CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

strategies ranged from $81,679/QALY for Atlanta to $141,454/QALY for Baltimore (Figure 1). Implemented at documented scale, these would result in 1.7% (Seattle) to 27.0% (Miami) reductions in new HIV infections among PWID across cities by 2030. PrEP for PWID was found to be cost-effective in Miami ($64,221/ QALY). Incidence reduction reached 11.8% (New York City) to 81.9% (Miami) when strategies were implemented at ideal scale. Conclusion: Evidence-based interventions targeted to PWID can deliver considerable value, however ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.

overdoses over the next decade. Conversely, scaling-up ART and CAP could increase HIV and overdoses. Conclusion: Integrating ART with OAT scale-up could provide synergistic benefits on ART recruitment/retention, and prevent new HIV infections and fatal overdoses among PWID in Tijuana. Conversely, non-evidence based CAP could contribute major harms. Policymakers should consider the synergistic benefits of integrated OAT and HIV services on HIV and overdose among PWID.

1146 SMARTPHONE INTERVENTION TO REDUCE HEAVY DRINKING IN HIV CARE: EFFECT ON ART ADHERENCE Deborah S. Hasin 1 , Efrat Aharonovich 1 , Barry S. Zingman 2 , Malka Schlesinger 3 , Claire Walsh 3 1 Columbia University Medical Center, New York, NY, USA, 2 Montefiore Medical Center, Bronx, NY, USA, 3 New York State Psychiatric Institute, New York, NY, USA Background: Heavy drinking among People Living With HIV (PLWH) reduces antiretroviral adherence and worsens health outcomes. Brief interventions to reduce heavy drinking in primary care patients are effective, but in heavy-drinking PLWH, more extensive intervention may be needed. Lengthy interventions are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed and tested HealthCall as an electronic (smartphone) means of increasing patient involvement in brief intervention to reduce drinking and improve medication adherence without making unfeasible demands on providers. Methods: Alcohol-dependent patients at a large urban HIV clinic were randomized to receive 1 of 2 brief (~25 min) baseline drinking-reduction interventions plus ART adherence education, and then HealthCall (daily use on the smartphone, ~4-5 min/day) or standard care for 60 days. All patients had 2 brief (15-min) check-in sessions at 30 and 60 days. Baseline interventions: NIAAA Clinician’s Guide (CG) or Motivational Interviewing (MI). HealthCall included coverage of drinking and ART adherence. Patients were randomly assigned to CG+standard care (n=37), CG+HealthCall (n=38) or MI+HealthCall (39). Outcomes assessed at 30, 60, 90 days, 6 and 12 months: drinks per drinking day; ART adherence (unannounced phone pill-count method; possible adherence scores: 0%-100%). Analysis: generalized linear mixed models with pre-planned contrasts. Results: Study retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. Drinking decreased overall during treatment, with continued declines at 6 and 12 months in the CG+HealthCall arm. During treatment, patients in MI+HealthCall drank less than others (p=0.07-0.003). However, at 6 and 12 months, drinking was lower among patients in CG+HealthCall (p=0.04-0.06). Overall ART adherence declined slightly by 12 months. However, at 60 days, 90 days and 6 months, ART adherence was significantly better among patients in CG+HealthCall than CG+standard care (p=0.03-0.09). Conclusion: HealthCall paired with CG resulted in better ART adherence than the other treatment conditions. Given the importance of ART adherence and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

Poster Abstracts

1145 INTEGRATING ANTIRETROVIRAL TREATMENT AND HARM REDUCTION SERVICES ON HIV AND OVERDOSE Javier Cepeda 1 , Annick Borquez 1 , Christopher Magana 1 , Anh T.Vo 1 , Claudia Rafful 2 , Maria Gudeia Rangel-Gomez 3 , Maria Elena Medina-Mora 4 , Steffanie A. Strathdee 1 , Natasha Martin 1 1 University of California San Diego, San Diego, CA, USA, 2 Universidad Nacional Autonoma de Mexico, Mexico City, Mexico, 3 U.S.-Mexico Border Health Commission, Tijuana, Mexico, 4 National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico Background: The HIV epidemic in Tijuana, Mexico is concentrated in key populations, including people who inject drugs (PWID). Mexico’s drug law reform included referral to drug treatment, yet funding was provided for non-evidence based compulsory abstinence programs (CAP) associated with elevated HIV and overdose risk. However, evidence-based opioid agonist therapy (OAT) reduces overdose, HIV transmission, and reincarceration, while improving antiretroviral therapy (ART) outcomes. We assessed the potential impact of integrated ART and drug treatment (OAT or CAP) on HIV and fatal overdose among PWID in Tijuana. Methods: We developed a dynamic model of HIV transmission, incarceration, and fatal overdose among PWID in Tijuana. We incorporated synergistic benefits of OAT on reducing injecting-related HIV transmission, increased ART recruitment and retention, reducing reincarceration, and averting fatal overdose. We also modeled harms associated with CAP on HIV and overdose. We assessed HIV incidence and fatal overdose over the next decade with the following scenarios: 1) status quo (10% ART among HIV-positive PWID and no drug treatment), 2) OAT scale-up to 40%, 3) ART scale-up (10-fold recruitment) among HIV-positive PWID, 4) scale-up OAT to 40% and ART (10-fold recruitment), 5) scale-up CAP to 40% (no ART scale-up). Results: OAT scale-up to 40% coverage could avert 32% (95%CI: 19–45%) and 19% (95%CI: 8-26%) of new HIV infections and fatal overdoses, respectively, over the next decade (see figure). Due to low ART coverage, OAT had marginal impact on averting HIV through its effect on ART recruitment/retention. However, with integrated OAT and ART scale-up synergistic benefits were observed, with the OAT effect on ART recruitment/retention averting 10% more new infections compared to ART scale-up alone. Scaling-up OAT and ART could avert 50% (95%CI: 28-67%)) of new HIV infections and one-fifth of fatal

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