CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1180 Ending the HIV Epidemic in Atlanta: A Mixed-Methods Study to Support the Local HIV/AIDS Response Micah Piske 1 , Bohdan Nosyk 2 , Justin C. Smith 3 , Bianca Yeung 1 , Benjamin Enns 1 , Xiao Zang 4 , Patrick S. Sullivan 5 , Wendy S. Armstrong 5 , Melanie Thompson 6 , Gaea Daniel 5 , Carlos del Rio 5 1 University of British Columbia, Vancouver, Canada, 2 Simon Fraser University, Burnaby, Canada, 3 Positive Impact Health Centers, Atlanta, GA, USA, 4 University of Minnesota, Minneapolis, MN, USA, 5 Emory University, Atlanta, GA, USA, 6 Thacker, Thompson and Bernard, MD, Atlanta, GA, USA Background: Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US 'Ending the HIV Epidemic' (EHE) initiative which aims for 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local epidemiology, service availability, and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to assess geographic HIV epidemiology and distribution of services, service needs, and organization infrastructure to implement or expand services for each pillar of the EHE initiative. Methods: We collected 2021 county-level data from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure (PrEP) locations), and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression, and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess availability of services, unmet needs, and organization infrastructure during June to December 2022. The Organizational Readiness for Implementing Change (ORIC) questionnaire assessed organization climate for services in need of scale-up or implementation. Results: We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA - particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton, and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (N=48; 52% care providers, 42% other health agency staff, 10% people living with HIV) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support, and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma. Conclusion: Service delivery across all EHE pillars must substantially expand to reach national goals for metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery with community input can inform equitable strategies for local EHE efforts.

Conclusion: Our results reveal evolving trends in rapid ART initiation in South Africa, underscoring the importance of ongoing efforts to ensure timely ART initiation for all individuals living with HIV.

1179 Routine Collection of Patient-Reported Outcomes in HIV Clinics: Findings After >100,000 Assessments Mindy Dai 1 , Lydia N. Drumright 1 , Rob Fredericksen 1 , Joseph A. Delaney 1 , L. Sarah Mixson 1 , Bridget Whitney 1 , William B. Lober 1 , Mari Kitahata 1 , Kenneth H. Mayer 2 , Jeffrey Jacobson 3 , Edward Cachay 4 , Laura Bamford 5 , Katerina Christopoulos 6 , Heidi M. Crane 1 1 University of Washington, Seattle, WA, USA, 2 Fenway Health, Boston, MA, USA, 3 Case Western Reserve University, Cleveland, OH, USA, 4 University of California San Diego, San Diego, CA, USA, 5 University of California San Diego, La Jolla, CA, USA, 6 University of California San Francisco, San Francisco, CA, USA Background: Patient-reported measures and outcomes (PROs) provide important information to improve clinical care and facilitate clinical research. Technological advances have decreased PRO collection barriers. We integrated routine PRO collection into a network of busy, multi-provider, outpatient HIV clinics. Here we describe notable findings among people with HIV (PWH) in care across the US. Methods: PWH presenting for HIV care at 8 geographically diverse sites in the CFAR Network of Integrated Clinical Systems (CNICS) were asked to complete a touch-screen-based assessment at routine clinic visits every 3-6 months using a web-based application. Assessments are available in English, Spanish, Amharic, Haitian Creole, and Brazilian Portuguese. The length and number of instruments are optimized based on prior responses, skip patterns, time since last PRO, and other factors. The assessment includes instruments validated in PWH measuring antiretroviral medication adherence, depression, anxiety, drug/alcohol use, quality of life, symptom burden, HIV stigma, social support, sexual risk behavior, intimate partner violence (IPV), and other clinically relevant domains. Results: 20,600 PWH have completed 116,895 unique PRO assessments. Mean age of PWH at first assessment was 44 (range 18-93), 17% were female, and over half (57%) were non-White. 41% of PWH endorsed moderate-severe depression symptoms at least once, and 22% endorsed moderate-severe depression symptoms on their most recent PRO. Over 1/3 of PWH reported currently smoking and ~1/3 reported binge alcohol use within the prior year. Additionally, 71% of PWH endorsed ever using illicit drugs, while 18% reported past 3-month use of cocaine/crack, methamphetamines, and/or illicit opioids. 18% reported concern about a sexually transmitted infection, and 11% reported experiencing past year IPV. In addition to facilitating clinical care, the PRO data have also been used in >80 research papers to date to improve care beyond CNICS sites. Conclusion: We identified a high prevalence of depression, anxiety, substance use, and IPV – all important domains to facilitate ending the HIV epidemic and improve clinical outcomes. Many of these behavioral health challenges are not measurable by physical exam or laboratory testing and may not be elicited by providers during routine visits without PROs. Collection of PROs is feasible and generates important information to enhance clinical care as well as data to address research questions on clinically important topics. The figure, table, or graphic for this abstract has been removed.

Poster Abstracts

1181 Barriers of Early Enrollment and Rapid ART Initiation Among US HIV Care Facilities Jesse G O'Shea 1 , Xin A. Yuan 2 , Jen-Feng Lu 2 , Kate Buchacz 1 , Kashif Iqbal 1 , Marie E. Johnston 1 , Linda Beer 1 , John Weiser 1 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 DLH Corporation, Atlanta, GA, USA Background: Rapid linkage to HIV care and antiretroviral therapy (ART) initiation is now the standard of care for treating people with HIV (PWH). Understanding and intervening on barriers to rapid enrollment and ART initiation are needed to meet the goals of the Ending the HIV Epidemic in the U.S. initiative. Methods: We analyzed 2021 data from the Medical Monitoring Project on characteristics of 514 facilities providing care to a national probability sample

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