CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

intervention arms. Logistic regression was used to compare primary and secondary outcomes, controlling for site differences. Results: A total of 1328 participants enrolled, with 661 in the SNS arm and 667 in the SNS+messaging arm. Overall, participants identified as 39.8% Black (n=529), 32.4% Hispanic (n=430), and 51.3% (n=681) assigned female at birth. 41.6% (n=553) of participants reported criminal legal involvement prior to enrollment, with no differences between arms by sociodemographics. High numbers of participants were tested (66.3%) and unvaccinated participants vaccinated (11.9%) at three-week follow-up across both arms. Compared to the SNS arm, there were no differences between testing (OR 1.07, 95% CI 0.85, 1.34, p=0.20) or vaccination rates (OR 1.49, 95% CI 0.79, 2.81, p=0.48) among participants in the SNS+messaging arm. Conclusion: Adding educational material including testimonial videos and misinformation correction to the Social Network Strategy (SNS) did not increase testing or vaccination compared to the SNS alone. COVID-19 testing and vaccination rates at follow-up were high among community members in both arms of the SNS intervention. Additional work is needed to address COVID-19 misinformation and implement SNS to increase testing and vaccination rates among communities most impacted by COVID-19 in the United States. The figure, table, or graphic for this abstract has been removed. 1096 Targeting Key Populations With HIV Testing Services in Emergency Care in Nairobi, Kenya Joshua Smith-Sreen 1 , Beatrice Ngila 2 , John W. Maina 3 , Sankei Pirirei 3 , John Kinuthia 3 , David Bukusi 3 , Harriet Waweru 3 , Rose Bosire 4 , Daniel Ojuka 5 , David Katz 2 , Carey Farquhar 2 , Michael Mello 1 , Adam Aluisio 1 1 Brown University, Providence, RI, USA, 2 University of Washington, Seattle, WA, USA, 3 Kenyatta National Hospital, Nairobi, Kenya, 4 Kenya Medical Research Institute, Nairobi, Kenya, 5 University of Nairobi, Nairobi, Kenya Background: Persons seeking emergency injury care have high-risk profiles for HIV. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential of this venue to reach key populations (KPs) and vulnerable populations (VPs). This study assessed impacts of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in enhancing HTS delivery for high-risk ED patients. Methods: The HEATED program employed evidence-based behavior-change interventions to promote ED-HTS utilizing resource reorganization and sensitization on HIV care for KPs/VPs. KPs included commercial sex workers, gay men, men who have sex with men, transgender persons, and persons who inject drugs. VPs included persons 18-24 years , interpersonal violence victims, persons with hazardous alcohol use (HAU). Data were collected in pre-implementation (6 March-16 April 2023), post-implementation (1 May-26 June 2023), with a two-week implementation period. Data were obtained from a sample of enrolled patient participants with injuries and via standard HTS records. Chi-squared tests and risk ratios were computed with Wald confidence intervals. Results: Among 2,578 injury care encounters, 2,303 (89.3%) patients were screened, 605 (26.3%) met inclusion and were enrolled. Overall, 442 (73.1%) participants identified as a KP (7.7%) or VP (89.4%). Commercial sex workers accounted for 68.4% of KPs, and interpersonal violence victims 23.7% of VPs. HTS delivery per 100 patient encounters increased significantly among KP/ VP from pre- to post-implementation (RR=12.2; 95% CI: 7.50-19.68). Post implementation, HTS delivery was significantly greater among participants identifying as a KP/VP than other enrolled participants (p=0.03). Identification of persons living with HIV (PLHIV) increased non-significantly from pre implementation (n=26) to post-implementation (n=53) (RR=1.15; 0.73-1.87). 73% of these PLHIV were newly diagnosed, and new diagnoses increased non significantly across phases (RR=1.26; 0.72-2.12), in addition to linkage of new diagnoses to care (RR=1.10; 0.54-2.25). Conclusion: The HEATED program increased HTS delivery targeting KP/VP and enhanced identification and linkage of new HIV diagnoses, suggesting that broader implementation in Kenya ED settings could support service improvement for high-risk persons already in contact with health systems, who are integral to achieving HIV control targets.

1097 Method for Analyzing Cabotegravir and Rilpivirine in Hair May Help Identify Risk Factors for Failure Monica Gandhi , Alexander Louie, Matthew Spinelli, Jennifer Velloza, Catherine A. Koss, Andrew Riselli, Pieter Van Brantegem, Erica Beckerdite, Hana Rivera Garza, Karen Kuncze, Hideaki Okochi University of California San Francisco, San Francisco, CA, USA Background: Long-acting (LA) cabotegravir (CAB) and rilpivirine (RPV) is a promising approach to improve virologic suppression, including among those with adherence challenges. However, resistance can occur among virologic failures. Risk factors for virologic failure defined in the clinical trials include high body mass index (BMI) which can decrease CAB levels, low RPV troughs, HIV subtypes A1/A6 and RPV resistance mutations. Population pharmacokinetic (PK) models of CAB and RPV are sparse given limited real-world roll-out but may help define risk factors for low levels and failure. LA therapies may need long term metrics to define exposure as exemplified by hair levels. The UCSF Hair Analytical Laboratory (HAL) has experience in validating methods to analyze antiretrovirals in hair. Methods: For CAB and RPV, the two drugs were extracted from hair from a patient on LA CAB/RPV (approximately 2 mg) into a mixture of methanol and trifluoroacetic acid, which included stable isotopic internal standards. This extraction was carried out through overnight incubation at 37˚C. The sample was then evaporated to dryness and reconstituted for analysis via liquid chromatography/mass spectrometry (LC-MS/MS) using an Agilent Infinity II 1290 system coupled with a triple quadrupole mass spectrometer. To separate CAB and RPV, a gradient analysis was performed using a mobile phase composed of methanol, water, formic acid, and acetic acid over 100% methanol. A reverse phase column was used for the separation of CAB and RPV. Results: Detection of CAB, [13C, 2H2, 15N]-CAB, RPV, and RPV-d6 was achieved using multiple reaction monitoring. Intra-day precision ranged from 1.98% to 4.88% for CAB and 1.31% to 4.09% for RPV, and intra-day accuracy ranged from -9.44% to +10.8% for CAB and -15.0% to +6.92% for RPV. The quantitative linear dynamic standard curve range for CAB was determined to be 0.00625 to 3.20 nanograms (ng)/milligrams (mg) hair, while for RPV, the range was 0.0625 to 32.0 ng/mg hair. Conclusion: The UCSF HAL has developed and validated a method to analyze CAB and RPV in hair samples. The UCSF HIV Clinic (Ward 86) has ~250 patients on long-acting CAB/RPV with demographics typically assessed in population PK models (age, sex, BMI, etc.) available in the medical record. A research study to analyze CAB and RPV levels in hair and plasma, construct population PK models, and define risk factors for low LA CAB/RPV exposure, portending virologic failure, will be launched at Ward 86 using the hair method described here. The figure, table, or graphic for this abstract has been removed. 1098 Toward Near-Patient HIV Drug Level Feedback: Implementing an Enzymatic Assay on a Portable Reader Megan Chang, John Tatka, Cosette Craig, Shane Gilligan-Steinberg, Nuttada Panpradist, Barry Lutz, Ayokunle Olanrewaju University of Washington, Seattle, WA, USA Background: Tenofovir diphosphate (TFV-DP) is used in most HIV prevention and treatment regimens. TFV-DP levels in whole blood correlate with efficacy, and providing regular drug level feedback (DLF) leads to higher medication adherence and improves clinical care. However, the gold-standard for DLF, liquid chromatography tandem mass spectrometry (LC-MS/MS), is centralized to a few highly equipped laboratories, leading to long delays, high costs, and limited

Poster Abstracts

CROI 2024 355