CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Among US patients with HIV who achieved viral suppression to <50 copies/mL, those with depression had a 35% higher risk of virologic rebound compared with patients who had similar demographic and substance use characteristics without depression. Patients with HIV and depression may need closer monitoring and support to avoid virologic rebound.

898 MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AND RETENTION IN HIV CARE IN NORTH AMERICA Cassandra Oliver 1 , Bryan Lau 2 , Keri N. Althoff 2 , Kate Buchacz 3 , Heidi M. Crane 4 , Michael John Gill 5 , Michael A.Horberg 6 , Kenneth H. Mayer 7 , Angel M. Mayor 8 , Richard D. Moore 2 , Asher Schranz 9 , Timothy R. Sterling 1 , April Pettit 1 , Peter Rebeiro 1 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Vanderbilt University, Nashville, TN, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 CDC, Atlanta, GA, USA, 4 University of Washington, Seattle, WA, USA, 5 Southern Alberta Clinic, Calgary, AB, Canada, 6 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 7 The Fenway Institute, Boston, MA, USA, 8 Universidad Central del Caribe, Bayamon, Puerto Rico, 9 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Retention in care (RIC) is associated with reduced HIV transmission and mortality. Mental health and substance abuse services are associated with better RIC and uptake differs by sex, but few studies include diverse clinics or assess sex as an effect modifier. We quantified the association between availability of mental health and substance abuse services on-site or by referral and individual RIC within the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), assessing sex as an effect modifier. Methods: Adults (≥18 years) with HIV who had ≥1 clinic visit at 13 NA-ACCORD sites in the US and Canada from 2000-2017 were included. Availability of mental health and substance abuse services were assessed by site survey in 2000, 2005, and 2010 and carried forward in other years. RIC was defined as ≥2 encounters per year, ≥90 days apart, recorded until death, administrative censoring (December 31, 2017), or loss to follow-up (no visit for >12 months with no future visits). Modified Poisson regression stratified by sex, clustered by site using generalized estimating equations, and adjusting for calendar year, age, race, and HIV risk factor, was used to estimate risk ratios (RR) with 95% confidence intervals (CI) for the association between clinic services and RIC. A Wald homogeneity test assessed sex as an effect modifier with α=0.20. Results: Among 28,831 individuals contributing 205,937 person-years (p-y), 67% of p-y were spent in care. The median age was 44 years and males contributed 76% of p-y. Almost half were white (46%),44%black, non- Hispanic, and 4% Hispanic. The most common HIV transmission risk was MSM (52%), though 11% reported injection drug use as a risk factor. Overall, 97% of patients had access to mental health and substance abuse services for ≥1 year; availability increased over time, and 99% had access at these sites by 2017 (Figure). There was heterogeneity of effects by sex (p=0.05). Available mental health and substance abuse services were associated with better RIC among both males (RR=1.11; 95% CI: 1.07-1.14) and females (RR=1.05; 95% CI: 1.01-1.10). Conclusion: Among patients receiving HIV care at NA-ACCORD clinical sites between 2000 and 2017, mental health and substance abuse services were associated with better individual RIC. These results may imply that mental health and substance abuse services themselves, or other services for which they are proxies, may enhance RIC in diverse settings, and males may benefit slightly more than females.

897 PREVALENCE AND FACTORS RELATED TO TRAUMA SYMPTOMS AMONG PEOPLE WITH HIV Bryan Lau 1 , Karine Yenokyan 1 , Catherine R. Lesko 1 , Mary McCaul 2 , Richard D. Moore 2 , Heidi Hutton 2 , Geetanjali Chander 2 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Among persons with HIV (PWH), trauma symptoms (TS) are a barrier to achieving HIV control. We sought to determine factors associated with TS among PWH and the association of TS with viral suppression. Methods: In the Johns Hopkins HIV Clinical Cohort (JHHCC) between 2013-2018, we measured trauma symptoms using the Primary Care Post Traumatic Stress Disorder Screen (PC-PTSD). We categorized TS as a PC-PTSD score ≥3. Prevalence of TS was examined by model based recursive partitioning allowing for repeated measures. Factors hypothesized to be associated with TS included age, race, depressive (PHQ-8≥5), anxiety symptoms (GAD-7≥5), cocaine, heroin, and hazardous alcohol. Logistic regression with generalized estimating equations was used to examine the association of TS with viral suppression. Models were stratified by gender. Results: Our analytic sample included 666 cis-gender women (89% African American (AA), 30% IDU as risk factor for HIV acquisition, 65%<55 years old), and 1154 cis-gender men (78% AA, 33% IDU, 59%<55 years old). At baseline, prevalence of TS was 10.4% among women and 8% among men. PWH with TS at baseline had lower ART adherence (visual analogue scale<90 35 vs 17%, p<0.001), less viral suppression (56 vs. 76% p=0.1), more depression (88 vs. 39%, p<0.001), and anxiety (85 vs. 16%, p<0.001), and greater substance use (hazardous alcohol: 31 vs 17%; cocaine: 13 vs 4.4%; heroin: 20 vs. 8.3%, all p<0.001) compared to PWH without TS. Among women, the co-occurrence of anxiety and depressive symptoms was associated with an increased prevalence of TS reaching 41% (figure, node 5) TS compared to 1% (node 2) among those without anxiety irrespective of depressive symptoms. For men, the prevalence of TS among those with anxiety and depressive symptoms was 38% (node 9), followed by those without anxiety, but with co-occurring depressive symptoms and hazardous alcohol use (20%, node 6). Among both women and men, those with TS were had similar risk of being virally suppressed as compared to those without TS (women: risk difference= -11%, 95%CI: -27, 5; men: RD= -2%, 95%CI: -13, 7). Conclusion: Overall prevalence of TS is high and related to other psychiatric comorbidities among PWH. Adding TS screening would significantly increase identification of overall psychiatric morbidity. While TS by itself was not related to non-suppression, it is likely that treatment of overall psychiatric morbidity together may potentially decrease the risk of viral non-suppression.

Poster Abstracts

CROI 2020 336