CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: this study demonstrates the benefits of POCT vs. standard protocol, reducing by more than 60% the time between confirmed diagnosis and initiation of ART. There are still opportunities for improvement because an immediate start of ART for patients from the POCT could have happened if there were no additional administrative hurdles, such as a low opportunity for a timely doctor's appointment 1088 Targeted Outreach to Increase Linkage to Preventative Services for Patients Tested for Mpox Hannah Blanchard 1 , Helen King 1 , Kristin Alvarez 2 , Ank Nijhawan 1 , Virali Soni 2 1 University of Texas Southwestern, Dallas, TX, USA, 2 Parkland Health and Hospital Systems, Dallas, TX, USA Background: Early in the Mpox outbreak, patients presenting for Mpox testing often did not receive comprehensive sexually transmitted infection (STI) screening upon presentation. Increased coordination of care for linkage to comprehensive preventive services such as HIV pre-exposure prophylaxis (PrEP) and other STI screening is critical to improving both individual and public health outcomes. We hypothesized that targeted outreach to those tested for Mpox would increase rates of PrEP counselling and follow-up STI screening. Methods: A retrospective chart review was conducted of individuals tested for Mpox between June 2022 and March 2023 at a large county health system in Dallas, Texas. This study assessed the impact of targeted outreach to Mpox tested persons to promote comprehensive HIV and STI testing and linkage to preventive care services like PrEP. Chi-square (χ²) test was used for categorical variable analysis. Results: A total of 414 individuals were tested for Mpox with 203 PCR confirmed cases. At the time of Mpox testing, 238/414 (57.6%) individuals were previously diagnosed with HIV. An additional 76/176 (43.2%) were screened for HIV, and six new cases of HIV were identified at the time of Mpox testing. Thirty-three percent (136/414) of patients were tested for other STIs (chlamydia, gonorrhea, or syphilis) at the same time as Mpox testing with 45 new cases of STIs identified. As part of targeted outreach following the initial presentation for Mpox testing, 94/414 (23%) individuals were contacted. Patients who were eligible for HIV screening that received targeted outreach were more likely to be tested for HIV (10/26 [38.4%]) compared with those who did not receive additional outreach (19/144 [13.3%]) (p<0.001). More individuals eligible for PrEP in the outreach group were counselled on starting PrEP than in the non outreach group, (14/26 [53.8%] vs 8/144 [5.6%]) (p=0.0016). Similarly, more individuals that received outreach underwent additional STI testing compared to those without outreach (58/94 [62%] vs. 109/320 [34%]) (p<0.001). Conclusion: Targeted outreach increased screening for HIV and other STIs and counselling for PrEP among patients presenting for Mpox testing. Strategies to increase and standardize linkage to comprehensive preventive services are needed to reduce co-infections of Mpox, HIV and other STIs, and promote public health. 1089 Detection of Diverse HIV Strains by the m-PIMA™ HIV-1/2 Detect Point-of-Care Assay Mark C Anderson , Lara I. Teodoro, Fiona Harley, Eduardo Almaraz, Carolyn Strobel, Barbara Harris, Todd V. Meyer, Mary Rodgers, Gavin Cloherty Abbott Labs, Abbott Park, IL, USA Background: HIV displays exceptionally high virus diversity that can impact detection by diagnostic assays which fundamentally rely on sequence conservation. Therefore, it is important to confirm their performance on the breadth of known HIV strains. We tested the m-PIMA™ HIV-1/2 Detect point-of care (POC) assay against a diverse HIV panel consisting of group M and N, group O, Circulating Recombinant Forms (CRF), Unique Recombinant Forms (URF), and HIV-2. In silico inclusivity analysis of HIV-1 and HIV-2 sequences from NCBI was performed to predict m-PIMA detection to an even broader range of circulating strains. Methods: m-PIMA™ HIV-1/2 Detect (Abbott Rapid Diagnostics Jena GmbH, Germany) was performed according to the manufacturer instructions. Serum from HIV patients or virus cultures with known viral load (VL) and classified sequences were tested. The panel (n=274) consisted of HIV-1 subtypes A (n=11), B (n=19), C (n=25), D (n=13), F (n=9), F1 (n=2), G (n=5), H (n=5), J (n=3), K Basal (n=2), L (n=1), group N (n=2), group O (n=16), CRF01 (n=6), CRF02 (n=13), CRF06 (n=7), CRF09 (n=4), CRF11 (n=8), CRF13 (n=4), CRF14 (n=1), CRF22 (n=1), CRF36 (n=2), CRF37 (n=2), CRF43 (n=2), HIV-1 URFs (n=106), and HIV-2 (n=5). For in silico inclusivity, 1,107,963 HIV-1 and 7,289 HIV-2 NCBI

1086 HIV Testing Pre- and Post-COVID-19 Pandemic Among Persons Who Inject Drugs: 19 Cities, 2018-2022 Rebecca B Hershow , Dita Broz, Lyssa Faucher, Johanna Chapin-Bardales, for the National HIV Behavioral Surveillance Study Group Centers for Disease Control and Prevention, Atlanta, GA, USA Background: HIV testing decreased since the onset of the COVID-19 pandemic among persons who inject drugs (PWID). There is limited understanding of how changes in HIV testing pre- and post-pandemic affected different sub-groups of PWID. Using data from CDC's National HIV Behavioral Surveillance (NHBS) from 2018 and 2022, we assessed changes in past-year HIV testing among PWID by sociodemographic and health care characteristics. Results from this analysis will help inform efforts to improve HIV testing uptake among PWID in response to service gaps identified during the COVID-19 pandemic. Methods: In 2018 and 2022, NHBS conducted biobehavioral surveys among PWID using respondent-driven sampling (RDS). Using log-linked Poisson regression models clustered on recruitment chain and adjusted for city and network size to account for RDS, we estimated the change in prevalence of past year HIV testing between 2018 and 2022 overall and by sociodemographic and health care characteristics. Analyses were conducted among participants who did not self-report HIV-positive. Results: Of participants (n=9,211 in 2018; n=6,162 in 2022), past-year HIV testing decreased from 55.1% in 2018 to 45.3% in 2022 (adjusted prevalence ratio: 0.84; 95% confidence interval: 0.80, 0.89). HIV testing prevalence significantly decreased over time across nearly all sub-groups of PWID, with large decreases among participants aged 18-29 years, participants living in the Midwest and West, and those who experienced homelessness, were incarcerated, or did not visit a health care provider in the past year (Table). There were also significant declines among participants accessing health care and prevention services, including those who visited a health care provider, used a syringe services program, and participated in drug treatment in the past year. Conclusion: Decreases in HIV testing during the COVID-19 pandemic were observed for most sub-groups of PWID, although there were regional variations. There were decreases in HIV testing among PWID accessing and not accessing medical and harm reduction services, suggesting efforts are needed to better engage PWID, especially young PWID and PWID experiencing homelessness, in services and ensure those services are resourced to offer routine HIV testing. Integrating HIV testing across medical and harm reduction services accessed by PWID and expanding community-based HIV prevention efforts might improve HIV testing uptake among PWID. The figure, table, or graphic for this abstract has been removed. 1087 Rapid Diagnosis of HIV Infection and Initiation of Antiretroviral Treatment Monica Mantilla Suarez 1 , Leonardo Arevalo 1 , Hector Mueses 2 1 Virrey Solís IPS, Bogota, Colombia, 2 Corporación de Lucha Contra el Sida, Santiago de Cali, Colombia Background: In Colombia, 39% of HIV infections are identified at stage 3, and the mean delay for starting antiretroviral treatment (ART) is 35 days after confirmed diagnosis. It is well known that once a diagnosis is established, the sooner ART is initiated, the highest the benefits in terms of therapeutic goals and reduction of transmission. There are several barriers to getting tested in real life: Medical prescription, informed consent might be requested, and administrative burden, among others. A potential solution could be a point of care test (POCT), which has been only implemented for pregnant women and in some community centers. Methods: An open-label randomized clinical trial was initiated comparing a group who received POCT vs. standard diagnostic protocol in a Medellin (CO) clinic. Patients with an HIV test order were randomized via telephone to receive POTC or standard diagnostic protocol. POCT included HIV screening and other tests (Syphilis, Hepatitis B, Hepatitis C, CD4 count and HIV viral load). Recruitment stopped when 50 diagnoses of HIV have been done in the POCT arm. Results: From Jan 31, 2022, and Jan 31 2023, from a universe of 17.859 HIV tests, 327 new infections were detected. Fifty patients were identified via POCT (per protocol) and 277 with the standard diagnostic approach. The time from test order to sampling was <48h in 95% of POCT vs. 15% in standard protocol (p<0.05). 100% of patients with POCT got a viral load measured in <8 days after the first positive test vs. 0% in the standard protocol. The mean time to initiation of ART after the first diagnostic test was 20 days in POCT vs. 52 days in standard protocol (p<0.05).

Poster Abstracts

CROI 2024 352