CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1039 Progress Toward 95-95-95 and Viral Suppression Among FSW/CSEG in Unguja, Zanzibar, 2023 Mtoro J. Mtoro 1 , Farhat J. Khalid 2 , Christen A. Said 3 , Thomas W. John 1 , Joel Ndayongeje 1 , Sarah Porter 4 , Mohamed Dahoma 5 , Tara Pinto 4 , Asha Ussi 5 , Ahmed Jahzumi 5 , Augustino Msanga 4 , Pili Khamisi 5 , Ahmed Khatib 6 1 Global Programs, Dar es Salaam, United Republic of Tanzania, 2 Ministry of Health, Zanzibar, United Republic of Tanzania, 3 University of California San Francisco, Dar es Salaam, United Republic of Tanzania, 4 US Centers for Disease Control and Prevention Tanzania, Dar es Salaam, United Republic of Tanzania, 5 Zanzibar Integrated HIV, Hepatitis, TB, and Leprosy Programme, Zanzibar, United Republic of Tanzania, 6 Zanzibar AIDS Commission, Zanzibar, United Republic of Tanzania Background: An integrated biobehavioral survey (IBBS) in Unguja Island, Zanzibar, in 2019 showed female sex workers and commercially and sexually exploited girls (girls <18 years given money/goods for sex) (FSW/CSEG) have a higher HIV prevalence (12.1%) than the general population (0.4%). HIV diagnosis, linkage to antiretroviral treatment (ART), retention, and viral suppression (VS) among FSW/CSEG are critical to epidemic control in Zanzibar. In a follow-up IBBS completed in August 2023, we measured progress towards UNAIDS 95-95-95 goals and VS among FSW/CSEG who completed ≥6 months of ART, in Unguja. Methods: We recruited women aged ≥15 years who reported living in Unguja for ≥3 months and exchanging sexual intercourse for money in the prior month using respondent-driven sampling. We assessed HIV testing and treatment history through an interviewer-administered questionnaire and offered point of-care HIV testing in accordance with national guidelines. For those testing HIV-positive, we quantified HIV viral load (VL). We defined VS as <1,000 HIV RNA copies/mL, which comprises low level viremia (LLV) (50–999 copies/mL) and undetectable VL (<50 copies/mL). Women who disclosed a positive HIV status or were virally suppressed were categorized as knowing their status. Women who self-reported ART use or were virally suppressed were classified as on ART. We produced weighted point estimates and standard errors, reported as percentages with 95% confidence intervals (CI). Results: We enrolled 598 FSW/CSEG; median age was 31 years (range: 15–55 years). HIV weighted prevalence was 21% (95%CI: 17–25%) and was highest among women aged ≥45 years (47%; 95%CI: 31–62%). Among 138 FSW/ CSEG who tested HIV-positive, 92% (95%CI: 85–100%) knew their status, 98% (95%CI: 78–100%) of those who knew their status were on ART, and 88% (95%CI: 79–98%) of those on ART were virally suppressed. Among 84 FSW/ CSEG who reported being on ART for ≥6 months, 71% (95%CI: 60–82%) had an undetectable VL, 17% (95%CI: 8–25%) had LLV, and 13% (95%CI: 5–21%) were unsuppressed. Conclusion: HIV prevalence among FSW/CSEG in Unguja remains high. While the UNAIDS target for ART coverage has been met among FSW/CSEG living with HIV, there are still gaps in HIV diagnosis and viral suppression. Finding a detectable VL among FSW/CSEG on ART for ≥6 months is alarming. Prioritizing interventions that address the 1st and 3rd 95 such as expanded HIV testing, including self-testing, and removing barriers to retention in ART will help to address these gaps. 1040 Individual- and Community-Level Predictors of HIV Care Continuum Progression: Clark County, Nevada Ravi Goyal 1 , Alan Wells 1 , Victoria Burris 2 , Angel Stachnik 2 , Preston Nguyen Tang 3 , Lyell Collins 3 , Sanjay R. Mehta 4 , Susan J. Little 1 1 University of California San Diego, La Jolla, CA, USA, 2 Southern Nevada Health District, Las Vegas, NV, USA, 3 Nevada Department of Health and Human Services, Carson City, NV, USA, 4 VA San Diego Healthcare System, La Jolla, CA, USA Background: The HIV care continuum provides a comprehensive framework to assess the progress of people with HIV (PWH) from diagnosis to sustained viral suppression. Methods: We investigated associations between HIV care progression (being diagnosed, being in care, and being virally suppressed) and individual- and community- level characteristics in Clark County, Nevada. Individual-level characteristics included: age at diagnosis, current age, being MSM or IDU, race, sex, education, income, and being HIV genetically clustered (distance threshold <1.5%). Community-level characteristics included aggregated metrics for education, employment, race, and poverty. We used LASSO (Least Absolute Shrinkage and Selection Operator) regression with a zip code-level random effect to simultaneously conduct model selection and multivariate analyses; model tuning parameter was estimated using cross-validation. Results: We identified 5,122 diagnosed PWH in Clark County from 2011 to 2022. Of these individuals, 29% were Black, 36% Hispanic, 86% male, 69% men who

have sex with men (MSM), and 56% with a high school education or less. More recent diagnosis year (estimate -0.14; SE 0.01; p-value: <0.001) and being MSM (est. -0.42, SE: 0.11, p-value: <0.001) were inversely associated with late-stage diagnosis, while older diagnosis age was associated with higher probability (est. 0.04, SE: 0.003, p-value: <0.001); no community-level predictors were associated with late-stage diagnosis. Individual-level predictors associated with being in-care include: MSM (est. 0.31, SE: 0.14, p-value: 0.03), being HIV genetically clustered with an another PWH (est. 0.63, SE: 0.20, p-value: 0.001), more recent diagnosis year (est. 0.15, SE: 0.01, p-value: <0.001), and older age at diagnosis (est. 0.03, SE: 0.004, p-value: <0.001). In addition, residing in areas with higher percentages of poverty (est. -2.67, SE: 1.32, p-value: 0.04) and Hispanics (est. -1.27, SE: 0.65, p-value: 0.050) were significantly associated with being out of care. Similar associations with an individual being in-care were identified for an individual being virally suppressed--though some predictors differed; see Table 1 for details. Conclusion: Further studies are needed to identify the factors associated with poverty (e.g., access to HIV services) that may contribute to being out of care and virally unsuppressed. This analysis can serve as a basis for proactively identifying and supporting patients at risk of disengaging from HIV care through personalized care plans.

Poster Abstracts

1041 Multiple Care Disengagements and CD4 Restoration: A Comparative Analysis in People With HIV Giota Touloumi 1 , Achilleas Stamoulopoulos 1 , Christos Thomadakis 1 , Vasilios Paparizos 1 , Vasileios Papastamopoulos 2 , Konstantinos Protopapas 1 , Georgios Adamis 3 , Maria Chini 4 , M. Psichogiou 1 , Georgios Chrysos 5 , Nikos Pantazis 1 , Helen Sambatakou 1 1 University of Athens, Athens, Greece, 2 Evangelismos General Hospital, Athens, Greece, 3 General Hospital of Athens, Athens, Greece, 4 Red Cross General Hospital, Athens, Greece, 5 Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, Piraeus, Greece Background: While CD4 count trends following ART initiation are well documented, limited attention has been given to CD4 count evolution after reengagement in care following disengagement from care, especially in cases of multiple disengagements. We aimed to characterize patients prone to disengage from care and compare CD4 trajectories among individuals who never disengaged and those who disengaged once or multiple times. Methods: Data were obtained from the Athens Multicenter AIDS Cohort Study (AMACS). We included people with HIV (PWH) who initiated ART and were diagnosed after the age of 15. Disengagement was defined as an absence of clinic visits for at least 1.5 years. Multinomial logistic regression was employed to compare the profiles of individuals who have disengaged from care (once or multiple times) with those who have never disengaged. Linear mixed models (LMMs) with subject-specific knots at disengagement and reengagement were used to model CD4 trends on the square-root scale separately for those who disengaged once and twice. Another LMM including individuals who had never disengaged was also fitted for comparison. CD4 evolution conditional on baseline CD4 categories (ART initiation, first and second reengagement) was calculated using properties of the bivariate normal distribution. Results: 6722 PWH were included, 86% male; 58% MSM and 12% IVDUs. The median age at ART initiation was 36 years. 27% of PWH disengaged from care once and 10% at least twice, with the median time from ART initiation to first and second disengagement being 3.5 and 7 years, respectively. Young IVDUs (≤40 years at diagnosis) and particularly those of non-Greek origin were most likely to disengage at least once, with female IVDUs being the most vulnerable. The average gradient of CD4 restoration after ART initiation was the highest among those who never disengaged from care, followed by those who

CROI 2024 334