CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

period identified clinically (73%), and by survey (65%). Results were similar in adjusted model (Table). Excluding follow-up during COVID-19 (after Mar 2020) did not impact findings (data not shown). Conclusion: Systematic screening using validated survey tools in HIV primary care identified 49% SU and 73% MH concerns previously unrecognized by providers. The reduced % treated for these PWH suggest systematic screening may identify lower-severity groups overall.

contribute ≥1 HbA1c value. Continuous PHQ9 score was included in models using natural splines. Analyses were adjusted for sex at birth, race/ethnicity, HIV risk factor, CNICS site, and time-updated age, time since DM diagnosis, CD4 count, HIV RNA, year of HbA1c measurement, BMI, substance use, high-risk alcohol use, and DM medication use. Results: Among 2040 PWH with DM, baseline median age was 54 years (IQR:47-59), 75% were male, 50% Black, 44% white, 14% Hispanic, and 22% had a PHQ9 ≥10 (severe depressive symptoms). Median baseline HbA1c was 6.5 (IQR:5.9-7.7), median time living with DM was 1.25 years, and 57% were on diabetes medication at baseline. Median follow-up time was 2.9 years (IQR:0.9-5.9) during which PWH contributed a median of 5 HbA1c measurements (IQR:3-10). Median time between HbA1c and PHQ9 measurements was 105 days (IQR:10-213). In multivariable analysis, we found a dose-dependent relationship between the PHQ9 score and an increased odds of HbA1c >7.0% (Figure A, p=0.009). Similarly, a higher burden of depressive symptoms was associated with higher HbA1c measures when assessed as a continuous outcome (Figure B, p=0.021). Conclusion: Higher depression symptom burden was associated with poor DM control among PWH in this multisite, US cohort. Diagnosis and management of depression remains critical for long-term HIV and DM outcomes.

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Group Therapy Reduces Depression Among People Newly-Enrolled in HIV Care in Kampala, Uganda Sarah Lofgren 1 , Vanessa Akinyange 2 , Anita Arinda 2 , Raymond Sebuliba 2 , David J. Bond 3 , David R. Boulware 1 , Noeline Nakasujja 2 1 University of Minnesota, Minneapolis, MN, USA, 2 Makerere University, Kampala, Uganda, 3 The Johns Hopkins University, Baltimore, MD, USA Background: Depression in people living with HIV (PWH) is associated with reduced medication adherence, viral suppression, and retention-in-care. In low resourced settings, depression interventions are needed for PWH to improve HIV outcomes. Methods: This study was conducted at a large, public HIV clinic. We enrolled PWH who started HIV medications within the last 3 months and had depression. They were randomized 1:1 into an 8-week group therapy intervention or enhanced usual care. The group therapy was held once a week, facilitated by adherence counselors at the subjects' HIV clinic in groups of 6-10 individuals divided by biological sex. Depression was measured with the Patient Health Questionnaire, PHQ, with mild and moderate depression cutoffs at 5 and 10. Basic statistics were calculated. Groups were compared using the t-test and chi-square. Results: Between February 2021 and March 2023, we enrolled 135 PWH into our study. The average age was 32 years; The group was 64% female. Of 46 PWH with data on chart review, the average CD4 cells/uL count was 369. Baseline PHQ-9 were similar between the intervention and control groups at median (IQR) 8(7-12) and 8(7-11), (p=0.36). Overall, 37% of those in the group therapy intervention group and 38% in the control group had a PHQ-9 score of >10 signifying moderate to severe depression. Of those enrolled in group therapy, 98% completed all 8 sessions. Of the 40 completing a satisfaction survey, 93% felt group therapy was acceptable. At three months, fewer subjects in group therapy had depression (PHQ-9 score median (IQR) 1.5 (1-3) versus 4 (3-5), p <0.001; PHQ-9 score of >5, 11% versus 34%, p= 0.005). By three months, only 1 of the 109 subjects overall had a PHQ-9 score of >10. By six months, the PHQ-9 had normalized in most with median (IQR) 1(0-2) from intervention group versus 2 (0-3) from control group, (p= 0.09). Only 2% of those in the group therapy group and 7% in the control had mild depression (p=0.35). No subjects had a PHQ-9 score of >10. There were two Covid-19 lockdowns during this study, which impacted follow-up rates as people moved to the countryside and back to different parts of the city. Conclusion: An 8-week group therapy depression intervention was successful in relieving depression in PWH newly enrolled in clinic by three months compared to control. By 6-month follow-up, depression had resolved in nearly all subjects. Group therapy can be adapted to different settings and is effective in improving mood in PWH.

Poster Abstracts

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Effectiveness of Electronic Screening for Substance Use, Depression, and Anxiety in HIV Primary Care Michael J Silverberg 1 , Tory Levine 1 , Varada Sarovar 1 , Alexandra Lea 1 , Amy S. Leibowitz 1 , Michael A. Horberg 2 , Charles B. Hare 3 , Mitchell N. Luu 4 , Jason A. Flamm 5 , Derek D. Satre 6 1 Kaiser Permanente Northern California, Oakland, CA, USA, 2 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 3 Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA, 4 Kaiser Permanente Oakland Medical Center, Oakland, CA, USA, 5 Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA, 6 University of California San Francisco, San Francisco, CA, USA Background: Substance use (SU), depression and anxiety are common in persons with HIV (PWH) yet are often not diagnosed or treated. Methods: The Promoting Access to Care Engagement (PACE) study is a stepped wedge trial to evaluate the effectiveness of electronic SU and mental health (MH) screening to increase treatment among PWH. PACE was conducted from October 2018-July 2020 in 3 large HIV primary care clinics in Kaiser Permanente Northern California, serving 5115 PWH. The intervention involved an electronic survey (via patient portal or clinic tablets) consisting of: Tobacco, Alcohol, Prescription medication and other Substance use (TAPS); Patient Health Questionnaire-9 (PHQ-9); and Generalized Anxiety Disorder-2 (GAD-2), with results visible in the electronic health record. Each clinic had a 2-year pre interventional comparison period. The study included PWH with incident SU (first of: SU clinical diagnoses or TAPS >1) or incident MH (first of: depression/ anxiety clinical diagnosis, PHQ-9 ≥10, or GAD-2 ≥3) during the pre-/post interventional periods. The post-interventional period was stratified by how SU or MH first identified (clinically or study survey). The outcome was % treated by 6 months, defined by: medications (antidepressant, antianxiety, SU), specialty care, or behavioral health specialist visits. We compared % treated in 3 groups: (1) pre-intervention (ref), or post-intervention with SU or MH first identified (2) clinically or (3) by study survey. Adjusted hazard ratios (HR) from Cox models (variables in Table footnote). Results: 1,988 PWH had evidence of SU problems: N=1285 pre-intervention; N=703 post-intervention (49% by survey). As shown in the Table, % treated was similar comparing PWH in pre- and post-intervention periods identified clinically (33% vs. 35%), but lower in PWH identified by survey in post intervention period (26%). 2119 PWH had evidence of MH problems: N=1099 pre-intervention; N=1020 post-intervention (73% by survey). % treated was lower, compared with pre-intervention (83%), for PWH in post-intervention

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