CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

venues were associated. Further, venues associated with seroconversion in the new recruits differed from those pre-COVID (Figure). The post-COVID network was sparser with greater diameter, path length, and fewer injection partners, featuring linear recruitment chains and fewer cross-network links. Conclusion: Post-COVID, the network structure of PWID was altered. HIV seroconversion in the post-COVID recruits was more strongly driven by spatial ties rather than individual-level behavior, though behaviors were largely comparable to the original cohort. The diffusion of incidence across several newer venues could signal an impending outbreak of HIV at venues that were previously low risk.

who are already enrolled in the study. We evaluated the relationship between RDS-network size and HIV and HCV infection using t-tests and permutation tests. Results: Among 2135 PWID enrolled thus far from May 2022 to August 2023, participants are mainly male (89.8%) and 34.6 years old (SD=±8.7) on average. 236/2135 (11.1%) are HIV positive; with highest regional prevalence in the Coast (130/962, 13.5%), followed by Nairobi (83/770, 10.8%), and Western Region (21/393, 5.3%). HCV follows a similar gradation moving inland – 425/2135 (19.9%) overall; 248/962 (25.8%), 175/770 (22.7%) and 2/393 (0.5%), respectively. On average, participants report they know 11.1 (SD=14.9) PWID who also know them among whom they have seen 8.4 (SD=6.2) in the last 30 days and have injected with 5.4 (SD=5.4). The average network size as determined by coupon and token recruits was 2.2 with 7 (0.3%) having >10 connections. We observed a highly significant positive relationship between the number of RDS connections and likelihood of HIV/HCV co-infected vs uninfected (p<0.001), HIV-monoinfected vs uninfected (p<0.001), and HCV mono-infected vs. uninfected (p<0.05). Conclusion: These data, while preliminary, may inform policy makers and programs on HIV and HCV treatment and prevention strategies among PWID. The robust link between network connectivity and elevated HIV and HCV risk highlights the importance of network dynamics in disease transmission. Further study is needed on the potential efficiency of network-based interventions compared with traditional testing and linkage to care to advance efforts toward ending the HIV epidemic and HCV elimination.

Poster Abstracts

1013 Spatial Clustering of HIV Viremia Among People Who Inject Drugs (PWID) in India Talia A Loeb 1 , Allison M. McFall 1 , Michael R. Desjardins 1 , Jiban J. Baishya 2 , Ashwini Kedar 3 , Archit Sinha 3 , Aylur K Srikrishnan 3 , Sunil Suhas Solomon 4 , Gregory M. Lucas 4 , Shruti H. Mehta 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 The Johns Hopkins University, Baltimore, MD, USA, 3 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 4 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: While India has made significant progress in engaging people on antiretroviral therapy (ART), people who inject drugs (PWID) living with HIV (PLWH) remain under-engaged in treatment with only ~26% on ART and 32% virally suppressed. Using geospatial data to identify geographical clusters of viremia could help find optimal locations to intervene. Methods: Respondent-driven sampling was used to enroll a sample of ~750 PWID in New Delhi from April-August 2023. Participants were ≥18 years and reported injection drug use in prior 2 years. Participants underwent HIV testing and provided up to 5 locations where they injected in the prior year. Viral load testing was conducted on all positive specimens. We mapped locations where PWID injected and used scan statistics to assess spatial clustering of HIV viremia (>1000 copies/mL). We explored distance from treatment centers (ARTCs) among PLWH and sociodemographic/risk behaviors associated with reporting injecting at a cluster location among PLWH with viremia using Fisher's exact test and logistic regression. Results: Among the 752 enrolled PWID, median age was 27, 99% were male, 66% experienced recent homelessness, 74% inject daily, and 32% of PLWH were viremic. Participants injected in places a median distance of 2.4km (IQR, 2.3 – 2.6) from ARTCs. This did not vary by viremia status. Only 39% of PLWH were previously diagnosed. Seven clusters were identified, and one (C1) was statistically significant, located near 'Old Delhi' (Figure 1). A higher proportion of PWID with viremia injecting in C1 reported injecting daily (94% v. 72%), missing treatment due to drug use (75% v. 29%), and a larger network size (median 60 v 12 PWID) compared to those not in C1. PWID with viremia who injected in C1 also had higher proportions of moderate/severe depression (50% v 21%) and of injecting with multiple persons over half the time (72% v 37%). Conclusion: In an urban setting with a growing HIV epidemic among PWID, there was a geospatial cluster of PWID with untreated HIV associated with higher levels of risk behaviors – potentially facilitating transmission. Most PWID injected daily and at least 2km from ARTCs. Finding additional areas of high

1012 HIV Incidence & Changes in Network Structure Among PWID in New Delhi Following the COVID-19 Pandemic Steven J Clipman 1 , Shruti Mehta 2 , Aylur K Srikrishnan 3 , Katie Zook 1 , Shobha Mohapatra 3 , Muniratnam S. Kumar 3 , Gregory M. Lucas 1 , Carl Latkin 2 , Sunil Suhas Solomon 1 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: Identifying transmission predictors among people who inject drugs (PWID) is vital for curbing HIV spread. We previously described the role of a particular venue on transmission of HIV among PWID in New Delhi. COVID-19 lockdowns forced PWID at this venue to return home or relocate. The impact of such regulations on HIV transmission remains unknown. Methods: From 2017-19 (Pre-COVID), 2,512 PWID were recruited into a dynamic cohort and followed semi-annually until March 2020. Over 1,000 participants were lost (migrated or deceased) when the site re-opened. An additional 987 PWID were recruited to replace lost participants using identical procedures between February 2022 and April 2023 (Post-COVID). In both samples, indexes initiated sampling; they recalled who they injected with in the past month and recruited them. Similarly, each recruit named and recruited their recent injection network. Biometric data was used to identify duplicates and establish cross-network links. Injection venues were captured via a survey. Individual and network factors were analyzed for associations with HIV seroconversion using Poisson regression. Results: Since 2017, 3,499 PWID were recruited; 37.2% were living with HIV (37.0% and 37.6% in the pre- and post-COVID recruits, respectively). Among those without HIV, median age was 28 years; 98% were male, 69% reported daily injection and 48% reported needle sharing in the prior 6 months. 243 seroconversions were observed over 1912.5 person years (HIV incidence of 12.7 per 100 p-y); incidence in the pre- and post-COVID recruits was 13.8 and 7.3 per 100 p-y, respectively. In pre-COIVD recruits, individual and network factors, and one particular venue were predictors of seroconversion. In post-COVID recruits, depression, needle sharing, network distance to an HIV-positive person, and 19

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