CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1005 Incarceration, Drug Use, and HIV: Optimizing Services for Women Who Use Drugs in Tanzania Kaitlyn Atkins , Haneefa T. Saleem The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: Women who use drugs (WWUD) in sub-Saharan Africa (SSA) face elevated HIV risk, which is linked to structural vulnerability including high rates of incarceration and arrest. However, little is known about the experiences of formerly incarcerated WWUD in SSA or their drug use and HIV outcomes. Methods: Using respondent-driven sampling (November 2018-February 2019), we recruited WWUD reporting past-month heroin use in Dar es Salaam, Tanzania and administered a structured survey (n=200). We described the prevalence of recent incarceration (being in jail or prison in the past six months) and characteristics of recently incarcerated WWUD. We used modified Poisson regression with robust variance estimation to calculate prevalence ratios (PRs) and 95% confidence intervals (CI) for the associations between recent incarceration and HIV and drug use outcomes, adjusting for age, education, and duration of heroin use in years. Results: Over half of WWUD (n=119, 61%) reported incarceration in the past six months. The most common reasons for arrest were using drugs (47%) and selling sex (27%). In bivariate analyses, incarceration was associated with transactional sex, symptoms of depression and anxiety, physical violence victimization, and drug use stigma from family and healthcare providers (Table). In adjusted analyses, incarceration was associated with 46% higher prevalence of concurrent sexual partnerships (PR 1.46, 95% CI 1.17-1.82), five times the prevalence of concurrent stimulant use (PR 5.70, 95% CI 1.74-18.70), and 76% higher prevalence of lifetime non-fatal overdose (PR 1.76, 95% CI 1.08-2.85). Among WWUD living with HIV, incarceration was associated with missing HIV care appointments (p=0.02). Conclusion: This study, one of the first to describe HIV-related outcomes among recently incarcerated WWUD in SSA, identified converging behavioral and structural risks related to incarceration, which may exacerbate HIV disparities among WWUD. Elevated stimulant use among recently incarcerated WWUD is of particular concern, given associations with adverse HIV outcomes. In the context of highly criminalized sex work and drug use, interventions that target policing practices such as drug diversion programs, may be effective at reducing incarceration-associated risks. For WWUD, including those living with or at risk for HIV, multilevel interventions may be needed to reduce service interruptions and ensure linkage to care during incarceration and reentry. The figure, table, or graphic for this abstract has been removed. 1006 Differences in Healthcare Access Among Persons Who Inject Drugs by Medicaid Expansion Policy, 2022 Amy R. Baugher, Rashunda Lewis , Larshie Sutter, Maya Haynes, Cyprian Wejnert Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Since 2014, 40 states expanded Medicaid, extending coverage to millions. Persons who inject drugs (PWID) are at increased risk for HIV, often have low income, and could benefit from Medicaid expansion. Yet, many PWID live in non-expansion states, mostly in the South. We compared healthcare access between PWID living in Medicaid expansion vs. non-expansion states. We conducted a subanalysis focused on PWID with HIV. Methods: We analyzed 2022 data from CDC's National HIV Behavioral Surveillance in 19 US cities sampling PWID aged 18-64 years (n=6245). We used multilevel log-linked Poisson models to compare PWID's healthcare access by state-level Medicaid expansion policy (defined as expanding Medicaid by June 1, 2022), producing adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Significance was determined by CIs overlapping with the null. Results: Most PWID lived in a Medicaid expansion state (85%). Most PWID in non-expansion states were Black (59%). Only 1 out of 10 PWID in expansion states were uninsured compared to 2 out of 3 PWID in non-expansion states (aPR=0.1, 95%CI=0.1-0.2). PWID in Medicaid expansion states were 5 times as likely to have Medicaid than PWID in non-expansion states (72% vs. 13%; aPR=5.3, 95%CI=5.3-5.3). PWID in Medicaid expansion states were more likely than those in non-expansion states to have visited a doctor in the past 12 months (76% vs. 66%; aPR=1.2, 95%CI=1.1-1.3) and have a usual source of healthcare (52% vs. 38%; aPR=1.4; 95%CI=1.1-1.9). PWID in expansion states were less likely than those in non-expansion states to have an unmet medical need due to cost (18% vs. 41%; aPR=0.4, 95%CI= 0.4-0.5). Only 4% of PWID with HIV in expansion states were uninsured compared to 54% of PWID with HIV in non-expansion states (aPR=0.1, 95%CI=0.0-0.1). PWID with HIV in expansion

states were less likely to have an unmet medical need due to cost than those in non-expansion states (12% vs. 38%; aPR=0.3, 95%CI=0.2-0.5). Conclusion: Medicaid expansion is associated with better access to healthcare and fewer unmet medical needs among PWID, a population that often has diverse medical needs and few resources. Non-expansion hinders efforts to end the HIV epidemic and disproportionately affects Black PWID, contributing to racial/ethnic inequities. Clinics in non-expansion states may link PWID patients to services and patient assistance programs to defray costs. States may consider expanding Medicaid. 1007 Unmet Need for Medication for Opioid Use Disorder Before and After the COVID-19 Pandemic Jacklynn De Leon , Anna Teplinskaya, Dafna Kanny, Senad Handanagic, Dita Broz, Teresa Finlayson, Cyprian Wejnert, for the NHBS Study Group Centers for Disease Control and Prevention, Atlanta, GA, USA Background: The COVID-19 pandemic substantially impacted harm reduction services for persons who inject drugs (PWID), including access to medications for opioid use disorder (MOUD) that reduce injection frequency, HIV and HCV transmission, and opioid-related overdose mortality. We sought to assess change in unmet need for MOUD among PWID from pre- to post-pandemic. Methods: PWID were recruited using respondent-driven sampling to participate in CDC's National HIV Behavioral Surveillance in 19 U.S. cities in 2018 and 2022. This analysis included PWID who were ≥ 18 years and reported injecting drugs and opioid use in the past 12 months. We obtained prevalence ratios (PRs) and 95% confidence intervals (CIs) using log-linked Poisson models adjusted for city and participant network size and clustered on recruitment chain to assess differences in self-reported unmet need for MOUD between 2018 and 2022. Results: The analysis included 9,282 PWID interviewed in 2018 and 5,882 PWID interviewed in 2022. Overall, fewer PWID reported unmet need for MOUD in 2022 than in 2018 (28% vs. 25%, PR 0.91; 95% CI: 0.85, 0.98). Additionally, unmet need for MOUD decreased from 2018 to 2022 among PWID who most commonly injected opioids (28% vs. 24%, PR 0.86; 95% CI: 0.77, 0.95), PWID who injected more than once a day (30% vs. 27%, PR 0.89; 95% CI: 0.82, 0.98), and PWID who received syringes from an SSP in the past 12 months (28% vs 25%, PR 0.87; 95% CI: 0.78, 0.97). Conclusion: Decreases in unmet need for MOUD were observed among those at high need for MOUD, specifically those who injected most frequently and most commonly injected opioids. Unmet need for MOUD also decreased among those accessing SSPs, which are important service programs for PWID. Low-threshold, affordable access to MOUD is key to reducing injection-related risk for HIV and other infectious disease. Despite COVID-19 pandemic-related disruptions in services for PWID, policy changes to federal guidance for MOUD treatment providers or other innovations in service provision may have contributed to increases in access to MOUD. Additional research is needed to assess what factors or potential policies mitigated the effects of service disruptions due to the pandemic on unmet need for MOUD and the resulting impact on HIV and other infectious diseases. 1008 HIV Prevention Service Use Among PWID in Washington, DC, Pre- and Post-COVID Pandemic Eras Xinyi Li 1 , Sydney Bornstein 1 , Manya Magnus 1 , Kate Drezner 2 , Brittani Saafir Callaway 2 , Alan Greenberg 1 , Hannah Latif 1 , Irene Kuo 1 1 George Washington University, Washington, DC, USA, 2 District of Columbia Department of Health, Washington, DC, USA Background: The COVID-19 pandemic disrupted access to critical healthcare and HIV prevention services for people who inject drugs (PWID). We explored the pandemic's potential impact on use of healthcare and HIV prevention services among PWID in the pre- and post-COVID pandemic eras. Methods: We used data from the 2018 and 2022 National HIV Behavioral Surveillance system in Washington, DC. PWID were recruited via respondent driven sampling (RDS) and were ≥18 years old, resided in the Washington metropolitan statistical area, and reported injecting non-prescribed drugs in the past 12 months. Self-reported healthcare and HIV prevention service utilization, drug-use behaviors, and drug treatment were assessed. RDS weighted percentages were calculated; Rao-Scott chi-square tests identified significant differences in service utilization and drug use behaviors comparing 2018 and 2022.

Poster Abstracts

CROI 2024 322