CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: For PWH with a high degree of structural vulnerability, retention in MOUD was low (<30%) despite the availability of low-barrier addiction services in a program serving PWH with homelessness. As all patients retained on MOUD were on methadone, it is crucial to investigate barriers to buprenorphine retention and to enhance methadone clinic referrals from primary care. Finally, addressing the widespread stimulant use observed in this sample of PWH experiencing homelessness is a top priority.

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Trends and Correlates of Methamphetamine Use Among Men Who Have Sex With Men in the US, 2014-2021 Michael P Barry 1 , Benjamin Meana 1 , Sara N. Glick 1 , David Katz 1 , Travis H. Sanchez 2 , Matthew Golden 1 , Steven M. Goodreau 1 1 University of Washington, Seattle, WA, USA, 2 Emory University, Atlanta, GA, USA Background: Methamphetamine (MA) is a powerful, addictive stimulant drug disproportionately used among men who have sex with men (MSM) in the United States (US). MA facilitates HIV acquisition and undermines HIV care engagement, threatening the US's goal of Ending the HIV Epidemic. Using a large, national dataset, we examined trends and correlates of MA use among US MSM to identify which subpopulations of MSM in the US have the highest use burden. Methods: We used data from the 2014-2021 American Men's Internet Survey, a serial, cross-sectional, web-based survey of cisgender MSM in the US conducted by PRISM Center at Emory University. Each year, approximately 10,000 MSM participate and provide behavioral and health data on the 12 months preceding the survey, including non-injection drug(s) used. We estimated the proportion of MSM who reported non-injection MA use in the past 12 months during each survey year. We used univariate log binomial regression to identify correlates associated with MA use and, with those variables, constructed a multivariate model. As a significantly higher proportion of MSM reported MA use in 2021 than in prior years, we repeated this analytic approach using data from only 2021. Results: Between 2014 and 2017, the proportion of MSM who reported last-year MA use remained from 3.1%-3.7%. In 2018, that proportion dropped significantly to 2.3%, then increased to 2.9% in 2020 and more than doubled to 6.2% in 2021 (Figure 1). In the multivariate model including all survey years, last-year non-injection MA use had notable associations with: living with HIV and using antiretroviral therapy (ART, PR: 4.83 [4.43, 5.27]); living with HIV and not using ART (PR: 4.38 [3.65, 5.19]); being HIV-negative and using pre-exposure prophylaxis (PR: 1.54 [1.37, 1.72]); and Indigenous race (PR: 1.39 [1.18, 1.62]). Results were similar when limited to 2021 respondents. Conclusion: From 2014-2020, non-injection MA use was largely stable, followed by a sharp increase in 2021. MSM living with HIV reported the highest use burden throughout the period. Those who did not use ART reported notably high rates of MA use, signaling potential for HIV transmission to their partners. Our finding that MA use increased after the first year of the COVID-19 pandemic suggests that there is an increased need for MA prevention efforts among MSM. Future work should explore the extent to which MA use has remained high post-pandemic.

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Validation of a Cumulative Substance Use Biomarker Improves Methamphetamine Use Detection in PWH Ayesha Appa 1 , Marjan Javanbakht 2 , Rachel Bolanos 2 , Hideaki Okochi 1 , Karen Kuncze 1 , Alexander Louie 1 , Matthew A. Spinelli 1 , Pamina Gorbach 1 , Monica Gandhi 1 1 University of California San Francisco, San Francisco, CA, USA, 2 University of California Los Angeles, Los Angeles, CA, USA Background: Methamphetamine (MA) use is a predictor of poor HIV outcomes as well as forward transmission. Despite this, objective assessment of MA use is suboptimal; self-report can be skewed and short-term markers of MA use (e.g., urine tests) have limited sensitivity. We hypothesize that cumulative assessment of hair MA in people at risk of or living with HIV (PWH) who report at least weekly MA use but have negative urine MA tests will increase detection of MA use. Methods: Leveraging the UCSF Hair Analytical Laboratory's expertise in the use of hair samples to monitor long-term antiretroviral adherence, we developed a hair analytical method to measure past-month MA use. We then examined stored samples from The mSTUDY, a well-established cohort of MSM that collected self-reported substance use data using validated tool (ASSIST), urine and hair specimens. We analyzed hair from participants who reported daily or weekly MA use but were MA urine test negative at the time of hair collection. Per Society of Hair Testing guidelines, hair was considered MA-positive if concentration was >200 picograms/mg. We defined sensitivity as proportion of positive hair samples from MSM who reported at least weekly use, despite negative urine tests. To determine specificity, we randomly selected n=22 hair samples from controls who reported no MA use and where urine testing was negative for substances, including MA. Results: Demographics and HIV status of the 44 MSM included in the analysis are presented in the Table. Of the 22 MSM who reported daily or weekly MA use but had negative urine tests, 3 (14%) reported daily use and 19 (86%) reported weekly use. Hair analysis detected MA use above the established threshold in 17 additional individuals, yielding a sensitivity of 77% (95% CI 60-95%). Among the 22 control subjects with no reported MA use and negative urine tests for all substances, 3 were found to have MA-positive hair samples, with a specificity of 85% (95% CI 72-100%). Conclusion: This novel hair-based biomarker identified twice as many individuals with past-month MA use than the urine MA test captured (20 additional individuals of 44 tested) in a cohort of MSM. The calculated sensitivity/specificity of hair tests are likely an underestimate, given inaccuracies in self-reported substance use. Our analysis underscores the potential advantage of hair-based assays in capturing cumulative MA exposure, offering a promising tool for objective assessment of MA use among people at risk for or living with HIV.

Poster Abstracts

CROI 2024 319