CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

a choice either to receive $30 conditional on attending their provider visit or to receive $30 conditional on both attending their provider visit and surpassing an ART adherence threshold. 6 of the 19 individuals in the BE arm chose the conditional contract. The primary endpoints were VS (pVL<=200 copies/mL) at the end of the incentive period and at an unanticipated post-incentive study visit that occurred approximately 6 months after incentives ended. Results: Overall median age was 41.49 years, 77.5%were male, and 87.5%were Black. Final results showed the odds of VS at the end of the incentive period were higher in the BE arm compared to the AC arm and compared to the PC arm [adjusted odds ratio (AOR) 1.336, 95%CI 0.325 to 5.498, p=0.688 and AOR 5.223, 95%CI 1.630 to 16.776, p=0.005, respectively]. Importantly, the differences were larger at the unanticipated post-incentive study visit [AOR 3.088, 95%CI 0.764 to 12.484, p=0.114 and AOR 5.791, 95%CI 2.031 to 16.508, p=0.001, respectively]. Conclusions: This research demonstrated the feasibility of using commitment contracts in routine HIV care to persistently improve ART adherence and VS. Financial rewards coupled with individual choice might sustain behaviors that would otherwise dissipate when incentives are removed. 1040 Quantifying Viral Load Distribution in a Clinic Population Using the Lorenz Curve Katerina Christopoulos ;Wendy Hartogensis; DavidV. Glidden; Christopher Pilcher; Monica Gandhi; Elvin H. Geng Univ of California San Francisco, San Francisco, CA, USA Background: Quantifying the extent to which viremia is concentrated within groups or equally distributed in a population can inform engagement efforts. We apply the Lorenz curve, which plots cumulative population viral burden against cumulative patient population, to characterize the distribution of viremia in a safety-net HIV clinic. Methods: We extracted demographic and clinical data from the electronic medical record of patients who had a primary care visit to a safety-net HIV clinic in San Francisco in 2012. We excluded patients not in care for at least 6 months at the first 2012 visit. We calculated viral copy-months for 2012 using a published trapezoidal method in which the months in an interval were multiplied by the average of two measurements defining the interval. Lorenz curves were generated in Stata 13 using the population percentiles for the cumulative distribution of total viral load copy-months in 2012. We then calculated unadjusted and adjusted odds ratios for being in the top 10 th percentile of viral load copy- months. The main multivariate model included age, gender, race/ethnicity, HIV risk factor, perfect retention in care (no missed visits and no gap in care >180 days), and ART initiation.

Results: In 2012, there were 1,917 established patients, of whom 40 had no viral load results. Of the remaining 1,877 patients, the median age was 47 (range 18,78), most were men (87%), and just over half were men who have sex with men (53%). Whites comprised 47%; blacks 22% and Latinos 24%. ART initiation had occurred in 97% of patients and 28% had perfect retention. Median CD4 cell count was 499 (IQR 330-694) and median viral load was 20 (range 20 – 2.6 x 10 6 ). The total number of viral copy-months was 2.33 x 10 8 , and 10% of patients held 94% of the virus. In a multivariate model controlling for the expected protective effects of ART initiation (OR 0.49, p=0.04) and perfect retention (OR 0.29, p<0.001), factors that increased the odds of being in the top 10 th percentile of viral load copy-months were age 18-29 years and 30-49 years vs. age 50 and above (OR=6.3, p<0.0001 and OR=2.6, p<0.0001), black vs. all other races/ethnicities (OR 1.7, p=0.01), or history of IDU vs. MSM or heterosexual (OR 1.5, p=0.04).< Conclusions: In a public HIV clinic, younger age, black race, and history of IDU were associated with a greater share of viral copy-months. The cumulative distribution function of the Lorenz curve offers a novel method to identify populations that could benefit from additional resources.

1041 Recent Increases in Virologic Suppression Among HIV-Positive MSM in Vancouver, Canada David M. Moore 1 ; Zishan Cui 2 ; Nathan J. Lachowsky 1 ; Henry F. Raymond 3 ; Eric A. Roth 4 ; Ashleigh Rich 2 ; Paul Sereda 2 ; David Hall 5 ; Julio Montaner 2 ;Willi McFarland 3 ; Robert S. Hogg 6 1 Univ of British Columbia, Vancouver, BC, Canada; 2 BC Cntr for Excellence in HIV/AIDS, Vancouver, BC, Canada; 3 Univ of California San Francisco, San Francisco, CA, USA; 4 Univ of Victoria, Victoria, BC, Canada; 5 Vancouver Coastal Hlth, Vancouver, BC, Canada; 6 Simon Fraser Univ, Burnaby, BC, Canada Background: MSM account for 60% of new HIV diagnoses in British Columbia (BC). We examined trends in virologic suppression and the determinants of significant viremia among HIV-positive participants in a cohort of MSM in Vancouver. Methods: Male participants aged ≥16 years and reporting sex with a man in the past six months were recruited between February 2012 and January 2015 using respondent driven sampling. Participants completed a self-administered computer-based survey every six months and a nurse administered rapid HIV test. Data included sexual and drug-use behaviour, and mental health using the Hospital Anxiety and Depression Scale (HADS). Attitudes towards HIV treatment were measured using the HAART Optimism Scale. We

Poster Abstracts

linked study participant information to VL and HIV treatment data in the BC HIV Drug Treatment Program to determine the proportion at each care cascade step during each six-month period from July 2012 to June 2015. We used generalized estimating equation modelling to identify factors associated with VL ≥200 copies/mL in each period. Results: We recruited 774 participants, of whom 134 (17.3%) were seeds. Median age was 33 years (IQR: 26 -47). Of these, 210 participants were HIV positive prior to July 2012; an additional 19 seroconverted by the final time period. We observed a significant trend towards increased levels of virologic suppression (VL<200 copies/mL) from 79% of HIV positive participants in the first six month period to 85% in the final period (p<0.001 for trend). An average of 14% of HIV positive participants were receiving ART, but were not VL suppressed, with another 1% newly diagnosed, and 7% either moved, died, lost to follow-up, not on ART or with no VL result in each six month period. Unsuppressed VL was independently associated with ecstasy use (adjusted OR [AOR]=2.00; 95% CI 1.22-3.26), crystal methamphetamine use (AOR=1.58; 95% CI 1.01-2.45), and mild symptoms of depression (HADS-depression subscale score >8) (AOR=1.61; 95% CI 1.00- 2.58). Older participants (AOR=0.97 per year; 95% CI 0.94-1.00) and those with greater HAART Optimism scores (AOR=0.91 per unit; 95% CI 0.87-0.95) were less likely to have episodes of unsuppressed VL.

Conclusions: Our results demonstrate a significant trend towards increased VL suppression among HIV infected MSM, reaching 85% in early 2015. Most individuals with unsuppressed VL were diagnosed and receiving ART. Improved clinical management of depression and reducing drug-use should be promoted as a means to optimize virological con

445

CROI 2016