1307. Virologic Failure in HIV-Infected Men Who Have Sex with Men and Transgender Women Treated in a Community-Based Model vs. a Hospital-based Model

BACKGROUND: Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV, especially those that belong to minority groups and lower socioeconomic status. The purpose of this study was to compare virologic failure in MSM and transgender women receiving HIV care at a community-based model (CBM) to a hospital-based model (HBM) of care. METHODS: This was a retrospective cohort study. We extracted data from electronic medical records of HIV-infected MSM and transgender women treated at one of the six community clinics or at a hospital-based clinic in Chicago between 2010 to 2014. The outcome was cumulative probability of virologic failure (i.e., viral load ≥200 copies/mL), measured in each semester of observation. We used multivariable Cox Proportional Hazards model to determine the association between CBM and HBM with virologic failure, adjusted for confounding variables. RESULTS: The sample consisted of 290 patients; of whom, 20 (7%) were transgender. Approximately half (49%) of the sample received care via CBM. Compared with patients receiving care at the HBM, CBM patients were more likely to be African American (72% vs. 61%), uninsured (50% vs. 39%) and with a history of substance abuse (38% vs. 24%). There was no difference in virologic failure between the two care models (57% in CBM vs. 52% in HBM; HR(adj) = 1.1; 95% CI: 0.8–1.6). Younger individuals (HR(adj) = 4.0; 95% CI: 2.3–7.1), alcohol users (HR(adj) = 1.6; 95% CI: 1.1–2.2) and patients without insurance (HR(adj) = 1.7; 95% CI: 1.1–2.6) were more likely to have virologic failure. CONCLUSION: The CBM was as effective as a traditional HBM in providing care to MSM and transgender women despite their more marginalized status. Intensive outreach and targeted case management likely contributed to the effectiveness of this model and need further study. DISCLOSURES: All authors: No reported disclosures.