CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

persistence among TGW are low. We aimed to estimate HIV incidence and its risk factors among Brazilian TGW. Methods: Transcendendo is an open, clinic-based cohort of TGW living with HIV or at HIV risk established in 2015 in Rio de Janeiro, Brazil. HIV testing for HIV-negative participants is performed on an annual basis, with HIV viral load determined for those reporting unprotected anal sex within 30 days of the appointment to assess acute HIV infection. HIV incidence rates were estimated using Poisson model overall and stratified by age and ever PrEP use (time updated). Risk factors associated with HIV seroconversion were evaluated using Cox proportional-hazards models. Results: Between August 2015 and December 2022, 255 HIV-negative TGW were enrolled with at least one follow-up visit, contributing to 355.37 person years. The median age was 29 years (interquartile range: 24-38). Overall, 25 TGW seroconverted for HIV during follow-up (HIV incidence: 3.50%, 95% confidence interval[CI]: 2.30-5.06]). The HIV incidence was higher among younger TGW (18-24 years: 7.87[95%CI:1.17-3.67] vs. >24 years: 2.19[95%CI:1.17 3.67]) and those who have never used PrEP (10.68% [95%CI:6.74-15.92] vs. 0.77[95%CI:0.24-1.80] among those who ever used it). On multivariate Cox models, ever using PrEP was associated with a lower risk of HIV seroconversion, while younger age (18-24 years), earning less than one minimal wage/month, and four years or less of schooling were associated with increased risk of HIV seroconversion. Conclusion: Despite the availability of prevention strategies provided by the Brazilian public health system targeting key populations, HIV incidence remains high among TGW in Brazil, especially among the younger, less educated, and disenfranchised. As the HIV response continues to fail the most vulnerable individuals, an urgent call to effectively reach this population at risk and address inequalities becomes an imperative need. 1022 HIV Situation in Areas Surrounding Larkana: Findings From Community Test and Treat Implementation Muhammad S Jamil 1 , Muhammad S. Pasha 2 , Tanweer Hussain 2 , Shahida Memon 3 , Atif Ali 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 Country Office for 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, with unsafe injections and infusions in healthcare settings as the primary mode of transmission. Anecdotal evidence suggests high HIV burden in surrounding districts of Larkana. To date, no data are available on HIV positivity or burden in these areas. We report the results of a first community-based educate, test and treat implementation to understand the HIV situation in surrounding areas of Larkana. Methods: Community-based door-to-door testing was performed in partnership with CDC Sindh and local administration. Testing focused on two tehsils neighboring Larkana, one in district Jacobabad (159019 population) and one in district Shikarpur (316513), for which routine data and expert opinion suggested high burden of undiagnosed HIV. 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 including one trained male and female mobilizer each offered a single rapid HIV test (Abbott Early Detect) moving from house-to-house. Those with a reactive result were referred to the nearest 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, November 28 and December 12, 2023, 24536 HIV tests were conducted (57% among females). Overall, 160 individuals (0.65%; male: 0.67%, female: 0.64%) had a reactive HIV result. The reactive rate was 0.56% in one district and 0.78% in the other. Nearly one-third (n=58) of all reactive results were among children (18 months-14 years). The positivity was higher among

by ICEincome+race (linkage, PR=0.94; CI=0.92–0.96; viral suppression, PR=0.90; CI=0.87–0.92). For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. Conclusion: We found that poor HIV outcomes and disparities were associated with income, racial, and racialized economic segregation as measured by ICE. Persons living in highly segregated and deprived communities experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that contribute to and sustain racial and income segregation. 1020 The TIME Study: Trans People Living With HIV Throughout Europe: Clinical Outcomes and Stigma Jo Smith 1 , Jose Eduardo de Carvalho Peres 1 , Sujin Kang 1 , Tara Suchak 1 , Lorena de la Mora Cañizo 2 , Amanda Clarke 3 , Tanya Adams 3 , Sally Jewsbury 4 , Yu Tang 4 , Andrea Calcagno 5 , Emanuele Drappero 5 , Anna Serra 5 , Maria Mazzitelli 6 , Annamaria Cattelan 6 , Marta Boffito 1 , for the TIME Study Group 1 Chelsea and Westminster NHS Foundation Trust, London, United Kingdom, 2 Hospital Clinic of Barcelona, Barcelona, Spain, 3 University Hospitals Sussex, Brighton and Hove, United Kingdom, 4 Manchester University, Manchester, United Kingdom, 5 University of Turin, Turin, Italy, 6 University of Padua, Padova, Italy Background: Transgender and gender-diverse (TGD) people are at up to 49x higher risk of acquiring HIV than general populations. We present findings from the TIME study (Transgender people living with HIV throughout Europe), assessing viral response to antiretroviral therapy (ART) in TGD people living with HIV (PLWH) in Europe; exploring demographics, risk behaviours, community needs, barriers and facilitators to ART adherence. Methods: 6 HIV centres in London, Manchester, Brighton, Barcelona, Turin, Padua targeted recruitment of all patients >18 diagnosed with HIV, having ever been prescribed ART, and identifying as TGD. Clinics submitted observational data from medical records on gender identity, HIV viral loads (VL), CD4 counts, ART prescription adherence and comorbidities at enrolment and 6-monthly for 18 months. Participants completed questionnaires on their lifestyles, transitions, self and societal perceptions of gender, HIV, ART, stigma and discrimination. Results: 100 participants were recruited to date, 88% were trans women, of mean age 41 (22-65). 66% had completed medical transition. 60% had one or more physical/mental comorbidities at recruitment; at 18 months 36% did. 25% experienced physical violence in the preceding year. Mean baseline CD4 counts were 685 (100-1846) and 696 (384-1229) at 18 months. 18% of patients had known detectable VLs (>50 copies/ml) at baseline, falling to 11% at 18 months. 5% had clinician-documented ART adherence issues during the study. 30% agreed or strongly agreed that having to take ART worried them. 57% were worried or very worried about long-term effects of ART. 22% found ART disruptive to their lives, and 22% experienced unpleasant ART side effects. 31% felt shame and 27% guilt relating to HIV. 10% described not always having sex as safe as they want, and 27% reported concern about rejection by a partner. 12% had recently received care for suicidal ideation, dropping to 7% at 18 months. 48% described their sex life as better since transition, and 61% the same or better since HIV diagnosis. Conclusion: Although immune status was fair, adherence issues and participant concerns about ART adverse effects were high; VL detectability rates were over 8x higher than in UK PLWH generally. However, a significant proportion of TGD PLWH reported sexual satisfaction since their gender transition and/or HIV diagnosis, indicating that supportive gender and HIV care can promote better quality of life, thus the need for intersectional stigma-aware health service design. 1021 Hazardous Impact of Social Determinants of Health on HIV Incidence in Brazilian Transgender Women Carolina Coutinho , Emilia M. Jalil, Eduardo M. Peixoto, Laylla Monteiro, Biancka Fernandes, Mayara Secco Torres da Silva, Monica D. Pedrosa, Cristiane R. Castro, Marcos D. Sousa, Ruth K. Friedman, Ronaldo Moreira, Sandra W. Cardoso, Valdilea Veloso, Beatriz Grinsztejn Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil Background: Transgender women (TGW) are disproportionally affected by HIV in Brazil. Although HIV pre-exposure prophylaxis (PrEP) is available to vulnerable populations through the Public Health System, its uptake and

Poster Abstracts

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