CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1018 Association Between Social Vulnerability, HIV Testing, and Positivity: United States, 2020-2022 Wei Song , Mesfin S. Mulatu, Nicole Crepaz, Guoshen Wang, Aba Essuon, Mingjing Xia Centers for Disease Control and Prevention, Atlanta, GA, USA Background: The estimated number of new HIV infections in the United States dropped 12% in 2021 compared to 2017, but the racial and ethnic disparities in HIV infection persist. Community-level factors contributing to social vulnerabilities (e.g., poverty, lack of access to health care and services) may affect HIV outcomes. This analysis assessed the association between county-level social vulnerability and CDC-funded HIV testing and HIV positivity rates, and whether the association varies by demographic characteristics, testing site type, and Phase I Ending the HIV Epidemic (EHE) jurisdiction status in 2020-2022. Methods: We used testing data submitted to CDC by 60 state and local health departments (HDs) and 117 community-based organizations (CBOs). We combined HIV testing data with the latest county-level composite measure of economic, medical, and social vulnerability captured by the Minority Health Social Vulnerability Index (MHSVI). HIV testing and HIV positivity rates were analyzed by age, gender, race/ethnicity, testing site type, and Phase I EHE jurisdiction status and stratified by low, moderate, and high MHSVI scores. We calculated prevalence ratio (PR) with a 95% confidence interval (CI) to measure relative disparity by comparing county tracts with high vs. low MHSVI scores. Results: In 2020-2022, CDC-funded HDs and CBOs conducted 4,906,507 HIV tests: 113,721 (2.3%) in low, 583,307 (11.9%) in moderate, and 4,209,479 (85.8%) in high social vulnerability counties. Overall HIV positivity rate was 1.03%, including 0.52% in low, 0.63% in moderate, and 1.09% in high social vulnerability counties. HIV positivity rate was higher in high than in low social vulnerability counties (PR=2.12; 95% CI=1.95-2.30). In addition, the relative disparity in HIV testing and positivity rates was consistently higher in high MHSVI counties than in low MHSVI counties regardless of age groups, gender, race/ethnicity, testing site type, and the Phase I EHE jurisdiction status. Conclusion: HIV testing supported by CDC funding, and HIV positivity rates are higher in communities characterized by high levels of social vulnerability. These findings suggest that CDC's HIV testing efforts are directed to the most vulnerable communities and are identifying persons with HIV infection. Continued monitoring of the association between county-level social vulnerability and HIV positivity rates would be informative in guiding HIV testing efforts and resource allocation for achieving EHE goals. 1019 Using the ICE Method to Examine Income/Racial Segregation and HIV Outcomes: US, 2021 Zanetta Gant Sumner, André Dailey , Xiaohong Hu, Shacara Johnson Lyons, Anna Satcher Johnson Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Assessing the role of segregation on poor health outcomes among Black persons in the United States (U.S.) can inform interventions aimed at increasing health equity. We examined associations between HIV outcomes (diagnoses, linkage to HIV medical care, and viral suppression) and Index of Concentration at the Extremes (ICE) measures for economic and racial segregation in the U.S. in 2021. Methods: Census tract-level data on diagnoses, linkage to HIV medical care, and viral suppression from the CDC's National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau's American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for diagnoses, and prevalence ratios (PRs) for linkage to care within 1 month of diagnosis and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs). Differences across ICE quintiles were examined using the most privileged communities (Quintile 5, Q5) as the reference group. Results: Across all outcomes and ICE measures, a general pattern of increasingly worse outcomes from most to least privileged quintile was observed. Among all 3 ICE measures, a higher likelihood of HIV diagnosis in Q1 compared with Q5 was observed for ICErace (RR =10.13; CI=9.58–10.70). For HIV diagnosis rates, RRs were consistently greatest for ICErace across quintiles. Among all 3 ICE measures for linkage to care and viral suppression, a lower likelihood in Q1 compared with Q5 were observed for ICEincome (linkage, PR=0.94; CI=0.92–0.95; viral suppression, PR=0.89; CI=0.87–0.91), followed

decreased prevalence of non-linkage to care. Persons born in Mexico (non-viral suppression aPR 0.75, 9% CI 0.64–0.87), South America (aPR 0.69, 95% CI 0.57–0.84), and other Caribbean areas (excluding Puerto Rico and Cuba; aPR 0.48, 95% CI 0.30–0.77) had a decreased prevalence of non-viral suppression, compared with those born in the U.S. No significant differences were seen among SVI quartiles, compared to the lowest SVI (lowest vulnerability) quartile, for either care outcome. Conclusion: Disparities in HIV care outcomes exist within the Latino population by birthplace, with those born in certain non-U.S. areas more likely to be linked to care and have viral suppression soon after diagnosis. Effective interventions that increase care and prevention access must be tailored and expanded for this diverse group. 1017 Prevalence of HIV Testing and HIV Positivity in the Hispanic Community Health Study/Study of Latinos Mario J Trejo 1 , Jonathan Ross 2 , Robert Kaplan 3 , Tonia C. Poteat 4 , Linda C. Gallo 5 , Krista M. Perreira 6 , Bonnie E. Shook-Sa 6 , Gregory A. Talavera 5 , David B. Hanna 2 1 Fred Hutchinson Cancer Center, Seattle, WA, USA, 2 Montefiore Medical Center, Bronx, NY, USA, 3 Albert Einstein College of Medicine, Bronx, NY, USA, 4 Duke University, Durham, NC, USA, 5 San Diego State University, San Diego, CA, USA, 6 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Although HIV disproportionately affects U.S. Hispanics/Latinos, over 50% of this population has never been tested for HIV. While factors such as healthcare access, English proficiency, acculturation, and nativity likely impact HIV testing among Hispanics/Latinos, few population-based studies have examined these associations. We aimed to describe patterns of HIV testing and test positivity among participants in the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL), a population-based longitudinal cohort study of U.S. Hispanics/Latinos which recruited participants between 2008-2011 aged 18-74 years. Methods: We analyzed data from HCHS/SOL participants who attended study visit 3 (between 2021 and 2023) at field centers in Bronx, NY; Chicago; Miami; and San Diego. Outcomes were lifetime HIV testing, past year testing, and test positivity, by self-report. We estimated prevalence of outcomes by assigned female at birth (AFAB) vs. assigned male at birth (AMAB), sexual orientation, nativity, preferred language, and level of acculturation (measured using the Short Acculturation Scale for Hispanics [SASH] social scale), and calculated 95% confidence intervals. Results: Among 7074 participants, mean age was 60 years (SD 12.1), 63% were AFAB, 73% spoke Spanish as their primary language, 75% were born outside of the U.S. and had been living in the U.S. for an average of 30 years (SD 11.9), and most reported sexual orientation as straight/heterosexual (91%). In total, 3317 (47%) had ever tested for HIV, 205 (3%) tested within the past year, and 69 (1%) reported testing positive. Ever HIV testing was higher among AFAB vs AMAB (49% vs 43%; p<.0001), persons identifying as not heterosexual vs. heterosexual (84% vs 46%; p<.0001), U.S./U.S. territories-born vs non-U.S. born (56% vs. 44%; p<.0001), primary English vs Spanish speakers (61% vs 44%; p<.0001), and highest vs lowest tertiles of social acculturation score (52% vs 42%, p<.0001). Similar patterns were observed with respect to past year HIV testing and test positivity (Table). Conclusion: In a large, representative study of Hispanic/Latinos at 4 U.S. sites, we observed large disparities in HIV testing and test positivity by nativity, language preference, and level of acculturation. Achieving CDC recommendations for universal lifetime HIV testing among Hispanic/Latinos will require targeted interventions to increase uptake among individuals who are less acculturated.

Poster Abstracts

CROI 2024 326