CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

assigned male at birth. After 10 weeks of implementation, a total of 470 patients were tested: 322(69%) girls and 148(31%) boys. Four new ALHIV; the median age was 16 and their assignment at birth was (3) male, 2 coinfected with syphilis, and (1) female. This demonstrates an overall positivity rate of nearly 1%, and 1 in 49 boys tested positive. A 77% increase in testing was noted at the site receiving educational promotion vs 34% at the other 2 sites. Overall, the initiative showed a 50% increase in newly diagnosed cases; all were linked to care within 1-48 days. Conclusion: Metro Atlanta remains a hotspot for new HIV cases. Four new cases in 10 weeks highlights the importance of universal HIV testing of adolescents and reflects a public health crisis. The new initiative significantly increased HIV screening among adolescents and will likely identify ALHIV at an earlier stage of infection, facilitating timely access to medical care. This can lead to improved clinical and immunological outcomes and a reduced risk of secondary transmission. Evaluation of Electronic Peer Navigation to Prevent Engagement Failure for Youth in Kenya I Lisa Abuogi 1 , Lina M. Montoya 2 , Edwin Nyagesoa 3 , Jayne L. Lewis-Kulzer 4 , Everlyne Nyandieka 3 , Gladys Ontuga 3 , Isaya Opondo 3 , James Nyanga 3 , Eliud Akama 3 , Thomas Odeny 3 , Elizabeth Bukusi 3 , Elvin H. Geng 5 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Kenya Medical Research Institute, Nairobi, Kenya, 4 University of California San Francisco, San Francisco, CA, USA, 5 Washington University in St Louis, St Louis, MO, USA Background: Adolescents and Young Adults with HIV (AYAHIV) require innovative approaches to address lower rates of virologic suppression and HIV care engagement. While peer-based interventions have strong developmental justification, AYA have many competing demands including school, life transitions, and emerging social needs that may limit reach of in-person support services. The ubiquity of mobile phones and social media, however, offers an alternative route for peer engagement and support. Methods: We randomized AYAHIV to trained virtual peer navigators who delivered structured peer support electronically (by phone) combined with biweekly automated text messages. We enrolled AYAHIV aged 14-24 years at three high volume public facilities in Kisumu County, Kenya between April 2021 and March 2022. Participants were block randomized to standard of care (SOC) or electronic navigations (eNAV) stratified by ages 14-19 and 20-24 years. Electronic navigators were trained youth with HIV. The primary outcome was AYAHIV engagement failure at one year defined as experiencing any of the following within the first year of follow-up: missed clinic visit (at least 14 days late for a scheduled visit) or viral failure (high viral load per national guidelines) or death. Targeted maximum likelihood estimation was used to estimate effect of virtual navigation versus SOC. We adjusted for baseline patient characteristics (e.g., sex, age, WHO stage, alcohol use, school attendance, etc.) to enhance precision. Results: Of the 579 participants, 285 (49.2%) were randomized to eNAV and 294 (50.8%) to SOC. Among all patients, 403 (69.6%) were female and median age was 20 years (interquartile range 17-23). Treatment assignment was balanced by sex, age, WHO Stage, study site, or school attendance at study enrollment between arms (Table 1). Overall, 75 (26.3%) AYAHIV experienced and engagement failure in eNAV and 93 (31.6%) in SOC resulting in an estimated risk difference of -5.18% (95% confidence interval -12.54%, 2.19%, p=0.1684). The risk difference was also non-significant in unadjusted analysis. Conclusion: Results from this trial comparing peer navigation and text messaging versus the standard of care demonstrate high levels of engagement failure in AYAHIV that are reduced, but not statistically significantly, through electronic navigation. Peer support to increase treatment success may require more intensive in-person interactions, despite the reach and flexibility provided by electronic approaches. The figure, table, or graphic for this abstract has been removed. Effectiveness of the mHealth Intervention, InTSHA, Among Adolescents With HIV in South Africa Brian C Zanoni 1 , Moherndran Archary 2 , Thobekile Sibaya 2 , Casiel T. Gethers 1 , Madeleine Goldstein 1 , Scarlett Bergam 3 , Christina Psaros 4 , Vincent Marconi 1 , Jessica Haberer 4 1 Emory University, Atlanta, GA, USA, 2 University of KwaZulu-Natal, Durban, South Africa, 3 George Washington University, Washington, DC, USA, 4 Massachusetts General Hospital, Boston, MA, USA Background: Retention in care for adolescents with HIV during transition from pediatric to adult care is more challenging than for younger children or

Prediction accuracy for the ML models was evaluated using root mean square error and mean absolute error. The most effective model, "tuned Lasso Regression", predicted the number of new HIV-positive pediatrics across 47 Kenyan counties based on national data between October 2022 and June 2023. These predictions were georeferenced at the county level for geostatistical analysis. Global spatial autocorrelation techniques based on Moran's I (MI) test revealed HIV infection distribution patterns, while hotspot analysis using Getis Ord (Gi*) spatial statistics identified significant clusters of pediatric HIV cases among neighboring counties. Results: By the end of June 2023, we predicted 3,160 pediatric HIV cases, a slight increase from the 3,092 cases reported by the national program between October 2022 and June 2023. A spatial autocorrelation analysis of pediatric HIV infections in Kenya revealed significant clustering for both reported (z-score=3.22, MI=0.21, p-value<0.001) and predicted cases (z-score=4.92, MI=0.36, p-value<0.001). The increased z-score in predicted cases suggests heightened clustering intensity, indicating that new pediatric HIV cases are predominantly localized. Hotspot analysis using the Getis-Ord Gi* statistic pinpointed these significant clusters to twelve counties in the Southwestern region of Kenya. Conclusion: The spatial distribution of new pediatric HIV cases was non homogeneous. This study pinpointed key geographical areas for prioritizing pediatric HIV infection control. This study will provide policymakers with essential insights to optimally allocate testing and treatment services to areas with the greatest needs.

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Poster Abstracts

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Pediatric Emergency Department-Based Opt-Out HIV Screening Identifies Adolescents Living With HIV Sandy Francois 1 , Mark A. Griffiths 1 , Melissa N. Cameron 1 , Jordan E. Daniel 1 , Bridget A. Wynn 1 , Sara P. Brown 2 , Sarah Thompson 2 , Rebekah G. Carter 2 , Kelly DeNaples 2 , Swaminathan Kandaswamy 1 , Evan Orenstein 1 , Andres Camacho Gonzalez 1 , Claudia R. Morris 1 , Lauren Middlebrooks 1 1 Emory University, Atlanta, GA, USA, 2 Children's Healthcare of Atlanta, Atlanta, GA, USA Background: The Centers for Disease Control and Prevention recommends universal HIV screening for all patients ≥13 years. Parts of Metro Atlanta have HIV+ rates at 8-times the national average. Adolescents are the least likely group to know their HIV status and have the lowest rate of linkage to care and viral suppression. Children's Healthcare of Atlanta (Children's) implemented an opt-out HIV testing program in its pediatric emergency departments (ED) for all patients ≥13 years undergoing venipuncture for any chief complaint in 1 of their 3 sites. The objective is to increase testing in adolescents in Atlanta leading to earlier HIV diagnosis and linkage to care. Methods: Children's electronic medical record EPIC and its population discovery tool were used to compare HIV testing volumes of 13–24-year-old patients, 10 weeks pre- (April 26–July 5, 2023) and 10 weeks post (July 6–September 14, 2023) clinical implementation. Data for all 3 sites was reviewed but only 1 site received educational promotion for staff and poster placement in the ED. Results were cross-referenced to determine new diagnoses from known positive's; all newly identified adolescents living with HIV (ALHIV) were linked to care. The data was compared using descriptive statistics. Results: A total of 309 patients were tested for HIV in the 10 weeks pre implementation, 202(65%) girls and 107(35%) boys. Two new ALHIV were identified, 1 coinfected with syphilis, the median age was 17 and both were

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