MOAX0101LB
Share
 
Title
HPTN 078: primary results of a randomized study to engage men who have sex with men (MSM) living with HIV who are virally unsuppressed in the US
Presenter
Chris Beyrer
Authors
R.H. Remien1,2, T. Gamble3, J.E. Farley4, Z. Wang5, C. del Rio6, D.S. Batey7, K.H. Mayer8,9, C. Foster10, J. Glorioso11, W. Graves8, K.J. King12, S. Shurbaji13, I.C. Balán1,2, L. McKinstry5, V. Cummings14, S.H. Eshleman14, M. Stirratt15, A. Adeyeye16, J.P. Hughes5,17, C. Beyrer18, for the HPTN 078 Study Team
Institutions
1NY State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, United States, 2Columbia University, New York, United States, 3FHI 360, HPTN Leadership and Operations Center, Durham, United States, 4Johns Hopkins School of Nursing, The REACH Initiative, Baltimore, United States, 5Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 6Emory University School of Medicine, Atlanta, United States, 7University of Alabama at Birmingham, Department of Social Work, Birmingham, United States, 8The Fenway Institute, Boston, United States, 9Harvard Medical School, Boston, United States, 10Emory University, Rollins School of Public Health, Emory Center for AIDS Research, Atlanta, United States, 11Johns Hopkins University, The REACH Initiative, School of Nursing, Baltimore, United States, 12University of Alabama at Birmingham, Birmingham, United States, 13Washington State Department of Health, Seattle, United States, 14Johns Hopkins School of Medicine, Department of Pathology, Baltimore, United States, 15National Institute of Mental Health, Division of AIDS Research, Bethesda, United States, 16National Institutes of Health, Prevention Science Program, Division of AIDS, NIAID, Bethesda, United States, 17University of Washington, Department of Biostatistics, Seattle, United States, 18Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States

Background: HIV infection in the United States (US) is increasingly concentrated among men who have sex with men (MSM), particularly MSM of color. To achieve the goals of “Ending the HIV Epidemic: A Plan for America,” everyone living with HIV, including MSM, must be identified, linked to care and supported so that they achieve and maintain viral suppression for their own health and to prevent onward HIV transmission.
Methods: MSM who were living with HIV and virally unsuppressed were recruited in four US cities (Birmingham, AL, Atlanta, GA, Baltimore, MD, and Boston, MA) and were randomized to either an enhanced case management (CM) intervention or standard of care (SOC). The CM intervention had three components: access to a CM and referral services, counseling using motivational interviewing techniques, and automated adherence and motivational messaging. Critically, participants determined intervention intensity by choosing frequency and content of CM interactions and automated messaging. Viral suppression (< 200 copies/mL) across arms was compared at Month 12 using logistic regression. Those who did not provide a 12-month sample (aside from deaths) were treated as unsuppressed.
Results: 1305 MSM were screened; 154 were living with HIV and unsuppressed; 144 were enrolled. 91% were retained at Month 12. The enrolled cohort was 84% Black, 7% Latinx and the average age was 39. Most were educated (90%≥ high school diploma), but not employed (67%), with an income below $20,000 (64%). 81% had health insurance. The majority (86%) were ART experienced by self‑report. At baseline, the median viral load was 19,459 copies/mL, and at Month 12, 48% were virally suppressed, with no difference between the CM and SOC arms (OR = 0.615 [p = 0.1526, 95% CI = 0.315, 1.197]).
Conclusions: HPTN 078 demonstrated that MSM living with HIV, but out of care, are willing to re-engage when reached, with nearly half achieving and maintaining viral suppression at 12 months. The CM intervention did not, however, enhance viral suppression; half of the men, overall, were not virally suppressed at 12 months. Greater investment for more intensive interventions is likely needed to address the multiple societal and behavioral challenges among disenfranchised MSM in the US.