CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1176 Forced Vaginal Sex Is Associated With Genital Immune Changes That May Increase HIV Susceptibility James Pollock 1 , Mary Kung'u 2 , Sanja Huibner 1 , Rhoda Kabuti 2 , Hellen Babu 2 , Erastus Irungu 2 , Pauline Ngurukiri 2 , Helen Weiss 3 , Janet Seeley 3 , Tanya Abramsky 3 , Joshua Kimani 2 , Tara Beattie 3 , Rupert Kaul 1 , for the Maisha Fiti Study Champions 1 University of Toronto, Toronto, Canada, 2 Partners For Health and Development, Nairobi, Kenya, 3 London School of Hygiene & Tropical Medicine, London, United Kingdom Background: HIV risk is increased among women exposed to forced vaginal sex, both in the short- and long-term. While the epidemiological pathways between forced sex and HIV infection have been previously explored, genital inflammation is a key biological determinant of HIV susceptibility that has not been well-investigated in the context of forced sex. Here we define the impact of recent forced vaginal sex on cervicovaginal inflammation and epithelial barrier disruption as potential biological mediators of HIV risk. Methods: This study was nested within the longitudinal Maisha Fiti cohort study, which investigates violence and HIV susceptibility among female sex workers (FSWs) in Nairobi, Kenya. Levels of proinflammatory cytokines and soluble E-cadherin (sE-cad), a novel biomarker of epithelial barrier disruption, were measured in self-collected cervicovaginal secretion samples from 746 HIV uninfected Maisha Fiti participants using a multiplex electrochemiluminescent immunoassay (Meso Scale Discovery, MSD). Sociodemographic factors were compared between participants who were physically forced to have sex in the 7 days preceding the study visit and those not recently exposed to forced sex using chi-square tests and Welch's t-tests. Genital inflammation was defined using a composite score of inflammatory cytokines (IL-1α, IL-1ß, IL-6, IL-8, IP-10, MCP-1, MIP-1α, MIP-1ß, TNFα) that has been previously associated with HIV acquisition. The presence of inflammation was compared between groups using mixed-effects logistic regression models to control for potential confounders. Results: 44 (6%) of 746 participants reported recent forced sex exposure at the baseline visit, and 42 of these 44 women continued to have sex with other clients during this time (median = 4). Poverty (p = 0.02), adverse childhood experiences (p < 0.001), and mental health issues (depression, anxiety, or PTSD; p < 0.001) were strongly associated with recent forced sex exposure. Recent forced sex was associated with increased genital inflammation (aOR = 2.74; 95% CI: 1.33 – 5.68; p < 0.01) independent of previously-defined biological confounders. There was no evidence that sE-cad concentrations differed by recent forced sex exposure (p = 0.56). Conclusion: Cervicovaginal inflammation is increased for at least a week in FSWs exposed to recent forced vaginal sex. This has important implications for HIV prevention programs that provide care to women who are experiencing gender-based violence and survival sex. 1177 Charting Achievable Milestones for HIV Care Enhancement and Prevention in the US Through 2035 Melissa Schnure 1 , Parastu Kasaie 2 , David Dowdy 2 , Maunank Shah 1 , Emily Kendall 1 , Anthony Fojo 1 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: Despite recent progress in reducing HIV infections, many cities in the US are not on track to reach the ambitious targets set by the Ending the HIV Epidemic initiative. We sought to identify attainable ten-year goals for the US HIV epidemic through improved pre-exposure prophylaxis (PrEP) programming and efforts to strengthen the HIV cascade of care. Methods: We adapted the Johns Hopkins Epidemiological and Economic Model, a dynamic model of HIV epidemics in US cities, to quantify the impact of improved PrEP coverage, linkage to HIV care, retention, and viral suppression among key risk groups across 18 metropolitan statistical areas (MSAs) in the US. Interventions were scaled up from 2025-2035 in three groups: young (age <35) Black and Hispanic men who have sex with men (MSM); all MSM and persons who inject drugs (PWID); and the full city population. Our primary outcome was the average projected reduction in HIV incidence across modeled MSAs from 2025 to 2035. Results: Assuming continuation of current trends in HIV transmission and care, HIV incidence was projected by fall by 20% on average across all MSAs (ranging from 14% in Dallas and Los Angeles to 46% in Detroit). Combined improvements to PrEP coverage, linkage, retention, and viral suppression provided an additional 47% reduction, resulting in an average total incidence reduction of 67% (ranging from 60% in Miami to 78% in Detroit). Among interventions

considered, expansion of PrEP coverage and increasing retention in care had the greatest individual impact: averaged across all MSAs, HIV incidence was projected to fall by 49% if PrEP were scaled up to 25% of the eligible city population, and by 39% if retention in HIV care were increased to 95%. Some cites (such as Los Angeles) benefited more from improvements in PrEP coverage, while others (such as Baltimore) benefited more from increased retention. The impact of expanding interventions to different populations also varied. In Atlanta, 51% of the maximum added benefit of the combined intervention came from targeting only young Black and Hispanic MSM. By contrast, in San Francisco, 64% of the maximum added benefit resulted from expansion from this group to include all MSM and all PWID. Conclusion: This analysis provides information to local decision-makers as they seek to identify the combinations of interventions and risk groups that will maximize impact with limited resources in their cities, ultimately helping chart a strategic roadmap to the US HIV policy through 2035.

Poster Abstracts

1178 Evolving Trends in Early ART Initiation in South Africa: An Analysis of Integrated HIV Program Data Dorina Onoya 1 , Khumbo Shumba 1 , Cornelius Nattey 1 , Dickman Gareta 2 , Evelyn Lauren 3 , William MacLeod 3 , Koleka Mlisana 4 , Jacob Bor 3 , Matthew P. Fox 3 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 Africa Health Research Institute, Mtubatuba, South Africa, 3 Boston University, Boston, MA, USA, 4 National Health Laboratory Service, Johannesburg, South Africa Background:South Africa (SA) has progressively improved HIV treatment guidelines to ensure rapid and sustained viral suppression. We describe the trends of the time between HIV diagnosis and the initiation of antiretroviral therapy (ART) for patients entering HIV care between 2010 and 2017. Methods: We conducted a prospective cohort study, utilizing integrated data from the clinic-based Three Integrated Electronic Registers (TIER.net) and the National Health Laboratory Service (NHLS) databases across four SA provinces (KwaZulu Natal, Mpumalanga, Limpopo and North West). The study population consisted of individuals diagnosed with HIV, entering in care between January 2010 and September 2017. Entry into care date was defined as either the first CD4 date from the NHLS data or the HIV diagnosis date from the TIER data. The time from entry to ART initiation (date of ART start noted in TIER data) was classified as same-day (HIV diagnosis date), 2-6 days, 7-89 days, and ≥90 days after entry into care. A trend analysis of the number of patients and proportions initiated by these subgroups was compared over time. Results: Among the 1,319,239 individuals with linked NHLS and TIER data, entering care within the study period, 1,316,410 had started ART. Most were female (69.5%), with a median age of 31 years (Interquartile Range(IQR): 24-39). The number of patients starting ART decreased over time but the median CD4 at entry increased from 298 cells/μl (IQR: 171-463) in 2010 to 321 cells/ μl (IQR: 173-500) in 2017. In the early stages of the epidemic, the majority of HIV patients initiated >90 days after entering HIV care, but by the end of the study period this was less than 10.0%. The percentage of patients starting ART ≥90 days after diagnosis decreased from 57.3% for 2010-2011 to 11.4% in 2016-2017. Conversely, same- day ART increased from 17.4% (2010-2011) to 36.0% (2016-2017). The percentage of patients initiated between 2-6 days post-diagnosis showed an upward trend, from 1.2% in 2010-2011 to 12.0% in 2016-2017. Additionally, the percentage of patients initiated within 7 to 89 days varied, starting at 24.1% in 2010-2011, increasing to 42.6% in 2012-2013 but then decreased to 12.0% in 2016-2017. Consistent trends were observed across provinces.

CROI 2024 384