CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1187 Met and Unmet Health and Welfare Services Needs Amongst People With HIV in the UK Anne Williamson 1 , Fiona Lampe 2 , Adamma Aghaizu 3 , Annegret Pelchen Matthews, 2 , Alex Sparrowhawk 4 , Janey Sewell 2 , Clare Humphreys 3 , Alison Rodger 2 , Meaghan Kall 3 , Colette Smith 2 , for the PV2022 Study Group 1 Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom, 2 University College London, London, United Kingdom, 3 UK Health Security Agency, London, United Kingdom, 4 Terrence Higgins Trust, London, United Kingdom Background: Despite accessible and effective HIV treatment, the health and wellbeing of many people with HIV (PWH) is negatively impacted by social and economic disadvantage and unmet need for services. We assessed unmet health and welfare services needs in a large UK survey. Methods: Positive Voices 2022 is the largest survey of PWH accessing care in the UK. Participants completed a questionnaire on demographics, socioeconomic status (money to meet basic needs), health and lifestyle factors, met and unmet needs, and sexual behaviour. We analysed factors associated with increased need for services, defined as follows: (i) Mental health/drug services: psychological/stress support, alcohol/drug counselling, chemsex/ drug detox; (ii) Physical health: weight management, sex life support, smoking cessation, family planning, home services; (iii) Welfare: housing, meal services, employment/benefits/financial advice, legal/immigration support. We conducted multivariable logistic regressions to quantify odds of reporting any need, and the odds of any unmet need amongst those with need. Each model was adjusted for age, demographics, time since HIV diagnosis, and other covariates if significant in unadjusted analysis (Table 1). Results: 4620 people participated; 2464 (53%) gay, bisexual and other men who have sex with men (GBMSM), 911 (20%) heterosexual women, 585 (13%) heterosexual men; 1117 (24%) were of Black ethnicity; median (IQR) age of 52 years (43-60). 1617 reported any mental health/drug service need, of whom 1066 (65.9%) had unmet need; 1879 any physical health need, of whom 1290 (68.7%) had unmet need; and 1454 any welfare need, of whom 1008 (69.3%) had unmet need. Table 1 shows all results. Need and unmet need were highest for younger people, except for unmet mental health need. Mental health need and unmet physical health need were higher for GBMSM, whilst physical health and welfare service needs were higher amongst Black African respondents. Lack of money to meet basic needs was associated with both mental and physical health needs, with mental health needs not met. Having depressive symptoms was associated with both physical health and welfare needs. Conclusion: There is a significant burden of unmet health and welfare service need amongst PWH in the UK, despite universal healthcare access. HIV services should assess unmet need and identify routes to accessing available support, especially for younger people, those from minority groups, and those facing poverty or mental health challenges.

characterized by 1, 2 or ≥3 Rx. Multinomial logistic regression was used to obtain the univariate odds ratio (OR) to compare persistence in ≥3 vs. 1 Rx for variables of interest. For those with ≥3 Rx, PrEP utilization was estimated by calculating proportion of days covered (PDC), and stratified by prescribed daily vs. non-daily use. Results: Overall, 9375 participants were included [median (Q1-Q3) age 32 (27-41) years; 96.9% cis-men, 1.3% trans-women, 0.9% cis-women, 0.5% trans men; 54.3% reside in Vancouver]. 98.4%, 0.7%, and 0.2% qualified with men who have sex with men (MSM)-, heterosexual-, and injection drug use-based risk criteria, respectively. 80% (n=7520) of participants persisted with PrEP ≥3 Rx, while 9% and 11% received only 1 and 2 Rx's, respectively. A significant difference in the odds of PrEP persisting ≥3 vs. 1 Rx was observed in several subgroups: age category 18-28 years (Ref. >48 years) (OR 0.7 [95% CI, 0.5-0.8], p=0.0002); gender cis-women (Ref. cis-male) (OR 0.2 [0.1-0.3], p<0.0001); trans-women (OR 0.3 [0.2-0.4], p<0.0001); trans-men (OR 0.4 [0.2-0.8], p=0.0077); non-MSM HIV acquisition risk group (Ref. MSM) (OR 0.5 [0.3-0.9], p=0.0323); no prior PrEP use (Ref. prior use) (OR 0.6 [0.5-0.7], p<0.0001); residence outside Vancouver (Ref. Vancouver) (OR 0.6 [0.6-0.7], p<0.0001). Of 7520 participants with ≥3 Rx, 93% were prescribed daily PrEP, with median (Q1-Q3) PDC 0.83 (0.6-0.96), median PDC follow-up time of 30 (15-50) months and median Rx count of 8 (5-14). For non-daily PrEP (7%), median PDC was 0.49 (0.3-0.67), median PDC follow-up time was 42 (21-54) months, and median Rx count was 7 (5-11). 77% of daily users had median overall PDC >0.57 and 53.6% had PDC >0.8. Conclusion: In a population-level program, 80% of participants demonstrated PrEP persistence ≥3 Rx. Persistence was decreased amongst younger, non-cis men participants, and those residing outside the urban centre. Overall estimates of PrEP utilization suggest non-daily or interrupted use in many prescribed daily PrEP. 1189 Community and Facility-Based PrEP Uptake and Adherence Among People Who Use Drugs in Uganda Joseph Kibuuka 1 , Patricia M. Smith 2 , Timothy Muwonge 3 , Peter Mudiope 4 , Liz Komuhangi 5 , Ritah Kansiime 4 , Tara Wood 2 , Florence Nambi 5 , Mai Nakitende 5 , Lylianne Nakabugo 5 , Herbert Kadama 5 , Peter Kyambadde 6 , Sara N. Glick 7 , Andrew Mujugira 7 , Renee Heffron 2 1 Infectious Disease Institute, Kampala, Uganda, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 Infectious Diseases Institute, Kampala, Uganda, 4 Ministry of Health Uganda, Kampala, Uganda, 5 Makerere University College of Health Sciences, Kampala, Uganda, 6 National AIDS Control Program, Dar es Salaam, United Republic of Tanzania, 7 University of Washington, Seattle, WA, USA Background: People who use drugs (PWUD) in Uganda experience a high HIV burden and limited access to HIV prevention services, which are often delivered in parallel to harm reduction programs and by different implementing organizations. Integrating HIV pre-exposure prophylaxis (PrEP) into harm reduction services could substantially enhance service uptake and reduce risk of HIV acquisition. Methods: From January 2022-August 2023, we enrolled PWUD into TDF-based oral PrEP programs integrated into harm reduction services at a community based needle and syringe program (NSP) and a facility-based medication assisted treatment (MAT) program located in Kampala, Uganda (NCT05040308). The 6-month PrEP refill data were abstracted from medical records to estimate PrEP persistence. We enrolled a subset of participants into a research cohort to measure tenofovir concentration levels in plasma to estimate PrEP adherence. We compared the frequency of PrEP persistence and adherence across program type using log binomial regression models. Results: Through August 2023, 100% of HIV-negative NSP clients (n=265) and 98.9% of MAT clients (n=91) with 6 months of follow up initiated PrEP. The median age was 31 (IQR 25-39), 90.7% were male, 63.7% reported using street opioids with injection and smoking being the most common route of use. Among 64% (n=227/355) of times when 1 bottle (30 pills) of PrEP was dispensed, a refill was sought within 30 days. When 60 pills were dispensed, 65% of participants returned within 60 days and when 90 pills were dispensed, 45% returned within 90 days. Six-month PrEP persistence in MAT and NSP was 12% and 62% (relative risk=0.16, 95% CI: 0.09-0.27, p<0.0001). In the subset using PrEP, 6-month plasma TFV levels were high (>31ng/ml) in 52% and moderate (0.1-31ng/ml) in 37% of NSP participants and high in 34% and moderate in 32% of MAT participants (global p-value p=0.07). Conclusion: In integrated PrEP and harm reduction programs, PrEP uptake was very high. We observed greater PrEP persistence in the community-based NSP

Poster Abstracts

1188 Real-World Utilization of HIV PrEP Medication in a Population-Level PrEP Program in BC, Canada Junine Toy 1 , Raquel M Espinoza 1 , Jason Trigg 1 , Tian Shen 1 , Paul Sereda 1 , Erin Ready 2 , Viviane Dias Lima 1 , Rolando Barrios 1 , Julio Montaner 1 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2 St Paul's Hospital, Vancouver, Canada Background: Publicly funded, centrally distributed HIV PrEP with emtricitabine-tenofovir has been available in British Columbia (BC) since January 2018. We evaluated PrEP persistence and estimated medication utilization using longitudinal prescription data from BC's PrEP program. Methods: BC PrEP participants with ≥1 dispensed PrEP prescription (Rx) between 1-Jan-2018 to 30-Jun-2022 and ≥1 year follow-up opportunity were included. Demographics and PrEP Rx data were described, and PrEP persistence

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