CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1073 COVID-19-Related Shutdowns and Viral Suppression in the US and Canada Keri N Althoff 1 , Brenna Hogan 1 , Milton L. Wainberg 2 , Kelly A. Gebo 3 , Michael A. Horberg 4 , John Gill 5 , Peter F. Rebeiro 6 , Mari Kitahata 7 , Kathleen A. McGinnis 8 , Jennifer Lee 1 , Vincent Marconi 9 , Michael J. Silverberg 10 , Richard D. Moore 3 , Angela Parcesepe 11 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Columbia University, New York, NY, USA, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 Southern Alberta Clinic, Calgary, Canada, 6 Vanderbilt University, Nashville, TN, USA, 7 University of Washington, Seattle, WA, USA, 8 VA Connecticut Healthcare System, West Haven, CT, USA, 9 Emory University, Atlanta, GA, USA, 10 Kaiser Permanente Northern California, Oakland, CA, USA, 11 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: COVID-19 disrupted in-person HIV care across North America. We compared frequency and type of HIV care encounters and viral suppression among people with HIV (PWH) prior to, during, and after COVID-19 shutdowns in the largest cohort collaboration of PWH linked to care in the US and Canada. Methods: Adult (≥18yo) PWH in 13 NA-ACCORD clinical cohorts newly engaged or re-engaged (if absent since 1 Sept 2018) in HIV care (≥1 in-clinic or telemedicine [phone/video] visit, CD4 measure, or HIV RNA measure) during shutdowns (1 Mar 2020–31 May 2020) were compared with those in HIV care prior to the pandemic (1 Sept 2018–29 Feb 2020). Within each group, we described numbers of telemedicine visits and proportions of suppressed HIV RNA measures (<50 copies/mL) each month from Jan 2019-Dec 2021. Results: There were 34,722 PWH in HIV care prior to the pandemic, of whom 51% received care during shutdowns, and 11% did not return to care as of 31 Dec 2021. There were 568 newly engaged (n=323, 57%) or re-engaged (n=245, 43%) PWH during shutdowns. Compared with those in prior care, those who newly engaged or re-engaged in care during shutdowns were younger (median=40.7 [30.9-51.8] vs. 49.7 [38.5-57.6] years), more likely to be Black (41% vs 38%), and a greater proportion had not initiated ART (20% vs. 2%, all p-values <0.01). Among PWH in care prior to the pandemic, telemedicine visits increased, and viral suppression was >80% during (n=9,159 viral load measures [VLs]) and after (n=81,994 VLs) shutdowns (Figure). Among those engaging or re-engaging in care during shutdowns, in-person visits were more common than telemedicine; viral suppression was 42% in April (n=131 VLs) and >85% in August 2020 (n=80 VLs). Among those in prior care, viral suppression remained stable, median time between care encounters were similar before and after (1 Jun 2020–31 Dec 2021) shutdowns (116 [40-182] vs. 109 [41-182] days, p<0.05), as was time between HIV RNA measures (182 [122-223] vs. 163 [105-203] days, p<0.05). Conclusion: Among PWH newly engaged or re-engaging in care during the pandemic in the NA-ACCORD, >85% of HIV RNA measurements were suppressed 3 months after shutdowns ended. With the rapid scale-up of telemedicine, half of adults in HIV care prior to the pandemic connected to HIV care in March–May 2020, maintained a high proportion of viral suppression, and had similar frequency of HIV care encounters and viral load measures before and after shutdowns.

in-person services at outpatient medical facilities. The extent of recovery for services has not been widely described. Methods: We analyzed longitudinal cohort data from participants seen during 2019-2022 at eight HIV Outpatient Study (HOPS) sites. Generalized linear mixed models (GLMM) estimated all encounter, office, telemedicine visits, and HIV viral load (VL) monthly test rates, using 2010-2022 data. We examined demographic correlates of having detectable viral load before and during the pandemic using GLMM for logistic regression with 2017-2022 data. Results: Of 2351 active HOPS participants, 76.0% were male, 57.6% aged ≥ 50 years, 40.7% non-Hispanic White, 38.2% non-Hispanic Black, 17.3% Hispanic/ Latino, and 51.0% publicly insured. As of December 31, 2019, 71.2% had a CD4 cell count ≥500 cells/mm³, and 92.6% had a VL <200 copies/mL. There was a sharp decline of in-person visits per person-month from 0.40 in January 2020 to 0.11 in April 2020, followed by a rebound to pre-pandemic levels in 2021, before a drop again to below 0.25 per person-month in May 2022. Correspondingly, there was an increase in telemedicine visits per person-month from 0.001 in January 2020 to 0.16 in May 2020, before declining to near pre-pandemic levels in 2022 (Figure 1A). The average rate of in-person visits per person-month decreased from 0.32±0.03 (mean±std) during 2010-2019 to 0.24±0.08 in 2020. The average rate of telemedicine visits per person-month was near zero during 2010-2019 and increased to 0.07±0.05 during 2020. In multivariable logistic regression models, persons with missing encounters were more likely to be male or have VL ≥200 copies/mL. For participants with ≥1 viral load test, the prevalence rate of detectable HIV viral load during 2020-2022 was close to the rate from 2014-2019 (Figure 1B). The change in probability of viral suppression was not associated with participant's age, sex, race/ethnicity, or insu $$$ Conclusion: In the HOPS, there were immediate changes in visit type in response to the early COVID-19 pandemic followed by a return to previous patterns over the subsequent 2 years albeit with overall declines for in-person visits. There was a relative maintenance of viral suppression. Ongoing recovery from the impact of COVID-19 pandemic on ambulatory care will require continued efforts to improve access to medical services and care retention.

Poster Abstracts

1075 Variation in Viral Load Testing and Outcomes in Telehealth HIV Care During COVID-19 Valerie Yelverton 1 , Jan Ostermann 2 , Michael E. Yarrington 1 , Andrew K. Weinhold 3 , Nabil Natafgi 2 , Bankole Olatosi 2 , Sharon Weissman 2 , Nathan M. Thielman 1 1 Duke University School of Medicine, Durham, NC, USA, 2 University of South Carolina at Columbia, Columbia, SC, USA, 3 Duke University, Durham, NC, USA Background: To maintain HIV care continuity during the COVID-19 pandemic, most HIV care facilities across the United States adopted telehealth. However, research on the impact of telehealth use on HIV care outcomes is conflicting. This study assessed variation in viral load (VL) testing and outcomes related to

1074 Impact of COVID-19 Pandemic on HIV Ambulatory Services and Viremia in a US HIV Cohort, 2019-2022 Ellen M Tedaldi 1 , Qingjiang Hou 2 , Carl Armon 2 , Jonathan Mahnken 2 , Frank Palella 3 , Gina Simoncini 4 , Jack Fuhrer 5 , Cynthia Mayer 6 , Alexander C. Ewing 7 , Kalliope Chagaris 2 , Kimberly Carlson 2 , Jun Li 7 , Kate Buchacz 7 1 Temple University, Philadelphia, PA, USA, 2 Cerner Corp, Kansas City, MO, USA, 3 Northwestern University, Chicago, IL, USA, 4 AIDS Healthcare Foundation, Philadelphia, PA, USA, 5 State University of New York at Stonybrook, Stony Brook, NY, USA, 6 St Joseph's Comprehensive Research Institute, Tampa, FL, USA, 7 Centers for Disease Control and Prevention, Atlanta, GA, USA Background: In 2020, the SARS COV-2 pandemic caused an unprecedented strain on the spectrum of services for persons living with HIV, including

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