CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

counties. Recent increases in HIV diagnoses have occurred in non-metropolitan counties. Whether through outbreaks or slower trends of increased transmission, HIV diagnoses among PWID may increase in areas across the urban-rural continuum.

Poster Abstracts

887 INJECTION AND SEXUAL BEHAVIORS AMONG PERSONS WITH DIAGNOSED HIV WHO INJECT DRUGS Sharoda Dasgupta, Yunfeng Tie, Ansley Lemons-Lyn , Kathleen Wu, Janet C. Burnett, R. L. Shouse, Linda Beer CDC, Atlanta, GA, USA Background: Injection and sexual practices of HIV-positive persons who inject drugs (PWID) can affect HIV transmission risk, but have not been described using nationally representative data. We examined high-risk injection and sexual practices among HIV-positive PWID using nationally representative data from the Medical Monitoring Project (MMP). Methods: During 6/2015–5/2016, interviews were conducted with adults with diagnosed HIV to assess sexual behaviors, injection drug use, and other behaviors during the past 12 months. Viral load results from the past 12 months were obtained through medical record abstraction. Among adults with diagnosed HIV who injected drugs in the past 12 months (n=113), we reported the percent who engaged in distributive sharing of syringes and other injection equipment (defined as giving used injection equipment to another person for use), injected drugs before or during sex, and needed and did not obtain alcohol or drug treatment. We estimated the percent of HIV-positive PWID who had condomless sex and were at high risk for sexual HIV transmission, defined as (1) having a detectable viral load (≥1 viral load ≥200 copies/mL), and (2) having condomless sex with an HIV-negative or HIV-unknown partner who was not known to be on PrEP, and compared estimates with HIV-positive adults who did not inject drugs (n=3,541) using Rao-Scott chi-square tests (P<.05). We reported weighted percentages to account for complex survey design. Results: Overall, 3% of adults with diagnosed HIV injected drugs in the past 12 months, of whom 9% engaged in distributive syringe sharing and 11% in distributive sharing of other injection equipment; 65% reported injecting drugs before or during sex. Over half (56%) needed alcohol or drug treatment, of whom 32% did not obtain treatment. Seventy percent of all HIV-positive PWID, compared with 31% of HIV-positive non-PWID, had condomless sex; 25% of HIV-positive PWID, compared with 7% of HIV-positive non-PWID, engaged in behaviors associated with high risk of sexual HIV transmission. Conclusion: Over 10% of HIV-positive PWID engaged in distributive injection equipment sharing, which is associated with HIV transmission. HIV-positive PWID were more likely to engage in behaviors associated with high risk of sexual HIV transmission. Additional resources to reduce HIV transmission risk among HIV-positive PWID, such as expanding access to sterile injection equipment, drug treatment options, and education on condom use, may be needed.

886 HIV DIAGNOSES AMONG PEOPLE WHO INJECT DRUGS BY URBAN-RURAL CLASSIFICATION, 2014-2016 Sheryl Lyss 1 , Tianchi Zhang 2 , Alexandra M. Oster 1 1 CDC, Atlanta, GA, USA, 2 ICF International, Atlanta, GA, USA Background: Concurrent with the U.S. opioid epidemic, the decline in the number of HIV diagnoses among people who inject drugs (PWID) has slowed. Although HIV diagnoses among PWID have been concentrated in urban areas, a 2015 HIV outbreak among PWID in Indiana revealed the vulnerability of rural areas to HIV outbreaks. We assessed the number of HIV diagnoses among PWID and recent changes over time across the urban-rural continuum. Methods: We used National HIV Surveillance System data reported through June 2018 for diagnoses occurring among persons aged ≥13 years during 2014 and 2016 (excluding the Indiana outbreak year) and preliminary data for 2017. We included persons with HIV attributed to injection drug use (IDU) only; those attributed to both IDU and male-to-male sexual contact were not included. Missing data on transmission category were imputed with standard methods. County of residence at diagnosis was categorized by the National Center for Health Statistics 2013 urban-rural classification scheme (Table) and the 220 counties identified by CDC as most vulnerable to HIV outbreaks. Results: In 2016, of 2177 HIV diagnoses among PWID, 1982 (91%) occurred among residents of metropolitan counties; 971/2177 (45%) were from large central metro counties (Table). In the 220 most vulnerable counties, 45 diagnoses occurred. The number of diagnoses in 2016 was >5% lower than in 2014 for large central metro (-83 diagnoses; -8%) and small metro (-8; -6%) counties and >5% higher for large fringe metro (+22, 5%) and micropolitan (+10, 10%) counties and for the 220 most vulnerable counties (+22, 96%). Preliminary data suggest that HIV diagnoses among PWID in 2017 are higher in number than in 2016 and distributed similarly across urban-rural categories. Conclusion: The vast majority of HIV diagnoses among PWID in the United States are among PWID who reside in metropolitan areas. Although diagnoses among residents of large central metro counties continued to decline through 2016, these counties still accounted for 45% of HIV diagnoses among PWID. Increases in diagnoses among PWID in 2016 compared with 2014 occurred outside of large, central metro areas, with the greatest absolute increase in large fringe metro counties, and the greatest relative increase in micropolitan

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