CROI 2016 Abstract eBook

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Poster Abstracts

1037 HIV Viral Suppression Among Adults DiagnosedWith Depression in the United States Runa Gokhale ; Heather Bradley; Shikha Garg; Roy L. Shouse CDC, Atlanta, GA, USA

Background: Reducing new HIV infections and improving health outcomes for people living with HIV are 2020 National HIV/AIDS Strategy (NHAS) goals achievable through viral suppression induced by antiretroviral therapy (ART). HIV patients’ depression may play a role in providers’ decisions to initiate ART and in HIV patients’ ability to adhere to ART and achieve viral suppression. Methods: Data were collected during 06/2009–05/2013 from 18,095 Medical Monitoring Project (MMP) respondents. MMP is a surveillance system that produces nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States. Using medical record data, we estimated the percentage of HIV-infected persons with diagnosed depression. We examined associations between diagnosed depression and sociodemographic and clinical characteristics, including ART prescription during the past year, ART adherence, and sustained viral suppression (all viral load measurements <200 copies/mL in past year). Multivariate logistic regression was used to estimate adjusted prevalence ratios for viral suppression among patients prescribed ART, with and without diagnosed depression. Results: Overall, 25% (95% Confidence Interval [CI]: 23–28) of HIV-infected adults in care were diagnosed with depression. Of all HIV patients, 91% (CI: 91–92) were prescribed ART; among those prescribed ART, 69% (CI: 67–70) had sustained viral suppression. Compared to those without depression, patients with depression were more likely to be prescribed ART and, among those prescribed ART, less likely to be adherent and achieve viral suppression (Table 1). After adjustment for ART adherence and race, those with depression were less likely than those without depression to achieve viral suppression (adjusted Prevalence Ratio [PR]=0.93, [CI: 0.91–0.96]). Adjustment for other factors associated with both depression and viral suppression, such as age and injection drug use, did not change this association. Conclusions: We did not find evidence that providers were less likely to prescribe ART to patients with depression. While ART adherence was lower among patients with depression, adherence alone did not account for the lower likelihood of viral suppression among patients with depression. Support of ART adherence in persons with depression and further exploration of reasons for lower viral suppression in these individuals will be instrumental in achieving NHAS 2020 goals.

1038 Clinician and Patient Attitudes Toward Financial Incentives for HIV Care (HPTN 065) Jennifer H. Farrior 1 ; Allison Zerbe 2 ; Ann Kurth 3 ; Brett Hanscom 4 ; Laura McKinstry 4 ; Barry Zingman 5 ; Fred Gordin 6 ; Deborah Donnell 4 ; Bernard Branson 7 ;Wafaa M. El-Sadr 2 1 FHI 360, Durham, NC, USA; 2 ICAP at Columbia Univ, New York, NY, USA; 3 New York Univ, New York, NY, USA; 4 SCHARP, Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 5 Montefiore Med Cntr, Bronx, NY, USA; 6 VA Med Cntr, Washington, DC, USA; 7 Scientific Affairs, Atlanta, GA, USA Background: HPTN 065 examined the feasibility of an enhanced test, link-to-care, plus treat approach for HIV prevention in Bronx, NY and Washington, DC. Financial incentives (FIs) were assessed for effectiveness of enhancing linkage-to-care of HIV-infected persons and viral suppression for patients on antiretroviral therapy (ART). We surveyed ART- prescribing clinicians and HIV-infected patients at care sites in the two jurisdictions to assess attitudes about the use of FIs to enhance these HIV care outcomes. Methods: All ART-prescribing clinicians at 37 participating care sites were asked by email to complete an anonymous web-based survey, administered 5/2013-12/2013, with a nominal incentive upon survey completion. During an ACASI computer-based survey, patients enrolled in HIV care at 10 clinics (4 in Bronx, 6 in DC; 6 randomized to FI, 4 to standard of care) participating in HPTN 065 were asked similar questions from 12/2013-12/2014, to those asked of clinicians. Both surveys were conducted before FI effectiveness data were analyzed. Results: We analyzed data from 141 clinicians (response rate of 53%) and from 725 patients, 479 (66%) from FI sites. Clinicians were female (57%), white (62%), 47 years (median) and physicians (67%) who reported caring for a median of 105 (interquartile range (IQR) 50-240) HIV-infected patients. Patient respondents were mostly male (69%); 62% African- American; median age 52 years (18-77); 42%were men who have sex with men, and 95%were on ART. Sixty nine percent of clinicians and 78% of patients agreed or strongly agreed that it is a “good idea” to provide “rewards” to get patients to link to care, and 80% of clinicians and 72% of patients agreed or strongly agreed that monetary “rewards” will encourage linkage more quickly. Both clinicians and patients suggested a median of $50 (clinician IQR $25-$75; patient IQR $25-$100) as a worthwhile FI for linkage. Seventy eight percent of clinicians and 69% of patients agreed or strongly agreed that “rewards” will help patients maintain ART adherence. Clinicians suggested a median of $40 (IQR $20-$50) and patients $50 (IQR $25-$100) as a worthwhile FI for an undetectable viral load. Of note, the suggested FIs were less than FI amounts used in the HPTN study. Conclusions: The majority of both clinicians and patients indicated that the use of FIs would likely improve linkage-to-care and ART adherence. Clinicians and patients suggested similar dollar amounts for incentives. 1039 A Commitment Contract for Virologic Suppression in Poorly Adherent HIV+ Individuals Marcela Alsan 1 ; John Beshears 2 ; Minh Nguyen 3 ; James Choi 2 ;Wendy Armstrong 4 ; Bridget Madrian 2 ; Carlos del Rio 4 ; David Laibson 2 ;Vincent C. Marconi 4 1 Stanford Univ, Stanford, CA, USA; 2 Harvard Univ, Boston, MA, USA; 3 Emory Univ, Atlanta, GA, USA; 4 Emory Univ Sch of Med, Atlanta, GA, USA Background: Effective interventions to improve adherence have remained an elusive goal. The goal of this clinical trial was to determine whether a commitment contract informed by behavioral economics principles would lead to persistent virologic suppression (VS) among HIV+ patients with poor antiretroviral therapy (ART) adherence. Methods: This study was a randomized controlled trial enrolling patients failing ART, combined with a non-randomized passive control group in a publicly funded HIV clinic serving inner-city Atlanta, GA, USA. Patients had to be >18 years and have evidence of virologic failure (plasma viral load (pVL) >200 copies/mL) while receiving ART. 19 individuals were randomized to a commitment contract arm (behavioral economics, BE, arm), and 21 individuals were randomized to a conditional cash transfer arm (active control, AC, arm). In addition, 92 individuals served as passive controls (PC arm). The PC arm received routine care and no financial incentives. The AC arm received conditional cash transfers of $30 if they attended their regularly scheduled provider visits. The BE armwas offered a commitment contract developed using behavioral economics insights. BE participants had

Poster Abstracts

444

CROI 2016