CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

20% of young black men who had current depression compared with who did not (53% vs. 78%, P <0.05) and among those who were homeless compared with those who were not (56% vs. 75%, P <0.05). Conclusion: Viral suppression among young black men in HIV care was much lower than in the overall population receiving HIV care, and there were no increases in viral suppression or ART adherence among this group during 2009–2014. Improving viral suppression is essential to ensure health and reduce HIV transmission in this key population.

Poster Abstracts

1127 BEYOND VIRAL SUPPRESSION: BROADENING QUALITY MEASURES (QM) FOR TOTAL HIV PATIENT CARE Michael A. Horberg 1 , Jackie Blank 1 , Kevin Rubenstein 1 , Leo Hurley 2 , Peter Kadlecik 1 , Daniel B. Klein 2 , Michael J. Silverberg 2 1 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 2 Kaiser Permanente Northern California, Oakland, CA, USA Background: The HIV Cascade emphasized the importance of linkage, retention, and viral suppression as outcomes, but comprehensive care of HIV patients requires a broader view of what constitutes quality care. At Kaiser Permanente Mid-Atlantic States (KP), an integrated health system providing comprehensive HIV care in District of Columbia, Maryland, and Virginia, we strove to define a more composite measure of quality care for our HIV patients, considering both process and outcome QMs, obtained from the electronic health record. Methods: Study population: HIV+ patients ≥18 years old with ≥6 months KP membership in both calendar years 2015 and 2016 (N=2,307). Process QM (based on expert panel) are: ever vaccination for Prevnar, Pneumovax, and flu (either year); ≥1 visit to primary care provider (PCP) and HIV/ID specialist each year; screening for syphilis and gonorrhea/chlamydia (either year). Outcome QM are: HIV RNA<200 copies/mL at last measure each year; no hospitalization or ED visit either year; non-smoker, blood pressure <140 systolic and <90 diastolic as of last office visit; no incident diagnosis of depression in time span (either year); hemoglobin ≥12g/dL, blood sugar <140mg/dL, ALT <51U/L, LDL cholesterol <130mg/dL, and eGFR ≥60 (all labs as last measured). Patients needed to achieve all process or outcome measures to meet the QM. Missing data was considered unachieved. We used a logistic model to estimate odds of achieving these QM associated with sex, age, race/ethnicity, coverage plan, and HIV risk. Results: 33.0%met all process QM, while only 17.0%met all outcome QM (Table). Only 1.1% and 1.9%met no process or outcome QM, respectively. Least frequently met process QM was visit to PCP (59.4%; but visit to HIV/ID was 81.7%); least met outcome QM was LDL <130 mg/dL (67.9%). Significantly greater odds of achieving all process QMwas associated with female sex (versus males; OR=1.37 [95% CI: 1.08,1.74]); Black (vs. White; OR=1.38 [1.06,1.81]); MSM (vs. heterosexual; OR=1.45 [1.12,1.89]); Medicaid and Medicare (vs. Commercial; OR=1.93 [1.34,2.78] and 1.50 [1.09,2.06], respectively). Medicare was the only coverage plan significantly less likely to achieve all outcome QM (vs. Commercial; OR=0.52 [0.33,0.85]). Conclusion: Broadening the scope of HIV patient care QM beyond viral suppression helps identify opportunities for improvement. Successful process QM does not necessarily translate into higher outcome QM. Certain measures merit attention, particularly for selected subgroups.

1128 HIV STIGMA IS ASSOCIATED WITH RETENTION AND VIRAL LOAD AMONG US PATIENTS IN CARE Katerina A. Christopoulos 1 , Torsten B. Neilands 1 , Wendy Hartogensis 1 , Michael J. Mugavero 2 , Heidi M. Crane 3 , Rob Fredericksen 3 , Elvin Geng 1 , W. C. Mathews 4 , Geetanjali Chander 5 , Joseph J. Eron 6 , Kenneth H. Mayer 7 , John Sauceda 1 , Kimberly Koester 1 , Troy Wood 1 , Mallory Johnson 1 1 University of California San Francisco, San Francisco, CA, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 University of Washington, Seattle, WA, USA, 4 University of California San Diego, San Diego, CA, USA, 5 Johns Hopkins University, Baltimore, MD, USA, 6 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 7 Fenway Health, Boston, MA, USA Background: HIV-related stigma is a barrier to engagement in care, yet few large-scale assessments of stigma and HIV outcomes exist in the United States (US). Methods: The Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort study integrates medical record and survey data from patients in primary care at seven academic HIV clinics across the US. We incorporated a yearly, validated 4-item assessment of internalized HIV stigma (1=strongly disagree to 5=strongly agree, α=0.91) into patient surveys administered every 4-6 months. We used multivariable logistic regression models to evaluate associations between mean stigma and: 1) poor retention in care (≥ 2 missed primary care visits in the year prior to stigma assessment); 2) concurrent viremia (viral load >200 copies/mL +/- 90 days of the stigma assessment), and controlled for age, gender, race/ethnicity, sexual orientation, time since CNICS enrollment, and site. We assessed linearity of stigma as a continuous predictor with the log odds of outcomes using cumulative sums of residuals. Results: FromMarch 2016 - April 2017, 4,428 patients completed the stigma assessment. Median (IQR) age was 48 (39-55) years; 83%were male, 36% were black, 14%were Hispanic, and 27% identified as heterosexual. Median (IQR) CNICS enrollment was 6 (3-11) years. Mean stigma was 1.99 (SD 1.07) and 28.3% agreed/strongly agreed with ≥1 stigma question. Among 3,345 patients with missed visit/covariate data, 19.0% had poor retention. Higher stigma was associated with increased odds of poor retention (aOR=1.13, 95% CI 1.04-1.22, p 0.004). The proportion of patients with concurrent viremia increased as mean stigma increased (Figure). In 3,290 patients with viral load/covariate data, 10.2% had concurrent viremia. Higher stigma was associated with increased odds of viremia (aOR=1.13, 95% CI 1.02-1.25, p 0.024). In both models, younger

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