CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

1003 The Causal Impact of ART Initiation on Household Food Security Bryan N. Patenaude 1 ; Natsayi Chimbindi 2 ; Deenan Pillay 2 ;Till Bärnighausen 1 1 Harvard Sch of PH, Boston, MA, USA; 2 Africa Cntr for Hlth and Pop Studies, Mtubatuba, South Africa

Background: There are several plausible mechanisms from ART to household welfare, and the direction of net effects is unclear: on the one hand, patients incur costs when utilizing ART (e.g., for travel, even where ART is free of charge); on the other hand, patients recover health and employment on ART. This study examines the impact of ART on one aspect of household welfare – household food security. Methods: We use routinely collected longitudinal data collected by the Africa Centre for Health and Population Studies and employ a regression discontinuity design over 2300 observations (collected between 2004 and 2012), to assess the causal impact of ART on three food security outcomes: probability of an adult in the household missing any food for financial reasons, probability of an adult in the household missing a meal for financial reasons, and probability of a child in the household missing a meal for financial reasons. Results: Our results show that for each outcome ART causes a significant increase in the probability of food insecurity in the year following ART initiation, which diminishes to 0 between 2 and 4 years after ART initiation, depending on the outcome examined. In the first year after initiation, ART initiation yielded a significant increase in the probability of an adult in the household missing food by 5.5% (coefficient = 0.055, 95% CI = [0.0190, 0.0904]), a significant increase in the probability of an adult in the household missing a meal by 6.5% (coefficient = 0.065, 95% CI = [0.0156, 0.1147]), and a significant increase in the probability of a child in the household missing a meal by 4.6% (coefficient = 0.046, 95% CI = [0.0036, 0.0892]). The upper bound on these causal estimates is an approximately 10% increase in household food insecurity as a result of ART initiation, with the effect size in all scenarios diminishing to zero within 3 years after initiation. Conclusions: ART initially places a significant burden on household food security; however, this effect disappears over time. It is likely that the financial burden of utilizing ART, which are high relative to income in this community, initially outweigh the longer-term beneficial ART effects on employment and income. Food and financial support programs should be considered to alleviate the temporary loss in food security following ART initiation, especially in the context of the expanding ART rollout and treatment-as-prevention strategies. 1004 Increased STD Testing Among HIV-Infected Adults in Care United States, 2009-2013 Christine Mattson ; Christopher Johnson; Heather Bradley; Linda Beer; Roy L. Shouse CDC, Atlanta, GA, USA Background: STD prevention services are important for HIV prevention efforts because STDs can be a marker for condomless sex and increase HIV viral load and genital shedding, which can increase HIV transmission. Current guidelines recommend that all sexually active HIV-infected persons be tested at least annually for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and syphilis. However, little is known about temporal trends in STD testing among HIV-infected adults in the United States. We examined CT, GC, and syphilis testing trends among HIV-infected adults receiving medical care in the United States from 2009 to 2013. Methods: The Medical Monitoring Project (MMP) is a surveillance system designed to produce nationally representative behavioral and clinical estimates for HIV-infected adults receiving medical care in the United States. Using weighted MMP data collected from 22,125 persons from the project’s 2009 to 2013 data collection cycles, we analyzed medical record data to examine testing for CT, GC, and syphilis by year and stratified by sexual behavior and race/ethnicity. Results: From 2009 to 2013, the proportion of sexually active HIV-infected adults tested for all three STDs in the year preceding interview increased from 20% to 36% (β=0.05, P for trend < 0.01); however, the majority of sexually active adults (64%) were not tested for all three STDs in the most recent year. Testing for all three STDs was highest among men who have sex with men (MSM), and the positive trend was statistically significant for MSM (29% to 39%, β=0.04, P for trend < 0.01), men who have sex with women (25% to 33%, β=0.04, P for trend < 0.01), and women who have sex with men (26% to 35%, β=0.03, P for trend < 0.01) (figure 1a). Statistically significant increases were also found for all race/ethnicity groups: non-Hispanic whites (23% to 30%, β=0.04, P for trend < 0.01), non-Hispanic blacks (28% to 35%, β=0.04, P for trend < 0.01) and Hispanics (34% to 47%, β=0.05, P for trend < 0.01) (figure 1b). Conclusions: Testing for STDs among sexually active HIV-infected adults receiving medical care in the United States significantly increased from 2009 to 2013. While this increase indicates progress, testing for all STDs remains far below recommended guidelines. Improvements in testing were seen across sexual behavior and race/ethnicity groups; testing was highest among MSM and among Hispanics. Our findings suggest that enhanced efforts may be warranted to screen all HIV-infected sexually active adults for CT, GC, and syphilis.

Poster Abstracts

428

CROI 2016