CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

should be a priority population for the development of differentiated service options, if we are to improve retention and VL suppression for the whole population on ART.

with a point-of-care (POC) metric and tailored counseling on the test may help patients achieve viral suppression (VS). We integrated a low-cost, POC urine test to detect TFV into standard WHO-recommended enhanced adherence counseling (EAC) to improve VS in adults with non-VS on TLD in Namibia. Methods: Patients on TLD with viral load (VL) >1000 copies/mL after completing ≥1 round of EAC were enrolled from 42 clinics across Namibia. At each monthly ART pick-up, participants completed the POC urine test and received EAC informed by test results. After 3 months (round 1), participants received a viral load (VL) test. If VS was not achieved, up to 3 additional rounds of POC urine testing with EAC was provided, with an HIV drug resistance test sent at month(M) 9. Acceptability of the urine assay was assessed via surveys administered to participants and providers. Results: Of 211 participants enrolled (median age 33 years, interquartile range 22-46, 61% female), 195 reached M3 and received a follow-up VL, with 169 (87%) achieving VS within M3 and 182 (93%) by M9. Moreover, in those who achieved VS, positive TFV in urine increased from 81% at baseline to 96% at M9 compared to a change from 31% to 41% among unsuppressed individuals. Drug resistance testing was performed in 5 remaining participants with high VL at M9. All 5 had variable urine TFV results over visits and one had DTG resistance (N155H and R263K mutations). Overall, 84% of participants and 89% of interviewed providers agreed/strongly agreed that the urine test improved EAC. Conclusion: Nearly 90% of patients on TLD with VL >1000 copies/mL achieved VS within 3 months (93% at M9) following EAC that incorporated a urine-based POC TFV test, compared to 33% of individuals receiving 1-3 rounds of standard WHO-recommended EAC. Encouraging results of this pre-post intervention support rigorous testing in a future randomized clinical trial. Given the cost of VL and resistance testing in lower-and middle-income countries, this POC urine test has great potential to help achieve the third 95-95-95 target in a low-cost, scalable manner. 1199 Persistent Challenges With Viral Suppression a Year After Return to Care: Evidence From South Africa Claire M Keene 1 , Jonathan Euvrard 2 , Tali Cassidy 2 , Mike English 1 , Jacob McKnight 1 , Catherine Orrell 2 , Ingrid Katz 3 1 University of Oxford, Oxford, United Kingdom, 2 University of Cape Town, Cape Town, South Africa, 3 Harvard Medical School, Boston, MA, USA Background: Even though 94% of people living with HIV in South Africa knew their status in 2021, only 74% were actually on antiretroviral therapy (ART) and 67% were virologically suppressed: undermining the potential of ART programmes to improve individual and public health outcomes. Understanding which populations drive this poor treatment success could focus efforts to improve outcomes. Methods: This retrospective study describes the incidence and impact of ART treatment interruptions using routine health data from the Provincial Health Data Centre, South Africa. The cohort includes individuals ≥15 years old who initiated ART under universal test-and-treat (≥01-Sep-2016), sought care in Khayelitsha or Gugulethu (low-resource, high HIV burden settings) and had ≥1 year follow-up. Treatment interruptions were defined as >90 days late for an expected visit (based on duration of treatment dispensed) or being lost to follow-up (no visit within 180 days of database closure on 30-Sep-2022). One-year retention was defined as a visit 9-15 months after ART initiation or restart, and suppression as a viral load (VL) ≤50 copies/mL. Results: The cohort included 68888 individuals, with 69% (47631/68888) female, 25% (17078/68888) under 25 years and a median follow-up time of 4 years (Interquartile Range [IQR] 3-5). The cumulative incidence of interruptions was 71% (95% Confidence Interval [CI] 71-72) by 5 years after initiation, with a median of one interruption (IQR 1-2) and a median of 4 months (IQR 1-9) to interruption after initiation or restart (Figure 1). Most returned to care (cumulative incidence of return: 73% [95% CI 72-73] by 5 years), after a median of 7 months (IQR 4-15). Of the 40384 individual interruptions, there was sufficient follow-up time to evaluate outcomes a year after re-engagement for 29967 (74%): 67% (20030/29967) were retained and 29% (8578/29967) had a VL that was suppressed year after return. In the 34% (23578/68888) who never had a treatment interruption, 73% (17201/23578) had a suppressed VL a year after ART initiation. Conclusion: Treatment interruptions are common. Even after reengagement, those with interruptions have poor treatment outcomes. Health services need to improve care after return to better support retention and adherence, particularly in the first six months after ART restart. People returning to care

1200 Durability of Viral Suppression Among People on HIV Treatment in S Africa: A National Cohort Study Jacob Bor 1 , Evelyn Lauren 2 , Dickman Gareta 1 , Khumbo Shumba 2 , Mazvita Muchengeti 3 , Wendy Stevens 3 , Dorina Onoya 2 , Koleka Mlisana 3 1 Boston University, Boston, MA, USA, 2 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 3 National Health Laboratory Service, Johannesburg, South Africa Background: People on HIV treatment with a viral load (VL) < 200 copies/ ml cannot transmit HIV sexually: "Undetectable = Untransmittible" (U=U). However, the utility of U=U as a prevention strategy has been questioned due to concerns about viral blips and viral rebound. We assessed durability of viral suppression in a national longitudinal cohort in South Africa. Methods: Data were obtained from the National Health Laboratory Service (NHLS) National HIV Cohort. The NHLS Cohort, created through deduplication of South Africa's national laboratory database, includes all viral loads in the public sector HIV program. People living with HIV (PLHIV) aged 15-59 years were included in the analysis if they had at least one VL <200 copies/ml between March 2015 – September 2016. PLHIV entered the study on the date of their first VL<200 and were followed for 18 months. PLHIV were defined as "monitored at 12 months" if they had any VL test 6-18 months after baseline. Durability of viral suppression was defined based on the value of the 12-month VL, reported in three categories: <200 copies/ml (zero transmission risk), 200-999 copies/ ml (minimal transmission risk), and ≥1000 copies/ml (elevated transmission risk). Analyses were stratified by age, gender, province, and viral load history reflecting prior experience in HIV care. Results: Of 2,383,871 PLHIV with VL<200 copies/ml at baseline, 73% were virally monitored at 12 months. Of those, 87% had a 12-month VL <200 copies/ ml and 95% had a 12-month VL <1000 copies/ml. PLHIV whose VL at entry was their first ever VL had the lowest probability of being monitored at 12 months, at 60% (Fig 1). Those with a history (>2 years) of viral suppression had the highest rates of 12-month viral monitoring (>84%) and suppression (>97%) (Fig 1). Individuals with previous VLs between 200-999 or >1000 copies/ml faced the greatest challenges remaining suppressed (Fig 1). VL monitoring rates were lowest among PLHIV under 35 years, but among those monitored, durability of viral suppression was relatively consistent across age and gender. Monitoring rates were similar across provinces, with higher variability in durability of viral suppression. Conclusion: 95% of PLHIV with VL<200 who returned for their 12-month VL had zero risk or minimal risk of transmission one year later. Our results highlight the importance of regular monitoring and the durability of viral suppression for PLHIV who remain in clinical care.

Poster Abstracts

CROI 2024 392