CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

procured up to September). Non-DTG treatments decreased from over 390,000 treatments in 2018 to 97,000 in 2022 and 57,880 by September 2023. In addition, the annual unit prices of DTG-based treatments decreased by 40% since 2018 (from 69 USD to 37.45 USD a year), while non-DTG regimens increased by 15% in the same period (from 75.72 USD to 86.76 USD a year). The acquisition of treatment was inversely associated with the cost (r 0.925). For pediatrics, dispersable pDTG 10mg was introduced in 2021 and continued to increase from 16% to 54% by September 2023. The use of pDTG represented a 90% price reduction compared to other regimens (53 USD a year compared to 549 USD a year). Conclusion: SF and PAHO technical cooperation increased the access to generic DTG-based ART for adults and children in Latin America and the Caribbean. The transition to DTG represented significant savings due to the lower price of DTG compared to non-DTG regimens, in particular for children, which was a strong incentive for transitioning to more effective and safer treatments in the Region.

of U.S. PWH. Facility data on number of business days to offer new patients an appointment, availability of, and barriers to, rapid intake and ART initiation and Ryan White HIV/AIDS Program (RWHAP) funding were collected. Weighted percentages with 95% confidence intervals of characteristics were reported by barriers, days to appointments, and by RWHAP funding. We assessed significant (p<0.05) differences among facilities using Rao-Scott chi-squared tests. Results: Overall, 20%, 48%, and 32% of HIV facilities could routinely offer a first appointment in <1, 2-9, and ≥10 business days, respectively (median 5 business days). Insufficient provider capacity (56%), patient preference (50%), and patient lacking required documents (19%) were the most reported barriers to offering new patient appointments (Figure). The prevalence of insufficient provider capacity as a barrier to offering an appointment within <1 day was significantly higher for non-RWHAP-funded facilities than funded facilities (62% vs. 48%, p=0.0048). The most reported documents required for scheduling the first appointment were positive HIV antibody or detectable viral load (52%), government-issued identification (36%), proof of residence (24%), proof of income (22%); percentages increased as days to offer an appointment increased and were significantly higher in RWHAP-funded than non-funded facilities (all p-values < 0.05). Most facilities (73%) were routinely able to obtain a 30-day supply of ART during the first HIV care provider visit. The most reported barriers to obtaining a 30-day supply of ART at the first HIV care provider visit included unavailable test results (56%), delays in getting medication paid for (49%), unavailable starter packs (36%), cannot afford copayment (31%), and patient preference (29%). Conclusion: Structural, personal, or provider-related barriers may delay rapid clinic enrollment or ART initiation. HIV care programs can benefit from removing barriers to care, easing requirements for clinical enrollment and ART prescriptions, and improving patient readiness.

1183 Evaluating Barriers to Care Among Adults With HIV Who Are Virally Unsuppressed in Philadelphia

Ngwi Tayong , Tanner Nassau, Kathleen Brady Philadelphia Department of Public Health, Philadelphia, PA, USA

Poster Abstracts

Background: Barriers to HIV care lead to decreased access to and engagement in care resulting in lower rates of viral suppression, and in turn delays in progress towards Ending the HIV Epidemic (EHE). We sought to assess the proportion of virally unsuppressed individuals whose detectable viral load can be attributed to identified barriers of HIV care. Methods: We used weighted data from the 2015-2021 cycles of the Medical Monitoring Project (MMP) among residents of Philadelphia, Pennsylvania. Weighted frequencies for barriers to care were calculated overall and by viral suppression status. We used generalized linear regression models to calculate the prevalence ratios for each barrier, adjusted for age and gender. We calculated the population attributable fraction (PAF) for the proportion of virally detectable PWH who could have become virally suppressed had they not experienced that specific barrier to HIV care. All relative risks and PAFs were stratified by race/ethnicity. Results: There were an estimated 7,541 individuals with a detectable viral load (>200 copies/ml) in Philadelphia included in analyses. Being busy with personal things, like family or work and difficulty getting to care, was the most commonly reported barrier to HIV care among individuals with a detectable viral load (30.1%), followed by mental health (21.7.5%), feeling well (17.2%), and problems with money or health insurance (11.8%) .The PAF of financial barriers on detectable viral load was highest among non-Hispanic Whites (8.3%), with non-Hispanic Black and Latine having similar PAFs. The PAF of mental health on detectable viral load was highest among non-Hispanic Blacks (5.8%), with non Hispanic White and Latine having similar PAFs. Non-Hispanic Black and Latine had similar PAFs of personal reasons on detectable viral load, but there was an inverse association between the barrier of personal reasons and detectable viral load among non-Hispanic Whites. Conclusion: No single barrier to HIV care accounts for the plurality of individuals with a detectable viral load. System-level implementation strategies for increasing viral suppression will need to be tailored to specific populations with a health equity lens. Better access to mental health services and supportive services for retention in care may be the best strategies for increasing viral suppression among racial/ethnic minorities. Future research should assess the PAF of barriers in combination to optimize service delivery.

1182 Strategic Advice and Expert Procurement Accelerates the Optimization to DTG in the Americas Omar M Sued , Nora Giron, Kemel Hallar, Monica Alonso, Ruben Mayorga, Christopher Lim Pan American Health Organization, Washington, DC, USA Background: The WHO guidelines recommend dolutegravir (DTG) as the preferred anchor drug for first-line ART, as for second-line ART after a NNRTI failure. DTG has a higher resistance barrier and efficacy, fewer side effects, and a safer profile than other options. The transition to DTG increases viral suppression and ART durability. The Strategic Fund (SF) of the Pan American Health Organization (PAHO) is a technical cooperation mechanism for pooled procurement of essential medicines and health supplies that meet international standards. PAHO provides technical assistance to countries on rational selection and use of medicines and health technologies, demand planning, and strengthening of supply management systems. Here we describe our experience supporting countries to access DTG for adults and children Methods: Quantitative, descriptive analysis of purchase orders from Latin American and Caribbean countries between January 2018 to September 2023. All products containing DTG were included in the analysis. For comparison, we included all NNRTIs, PIs, and other integrase inhibitors, but excluded NRTI drugs to avoid duplication. We calculated the average annual cost of treatment per unit procured, weighted by the number of units procured. Correlations were calculated using the Pearson coefficient (r). Results: Adult DTG-based treatments procurement increased from 13% in 2018 (58,135 annual treatments) to 81% in 2023 (240,282 annual treatments

CROI 2024 386