CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

1007 Incident Syphilis, Gonorrhea, and Chlamydia Infection Among a Cohort of MSM Nathan J. Lachowsky 1 ; Kristine Stephenson 2 ; Zishan Cui 3 ; Susan Shurgold 3 ; Ashleigh Rich 3 ;Troy Grennan 4 ; JasonWong 4 ; Eric A. Roth 5 ; Robert S. Hogg 6 ; David M. Moore 1 ; for the Momentum Health Study 1 Univ of British Columbia, Vancouver, BC, Canada; 2 Vancouver Coastal Hlth, Vancouver, BC, Canada; 3 BC Cntr for Excellence in HIV/AIDS, Vancouver, BC, Canada; 4 BC Cntr for Disease Control, Vancouver, BC, Canada; 5 Univ of Victoria, Victoria, BC, Canada; 6 Simon Fraser Univ, Burnaby, BC, Canada Background: Implementing HIV treatment as prevention (TasP) may potentially influence risk behavior among key groups such as men who have sex with men (MSM). We measured the incidence and determinants of chlamydia (CT), gonorrhea (GC) and syphilis infection within a prospective cohort of MSM in Vancouver, Canada where TasP has been policy since 2010. Methods: Eligible participants were recruited from 2012-2015, aged ≥16 years of age and reported recent sex with another man. Participants completed study visits every 6 months, which included a computer-assisted self-interview on demographics, sexual behavior and substance-use, and a nurse-administered clinical questionnaire. A rapid HIV test was administered and venous blood sample taken for serology for syphilis. Urine NAAT tests and/or pharyngeal, rectal or urethral swabs for chlamydia and gonorrhea were offered as an optional service. We used generalized estimating equations to identify factors associated with any incident STI infection, either diagnosed through a study visit or reported between study visits by the participant. A multivariable model was built using backward selection, Type III p-values (p<0.05), and QIC minimization. Results: Of 575 MSM (29.4% HIV-positive and 70.6% HIV-negative at enrollment) with follow-up, 134 (23.3%) had an incident STI. Prior STI diagnosis was strongly associated with an incident STI (relative risk [RR]: 25.07, 95% CI: 19.03-33.03, p<0.001). During a median of 1.98 person-years of follow-up 77 chlamydia, 69 gonorrhea, and 37 syphilis cases were reported/diagnosed, for an incidence rate of 7.14 per 100 person-years (PYRs) for CT, 6.40 per 100 PYRs for CT and 3.43 per 100 PYRs for syphilis. Any STI incidence did not differ by HIV status (p=0.85). Factors independently associated with incident STI were younger age (adjusted RR [aRR]=0.98 per year older; 95% CI: 0.96-0.99), group sex event attendance (aRR=1.49, 95% CI: 1.08-2.07), anal sex with casual partners (aRR=2.78, 95% CI: 1.87-4.14), poppers use (aRR=1.61, 95% CI: 1.16-2.22), and injection drug use behavior (aRR=1.89, 95% CI: 1.20-2.97). Further, MSM who reported only having condomless anal sex with HIV-positive men on treatment or with low viral loads were more likely to have an incident STI infection (aRR=1.40, 95% CI: 0.98-1.98). Conclusions: STI incidence and re-infection was common. This may be a partial concomitant effect of TasP scale-up, and may reduce some of its benefits without an additional focus on primary prevention of other STIs. 1008 The Importance of Linkage and Engagement of Care in Post HIV STI Acquisition Kerri Dorsey 1 ; Amanda Castel 1 ; Adam Allston 2 1 George Washington Univ Milken Inst Sch of PH, Washington, DC, USA; 2 District of Columbia Dept of Hlth, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA Background: It is well documented that HIV/sexually transmitted infections (STI) coinfections increase the risk of transmitting HIV. STI infections post HIV diagnosis can also serve as a proxy of ongoing high risk sexual behaviors. This analysis sought to quantify the prevalence of and timing of HIV/STI infections and assess the association of linkage and engagement in care on STI acquisition post HIV diagnosis. Methods: HIV diagnoses reported to the District of Columbia Department of Health (DOH) surveillance system between 2007 and 2013 were matched to new chlamydia, gonorrhea and primary/secondary syphilis infections reported to the DOH during the same time period. Coinfection was defined as an STI that occurred 3 months after HIV diagnosis; monoinfected HIV cases had not had an STI reported to the DOH. Demographics, linkage to care within 3 months, engagement in care (>2 visits per year, 30 days apart) and the interval between HIV infection and first STI were calculated. Descriptive analysis of the covariates and Cox regression were used to describe the risk of STI acquisition after HIV infection. Results: Among the 6,719 HIV cases identified between 2007 and 2013; 411 (6%) individuals had new STI coinfections after their HIV diagnosis and 5,236 were monoinfected with HIV. Median time to first STI infection was 2 years after HIV diagnosis. Of the 411 coinfected persons, 88.3%were male, 66.9%were Black, mean age at HIV diagnosis was 31 yrs., and 63.5%were HIV infected through MSM. Individuals had a mean of 1.5 STIs (range, 1-11) after HIV diagnosis and the most common coinfection was Chlamydia (42%). The adjusted regression model found that individuals ages 15-19 at HIV diagnosis had more than 7 times the risk of STI acquisition (aOR 7.2: 95%CI 4.8-10.9). Persons never linked to care had > 6 times the risk of an STI coinfection (aOR 6.6: 95%CI4.9-8.9), with a median time to STI acquisition of 2 years. Those not engaged in care had >2 times the risk of contracting an STI (aOR 2.6: 95%CI1.7-4.0), with a median time to STI acquisition of 1.35 years. Conclusions: Persons never linked to care, those poorly engaged in HIV care, and younger persons had a higher risk for STI acquisition after HIV diagnosis, indicative of ongoing high-risk sexual behaviors. These data further support the importance of linkage and engagement in care among HIV-infected persons and emphasize the need for continued education regarding safe sex and secondary prevention. Background: In 2012, over 1,200 HIV-positive patients accessed services at New York City’s (NYC) nine sexually transmitted disease (STD) clinics. Counseling, linkage, and social services are offered by medical providers and public health advisors at these facilities to help patients in need of HIV care services engage (or re-engage) in HIV primary care. Methods: We matched data from the STD clinic electronic medical record and the NYC HIV/AIDS Surveillance Registry for HIV-positive persons who sought services at NYC STD clinics in 2012. We identified patients who were out of HIV care (<2 viral load [VL] or CD4 results) in the 365 days preceding their STD clinic visit and looked for subsequent evidence of HIV care ( ≥1 VL or CD4 result) within 3 months after the STD clinic visit. We compared patient characteristics (demographics, receipt of an HIV test on day of clinic visit, sexual risk behaviors, and STD diagnoses) among those with and without evidence of HIV care within 3 months after the STD clinic visit. Results: Among 378 out-of-care patients, 164 (43%) had evidence of HIV care during the 3 months after the STD clinic visit. Within 12 months, 99% (162/164) of these patients had a VL recorded (with 69% virally suppressed); of 214 patients who did not have evidence of HIV care during the 3 months after the STD clinic visit, 42% (90/214) had a VL within 12 months and 50%were virally suppressed (p<0.01 for VL report). Evidence of HIV care was more common among those who received an HIV test during their STD clinic visit (largely persons originally reported to the HIV Registry by a non-STD clinic provider in the year prior) than among those who did not receive an HIV test (66% vs. 40%, p<0.01). Evidence of HIV care following the STD clinic visit was also more common among Hispanic than non-Hispanic patients (51% vs. 41%, p=0.08) and women vs. men (67% vs 42%, p=0.02). Lack of evidence of HIV care did not differ significantly among persons reporting ≥5 sexual partners in 3 months prior to visit compared to those with <5 partners (69% vs. 57%, p=0.10), but was more common among patients diagnosed with gonorrhea on the day of the clinic visit than those not diagnosed (69% vs. 54%, p=0.03). Conclusions: STD clinic visits provide an opportunity to link or re-link patients who may be unengaged in HIV care. Targeting patients less likely to access HIV care in the months 1009 Evidence of HIV Care Following STD Clinic Visits by Out-of-Care HIV-Positive Persons OlgaTymejczyk 1 ; Kelly Jamison 2 ; Preeti Pathela 2 ; Sarah L. Braunstein 3 ; Julia Schillinger 2 ; Denis Nash 1 1 Sch of PH, City Univ of New York, New York, NY, USA; 2 New York City DHMH, Long Island City, NY, USA; 3 New York City DHMH, Queens, NY, USA

Poster Abstracts

after their visit may help reduce disparities in subsequent VL suppression and onward transmission. 1010 Successful Implementation of Extended ART Initiation Criteria in Rural South Africa

Sarah Jane Steele 1 ; Amir Shroufi 2 ; Guillermo Martínez Pérez 3 ; Carol Metcalf 4 ;Tsion Solom 3 ; Gemma Arellano 3 ; Aline Aurore Niyibizi 5 ;Tom Ellman 4 ; GillesVan Cutsem 2 1 Médecins Sans Frontières, South Africa & Lesotho, Cape Town, South Africa; 2 Médecins Sans Frontières, Cape Town, South Africa; 3 Médecins Sans Frontières, South Africa & Lesotho, Eshowe, South Africa; 4 Médecins Sans Frontières, Southern Africa Med Unit, Cape Town, South Africa; 5 Médecins Sans Frontières, Roma, Lesotho Background: There is concern that earlier initiation of antiretroviral treatment (ART) in lower resource settings may compromise access to care for patients with lower CD4 counts, and that patients with higher CD4 counts may have lower retention in care (RIC). In July 2014, we extended ART initiation criteria from CD4 cell counts of ≤350 to ≤500 copies/ µl in

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CROI 2016