CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Results: Data from 7,126 participants, including 21,741 SUD assessments, were included. The median age was 51 (IQR 39-58); 47% of the sample identified as Black, 35% White, 13% Hispanic; and 17% were female. Overall, 43% had used marijuana in the last quarter, 34% cocaine, 15% methamphetamine, and 3% opioids. In the ITS analysis, the rate of moderate/severe SUD risk increased markedly during the pandemic with 43% (95% CI=40-46%) compared to 24% (95% CI=22-26%) having moderate/severe SUD risk post-SIP compared to pre-SIP (P<0.001; Figure). Conclusion: We found a significant increase in moderate/severe SUD risk among PWH in a large multi-site network of HIV clinics throughout the US. This rising prevalence could be related to an increase in depression, anxiety, and social isolation among PWH during the COVID-19 pandemic. Substance use and misuse are often coping mechanisms for poor mental health conditions, and general life stress. Further, service disruptions due to the pandemic and a transition to telehealth may have caused substantial interruptions in substance use and mental health treatment services among PLWH. To address the combined epidemics of substance use and HIV following the COVID pandemic, a renewed investment in integrated substance use treatment and mental health services is vital.

based on age, sex, race/ethnicity, state, and dual eligibility status. Primary outcomes included receipt of 1+ opioid prescription and diagnosed OUD during that calendar year. Secondary outcomes included receipt of 'high-risk' opioid prescriptions [i.e., 2+ overlapping prescriptions >7 days, ≥90 mg total morphine milligram equivalent (MME) daily dose, and ≥90 consecutive days of coverage], use of medication for OUD, and opioid-related hospitalizations/ emergency department (ED) visits. Logistic regression estimated the odds of each outcome comparing matched HIV and HIV- beneficiaries. Results: The cohort was predominantly male (68.5-74.3%) and White (39.7-49.0%) or African American (34.7-41.4%). Among beneficiaries with HIV, the prevalence of receiving 1+ opioid prescription (31.7-43.0%) and an OUD diagnosis (2.1-4.7%) was higher than their matched HIV- counterparts (24.9-35.6 and 0.6-2.3%, respectively). Consistent across all years, beneficiaries with HIV had significantly increased odds of receiving 1+ opioid prescription (OR=1.32-1.40) and diagnosed OUD (OR=2.08-3.84) compared to their matched HIV- counterparts (Figure 1). Similar trends were observed for all secondary outcomes, including receipt of 2+ overlapping prescriptions >7 days (OR=1.41 1.70), ≥90 mg total MME daily dose (OR=1.41-2.17), ≥90 consecutive days of coverage (OR=1.50-1.72), use of medication for OUD (OR=2.73-7.51), and opioid related hospitalizations/ED visits (OR=2.48-3.60). Conclusion: Medicare beneficiaries with HIV have higher odds of receiving opioid prescriptions, diagnosed OUD, and receiving 'high risk' opioid prescriptions compared to matched HIV- beneficiaries. Trends are consistent across all years. Our findings may help guide opioid use management among this vulnerable population.

Poster Abstracts

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The Opioid Use Disorder Care Cascade for PWH Experiencing Homelessness in Low-Barrier HIV Care Ayesha Appa , Gabriela Steiner, Matt Hickey, Elizabeth Imbert, Caycee Cullen, John Friend, Rodrigo Avila, Joi Jackson, Pierre-Cedric Crouch, Jon Oskarsson, Francis Mayorga-Munoz, Janet Grochowski, Monica Gandhi University of California San Francisco, San Francisco, CA, USA Background: Among people with HIV (PWH) with co-morbid opioid use disorder (OUD), initiation and retention in OUD treatment (e.g., buprenorphine, methadone) substantially reduces overdose deaths and improves HIV viral suppression. We sought to characterize the OUD care cascade for viremic PWH experiencing homelessness enrolled in a low-barrier HIV primary care model with embedded addiction support services. Methods: The POP-UP clinic at Ward 86 provides comprehensive primary care for viremic PWH with housing instability using a drop-in model with interdisciplinary services including counseling, same-day buprenorphine initiation, methadone clinic in an adjacent building, and on-demand Addiction Medicine consultation. We conducted a retrospective chart review of enrolled patients from February 2019 to July 2023. We identified those with opioid use upon enrollment and tracked their progression through a previously published care cascade for OUD (Figure). Results: Among 145 PWH experiencing homelessness enrolled in low-barrier primary care, 138 (94%) used substances (78% methamphetamine, 17% opioids, 10% cocaine). Of the 17% who used opioids (25/145), 84% identified as cisgender men, 58% identified as White, 20% Latine, and 16% Black. Almost all opioid use was fentanyl (24/25 fentanyl, 1/25 heroin). All 25 patients reported concomitant use of methamphetamine. Median follow up time was 28 months (interquartile range 12 - 39). Of n=25, 80% (20) were diagnosed with OUD and offered methadone or buprenorphine (i.e., engaged in OUD-specific care); 68% (17) initiated MOUD, but only 28% were retained on MOUD in the subsequent 6 months (Figure). Of n=5 not diagnosed with OUD, n=3 had remote history of OUD, n=2 reported unintentional exposure to fentanyl (with clinical opioid overdose). Of PWH retained on MOUD, 100% were on methadone. HIV viral suppression in PWH retained on MOUD was 86% (6/7) vs. 56% (10/18) HIV viral suppression in PWH with opioid use not initiated or retained on MOUD.

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The Impact of the COVID-19 Pandemic on Substance Use Disorder Risk Among People With HIV in the US Jennifer P. Jain 1 , Nadra E. Lisha 1 , Carlos Moreira 1 , David V. Glidden 1 , Greer Burkholder 2 , Heidi M. Crane 3 , Jeffrey Jacobson 4 , Edward Cachay 5 , Kenneth H. Mayer 6 , Sonia Napravnik 7 , Richard D. Moore 8 , Mallory Johnson 1 , Katerina Christopoulos 1 , Monica Gandhi 1 , Matthew A Spinelli 1 1 University of California San Francisco, San Francisco, CA, USA, 2 University of Alabama at Birmingham in Zambia, Lusaka, Zambia, 3 University of Washington, Seattle, WA, USA, 4 Case Western Reserve University, Cleveland, OH, USA, 5 University of California San Diego, La Jolla, CA, USA, 6 Fenway Health, Boston, MA, USA, 7 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 8 The Johns Hopkins University, Baltimore, MD, USA Background: The COVID-19 pandemic has disproportionately impacted vulnerable populations who experience syndemic conditions, including HIV and co-occurring substance use disorder (SUD). We examine here whether there was a significant change in moderate or severe SUD risk among people with HIV (PWH) enrolled in a large multisite clinic-based cohort in the US, before and after the COVID-19 shelter in place (SIP) mandate. Methods: Data collected between March 2018 and October 2022, among PWH enrolled in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort across eight sites were used for this study. PWH were asked about their use of the following substances: cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens, or opioids. Moderate or severe SUD risk was defined as having a score of 4 or greater on the validated ASSIST tool. Using interrupted time series (ITS) analyses, we evaluated whether there was a change in moderate or severe SUD risk over time, comparing trends before and after SIP within a mixed-effects logistic regression model. Analyses were adjusted for age, race/ethnicity, gender, study location, and current HIV viral load.

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