CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

initiated ART and two persons initiated TB treatment). The mode of transmission for 43 individuals (78%) was reported to be reuse of contaminated needles or syringes. Conclusion: HIV positivity was comparable to national HIV prevalence (0.2%) suggesting low level community transmission. Children continue to be at a greater risk of acquiring HIV and reuse of contaminated needles and syringes continue to drive the transmission in this setting. Urgent action is needed to address unsafe injection practices to stop the transmission. Data Informed Stepped Care (DiSC) to Improve HIV Care for Youth With HIV: A Cluster Randomized Trial Pamela Kohler 1 , Wenwen Jiang 1 , Jacinta Badia 2 , James Kibugi 2 , Jessica Dyer 1 , Julie Kadima 2 , Dorothy Oketch 2 , Kristin Beima-Sofie 1 , Sarah Hicks 1 , Barbra Richardson 1 , Irene Inwani 3 , Seema Shah 4 , Grace John-Stewart 1 , Kawango Agot 2 1 University of Washington, Seattle, WA, USA, 2 Impact Research and Development Organization, Kisumu, Kenya, 3 Kenyatta National Hospital, Nairobi, Kenya, 4 Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA Background: Adolescents and young adults living with HIV (YLH) may benefit from differentiated care, however providers and policy makers are hesitant to assign YLH to differentiated care due to concerns over poor retention and viral suppression. Methods: This cluster randomized trial tested effectiveness of a multi component data-informed stepped care intervention that assigned YLH to different intensities of care according to need. YLH at 12 intervention facilities underwent risk assessment and step assignment at each visit; those at lowest risk were eligible for differentiated services including multi-month refill and pharmacy fast-track. At enrollment YLH received a standardized questionnaire to assess baseline characteristics and were followed for 12 months. Electronic medical record data were abstracted for clinic visit and viral load data. The primary trial outcome was proportion of missed visits during 12-month follow-up. Secondary outcomes included loss to follow-up, viral suppression, and differentiated care assignment. Mixed effects regression was conducted, clustered by individual and facility and adjusted for baseline retention and viral suppression during the pre-enrollment period and for any variable that differed by arm at baseline. Results: Between April to July 2022, 1911 YLH ages 10-24 were enrolled (1016 at control and 895 at intervention facilities). Median age was 17, 1102 (57.9%) were female, and 1512 (79.5%) were in school, and were balanced between trial arms. More YLH attended clinic alone at baseline in the intervention arm. Among YLH in intervention arm, 574 (64.6%) were assigned to differentiated care services, 122 (13.7%) to standard care, 100 (11.3%) to mental health and retention counseling, and 92 (10.4%) to intensive case management. YLH at control sites received standard care. Missed visits were not significantly different between intervention (8.5%) and control groups (8.3%) (aRR 1.04, 95%CI: 0.89-1.20). Assignment to fast-track pharmacy visits increased at intervention sites (aRR 1.21, 95%CI: 1.01-1.45). Viral suppression was similar between arms (aRR 0.78, 95%CI: 0.49-1.23). Conclusion: The data-informed stepped care tool resulted in increased assignment of low risk YLH to fast-track visits without additional loss to follow up or viral non-suppression. Differentiated services were readily implemented in YLH and may align well with school schedules, decrease health system burden, and enable tailored intensive care for YLH with additional needs. Prescription Opioid Use and Disorder Among Older Adults With HIV in the US From 2008-2019 Stephanie Shiau 1 , Fabrizio Drago 1 , Kylie Getz 1 , Greta Bushnell 1 , Hillary Samples 1 , Alexis Bender 2 , Laura Bennett 1 , Perry N. Halkitis 1 , Tobias Gerhard 1 , Jason A. Roy 1 , Silvia S. Martins 3 , Michael T. Yin 3 , Stephen Crystal 1 1 Rutgers University, Piscataway, NJ, USA, 2 Emory University, Atlanta, GA, USA, 3 Columbia University, New York, NY, USA Background: Despite growing concern that people living with HIV receive prescription opioids at elevated rates and experience a disproportionate burden of opioid use disorder (OUD) compared to their HIV- counterparts, few studies have described opioid prescription and OUD trends over time. Our objective was to evaluate these trends among older adults comparing those with HIV to their HIV- counterparts. Methods: We constructed annual cross-sectional cohorts (2008-2019) using a nationally representative sample of fee-for-service Medicare beneficiaries 65+ years in the US with Part D coverage. Beneficiaries with HIV (n=124,488) were matched to HIV- beneficiaries (n=373,464) using propensity scores

older adults not transitioning. We describe the results of a pilot, type 3 hybrid, randomized clinical trial of a mobile phone-based intervention, InTSHA: Interactive Transition Support for Adolescents with HIV, compared to standard care. Methods: InTSHA uses encrypted, closed group chats delivered via WhatsApp to provide peer support and improve communication between adolescents, their caregivers, and healthcare providers during transition from pediatric to adult care. We randomized 80 South African adolescents with perinatally acquired HIV who were aware of their HIV status and aged between 15 to 19 years to receive either the InTSHA intervention or standard care. We measured acceptability (Acceptability Implementation Measure) and feasibility (Feasibility Implementation Measure) in those randomized to InTSHA as primary outcomes. We also measured retention in care (missed clinic visits and/or late pharmacy refills), viral suppression (viral load <200 copies/ml), depression (PHQ-9), transition readiness (HIV Adolescent Readiness for Transition), peer support (Adolescent Social Support Scale), and connection to clinical staff (Working Alliance Inventory) at baseline and 12 months after randomization. We examined the differences from baseline and 12 months in the InTSHA and standard care groups using independent sample t-tests and chi-square tests. Results: Among adolescents randomized to the InTSHA intervention (n=40) versus standard of care (n=40), we found no difference in 12-month viral suppression rates n=32, 80% and n=34, 85%, respectively (OR 0.7, 95%CI 0.2 – 2.3; p=0.56). All participants were retained in care at one year. Among adolescents randomized to the InTSHA group, acceptability was 80% and feasibility was 78%. Non-significant improvement was seen in scores for depression 0.8 vs 1.47 (p = 0.68), peer support 2.1 vs -1.7 (p=0.19), transition readiness 0.4 vs 0.1 (p=0.35), and connection to clinic 1.3 vs 0.4 (p=0.55) comparing baseline to 12-month responses in InTSHA compared to standard care respectively. Conclusion: InTSHA is an acceptable and feasible intervention for adolescents with HIV who are transitioning to adult care in South Africa. Although this pilot study did not improve viral suppression or retention in care, potential improvements were seen in depression, peer support, transition readiness, and connection to clinic. Is HIV Outbreak Among Children in Larkana Over? Findings From a Large Test and Treat Initiative Muhammad S Jamil 1 , Muhammad S. Pasha 2 , Shahida Memon 3 , Atif Ali 2 , Tanweer Hussain 2 , Altaf A. Soomro 4 , Saima Mushtaq 5 , Sikandar Memon 5 , Joumana Hermez 1 1 World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt, 2 World Health Organization County Office Pakistan, Islamabad, Pakistan, 3 HIV Treatment and Support Centre Ratodero, Larkana, Pakistan, 4 Bridge Consultants Foundation, Karachi, Pakistan, 5 Communicable Disease Control (HIV-AIDS), Karachi, Pakistan Background: An outbreak of HIV among children was reported in Ratodero (district Larkana, Sindh province, Pakistan) in April 2019. The main sources of transmission were nosocomial namely, unsafe injections and infusions in healthcare settings. In 2022, routine ART registration data suggested ongoing community transmission with more adults being diagnosed than children, but positivity rates were unclear given the lack of testing data. We present the results of a community-based educate, test and treat initiative in Ratodero to understand the status of outbreak nearly five years after it was first reported. Methods: Door-to-door testing was done in partnership with CDC Sindh and local administration which focused on selected union councils (UCs) of Ratodero (370000 population), the epicentre of 2019 outbreak. Those aged 18 months to 60 years were eligible, while those who self-reported HIV test in the past 6 months or were already on ART were excluded. Thirty mobile teams of one trained male and female mobilizer each offered a single rapid HIV test (Abbott Early Detect) from house to house in pre-defined geographic areas. Those with a reactive result were referred to Ratodero ART centre for confirmation and ART initiation. Information, education and communication materials related to injection safety were displayed in health facilities and in the community. Results: Between, September 6 and 21, 2023, 43877 HIV tests were performed (58% among females). Overall, 75 individuals (0.17%; male: 0.19%, female: 0.16%) had a reactive HIV result. The reactive rate varied by UC, ranging from 0% to 0.27%. Two-thirds (n=49) of all reactive results were among children (18 months-14 years). The reactive rate among children (0.24%) was higher than those 15 years and above (0.11%). Of those with reactive results, 55 (71%) were linked to ART centre as of January 9, 2024 (53 confirmed HIV-positive and

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CROI 2024 317