CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

921 MULTILEVEL PREDICTORS OF SUICIDALITY AMONG HIV+ SUBSTANCE USERS IN 11 US CITIES AdamW. Carrico 1 , Viviana Horigian 1 , Rui Duan 1 , Daniel Feaster 1 , Lauren Gooden 1 , Allan Rodriguez 1 , James Sorensen 2 , TimMatheson 3 , Susan Tross 4 , Grant Colfax 2 , David Metzger 5 , Petra Jacobs 6 , Carlos del Rio 7 , Lisa Metsch 4 1 University of Miami, Miami, FL, USA, 2 University of California San Francisco, San Francisco, CA, USA, 3 San Francisco Department of Public Health, San Francisco, CA, USA, 4 Columbia University, New York, NY, USA, 5 University of Pennsylvania, Philadelphia, PA, USA, 6 NIH, Bethesda, MD, USA, 7 Emory University, Atlanta, GA, USA Background: People living with HIV/AIDS have an elevated risk for suicide. Although HIV+ substance users are at even greater risk, few studies have been conducted to inform comprehensive management of suicide risk in this population. Methods: Project Hope (CTN0049) was a 3-arm randomized controlled trial that tested six months of patient navigation (with and without financial incentives) compared to treatment as usual in HIV+, substance-using hospitalized patients. Project Hope recruited 801 patients from 11 hospitals in the U.S. from 2012- 2014. Predictors of two time-varying outcomes were examined over 12 months: 1) any suicidal thoughts (past week); and 2) a composite measure of suicidality measuring the frequency of suicidal thoughts, considering methods for suicide, and making plans for suicide in the past week. Medical, structural, and psychosocial predictors of these outcomes at baseline, six, and 12 months were examined using mixed linear and logistic regression models. Results: The sample was predominantly Black (78%), middle-aged (Mean = 44.6; SD = 10.0), and male (67%) with a median CD4+ count of 109 cells/ mm. 3 Approximately 18% of participants reported any suicidal thoughts at baseline. The Figure summarizes the percentage of participants reporting any suicidal thoughts, methods, or plans over the 12-month follow-up. More severe substance (Adjusted Odds Ratio [AOR] = 1.29; 95% CI = 1.07 – 1.55) and alcohol (AOR = 1.26; 95% CI = 1.02 – 1.55) use disorder symptoms were independently associated with greater odds of reporting any suicidal thoughts over 12 months. Hispanic/Latino ethnicity, a CD4+ T-cell count < 200 cells/mm, 3 injection drug use (IDU) during the past year, and more severe alcohol and tobacco use disorder symptoms significantly predicted higher suicidality composite scores over 12 months. In contrast, stable housing and greater social support were associated with significantly lower suicidality composite scores over 12 months. There were no intent-to-treat effects of patient navigation (with or without financial incentives) on any suicidal thoughts or suicidality. Conclusion: Greater severity of alcohol, tobacco, and other substance use disorders as well as recent IDU are key risk factors for suicidality among HIV+ substance users. Findings also underscore the need for comprehensive approaches to address the medical, structural, and psychosocial factors that may modify suicide risk in this population.

920 DATING VIOLENCE AND HIV-ASSOCIATED OUTCOMES AMONG ADOLESCENT SEXUAL-MINORITY MALES

Christine Agnew-Brune 1 , Susan Cha 1 , Alexandra Balaji 1 , Brian Mustanski 2 , Michael E. Newcomb 2 , Kathleen Brady 3 , Sarah L. Braunstein 4 , Cyprian Wejnert 1 , for the NHBS-YMSM study group 1 CDC, Atlanta, GA, USA, 2 Northwestern University, Evanston, IL, USA, 3 Philadelphia Department of Public Health, Philadelphia, PA, USA, 4 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: Adolescent sexual-minority males (ASMM) in the United States are disproportionally affected by HIV and dating violence (DV) compared to their heterosexual peers. While previous research has typically focused solely on one-sided DV, recent studies suggest bidirectional violence in relationships is associated with increased HIV risk and may affect healthcare service use. However, this association has not been examined among ASMM. We used data from CDC’s National HIV Behavioral Surveillance to examine dating violence experiences of ASMM and estimate associations between DV profiles and behaviors known to increase HIV risk in 3 cities participating in the NHBS-Young Men who have Sex with Men pilot. Methods: ASMM, defined as males aged 13-18 years who reported ever having sex with another male, gay/bisexual identity, or same-sex attraction, were asked about several past 12 month HIV-associated outcomes: condomless anal sex, ≥4 sexual partners, exchanged sex for money or drugs, sexually transmitted infection (STI) diagnosis, non-injection drug use, and HIV testing. DV experience in the past 12 months was divided into three profiles: DV perpetration only (DVP), DV victimization only (DVV), and DV perpetration and victimization (mutual DV). Using log-linked Poisson regression, we calculated separate adjusted prevalence ratios (aPR) for associations between DV profiles and HIV-associated outcomes. Models were adjusted for city and race/ethnicity. Results: Of 548 ASMM, 6% reported DVP, 8% DVV, and 8% reported mutual DV. The majority of ASMM reporting any type of DV visited a healthcare provider in the last year (89%). Compared to those reporting no DV, ASMM reporting mutual DV were more likely to report condomless anal sex (aPR=2.47, 95% CI: 1.38–4.42). ASMM reporting DVP or mutual DV were more likely to report a STI diagnosis (aPR=2.71, CI: 1.09–6.68; aPR=2.71, CI: 1.30–5.62, respectively) drug use (aPR=2.33, CI: 1.12–4.85, aPR=2.45, CI: 1.26–4.94, respectively), and HIV testing (aPR=3.81, CI: 1.58–9.21, aPR=4.23, CI: 1.94–9.26, respectively). Conclusion: Our findings suggest that DV is prevalent among ASMM. These results highlight that exposure to DV as a victim and perpetrator are associated with increased HIV-related behaviors. The majority of ASMM experiencing DV were engaged in healthcare suggesting an opportunity for provider-initiated screening for violence and additional integration of services to reduce HIV risk among this population.

Poster Abstracts

CROI 2019 360