CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

1040 ENGAGEMENT IN CARE OF HIGH-RISK PATIENTS AT AN URBAN HIV PRIMARY CARE CENTER Raaka Kumbhakar 1 , Mila Gonzalez Davila 2 , Randi Scott 2 , Noga Shalev 1 , Susan Olender 1 1 Columbia University Medical Center, New York, NY, USA, 2 New York Presbyterian Hospital, New York, NY, USA Background: Socioeconomic and behavioral factors are associated with poor engagement in HIV care (EIC) and lower rates of viral suppression (VLS) among persons with HIV. Our agency participated in a multidisciplinary care coordination intervention designed to address these disparities as part of New York City’s Ryan White Part A HIV Care Coordination Program (CCP). In this study, we describe our experience with CCP in our hospital-based HIV center, which provides comprehensive HIV primary care with co-located mental health services to a predominantly poor, minority, and immigrant population. Methods: Clients were eligible for CCP enrollment if they were newly diagnosed with HIV or met criteria for poor EIC. All were paired with a dedicated field navigator and received patient-centered care coordination, health promotion, and outreach services. This study includes all CCP participants enrolled between January 2013 and December 2016. Univariate and multivariate regression were used to evaluate the association between patient characteristics and CCP activities on VLS and EIC. Results: 241 CCP clients were enrolled from 2013-2016. Factors significantly associated with VLS at 12 months include: EIC (p < 0.05), VLS at enrollment (p = 0), respiratory disease (p < 0.01), cardiovascular disease (p < 0.06), and mental illness (p < 0.09). In the multivariate model, EIC (OR 2.57, CI 0.29-0.81, p<0.01) and VLS at enrollment (OR 2.41, CI 0.32–1.04, p<.01) remained significant. Univariate analyses showed that new diagnosis (p < 0.02), engagement in psychiatric care (p = 0), VLS at 12 months (p < 0.05), malignancy (p < 0.08), serious mental illness (bipolar disorder and/or schizophrenia; p = 0), substance use (p < 0.08), and homelessness (p = 0) were associated with EIC. In a multivariate model, new diagnosis (OR 4.01, CI 1.26-1.24, p<0.02), VLS at 12 months (OR 2.32, CI 1.25-12.71, p<0.01), and mental illness (OR 2.59, CI 1.42-4.7, p<0.01) remained significant. Conclusion: Despite intensive interventions, rates of VLS at 12 months and EIC among CCP clients remained below 90%. Disproportionately high rates of mental illness and substance abuse are likely playing in a role in this finding. However, mental illness was significantly positively associated with EIC which suggests that co-location of mental health services has had significant impact on key HIV outcomes. This suggests that additional embedded behavioral health resources are needed to address the complex psychosocial needs of people living with HIV.

HIV-positive MSM were nominally (although not significantly) more likely than PWID to meet care continuum benchmarks, including awareness of status, HIV care received in prior 6 months, ART use, and suppressed viral load (HIV RNA <150 c/mL). Although care continuum outcomes increased over the next 4 years in both groups, the increases were markedly larger for MSM than PWID (Figure). For example, the increase in those reporting HIV care in the prior 6 months was 32 percentage points (95% CI: 16, 48) higher in MSM than PWID sites, and the increase in viral suppression was 15 percentage points (95% CI: 0, 31) higher in MSM than PWID sites. Conclusion: In serial large population surveys across 22 sites in India, we found that HIV-positive MSM had substantially larger improvements in care continuum outcomes 4 years later compared with HIV-positive PWID. This highlights the value of high-quality HIV treatment surveillance data to target resources for key populations effectively.

Poster Abstracts

1039 HIV OUTCOMES AMONG TRANSGENDER MEN IN HRSA’S RYAN WHITE HIV/AIDS PROGRAM, 2010-2016 Stacy Cohen , Demetrios A. Psihopaidas, Antigone Dempsey, Laura W. Cheever HRSA HIV/AIDS Bureau, Rockville, MD, USA Background: Transgender men living with HIV have been underrepresented in HIV studies in the United States, yet many social, behavioral, and systemic determinants of health act as barriers to care and successful treatment of HIV. The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) supports direct medical and support services to uninsured and underserved people living with HIV (PLWH) and is uniquely situated to address these health determinants. This analysis examines sociodemographic and clinical information among transgender men receiving RWHAP services during 2010–2016. This study serves as the first focused analysis on transgender men using a national dataset of PLWH receiving care through the RWHAP in the United States. Methods: Data from the RWHAP Services Report submitted to HRSA by RWHAP Parts A-D recipients were used to identify transgender men aged ≥13 years who received RWHAP services during 2010-2016. A 2-step method was used to calculate current gender, including sex assigned at birth and current gender identity. Sociodemographic characteristics, clinical information, HIV-related outcomes, and service utilization were examined during 2010-2016. Results: The number of transgender men served by RWHAP increased from 161 in 2010 to 430 in 2016. In 2016, these clients accounted for 0.08% of all RWHAP clients and 6.0% of transgender clients. Among transgender men in 2016, 81.8% were racial/ethnic minorities, 59.7%were living at or below poverty, 10.2% had unstable housing, and 12.0% had no health care coverage. Clinical data for those receiving medical care in 2010-2016 (approximately two-thirds of total transgender men) showed viral suppression increased from 49.1% in 2010 to 84.1% in 2016. In addition in 2016, 91.4%were prescribed ART and 5.5% had a CD4 count <200 cells/µL at last test. Other services frequently accessed included medical case management (43.2%), mental health services (22.9%), and non- medical case management (14.3%). Conclusion: Although they represent a small proportion of RWHAP clients, transgender men have unique healthcare needs. High proportions of these clients have unstable housing and access mental health services, both of which have been associated with poorer HIV-related health outcomes. Despite these challenges, transgender men are receiving ART and achieving viral suppression similar to the general RWHAP medical population.

1041 PRAISE MESSAGES TO INCREASE ART ADHERENCE AND RETENTION IN CARE FOR FSW IN ETHIOPIA Nicholas Wilson 1 , Kristen Little 2 , Aderaw Anteneh 3 , Woldemariam Girma 3 , Kelly Bidwell 4

CROI 2019 408