CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Latin America had the highest mortality rate and the Central and Tropical Latin American region had the second-highest mortality rate in all three models (Figure). After adjusting for underreporting and age, the countries with the highest mortality rates were Bolivia, Peru, Ecuador, and Mexico. In multivariate regression analyses, GDP emerged as the only significant predictor of COVID-19 mortality. Conclusion: Countries in Andean Latin America consistently had the highest COVID-19 mortality rates, even after accounting for underreporting and age difference. Country-level differences were largely attributed to socioeconomic status, with lower- and middle-income countries having the highest rates of COVID-19 mortality in the Western Hemisphere.

visit type patterns among people living with HIV (PWH) receiving care from a large university-based clinic in North Carolina (NC) during the first year of the COVID-19 pandemic. Methods: Aggregated electronic health record (EHR) data from the Duke University Infectious Disease clinic in NC were extracted using Epic's SlicerDicer tool to assess bivariate differences between visit type patterns and VL testing history and outcomes. Visit type patterns were categorized as PWH who have used only in-person, a combination of in-person and telehealth, or only telehealth HIV care between March 16, 2020 and March 15, 2021. Nonparametric Pearson's chi-square (χ2) tests were used to assess variation in VL testing history and outcomes in 2022 (i.e., not having any VL test recorded in 2022, VL was suppressed at all tests in 2022 [<200 copies per ml blood], or at least one VL test was unsuppressed in 2022 [≥200 copies]) by visit type pattern. Results: EHR data from 1,835 PWH were included. Telehealth use steeply increased in the first months of the pandemic, surpassing in-person visits, and decreased thereafter, stabilizing approximately one year after the beginning of the pandemic with <3% of PWH receiving telehealth per month. Between March 16, 2020 and March 15, 2021, 970 PWH used in-person HIV care only, 583 used telehealth and in-person HIV care, 282 used telehealth only. χ2 tests indicated that telehealth only users were more likely to not have any VL test recorded in 2022 as compared to PWH using in-person only or a combination of in-person and telehealth HIV care (p<0.001; Table 1). The proportion of PWH having at least one VL test ≥200 was similar regardless of visit type use. Conclusion: This study's results indicate that VL outcomes among telehealth users who have VL testing results documented in EHR one year later may not be inferior as compared to exclusive in-person HIV care users. However, VL testing uptake is lower among telehealth only users. As VL testing is crucial to monitor treatment success, strategies such as remote VL testing at home or a local lab are needed to ensure regular VL testing among PWH who use telehealth HIV care. 1076 Differences in Country-Level COVID-19 Mortality Across the Western Hemisphere Katie Kerckaert 1 , Adina Z. Zhang 2 , Serena Koenig 3 , Pierre Cremieux 2 , Vanessa Rouzier 4 1 University of Toronto, Toronto, Canada, 2 Analysis Group, Inc, Boston, MA, USA, 3 Harvard Medical School, Boston, MA, USA, 4 GHESKIO, Port-au-Prince, Haiti Background: Country-level differences in reported COVID mortality rates and their risk factors have been studied in some regions, however, country and region-level variations in COVID-19 mortality rates within the Western Hemisphere are not well understood. Methods: Using data reported from each country's health ministry, we examined COVID-19 mortality rates across countries and regions in the Western Hemisphere starting from the first reported death to 12/31/2021. We adjusted for underreporting using three models developed by the Institute for Health Metrics and Evaluation (IHME), the World Health Organization (WHO), and the Economist. Age-adjusted analysis was performed to control for the association between COVID-19 mortality and older age. To account for additional country level variations in mortality rates, we collected publicly available data on underlying medical conditions associated with higher risk for severe COVID-19 (identified by the Centers for Disease Control), as well as demographic and socioeconomic factors. Univariate and multivariate analyses were conducted to evaluate associations between each risk factor and adjusted COVID-19 mortality. Results: The annualized reported COVID-19 mortality rate was 131.3/100,000 people in the Western Hemisphere, ranging from 31.4/100,000 in the Caribbean to 227.7/100,000 in Andean Latin America. Country-level mortality rates ranged from 1.8/100,000 (Nicaragua), 3.8/100,000 (Haiti), and 10.2 (Venezuela); to 142.4 (Argentina), 160.1 (Brazil), and 340.2 (Peru). After adjusting for underreporting, mortality rates increased between 20% and 64% depending on the model used, with the Caribbean having the lowest rates and Andean Latin America the highest. With adjustment for underreporting and age, Andean

1077 What’s in a Wave: Using COVID-19 Data to Explore the Definition of Epidemic Waves Joshua Smith-Sreen , Jorge Ledesma, Mark Lurie Brown University, Providence, RI, USA Background: Objectively defining and classifying epidemic or pandemic waves is critical in providing opportunities for timely resource allocation. However, there is no consensus about what composes a pandemic wave despite proposed definitions in the literature. This analysis aimed to identify, apply and characterize wave definition approaches using COVID-19 case data to build towards standardized definitions for improving pandemic preparedness and response. Methods: We obtained daily United States (US) case data from February 2020 to March 2022 from the Johns Hopkins COVID-19 data repository. We identified three major definitions of epidemic waves by scoping review. The "eR approach" defined waves as periods where the effective reproduction number (eR) was greater than 1 for at least 14 days. The "fold approach" defined waves as periods where the weekly case rate increased by at least one-fold followed by a decrease by at least one-fold. The "threshold approach" defined waves as periods where the weekly case rate per 100,000 population surpassed 49.99, the US CDC threshold for moderate community transmission. We then compared wave characteristics across definitions. Results: The eR approach generated 5 waves with an average length of time between waves of 79 (IQR 47–90) days and average wave duration of 65 (56–73) days. The fold approach generated 10 waves with 25 (7–44) days between waves and average wave duration of 47 (29–54) days. The threshold method produced 2 waves with 62 days between the two waves and average wave duration of 276 (251–301) days. The in-wave average daily case rates per 100,000 population were 24.2 (95% CI 20.9–28.1), 19.7 (17.2–22.5), and 30.4 (28.6–32.3) for the eR approach, fold approach, and threshold approach, respectively. Conclusion: This analysis provides novel characterization of various approaches to epidemic wave definition. The fold approach produced the greatest number of waves, likely due to its sensitivity to weekly changes in case rates. The threshold approach produced the highest in-wave average case rate and lowest between-wave average case rate, indicating it may not adequately capture periods of inflection. These findings have public health implications, as overestimating waves may trigger preemptive allocation of limited health resources, and underestimating may result in a reactionary response with poor targeting of treatment and prevention. Further application of the definitions

Poster Abstracts

across countries and diseases are needed to build towards consensus. The figure, table, or graphic for this abstract has been removed.

CROI 2024 348