CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1201 Motivational Interviewing Training Effect on HIV Viral Suppression: A Cluster Randomised Pilot Trial Dorina Onoya 1 , Tembeka Sineke 2 , Idah Mokhele 1 , Robert A. Ruiter 2 , Marnie Vujovic 3 , Khumbo Shumba 1 , Jacqui Miot 1 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 Maastricht University, Maastricht, Netherlands, 3 Anova Health Institute, Johannesburg, South Africa Background: We developed a Motivational Interviewing (MI) skills training program for lay counsellors (The Thusa Thuso program) to improve the quality of patient-centred HIV retention counselling in South Africa (SA). We report the effect of the Thusa Thuso intervention on HIV patient outcomes at 12 months after HIV diagnosis. Methods: We randomized eight primary healthcare clinics (PHC) in Johannesburg (SA) to either the intervention condition (n= 4 clinics) where all lay counsellors were supported for 12 months before the patient enrolment or the standard of care support (n=4 clinics). Recorded Motivational Interviewing Treatment Tntegrity (MITI) coding of training was used to determine counsellor MI technical skills level (Cultivating Change Talk (CCT), Softening Sustain Talk (SST), Empathy and Partnership towards clients. A total of 554 adult (≥ 18 years) patients were recruited immediately after HIV diagnosis from March 2020 to August 2021 (n=293 intervention, n=261 control). We conducted cluster adjusted Poisson regression to assess the intervention effect on retention in care (being within 90 days after a scheduled appointment) and viral suppression (<50 copies/ml) at 12 months after HIV diagnosis, reporting risk ratios (RR) with 95% confidence intervals (CIs). Results: We observed modest retention rate improvement in patients supported by intervention clinic counsellors compared to control patients (RR 1.3, 95% CI: 0.9-2.0) and a marked increase in retention rates proportional to increasing MI skill levels (Fig 1.) (CCT, RR 1.6, 95%CI: 1.1-2.5; SST, RR 1.5, 95%CI: 0.8-2.9; Empathy, RR 1.4, 95%CI: 1.0-1.8); Partnership RR 1.5, 95%CI: 1.2-1.9). Viral suppression at 12 months also increased in the intervention group (RR 1.4, 95%CI: 1.1-1.8. Similarly, to the retention outcome, increasing counsellor MI skills resulted in higher patient VL suppression at 12 months (CCT, RR 1.2, 95%CI: 1.2-1.3; SST, RR 1.3, 95%CI: 0.8-2.2; Empathy, RR 1.1, 95%CI: 0.9-1.4; Partnership, RR 1.2, 95%CI: 1.1-1.3). Conclusion: Appropriately tailored MI training for lay counsellors, resulting in documented improvement in counsellor skills, can improve retention and VL suppression outcomes. While these preliminary data indicate potentially significant effects, statistical significance is limited by the pilot's small cluster sample size and statistical power. 1202 Undisclosed ART Use Found by Urine LFA Is Common in South Africa, Not Associated With Lower TB Risk Nsika N Sithole 1 , Indira Govender 2 , Matthew A. Spinelli 3 , Theresa Smit 1 , Meighan Krows 4 , Connie Celum 4 , Alison Grant 2 , Monica Gandhi 3 , Adrienne E. Shapiro 4 1 Africa Health Research Institute, Mtubatuba, South Africa, 2 London School of Hygiene & Tropical Medicine, London, United Kingdom, 3 University of California San Francisco, San Francisco, CA, USA, 4 University of Washington, Seattle, WA, USA Background: People with HIV (PWH) not on ART are at high risk for TB and low CD4 counts. TB screening and CD4 count measurement are recommended at ART initiation or re-initiation. In South Africa, estimated undiagnosed TB prevalence is 5-10% in PWH not on ART. An interim analysis of an ongoing cohort study of intensive TB screening in ART initiators found <1% TB prevalence. We used a urine tenofovir (TFV) assay to objectively assess the prevalence of undisclosed ART use as a potential explanation of the low TB prevalence in the cohort. Methods: Adults with confirmed HIV reporting no ART use within 90 days had CD4 count testing and were systematically tested for TB at the time of ART initiation at 2 public clinics in KwaZulu-Natal, South Africa

using sputum TB culture, sputum Xpert Ultra and urine TB-LAM testing. Remaining urine was frozen and stored. Participants were followed for >6 months to identify incident TB. We tested thawed urine samples for TFV, indicating undisclosed ART use, using a novel lateral-flow urine assay (96% sensitive, 100% specific vs. LC-MS/MS). TB was defined as a positive Xpert Ultra or culture, or initiation of TB treatment within 3 months. We assessed predictors of ART nondisclosure and the relationship between ART nondisclosure and TB. Results: Between 12/2021-8/2023, 315 PWH (126, 40% male) reporting no ART use presented for ART initiation and provided urine; of these 63 (20%) had detectable TFV indicating undisclosed ART use. Median CD4 count among persons with vs. without undisclosed ART was 503 cells/mm 3 (IQR 280-637) vs. 336 (IQR 178-510, p=0.001). Undisclosed ART was more common in PWH attending a remote rural vs. a peri-urban clinic (35% vs 12.5%, p<0.001). In a multivariable model, undisclosed ART was associated with older age, rural clinic site, and increasing CD4 count, but not with gender, education, or employment. TB screening identified 15 (5%) PWH with undiagnosed TB (11/15 male, 15/15 reporting TB symptoms, 8.7% prevalence in men). There was weak evidence for undisclosed ART being more common in persons with undiagnosed TB, after adjusting for gender (aOR 2.70, 95% CI 0.91-8.03). Conclusion: In the mature South African ART program, undisclosed ART use is common at 20% but is not associated with a reduced risk of undiagnosed TB. Undisclosed ART use may result in inappropriate use of resources and baseline testing. Use of a point-of-care urine assay to assess TFV could triage costly CD4 testing, however TB testing among all ART initiators should continue. Neha S Pandit 1 , Abree Johnson 1 , Tsung-Ying Lee 1 , Eberechukwu Onukwugha 1 , Hope Cassidy- Stewart 2 1 University of Maryland, Baltimore, MD, USA, 2 Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA Background: Adherence interventions are often implemented after virologic failure is identified. Antiretroviral therapy (ART) prescription claims data can guide adherence interventions for people with HIV (PWH) at risk of virologic failure. This study determined the effectiveness of using ART prescription claims to provide adherence interventions and achieve virologic suppression (VS). Methods: Participants were deemed eligible if they: 1) received care at a collaborating clinic; 2) failed to pick up ART at least 30, 60, and 90 days from prior fill date; 3) eligible to receive an intervention between November 2020 and December 2021; and 4) had an HIV RNA 12 months prior to and following the index date (date of intervention). Interventions were categorized as "no" (no patient contact), "soft" (indirect patient contact: e.g., voicemail), or "full" (direct patient contact: e.g., in-person visit). Across intervention groups, mean difference in HIV RNA was calculated and proportion of patients with VS (HIV RNA <200 copies/mL) was reported. We compared the pre- and post-index VS proportions by intervention group and reported differences using the Chi- square test with an a priori significance level of 0.05. Results: A total of 508 patients were eligible. The mean age was 50 years, 41% of the sample was female, and 79% of the sample was African American. Sixty-seven percent (n=343) received an intervention (full =241; soft =102). The change in HIV RNA from baseline across the full, soft, and no intervention groups was -3,394, -4,266, and 237 copies/mL, respectively. Of the 343 patients that received an intervention, 107 did not have VS at baseline; of which 50% (n=54/107) achieved VS at follow-up. The proportion of patients who were viremic (HIV RNA >200 copies/mL) decreased pre- to post-index in the full (30% to 27%) and soft (33% to 24%) intervention group while the proportion of viremic patients increased in the no intervention group (4% to 7%). Conclusion: Individuals who received the adherence intervention achieved lower HIV RNA values on average compared to PWH who did not receive an

Poster Abstracts

1203 Impact of Proactive Adherence Interventions on HIV RNA Using Prescription Claims

CROI 2024 393