CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

1141 HRSA’S RYAN WHITE HIV/AIDS PROGRAM RESPONSE TO THE OPIOID EPIDEMIC Nicole S. Chavis 1 , Pamela W. Klein 1 , Stacy Cohen 1 , Letha Healey 1 , Antigone Dempsey 1 , Heather Hauck 1 , Laura W. Cheever 1 1 HRSA HIV/AIDS Bureau, Rockville, MD, USA Background: The U.S. is in the midst of an unprecedented opioid crisis with injection drug use (IDU)-related HIV outbreaks increasing, particularly in rural areas. The Health Resources and Services Administration’s Ryan White HIV/ AIDS Program (HRSA RWHAP) is well positioned to integrate treatment for IDU- associated HIV infections with treatment for drug use disorders. The purpose of this study was to evaluate the sociodemographic characteristics and substance use service utilization of RWHAP clients with HIV attributed to IDU nationwide compared to seven southern states identified with large rural HIV epidemics. These activities will be crucial for the “Ending the HIV Epidemic: A Plan for America” initiative. Methods: Data from the 2017 RWHAP Services Report were used to assess the sociodemographic characteristics of RWHAP clients aged 13 and older with HIV attributed to IDU (“IDU clients”). We also examined the proportion of RWHAP- funded providers who delivered substance use services and the characteristics of RWHAP clients who accessed these services. Data were examined nationally and in seven states with significant rural HIV epidemics. HRSA convened a technical expert panel to explore how the RWHAP can best respond to the opioid crisis; we identified key themes. Results: In 2017, RWHAP 6.7% of clients served (31,683) had HIV attributed to IDU. When compared with IDU clients served by the RWHAP nationwide, IDU clients in the seven rural states were younger (27.2% aged <45 years vs. 17.0% nationally), White (52.8% vs. 30.7% nationally), and stably housed (84.7% vs. 80.1% nationally). Nationwide, 17.5% (269) of RWHAP providers delivered substance use services, but only 3.3% (17,716) of RWHAP clients accessed substance use services. Key themes from the panel included the impact of stigma on service availability and access, workforce challenges, and social determinants of health. Conclusion: A significant proportion of RWHAP clients are impacted by substance use disorder and the opioid crisis with sociodemographic differences observed in rural areas as compared to national trends. RWHAP data and input from experts highlight the RWHAP’s unique position to respond to the growing opioid crisis, nationally and in rural areas, and can inform the RWHAP’s approach to care delivery in areas at the intersection of the HIV and opioid crises.

a recent systemic review of 37 ED programs across the US showed that linkage to care (LTC) from EDs is suboptimal. The Los Angeles County plus University of Southern California (LACUSC) ED is the largest ED in the western US sitting in the heart of the epidemic in LAC with 50% of the PLWHIV in it’s catchment area. 170,000 patient visits annually, 65% by Hispanics, 15% blacks, 5% Asians, 42%women and 80% of the patients claim a household income of <$20,000 annually. We describe LACUSC EDs HIV testing program and its uniquely successful LTC programs for newly diagnosed and return to care patients. Methods: Results In March of 2011, the LACUSC ED implemented routine HIV screening via a parallel programwith a designated tester and POC tests. In June of 2013, it implemented HIV 1-2 antigen antibody immune assay testing and offered provider initiated routine screens to all patients getting labs, in 2015 adding an EMR pop-up window. In Dec 2014, we began Rapid ART for first for acutely infected individuals then newly diagnosed and return to care patients. Results: To date we have tested 116,116 patients, 71420 (61.5%) male, 44672 (38.5%) female, 22 (0.0%) trans including Hispanic 61.6%, Black 15.6%, White 10.3% the majority over the age of 30. See Table 1 and 2. 2479 positive tests (males 2110 (85.1%), females 365 (14.7%) and transgender 1(0.0%). 609 (24.5%) newly diagnosed (Hispanic (44%), Blacks (21.1%) and whites 10.3%) and 61 (10%) acutely infected with HIV (Hispanic (70.5%), White (30%) and Blacks (11.5%). And 1870 (75%) were previously known positives. Of newly diagnosed patients 574 (94%) successfully LTC. For return to care patients 51% seen in ED and 48% LTC <60days. Conclusion: HIV screening programs in ED’s reach into the heart of the US epidemic and ensures some of the most difficult to reach individuals access testing and rapid treatment. Scale up will contribute substantially to ending the US epidemic. 1140 BUPRENORPHINE VS METHADONE AND ART PRESCRIBING IN VIETNAM: A RANDOMIZED TRIAL P. Todd Korthuis 1 , Caroline King 1 , Gavin Bart 2 , Lynn Kunkel 1 , Thuan Nguyen 1 , Khuyen Tong 3 , Sarann Bielavitz 1 , Le Minh Giang 3 1 Oregon Health and Sciences University, 2 Hennepin Healthcare Research Institute, Minneapolis, MN, USA, 3 Hanoi Medical University, Hanoi, Vietnam Background: Integrating methadone or buprenorphine treatment of opioid use disorder (OUD) into HIV care is a recommended strategy for achieving UNAIDS 90-90-90 targets, and associated with improved antiretroviral therapy [ART] uptake in observational studies and a single-site U.S. trial, but adoption of HIV clinic-based buprenorphine has been limited in many countries. We hypothesized that HIV-infected persons with OUD in Vietnam randomized to HIV clinic-based buprenorphine versus methadone would experience comparable 12-month uptake of ART. Methods: We conducted a non-blinded, multi-center non-inferiority trial randomizing people with HIV and DSM-5 moderate-to-severe OUD to HIV clinic- based buprenorphine versus referral for methadone for treatment of OUD in 6 Vietnam HIV clinics. The primary outcome was medical record documentation of ART prescription. Secondary outcomes included retention on OUD treatment and positive urine drug screen (UDS) for opiates, assessed at baseline, 3, 6, 9, and 12 months. Generalized linear mixed models assessed buprenorphine versus methadone and change in outcomes over time in intention-to-treat analyses. Results: Participants (n=281) were randomized to receive buprenorphine (n=141) or methadone (n=140). At baseline, 96.8% of participants were male, 45.9% employed, with mean age 38.3 (SD 6.1) years and 7.4 (SD 5.7) years since HIV diagnosis. Mean CD4 count was 405 (SD 224). At baseline, 100% tested positive for heroin and 18.7% for methamphetamines. Retention in treatment at 12 months was 75.9% for buprenorphine and 82.1% for methadone and did not differ by treatment group (p=0.92). Heroin use at 12 months decreased to 46.8% for buprenorphine and 51.4% for methadone and did not differ by treatment assignment at 12 months (p=0.58). ART receipt increased from 68.0% to 73.8% for buprenorphine and 67.9% to 80.7% for methadone, and was higher for participants on methadone versus buprenorphine at 12 months ( p =0.009). Conclusion: Both buprenorphine and methadone improved ART receipt despite modest decreases in heroin use, comparable to those achieved in U.S. practice. Opioid agonist treatment can help achieve UNAIDS 90-90-90 goals for ART uptake.

Poster Abstracts

CROI 2020 431