ADHERENCE CONFERENCE 2017 ABSTRACTS

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Rupa Patel1, K Rivet Amico2, Laura Harrison1, Linden Lalley-Chareczko3, Rachel Presti1, Kenneth Mayer4, Pablo Tebas5, Ganesh Moorthy6, Athena Zupp6, Helen Koenig (presenting)3 1 2 3 4 5 6

Washington University in St. Louis, MO, USA University of Michigan School of Public Health, Ann Arbor, MI, USA Philadelphia FIGHT, Philadelphia, PA, USA Fenway Health/Harvard Medical School, Boston, MA, USA Hospital of the University of Pennsylvania, Philadelphia, PA, USA Children’s Hospital of Philadelphia, PA, USA

Background: Oral daily pre-exposure prophylaxis (PrEP) prevents HIV acquisition and can be monitored through dried blood spot (DBS) drug concentration analysis. Clinical settings are often without access to DBS monitoring; however tenofovir (TFV) levels in urine are gaining evidence. To contribute to this evidence-base, we evaluated the association between urine TFV concentrations with medication possession ratio (MPR) and patient self-report (SR). Methods: We examined urine TFV levels, 7-day SR, and 3-month MPR, using pharmacy refill data, in 84 patients who were enrolled in the Washington University in St. Louis PrEP cohort from May-August 2016. Urine TFV concentrations of >1,000ng/mL were categorized as having been dosed in the past 48-hours. Pharmacy MPR ≥0.57 was categorized as dosing ≥4 times/week on average over the past 12 weeks. SR of having taken ≥4 doses in the past week was used. Results: Patient median age was 27 years (IQR 24-33); 92% were male, 33% Black, 90% MSM; and median time to urine TFV testing was 10 months (IQR 4-13). Majority (88%) had urine TFV >1,000ng/mL, 73 (94%) met the MPR cut-off and 74 (88%) met the SR cut-off. Of those with urine TFV >1,000ng/mL, cut-off values for MPR were reached by 68 (99%) and 71 (96%) for SR. For those below the cut-off for urine TFV, 4 (44%) also were below the cut-off for MPR, and 7 (70%) for SR. Misclassification was uncommon (20% of those below the MPR cut-off and 7% above it were misclassified by urine; whereas 30% of those below the SR cut-off and 4% above it).

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Associations between Urine Tenofovir Levels, Pharmacy Measures, and Self-Report for HIV Pre-Exposure Prophylaxis Adherence Monitoring

Conclusions: There is a growing need to accurately and easily monitor PrEP adherence in the clinic setting. Our results suggest that urine TFV concentrations mapped well onto other measures. Combined with evidence supporting urine TFV validity, this approach may offer additional approaches for PrEP adherence monitoring.

12th International Conference on HIV Treatment and Prevention Adherence

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Adherence and Risk for Incident Sexually Transmitted Infection among Methamphetamine Using Men who have Sex with Men on HIV Pre-Exposure Prophylaxis

Martin Hoenigl (presenting)1, David Moore1, Sonia Jain1, Xiaoying Sun1, Peter Anderson2, Michael Dube3, Deborah Collins4, Katya Corado5, Sheldon Morris1 1 2 3 4 5

University of California, San Diego, CA, USA University of Colorado, Denver, CO, USA University of Southern California, Los Angeles, CA, USA Long Beach Department of Health and Human Services, Long Beach, CA, USA Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA

Background: Methamphetamine (METH) use is related to increased sexual risk behavior among men who have sex with men (MSM). METH-using MSM may therefore be good candidates for HIV pre-exposure prophylaxis (PrEP). The effectiveness of PrEP, however, strongly depends on maintaining adherence, and METH users have been shown to have medication adherence difficulties in the context of living with HIV. As such, we hypothesized that among MSM enrolled in a randomized controlled PrEP trial, METH users would have lower levels of PrEP adherence. Methods: We examined baseline and ongoing METH use over 48 weeks for association with dried blood spot (DBS) intracellular tenofovir-diphosphate (TFV-DP) levels in 394 study participants (391 MSM and 3 transgender women). METH use was assessed (for the past 3 months) at all study visits using a SCID screening questionnaire for “No use,” “Some use” (1-4 times), and “Heavy use” (≥5 times). The adherence composite outcomes were defined as displayed in the table. We also assessed whether baseline METH use impacted study completion and incident sexually transmitted infections (STIs) while on study. Results: METH use did not significantly impact PrEP adherence (Table). “Some” METH use at baseline was associated a.) with significantly lower likelihood of study completion (OR0.48, p=0.048; “Some” METH 70% study completion versus each 83% in “No” or “Heavy” METH use), and b.) significantly higher likelihood of developing incident STI while on study (OR 2.44, p=0.011; 58% incident STI with “Some” METH use versus 36% and 39% incident STI in “No” and “Heavy” METH use, respectively) Conclusions: Self-reported METH uses did not relate to lower PrEP adherence. Interestingly, “Some” METH use, which may relate to binge use or potentially use only during sexual encouters, was associated with lower likelihood of study completion and higher likelihood of incident STI when compared to “Heavy” or “No” use.

Primary and Secondary Adherence Composite among Categories of METH Use

METH use

Primary Adherence Composite (i.e. DBS TFV-DP levels > 719 fmol/punch at the week 12 and 48 visits; cutoff is associated with taking ≥ 4 doses of TDF in the past week); YES (%)

Baseline METH use No (n=331)

0.53 96/331 (29%)

Some (n=40)

28/40 (70%)

9/40 (23%)

Heavy (n=23)

14/23 (61%)

10/23 (43%)

No (n=342)

p-value 0.22

23/3317 (72%)

Ongoing METH use (i.e. METH use reported at >50% of visits)

2

p-value

Secondary Adherence composite (i.e. DBS TFV-DP levels > 1246 fmol/punch at the week 12 and 48 visits; cutoff is associated with taking 7 doses of TDF in past week); YES (%)

0.66

0.10

240/342 (70%)

97/342 (28%)

Some (n=32)

25/32 (78%)

8/32 (25%)

Heavy (n=20)

14/20 (70%)

10/20 (50%)

12th International Conference on HIV Treatment and Prevention Adherence

Cherie Rooks-Peck (presenting)1, Adebukola Adegbite2, Megan Wichser2, Rebecca Ramshaw1, Mary Mullins1, Darrel Higa1, Theresa Sipe1 1 2

Centers for Disease Control and Prevention, Atlanta, GA, USA ICF International, Washington, DC, USA

Background: Mental health disorders are common among persons living with HIV and may be linked to poor retention in HIV primary care. The purpose of this review was to synthesize the quantitative evidence examining the association between mental health diagnosis/symptoms and retention in HIV care, as well as determine whether mental health service utilization is associated with improved retention in HIV care. Methods: A comprehensive search of the CDC’s HIV/AIDS Prevention Research Synthesis Database (e.g. MEDLINE, EMBASE, PsycINFO) and manual searches were conducted to identify relevant studies published between January 2002 and March 2016. Studies were included in this review if they were conducted in the US and assessed the association between mental health diagnosis/symptoms or mental health service utilization and retention in HIV care. Effect estimates from individual studies were pooled using random-effects meta-analysis. A moderator analysis was conducted to identify potential sources of heterogeneity. Study quality was assessed using the NHLBI Quality assessment tool for observational studies. Results: Forty studies, including 55,800 participants, met the inclusion criteria: 35 examined mental health diagnosis/symptoms, and 12 examined mental health service utilization. Overall, there was a small, significant association between having a mental health diagnosis/symptoms and lower rates of retention in HIV primary care (OR=0.95, 95% CI=0.91, 0.99). Health insurance status (β=0.004, Z=3.25, p=0.001) significantly modified the association between mental health diagnosis/ symptoms and retention in HIV care. In addition, mental health service utilization was significantly associated with higher rates of retention in HIV care (OR=1.95, 95% CI=1.50, 2.52). Conclusions: Results suggest that mental health diagnosis/symptoms are a barrier to retention in HIV care and emphasize the importance of providing mental health treatment for HIV patients who need it.

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Role of HIV Testing Site Type in Timely Linkage to HIV Care, Florida 2014–2015 Mary Jo Trepka (presenting)1, Diana Sheehan1, Kristopher Fennie1, Daniel Mauck1, Rehab Auf1, Lorene Maddox2, Spencer Lieb3 1 2 3

Florida International University, Miami, FL, USA Florida Department of Health, Tallahassee, FL, USA The AIDS Institute, Washington, DC, USA

Background: Delayed linkage to HIV care and subsequent treatment impacts disease progression and survival. The objective of this study was to determine the role of HIV testing site type in delayed linkage to HIV care among people aged ≥13 years without AIDS at time of HIV diagnosis. Methods: De-identified data for people diagnosed with HIV during 2014– 2015 were obtained from the Florida Enhanced HIV/AIDS Surveillance System. Delayed linkage to care was defined as no evidence of a physician visit, receipt of an antiretroviral prescription, or laboratory test (viral load or cluster of differentiation 4 [CD4] count) within 3 months of HIV diagnosis. Multilevel logistic regression was performed to calculate adjusted odds ratios (AOR) for non-linkage to care by HIV testing site type adjusting for birth sex, race/ethnicity, age at diagnosis, United States nativity, HIV transmission category, and the neighborhood variables of socioeconomic status, percentage black, and rural/urban status.

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Relationship between Mental Health and Retention in HIV Primary Care: A Systematic Review and Meta-Analysis

Results: Of the 6,900 people diagnosed with HIV, 1,594 (23.1%) had delayed linkage to care. This percentage ranged from 14.1% among 1,308 people tested at HIV/infectious disease outpatient clinics to 59.9% among 399 tested at blood banks/plasma centers. Relative to being tested at an HIV/infectious disease outpatient clinic, the AOR for delayed linkage to care of testing at blood banks/plasma centers was 6.38 (95% confidence interval [CI] 4.89-8.33), followed by HIV case management site (3.23; 95% CI 2.47-4.22), HIV counseling and testing site (2.25; 95% CI 1.83-2.77) and tuberculosis/sexually transmitted disease/family planning site (2.29; 95% CI 1.61-3.25). Conclusions: Despite controlling for sociodemographic and other presumed relevant factors, testing at blood banks/plasma centers, HIV case management, HIV counseling and testing or tuberculosis/sexually transmitted disease/family planning sites was associated with delayed linkage to care. Procedures at these sites need to be systematically evaluated to identify ways to improve linkage.

12th International Conference on HIV Treatment and Prevention Adherence

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The Impact of Internalized HIV Stigma on Retention in HIV Care

Drenna Waldrop-Valverde (presenting)1, Eduardo Valverde2, Tian Dai1, Ying Guo1 1 2

Emory University, Atlanta, GA, USA Centers for Disease Control and Prevention, Atlanta, GA, USA

Diana Sheehan1, Mary Jo Trepka1, Daniel Mauck1, Kristopher Fennie (presenting)1, Lorene Maddox2 1 2

Background: Internalized HIV stigma may be an important construct related to poor retention in HIV care given evidence for its negative role in several areas of the HIV care continuum. Stigma has been shown to reduce access to HIV care and medication adherence. Little is known however, about the association of internalized HIV stigma with retention in care. This study therefore, examined the relationship of internalized HIV stigma to retention in HIV care and also tested for protective, moderating effects. Methods: Data from 188 men and women living with HIV/AIDS in Miami, FL, USA were collected via medical chart abstraction and interview. The number of missed visits over a 14-month time period was used as the measure of retention in HIV care. Demographic characteristics, HIV risk behaviors, HIV care related factors (ex. level of engagement with provider, time to travel to the clinic), as well as psychosocial constructs (ex. social support, depression) were administered as well as a validated internalized HIV stigma scale to explore the association of internalized HIV stigma with missed visits. Variables significant with missed visits at p 6 and >12 months without any registered laboratory results. Logistic regression models including inverse-probability of treatment weights (IPTW) were used to adjust for differences in the patient populations at the two centers. Results: The IG included 451 patients, CG 311. In the IG, 180 (40%) took part in the intervention for a median of 109 weeks (IQR: 39-189). LTFU was significantly less likely in the IG compared to the CG (56.9% vs. 74.6% and 12.5% vs. 22.6% at 6 and 12 months, respectively, both p