1275. Leveraging Big Data to Understand and Improve Continuity of Care Among HIV-Positive Individuals with Criminal Charges in North Carolina

Abstract

Abstract Background Little is known about the impact of having criminal charges on HIV outcomes. We sought to understand the relationship between having criminal charges and viral suppression among people living with HIV (PLWH) in North Carolina (NC). Methods We linked statewide NC criminal court records to the state’s confidential HIV records (both databases: 2017-2020) to assess HIV viral suppression (viral load [VL] < 200 copies/ml) in the 12 months before receiving and after resolution of criminal charges using the viral load most closely preceding and proceeding the charges. For each period, PLWH without a VL were coded as unsuppressed. We used generalized estimating equations to examine changes in viral suppression pre-post criminal charges, adjusting for other demographic and legal system factors. Results During the study period, 9,586 PLWH experienced criminal charges. Compared to others with charges, PLWH were more likely to be male (78% v 69%, p < 0.001) report Black race (77% vs 37%, p < 0.001) and be older (median age: 41 vs 36 years, p < 0.001). The median duration of unresolved charges was longer for PLWH compared to others (68 vs. 37 days, p < 0.001). The proportion with suppressed viral load pre- and post-charges was respectively 71% and 73%, p = 0.01. When adjusting for demographic and legal factors, the period following resolution of criminal charges was associated with an increased odds of viral suppression (adjusted odds ratio [aOR] 1.11; 95% Confidence Interval [CI] 1.03-1.19) compared to the period prior to charges. Factors negatively associated with viral suppression included Black race (aOR 0.60; 0.51-0.70), HIV acquisition via self-reported heterosexual contact (aOR 0.75; 0.62-0.91) or intravenous drug use (IDU) (aOR 0.51; 0.41-0.63) compared to men who report sex with men (MSM). Compared to those aged 18-29 years, those aged 60-69 were more likely to be suppressed (aOR 2.41; 1.78-3.25). Conclusion In the context of other risk factors for sub-optimal HIV suppression, the resolution of criminal charges was modestly associated with improvement in viral suppression. To further understand the mechanism underlying this association, future analyses will incorporate the role of additional factors such as charge type, incarceration, and state region. Disclosures All Authors: No reported disclosures.