CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 Hunter College, CUNY, New York, NY, USA Background: A goal of the New York State Ending the Epidemic (EtE) Initiative is to achieve viral load suppression (VLS <200 copies /µL) in 85% of all HIV-diagnosed persons by 2020. To accomplish this, factors associated with clinics already achieving VLS in ≥85% of their patients must be identified. We hypothesized that, compared to clinics with lower HIV caseloads, those with larger HIV caseloads are more likely to achieve ≥85% VLS. Methods: Using purposive sampling, the New York City Department of Health and Mental Hygiene administered a survey assessing clinic capacity and practice to 154 HIV clinics in New York City; 110 (75%) responded. Clinics were classified as either ≥85% VLS (n=36) or <85% VLS (n=74). HIV caseload was defined by the total number of unique HIV patients receiving care at a clinic in 2016 and was categorized into quartiles. We used multiple logistic regression to examine the association between HIV caseload and clinics achieving ≥85% VLS, adjusting for age, sex, race, and ethnicity of clinic patient populations. Thereafter, chi-square/ Fisher’s exact/Mann–Whitney U tests identified clinic practice characteristics unique to caseload quartiles associated with ≥ 85% VLS. Results: After adjusting for covariates, only quartile-2 (Q2) caseload of 61-200 HIV patients (n=31) was associated with significantly higher likelihood of achieving ≥ 85% VLS (OR = 6.6, 95% CI 1.2 – 37). Q2 clinics had significantly higher use of device based medication adherence reminders (p<0.01), Saturday hours (p=0.04), queried electronic medical records monthly for virally unsuppressed patients (p=0.02), utilized personal phone call reminders for patient appointments (p=0.03), and had more patients in Health Home medical case management (p = 0.04) compared to other quartiles combined. Q2 clinics also mandated more HIV-related continued medical education training (p=0.052); had lower rates of missed appointments (p=0.052); and reported hiring diverse, culturally competent staff based on patient population (p=0.10) than other quartiles combined. The majority of Q2 clinics (n=23) had HIV patients comprising fewer than 15% of total patient population and 16 reported >50% Black HIV patient population. Conclusion: An HIV caseload of 61-200 patients may allow for best planning and execution of effective clinical practice particularly with demographics that may face more barriers in achieving VLS.

1048 SOCIAL NETWORKS AND TIE STRENGTH PREDICT OUTCOMES OF HIV+ YOUTH IN SEARCH TRIAL Lillian Brown 1 , Laura B. Balzer 2 , Jane Kabami 3 , Dalsone Kwarisiima 3 , Norton Sang 4 , James Ayieko 4 , Edwin D. Charlebois 1 , Gabriel Chamie 1 , Theodore Ruel 1 , Elizabeth A. Bukusi 4 , Craig R. Cohen 1 , Moses R. Kamya 5 , Diane V. Havlir 1 , Maya L. Petersen 6 1 University of California San Francisco, San Francisco, CA, USA, 2 University of Massachusetts Amherst, Amherst, MA, USA, 3 Infectious Disease Institute, Kampala, Uganda, 4 Kenya Medical Research Institute, Nairobi, Kenya, 5 Makerere University, Kampala, Uganda, 6 University of California Berkeley, Berkeley, CA, USA Background: HIV+ youth in sub-Saharan Africa are at high risk of virologic failure on ART; peer support within their social networks may improve clinical outcomes. We used comprehensive social network and HIV testing data from the SEARCH test-and-treat trial (NCT01864603) to evaluate whether HIV+ youth with HIV+ social network contacts at baseline were more likely than those without this support to engage in care and virally suppress. Methods: Adult (≥ 15 years) residents enumerated during a census in 32 communities in rural Kenya and Uganda named social contacts in five domains: health, money, emotional support, food, and free time. Named contacts were matched to enumerated residents to build social networks among 150,395 adult residents; 90%were tested for HIV. Among youth (15-24 years) who were ART-naive at baseline (2013-2014), we evaluated whether having ≥1 baseline network contact who was i) HIV+, or ii) HIV+ and virally suppressed (HIV RNA <400 copies/ml) predicted ART initiation and viral suppression 3 years later, and whether the association was greater for strong ties (network contacts named in >1 domain). We used logistic regression with robust standard errors to adjust for sex, study arm, new diagnosis, and region. Results: Among 1,120 HIV+ youth who were ART-naive at baseline, 857 remained alive and resident in the community after 3 years of follow-up. At 3 years, 68% (579/857) had engaged in ART care and among 521 with viral loads, 400 (77%) were virally suppressed. Youth named an average of 2.7 contacts (SD 3.1); 275 (32%) named ≥1 HIV+ contact and 81 (9%) had ≥1 virally suppressed contact. 340 (42%) named ≥1 strong tie; 117 (15%) had HIV+ strong ties and 31 (4%) had virally suppressed strong ties. Youth with ≥1 HIV+ baseline contact were more likely to initiate ART (aOR 1.76; 1.26-2.46) and youth with ≥1 virally suppressed baseline contact were more likely to be suppressed themselves 3 years later (aOR 1.80; 1.11-2.89). The magnitude of these associations was (non- significantly) greater if ties were strong: ≥1 HIV+ strong tie was associated with ART initiation (aOR 2.07; 1.27-3.37) and ≥1 virally suppressed strong ties was associated with viral suppression (aOR 2.53; 1.18-5.42). Conclusion: HIV+ peers, particularly those with viral suppression, in the local social networks of ART-naive HIV+ youth in rural East Africa may support engagement in care and viral suppression. Interventions that increase social connections to HIV-infected youth in HIV-care may improve clinical outcomes. 1049 ASSOCIATION BETWEEN HIV CLINIC CASELOADS AND VIRAL LOAD SUPPRESSION IN NEW YORK CITY Saiganesh Ravikumar 1 , Erica D’Aquila 1 , Muhammad Daud 1 , Carly Skinner 1 , Craig Hayes 1 , Ellen Brazier 2 , Tyeirra Seabrook 1 , Erica Crittendon 1 , Demetre C. Daskalakis 1 , Bisrat Abraham 1

Poster Abstracts

1050 VIRAL SUPPRESSION AMONG PEOPLE INITIATING HIV CARE: OUTCOMES FROM THE IENGAGE TRIAL K. Rivet Amico 1 , Riddhi Modi 2 , AndrewWestfall 2 , James Willig 2 , Jeanne C. Keruly 3 , Sonia Napravnik 4 , Heidi M. Crane 5 , Evelyn B. Quinlivan 4 , Anne L. Zinski 2 , Carol E. Golin 4 , Dustin M. Long 2 , Richard D. Moore 3 , Michael Saag 2 , James Raper 2 , Michael J. Mugavero 2 1 University of Connecticut, Storrs, CT, USA, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 Johns Hopkins University, Baltimore, MD, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 University of Washington, Seattle, WA, USA Background: Optimizing engagement in HIV care represents the greatest opportunity to maximize the individual and population health benefits of sustained viral suppression (VS; <200 c/ml). Among people living with HIV (PLWH) initiating outpatient HIV care, early missed clinic visits and suboptimal

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