CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

were HIV acquisition from injection drug use (adjusted hazard ratio [aHR] 1.53), low CD4 count at diagnosis (200-499 cells/µL: aHR 2.37; <200 cells/ µL: aHR 3.26), higher re-incarceration rate during follow-up (aHR 5.62), HIV virologic failure within 6 months of death/censoring (aHR 2.91), and ≥1 medical comorbidity (1 comorbidity: aHR 1.51; ≥2 comorbidities: aHR 1.82). Protective factors were black race (aHR 0.53), at least a high school diploma (aHR 0.72), medical insurance (aHR 0.09), at least one long (>1 year) re-incarceration during follow-up (aHR 0.42), higher percentage of re-incarcerations in which ART was prescribed (compared to never re-incarcerated, 0-10%: aHR 0.45; 11-50%: aHR 0.16; 51-90%: aHR 0.04; 91-100%: aHR 0.13), and a moderate addiction severity score during one’s last incarceration (aHR 0.53). Conclusion: Among PLH, there is a high rate of death after release. Advanced HIV disease, substance use disorders, and lack of medical insurance strongly predict death post-release. Long re-incarcerations and those involving ART are protective, but frequent re-incarceration is highly detrimental. While healthcare provided during incarceration is beneficial, linkage to and retention in community-based healthcare, addiction treatment, and other resources are crucial to reducing mortality after release.

poverty (27.5%) vs. not in poverty (15.1%). Homelessness was associated with higher discrimination regardless of facility type, but was less common in RWHAP (21.5%) vs. non-RWHAP facilities (34.0%; Table 1). Conclusion: More than 1 in 10 PLWH with recent diagnoses experienced discrimination in healthcare settings. PLWH reporting poverty or homelessness were disproportionately affected, particularly those attending non-RWHAP facilities. Ensuring PLWH receive HIV care in settings free of discrimination may improve outcomes in the HIV care continuum. Incorporating practices typical of RWHAP facilities, such as anti-discrimination training and the medical home model may reduce discrimination in non-RWHAP healthcare settings.

Poster Abstracts

1135 LONGITUDINAL DIFFERENCES IN POOR ADHERENCE AMONG YOUTH AND ADULTS LIVING WITH HIV Kalysha Closson 1 , Alexis Palmer 1 , Cathy Puskas 1 , Kate Salters 1 , Surita Parashar 1 , Karyn Gabler 1 , Lateefa Tiamiyu 1 , Wendy Zhang 1 , Angela Kaida 2 , Robert S. Hogg 1 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, 2 Simon Fraser University, Burnaby, BC, Canada Background: Youth (aged <30) living with HIV (YLWH) experience worse HIV treatment outcomes compared with adults. This inequity may be due, in part, to differences in adherence to combination antiretroviral therapy (cART). Few studies have examined longitudinal differences in cART adherence between youth and adults. As such, we examined cART adherence differences among YLWH and adults with HIV and the factors associated with sub-optimal adherence from 2010-2016. Methods: Data from the British Columbia (BC) Centre for Excellence in HIV/ AIDS Drug Treatment Program, a population-level provincial database of all individuals living with HIV who have been linked to care in the universal care setting of BC. Adherence was measured based on pharmacy refill compliance. Poor cART adherence was defined as <80% pharmacy refill vs ≥80% adherence. The proportion of participants with sub-optimal adherence (<80%) among youth (15-29 years) and among adults (30+) was compared per year from 2010-2016. Univariable and multivariable generalized estimating equation (GEE) confounding models assessed the independent association between sub- optimal adherence and being a youth (vs. adult). An explanatory GEE model was conducted to examine factors associated with poor adherence from 2010-2016 among YLWH specifically. Results: A total of 7485 individuals were included in this analysis, 291 (3.9%) of which were youth. Of the YLWH, 39 (13.3%) had a history of injection drug use (IDU), and were on cART for a median of 2 years (Q1, Q3: 1-5). Over the study period YLWH showed significant time-trend reductions in poor adherence from 53% in 2010 to 26% in 2016 (p=<0.001) (See Figure 1), however this remained to be significantly higher than adults. In adjusted analyses, youth had significantly higher odds of poor adherence compared to adults (OR= aOR=2.00, 95%CI=1.85-2.17), controlling for IDU history and years on cART.

1134 DISCRIMINATION IN HEALTHCARE SETTINGS AMONG PATIENTS WITH RECENT HIV DIAGNOSES Amy R. Baugher , Linda Beer, Jennifer Fagan, Christine Mattson, R. L. Shouse CDC, Atlanta, GA, USA Background: Discrimination in healthcare settings has been associated with sub-optimal healthcare utilization and medication adherence among persons living with HIV (PLWH). Reducing discrimination is a national HIV prevention goal. We estimated the prevalence of healthcare discrimination among PLWH with recent diagnoses. We examined the association between discrimination and poverty and homelessness by whether patients attended a facility funded by Ryan White HIV/AIDS Program (RWHAP), which was designed to assist vulnerable PLWH. data from 2011−2014 on self-reported discrimination among PLWH with diagnoses ≤5 years before interview (N=3,770). Discrimination was defined as reporting ≥1 of the following experiences since testing positive for HIV: a healthcare worker exhibited hostility towards them, gave them less attention than other patients, or refused them service. We assessed whether RWHAP facility attendance modified the relationship between discrimination and poverty and homelessness using chi-square tests. Results: Of PLWH with recent diagnoses, 13.8% experienced discrimination since receiving the diagnosis. Overall, PLWH were more likely to report discrimination if their income was below the poverty level (15.3%) vs. above (13.0%), they experienced homelessness in the past 12 months (22.1%) vs. no homelessness (12.8%), or they attended a non-RWHAP facility (17.4%) vs. RWHAP facility (13.1%). Among patients attending RWHAP facilities, discrimination was similar by poverty status (12.5%−14.9%); among patients attending non-RWHAP facilities, discrimination was higher among those in Methods: We used nationally representative data from the Medical Monitoring Project, a surveillance system of PLWH receiving HIV care. We analyzed pooled

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