563. Not Your Parent’s Epidemic: New HIV Diagnoses and the New Patient Cascade of Care in the Bronx, New York

Abstract

BackgroundThe Bronx was one of the first counties in the United States to describe HIV infection, and with over 29,000 PLWH remains an epicenter of the epidemic and a major driver of US outcomes. The Bronx epidemic was historically most among minorities, with heterosexual (HSP) and IDU risk factors predominating, and poor outcomes along the care cascade. The Bronx epidemic is changing, and multiple efforts have been made to address the high needs of PLWH in the area. Up to date data would be enlightening.MethodsWe identified those age ≥18 newly diagnosed with HIV at Montefiore Medical Center, Bronx, New York in 2013 and 2016. Retrospective review was undertaken of all cases for up to 1 year after diagnosis, including demographics, clinical data, and outcomes along the care cascade. We used univariate, multivariate logistic and cox regression models to identify factors associated with linkage to HIV care (LTC), retention in care (RIC), ART prescribing, and viral load suppression (VLS).ResultsA total of 217 newly diagnosed cases were identified. Demographics included: 137 (63%) male, 77 (35%) female, 3 (1.3%) transgender; 44% Black, 39% Latino; 80% noncommercially insured; 16% unstably housed; risk factor HSP 57%, MSM 30% (38% 2016, 22% 2013 [P 0.053]), IDU 0.5%; 36% CD4 < 200. Among those eligible, 191/215 (89%) were LTC (median = 24 days, IQR 9–59); 161/214 (75%; 84% of those LTC) were RIC; ART was prescribed to 175 (81%; 92% of those LTC); and 148/189 (78%; 85% of those on ART) were virally suppressed (median = 126 days, IQR 76–282). In multivariate models, no associations were seen between age, gender, race, risk factor, housing, psychiatric disorder; and outcomes of interest. Compared with public insurance, having commercial insurance was associated with earlier LTC (HR 1.8, 95% CI 1.2–2.6 P < 0.05). Active substance use was associated with delayed VLS (HR 0.5, 95% CI 0.2–1.0 P 0.04).ConclusionThe Bronx HIV epidemic has changed dramatically, reflecting new demographics and effective approaches to testing and care across the HIV care cascade. Most of the historical disparities associated with poor outcomes have been eliminated in newly diagnosed PLWH at Montefiore. These findings hold great promise for the future epidemic in the Bronx—and across the US—if the gains can be maintained and replicated.Disclosures All authors: No reported disclosures.