CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

919

The Impact of HIV and the Postpartum Period on the Gut Microbiota in South African Women Lara R Dugas 1 , Hlengiwe P. Madlala 1 , Gertrude Ecklu-Mensah 2 , Candice Choo Kang 3 , Julia Goedecke 4 , Amy Mendham 5 , Jess Davies 1 , Chad Africa 1 , Demi Meyer 1 , Jack Gilbert 2 , Brian Layden 6 , Jennifer Jao 7 , Elaine J. Abrams 8 , Angela Bengtson 9 , Landon Myer 1 1 University of Cape Town, Cape Town, South Africa, 2 University of California San Diego, La Jolla, CA, USA, 3 Loyola University Chicago, Chicago, IL, USA, 4 South African Medical Research Council, Cape Town, South Africa, 5 South Australia Health, Lyrup, Australia, 6 University of Illinois at Chicago, Chicago, IL, USA, 7 Northwestern University, Chicago, IL, USA, 8 Columbia University, New York, NY, USA, 9 Emory University, Atlanta, GA, USA Background: The perinatal and post-partum (PP) period is a window to future metabolic health, including type 2 diabetes (T2D). Between the 1st and 3rd trimester (T3), the gut microbiota (GM) is altered and associated with increased inflammation and reduced insulin sensitivity (IS) at T3. Similarly, among persons with HIV (PWH), there is emerging evidence for GM alterations, including reduced microbial diversity and altered functional features. Approximately 30% of pregnant South African (SA) women are PWH. We hypothesized that the composition of the GM differed by HIV status and PP period among SA women. Methods: We performed a cross-sectional analysis of GM composition, using 16S rRNA amplicon sequencing, on early morning stool samples collected from 65 PP women originally enrolled in the Cardiometabolic Health in Pregnancy study (2019-2022). Body composition was measured using dual x-ray absorptiometry and IS measured using an oral glucose tolerance test to derive the Matsuda Index. Results: Of 65 PP women, 46 were PWH, with no differences in the length of the PP period by HIV status. PWH had lower BMIs (28.1 [24.1-33.8] vs. 31.2 [27.8-40.2] kg/m 2 , p=0.046), and fat (31.9 [25.1-43.3] vs. 40.3 [27.1-54.5] kg) and fat free mass (37.7 (34.6-43.6) vs. 42.6 [36.9-49.0] kg), but similar fasted glucose, insulin, and Matsuda Index. After demultiplexing, 2,162,496 sequence reads were obtained from the stool samples, with a median of 32,990 sequence reads. Overall, 1,569 amplicon sequence variants (ASVs) including 19 phyla and 370 genera were identified, with the most abundant phyla across all the two groups being Firmicutes, Bacteroidetes, Firmicutes C and D and Proteobacteria. At the genus level, most ASVs belonged to Prevotella, Faecalibacterium, Agathobacter_164117, Dialister and Blautia_A_141781. Thirteen microbial taxa differential abundance differed by HIV status, with 11 being over-represented in PWH, including Fusobacterium, Bilophila, Sneathia and Clostridium. These genera have previously been associated with persistent immune dysfunction. The PP period also differed by microbial taxa, whereby those >12 months had a greater proportion of Ellagibacter, associated with anti-inflammatory activity, irrespective of HIV status. Conclusion: We confirm that the GM differs by HIV status and the length of PP period. Future research should explore the persistent effects of the PP period and HIV status on the composition of the gut microbiota, given the syndemic of HIV and T2D in SA.

SPS), on disclosure and ART adherence among pregnant and postpartum women with HIV in rural Uganda. Methods: We developed an ENHANCED-SPS intervention informed by the empirically-validated PRECEDE framework. Intervention components included: 1) Provider training and mentorship on enhanced VL counselling (predisposing), 2) standardized peer mother support and bi-weekly phone calls to mothers to provide VL and adherence counselling (enabling) and, 3) point of care VL monitoring and feedback meetings with providers and peer mothers (reinforcing). At routine clinic visits, mothers also received an assessment of barriers to disclosure and adherence as well as discussion on plans to address those barriers. We evaluated the effect of the intervention on disclosure and adherence after 12-month of follow-up Results: We enrolled 505 pregnant and post-partum women at the 7 public health clinics from September 2019 to October 2020. Participants' median age was 28 years [Q1:24, Q3:24], 157/505 (31%) were newly diagnosed with HIV, 318/455 (70%) were virally suppressed (HIV RNA<1000 c/mL) and 79% (95%CI:69-90%) had disclosed their HIV status to anyone at baseline. After 12 months of the intervention, disclosure increased to 88% (95%CI:83-94%), corresponding to a 9% (95%CI:1-18%; p=0.02) absolute increase from baseline. The intervention increased disclosure within subgroups of age and enrollment group, especially among younger women (15-24years) with 17% increase (95%CI:5-29%; p=0.008) and the newly diagnosed pregnant women with 39% increase (95%CI:18-61%; p=0.003). Similar effects were observed when examining disclosure to a partner or spouse. Additionally, the intervention increased adherence to ART to 93% (95%CI:83-100%), corresponding to a 25% (95%CI:12-39%; p=0.002) absolute increase from the baseline measurement of 68% (95%CI:62-73%). Conclusion: The multi-component, peer-led, enhanced VL counselling intervention significantly increased disclosure of HIV status and ART adherence among pregnant and postpartum women within 1 year of implementation. Young women and 1st time presenters with new HIV diagnosis had increased benefit.

Poster Abstracts

921

High Prevalence of Depression and Anxiety in Women Without HIV and Women With HIV on DTG-ART Kebaiphe Moabi 1 , Gloria K. Mayondi 1 , Allison LeMahieu 2 , Paige L. Williams 3 , Naledi Kamanga 1 , Ame Diphoko 1 , Kathleen M. Powis 4 , Gaerolwe Masheto 1 , Dinah Ramaabya 5 , Francis Banda 6 , Alexander C. Tsai 7 , Betsy Kammerer 8 , Adam R. Cassidy 2 , Shahin Lockman 9 1 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana, 2 Mayo Clinic, Rochester, MN, USA, 3 Harvard University, Cambridge, MA, USA, 4 Massachusetts General Hospital, Boston, MA, USA, 5 Botswana Ministry of Health, Gaborone, Botswana, 6 University of Botswana, Gaborone, Botswana, 7 Harvard Medical School, Boston, MA, USA, 8 Boston Children's Hospital, Boston, MA, USA, 9 Brigham and Women's Hospital, Boston, MA, USA Background: Common mental disorders are a leading global cause of disability. Little is known about the prevalence and nature of depression and anxiety symptoms among women living with HIV taking dolutegravir (DTG)- based antiretroviral treatment (ART), particularly in southern Africa. Methods: From March 2021 to May 2023 (a period affected by COVID-19), we enrolled women living with HIV (most on DTG-based ART at enrollment) and without HIV in the "Motheo" study of child neurodevelopment and maternal mental health, in one city and one village in Botswana. At enrollment, trained staff administered the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) in Setswana or English. PHQ-9 score >8 was defined as probable depression (per prior Botswana data) and GAD-7 >8 as probable anxiety. For 3-category ordinal endpoints, we used PHQ-9 score 1-4 (minimal), 5-9 (moderate), and >9 (moderate/severe) for depression; and GAD-7 score 0-4

920

A Multicomponent Intervention Improves Disclosure and ART Adherence for Pregnant/Postpartum Women Jane Kabami 1 , Laura B. Balzer 2 , Faith Kagoya 1 , Jaffer Okiring 1 , Joanita Nangendo 1 , Emmanuel Ruhamyankaka 3 , Peter Ssebutinde 4 , Elizabeth Arinitwe 1 , Michael Ayebare 1 , Stella Kabageni 1 , Anne R. Katahoire 5 , Moses R. Kamya 5 , Philippa Musoke 5 , for the ENHANCED-SPS Study Team 1 Infectious Diseases Research Collaboration, Kampala, Uganda, 2 University of California Berkeley, Berkeley, CA, USA, 3 Duke University, Durham, NC, USA, 4 Mbarara District Health Office, Mbarara, Uganda, 5 Makerere University College of Health Sciences, Kampala, Uganda Background: Disclosure of HIV status to anyone and adherence to ART among pregnant and postpartum women are critical for sustained HIV care engagement and elimination of vertical transmission in Sub-Saharan Africa. We evaluated the effect of a multi-component intervention, including Enhanced viral load (VL) counseling and Standardized Peer-mother Support (ENHANCED

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