CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

to care in the past 12 months. Among persons who injected drugs during the prior 12 months (n=340), we reported the percent who received certain services and percent of persons who needed, but did not receive those services during the past 12 months (i.e., experienced unmet need). Of those with unmet needs, we reported barriers to care for each service. We reported weighted percents to account for complex survey design. Results: Of adults with diagnosed HIV, 3% injected drugs in the past 12 months. Almost all (99%) HIV-positive PWID received ≥1 service; most commonly used services included those for HIV case management (61%) and mental health (55%) (Figure). Forty percent received drug/alcohol treatment. Overall, 79% had an unmet need for ≥1 service. The services with the highest unmet need were for dental care (38%), drug/alcohol treatment (20%), transportation assistance (20%), and HIV peer group support (20%). Of those with unmet needs, 46% of persons needing dental care did not seek services because they could not pay for services; 79% of those needing drug/alcohol treatment did not seek services due to personal reasons, such as fear or embarrassment; 53% of those needing transportation assistance did not have information on services; 57% of those needing HIV peer group support also did not seek services due to personal reasons. Conclusion: Almost all HIV-positive PWID received ≥1 medical service, but a substantial proportion had unmet needs, including for drug/alcohol treatment. Barriers to care varied by service type. Addressing barriers to receiving services, including for drug/alcohol treatment, may help improve ART adherence and viral suppression among HIV-positive PWID.

887 UNMET NEED FOR MEDICATION-ASSISTED TREATMENT AMONG PERSONS WHO INJECT DRUGS Senad Handanagic 1 , Dita Broz 1 , Cyprian Wejnert 1 , for the NHBS Study Group 1 CDC, Atlanta, GA, USA Background: Persons who inject drugs (PWID) are at increased risk of HIV and hepatitis C virus (HCV) infections and premature mortality due to drug overdose. Medication-assisted treatment (MAT) reduces high-risk injecting behaviors, HIV and HCV transmission, and mortality from opioid overdose among PWID with opioid use disorder. Using data from National HIV Behavioral Surveillance (NHBS), we evaluated self-reported unmet need for MAT among PWID in 23 US cities in 2018. Methods: PWID were recruited by respondent-driven sampling in 2018 and interviewed. This analysis includes PWID who reported injecting drugs in the past 12 months, were 18 years or older and reported opioid use (including heroin) in the past 12 months. Unmet need for MAT was measured by asking participants if they tried to get methadone or buprenorphine to treat drug use but were unable to in the past 12 months. We used log-linked Poisson regression with generalized estimating equations to examine the association between self-reported unmet need for MAT and high-risk injecting practices and nonfatal opioid overdose. Models were adjusted for complex survey design and for confounding for age, race/ethnicity, city of residence, peer network size, current homelessness, having health insurance and being enrolled in MAT in the past year; we obtained adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Of 10,965 PWID who reported opioid use in the past 12 months, 30% were female, and the median age was 44 years. In total, 28% of PWID reported unmet need for MAT in the past 12 months, and 82% of those reported visiting a health care provider in the previous year. After adjusting for confounding, PWID who reported unmet need for MAT were more likely to report injecting more than once a day (aPR 1.09, 95% CI: 1.07-1.12), receptive sharing of syringes (aPR 1.11, 95% CI: 1.04-1.19) and opioid overdose (aPR 1.33, 95% CI: 1.24-1.43) in the past 12 months. Conclusion: More than 1 in 4 PWID reported unmet need for MAT and more than 80% of those had seen a health care provider in the past 12 months. PWID with reported unmet need for MAT were more likely to report high-risk injecting behaviors and experiencing opioid overdose. These findings highlight a missed opportunity for enrolling PWID on MAT as part of a comprehensive prevention approach to reduce the risk of HIV and HCV transmission and opioid overdose among PWID. Health care providers engaging with PWID could be an important source for linkage to MAT. 888 UNMET NEEDS AND BARRIERS TO CARE SERVICES AMONG HIV-POSITIVE PERSONS WHO INJECT DRUGS Sharoda Dasgupta 1 , Yunfeng Tie 1 , Linda Beer 1 , Dita Broz 1 , Quan M. Vu 1 , Hanna B. Demeke 1 1 CDC, Atlanta, GA, USA Background: HIV-positive persons who inject drugs (PWID) have poorer clinical outcomes compared with other persons, and limited access to medical care services may be a contributing factor. Data on use of and barriers to services can inform interventions intended to improve access to care but estimates are lacking. We report nationally representative estimates on use of, need for, and barriers to services among HIV-positive PWID. Methods: We used data from the Medical Monitoring Project, a national surveillance system that reports representative estimates of characteristics among adults with diagnosed HIV. During 6/2015–5/2018, interviews were conducted to assess injection drug use, use of and need for services, and barriers

Poster Abstracts

889 ESTIMATING HIV INCIDENCE AMONG PWID: POPULATION- AND FACILITY- BASED APPROACHES Allison M. McFall 1 , Sunil S. Solomon 2 , Oliver Laeyendecker 3 , Syed Iqbal 4 , Shanmugam Saravanan 4 , Nandagopal Paneerselvam 4 , Pachamuthu Balakrishnan 4 , Aylur K. Srikrishnan 4 , David D. Celentano 1 , Gregory M. Lucas 2 , Shruti H. Mehta 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 NIAID, Baltimore, MD, USA, 4 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: Monitoring HIV incidence is vital for characterizing the epidemiology and trajectory of HIV epidemics and impacts of prevention efforts. Standard methods for measuring incidence such as cohort studies take considerable time and cost and are often not feasible in settings, leading to a reliance on new HIV diagnoses, inherently a biased measurement. We compare HIV incidence estimation using 3 different methods/data sources which might leverage available program data in a variety of settings. Methods: We used data derived from a cluster-randomized trial among people who inject drugs from 12 Indian cities to estimate HIV incidence. First, we used a validated multi-assay algorithm (MAA) to define recent HIV infection within the trial’s follow-up cross-sectional samples (Aug 2016-Apr 2017) accrued using respondent-driven sampling (RDS). Second, we estimated incidence from PWID that participated in two (confirmed via biometrics) cross-sectional RDS samples - baseline (Jan-Dec 2013) and follow-up (Aug 2016-Apr 2017) - and were serologically HIV negative at baseline. Third, we estimated incidence from initially HIV-negative PWID clients who received one or more repeat HIV tests at integrated care centers (ICCs) (Jun 2014-Feb 2017) in 6 of the 12 cities. The goal was to test clients every 6 months. ICCs also provided opioid agonist therapy and other PWID services (e.g., needle exchange).

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