CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Conclusions: Engagement in HIV care is associated with gender, age, sexual orientation and education. Different patterns of attendance are also associated with multiple underlying causes. Our findings suggest no one-size-fits-all method of improving engagement and support the use of a range of approaches.

997

Computer-Based Prevention Counseling for HIV-Infected Persons (HPTN 065) Ann Kurth 1 ; Jennifer H. Farrior 2 ; Brett Hanscom 3 ; Laura McKinstry 3 ; Jill Stanton 2 ; Allison Zerbe 4 ; Richard Elion 5 ; Jason Leider 6 ; Bernard Branson 7 ;Wafaa M. El-Sadr 4 1 New York Univ, New York, NY, USA; 2 FHI 360, Durham, NC, USA; 3 SCHARP, Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 4 ICAP at Columbia Univ, New York, NY, USA; 5 George Washington Univ Sch of Med, Washington, DC, USA; 6 Jacobi Med Cntr, Bronx, NY, USA; 7 Scientific Affairs, Atlanta, GA, USA Background: HPTN 065 examined the feasibility of an enhanced Test, Link to Care, plus treat (TLC-plus) approach for HIV prevention in the Bronx, NY and Washington, DC. One component of the study evaluated a computer-based prevention counseling intervention (CARE+) for HIV-infected persons in care, to determine its effect on reducing unprotected sex. Methods: HIV patients at 10 study clinics (6 in DC, 4 in NY) were randomized 1:1 to either the intervention of CARE+ plus standard of care (SOC) prevention counseling or to the control arm of ACASI-risk assessment only plus SOC prevention counseling. Participants completed the assigned computer-based session at baseline, 3, 6, 9, and 12 months. Generalized estimating equation models were used to analyze the proportion of participants reporting unprotected vaginal or anal sex the last time they had sex. Results: Of 948 participants who completed at least one follow-up, 643 (68%) were men; 581 (61%) African-American; 190 (20%) Latino; 391 (41%) men who have sex with men; median age was 51 years (range 18-77 years). Eighteen percent (n=173) had less than high school-education and 28% (n=266) had an annual household income under $10,000. The majority of respondents, 88% (n=834), were on ART. Retention at month 12 was 75% (n=354) in the CARE+ arm and 78% (n=370) in the control arm. At baseline, 499 (53%) participants reported any sex in the last 3 months (236 [50%] CARE+ participants and 263 [55%] controls). The frequency of reported unprotected sex with any partner did not change over time in CARE+ participants (13% at baseline, 12% at 12 months, odds ratio (OR): 0.995 (95% CI: 0.91, 1.1), p=0.91) (Image 1A). No difference occurred between CARE+ and control participants in unprotected sex over time (OR comparing time trends, control versus CARE+: 1.03 (95% CI: 0.91, 1.2), p=0.67). At baseline, 33/471 (7%) of CARE+ participants reported unprotected sex with an HIV-negative or unknown status partner compared to 35/477 (7%) among control participants. At 12 months, the numbers were 26/354 (7%) among CARE+ and 34/370 (9%) among controls (difference not significant) (Image 1B). Conclusions: The computer-based HIV prevention intervention (CARE+) did not reduce the reported frequency of unprotected sex among these HIV-infected patients in care at participating HPTN 065 study sites. Overall rate of reported unprotected sex was low.

Poster Abstracts

998

The Swedish HIV Treatement Cascade Magnus Gisslén 1 ;Veronica Svedhem 2 ; Lena Lindborg 3 ; Leo Flamholc 4 ; Hans Norrgren 5 ; SuzanneWendahl 6 ; Anders Sönnerborg 2 1 Univ of Gothenburg, Gothenburg, Sweden; 2 Karolinska Inst, Stockholm, Sweden; 3 Venhalsan, Sodersjukhuset, Stockholm, Sweden; 4 Skåne Univ Hosp, Malmö, Sweden; 5 Lund Univ, Lund, Sweden; 6 Luleå Hosp, Luleå, Sweden Background: Access to antiretroviral treatment (ART) has dramatically reduced HIV-related mortality and morbidity, but for viral suppression and good clinical outcome, HIV-infected individuals must fulfill several steps along the HIV care continuum. It has been estimated that only a minority of HIV-infected individuals in the United States have suppressed HIV- 1 RNA levels. The process of achieving virologic suppression proceeds through 5 stages: HIV diagnosis, linkage to care, retention in care, receipt of ART, and virologic suppression. This progression is often called the cascade of care or the HIV care continuum. Methods: All patients in Sweden diagnosed with HIV are included in the InfCare HIV database. We used InfCare HIV data reported through May 2015 to estimate the HIV care continuum for the complete Swedish HIV-infected adult cohort. All adult patients ever diagnosed with HIV and still alive were included. Results: Using HIV surveillance data reported to the Public Health Agency of Sweden it was estimated that 10% of all HIV-infected subjects in Sweden remain undiagnosed. Among 6794 diagnosed patients, >99.9%were linked to care and >99% of those stayed in care. 94.3%were on ART and of those 95.5% had a viral load <50 copies/mL (snapshot analysis). The vast majority of patients with a viral load >50 copies/mL had a so called viral blip and a subsequent viral load <50 copies/mL. Conclusions: Of estimated 8000 HIV-infected subjects in Sweden, 90%were diagnosed with HIV, and 80%were on suppressive ART with a viral load <50 copies/mL.

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CROI 2016