first-line ART in the public sector. We assessed whether this policy had an impact on retention in HIV care using a quasi-experimental regression discontinuity design. Methods: We analyzed data on 1124 patients initiating ART at Themba Lethu clinic, a large public-sector HIV clinic in Johannesburg, South Africa. The sample was limited to patients starting ART between October 2012 and September 2013, the 6 months before and after FDCs were introduced. We estimated the intention-to-treat effect of the FDC policy change on the risk of attrition, defined as a ≥3-month lapse in care within the first 12 months, using a regression discontinuity analysis that compared outcomes for patients starting ART just before and just after the policy change. We also assessed sensitivity of our results to other definitions of retention and assessed effect heterogeneity by age, sex, and measures of baseline health status. Results: The percentage of patients starting FDC increased from 2.5% in the 6 months before the guideline change to 85.7% in the 6 months afterwards. The FDC policy change was associated with an 11.3 percentage point decrease in attrition within the first year (95% CI: -22.0; -0.6). In instrumental variables analysis, starting FDC led to an 18.0 percentage point drop in attrition compared to multiple pills (95% CI: -33.6; -2.4) among patients induced to start FDC because of the policy change. Results were robust to other attrition outcomes. The greatest decreases in attrition were among the healthiest patients (i.e., those without anemia, with early WHO clinical stage disease, or higher CD4 counts). Conclusion: South Africa’s switch to FDC for first-line ART substantially reduced attrition among patients starting therapy in this large public-sector cohort. The effect was greatest among healthier patients, who represent a growing share of ART initiators under universal test-and-treat.

Poster Abstracts

1078 INTEGRATED COCAINE & MENTAL HEALTH TREATMENT WITH NAVIGATION RCT FOR HIV+ OUTPATIENTS

Lisa Metsch 1 , Daniel Feaster 2 , Lauren Gooden 1 , Christin Root 3 , Pedro C. Castellon 1 , Jonathan Colasanti 3 , Eugene W. Farber 3 , Gabriel Cardenas 2 , Terri Liguori 1 , Wendy S. Armstrong 3 , Allan Rodriguez 2 , Carlos del Rio 3 1 Columbia University Medical Center, New York, NY, USA, 2 University of Miami, Miami, FL, USA, 3 Emory University, Atlanta, GA, USA Background: HIV+ cocaine users are less likely to be virally suppressed (VS, <200 copies/mL) due to poor engagement in care. We tested the efficacy of an integrated substance use treatment (SUT), mental health, and outpatient HIV care intervention on improving viral suppression in non-suppressed HIV- infected cocaine users. Methods: Project RETAIN recruited 360 cocaine-using HIV+ patients who were not VS between 1/28/2013 and 3/9/2016 in Miami, FL and Atlanta, GA. Patients were randomized to treatment as usual (TAU) or to a Retention Clinic (RC) which included 11 sessions of strengths-based patient navigation, 9 sessions of SUT (2 of motivational enhancement therapy and 7 of cognitive-behavioral therapy) and mental health services over 6-months. The a-priori outcome was treatment success (viral suppression at both 6 and 12-month follow-up) versus failure (viral non-suppression at one or both, death or drop out). Results: Patients were 63%male, 84% black, 9% Hispanic, with a mean age of 46 and most (94%) had incomes under $10,000. Median HIV viral load and CD4 count were 30,588 copies/mL and 157 cells/uL, respectively. There was no difference in treatment success across arms (TAU=16%, RC=13%, p=.328). There was not a significant gender by treatment interaction (p=.061). Although not significant, women in the RC arm tended to have more treatment success (20%) than men (10%). The RC group had significantly more individuals participate in SUT (87%) than did the TAU group (9%, p<001). RC participants attending 5 or more SUT sessions had higher rates of viral suppression (19%) than those with 4 or fewer (7%, p=.022). Urine tested substance use decline from baseline (85%) to 6- (74%, p<.001) and 12-months (65%, p<.001) was not different by study arm (p=.187). Finally, severe psychological distress in 32% of the sample at baseline declined differentially at 6 months (TAU=25%, RC=16%, p=.049). There were 33 deaths during the trial (9%) with no difference between TAU (10%) and RC (8%, p=.607). Conclusion: Only a minority of HIV+ cocaine-using patients became VS over the 12-month study and there was no effect of the integrated SUT, mental

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