CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Differences in HIV- related outcomes before and after flooding/COVID-19, and between residents of flooded and non-flooded households were assessed using difference-in-difference statistical modeling. Results: 1,226 people participated in the pre- and post-COVID surveys, of whom 506 (41%) were affected by flooding and 513 (41.8%) were female. HIV seroprevalence pre-COVID was 37% in both flooded and non- flooded households. Following onset of the COVID-19 pandemic, there was a decline in HIV risk behaviors. Transactional sex declined from 29.4% to 24.8% (p=0.011), inconsistent condom use with non-marital partners declined from 41.6% to 37% (p=0.021) in the pre-and post-COVID periods. ART coverage significantly increased from 91.6% to 97.2% (p<0.001). There was also a non-statistically significant increase in HIV viral load suppression in both flooded and in non flooded households following COVID-19 Conclusion: Despite a high background HIV burden, the COVID-19 pandemic and serious flooding, had no adverse impact on key HIV risk and outcomes. This may be attributable to innovative programming and or population resilience. Understanding what HIV strategies helped maintain good public health outcomes despite extreme conditions may help improve HIV epidemic control during future natural disasters. The figure, table, or graphic for this abstract has been removed. 1206 Prevalence of HIV and Viral Load Suppression Among Refugees in Uganda, October to December 2021 Samuel Biraro 1 , Shannon M. Farley 2 , Joshua Musinguzi 3 , Wilford Kirungi 3 , David Okimait 1 , Veronicah Mugisha 2 , Ronald Nyakoojo 4 , Sam Sendagala 5 , Herbert Kiyingi 5 , Jennifer Nel 5 , Lisa Nelson 6 , Brittany Gianetti 6 , Christine West 6 , David Hoos 2 , Wafaa El-Sadr 2 1 ICAP at Columbia University, Kampala, Uganda, 2 ICAP at Columbia University, New York, NY, USA, 3 Ministry of Health Uganda, Kampala, Uganda, 4 United Nations High Commissioner for Refugees, Kampala, Uganda, 5 Centers for Disease Control and Prevention, Kampala, Uganda, 6 Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Uganda hosts the largest number of refugees in Africa and provides HIV services to people living with HIV (PWH) in refugee settlements. However, limited HIV-related data exist for this population. A representative population-based HIV household survey was conducted in refugee settlements to estimate HIV prevalence, the prevalence of viral load suppression (VLS) (HIV RNA <1,000 copies/mL), and progress toward the UNAIDS 95 95 95 targets. Methods: Using a multistage probability sampling design, 11 settlements, 40 enumeration areas and 1,296 households were selected. All adults (>15 years) in a selected household were eligible to complete the survey, and venous blood samples were tested for HIV, CD4+ cell count, viral load (VL) and presence of antiretrovirals (ARV). VLS estimation included all PWH, irrespective of their awareness of their HIV status. Weighted estimates for the UNAIDS targets were based on self-report of awareness of HIV status or of HIV treatment, combined with detectable ARVs in the blood to provide 95 95 95 estimates. Results: Overall, 93.4% of 1,250 eligible households, and 84.2% of 2,999 eligible adults (87.3% women, 79.5% men) participated. Most participants (44.7%) were aged 15-24 years; 61.6% reported living in the settlements for 3 to 5 years at the time of the survey; and the most common countries of origin were South Sudan (61.4%) and the Democratic Republic of Congo (31.9%). The prevalence of HIV among adults aged >15 years was 1.5% (95% CI: 0.8-2.1): 1.8% (95% CI: 1.0-2.7) among women and 1.1% (95% CI: 0.3-1.8) among men. HIV prevalence was highest among women aged 45-49 years at 6.2% and men aged 50-54 years at 5.8%. The prevalence of VLS among all PWH, irrespective of awareness of HIV status, was 72.4% (95% CI: 59.8-85.1) among those aged ≥15 years. Among PLHIV ≥15 years, 81.8% were aware of their HIV status, 89.5% of those aware of their status were on antiretroviral treatment (ART), and among those on ART, 92.5% had VLS. Conclusion: In this refugee population, overall HIV prevalence was at 1.5%; however, prevalence among older women and men was above 5%. Overall, one out of five PWH was not aware of their HIV status and overall VLS was low at 72.4% indicating that more than a quarter of PWH had unsuppressed VL. These findings suggest that a substantial number of PWH in this refugee population would benefit from expansion of tailored case-finding and treatment support efforts.

intervention. Proactive dissemination of fills information from pharmacy claims data to health care providers can guide targeted adherence interventions, potentially leading to VS. 1204 Antiretroviral Therapy Outcomes at 6 Months by HIV Recent Infection Classification, Rwanda 2021-2022 Monita R Patel 1 , Eugenie Poirot 2 , Straso Jovanovski 2 , Beata Sangwayire 3 , Jean Claude Irabona 4 , Veronicah Mugisha 4 , Collins Kamanzi 4 , Eric Remera 5 , Elysee Tuyishime 3 , Giles A. Reid 6 , Tom Oluoch 3 , Suzue Saito 2 , Gallican Rwibasira 5 , for the Rwanda HIV Recency Evaluation Study Team 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 ICAP at Columbia University, New York, NY, USA, 3 Centers for Disease Control and Prevention, Kigali, Rwanda, 4 ICAP at Columbia University, Kigali, Rwanda, 5 Rwanda Biomedical Centre, Kigali, Rwanda, 6 Columbia University, New York, NY, USA Background: Globally, over 25 countries have implemented HIV-1 recent infection surveillance to help detect and monitor recent infections among those newly diagnosed. As countries approach epidemic control and focus on early detection and life-long effective antiretroviral therapy (ART), we expect that an increasing proportion of persons newly diagnosed with HIV may be recently infected. However, there is limited evidence on whether persons with recent infection are more or less likely to initiate and stay on effective ART compared to persons with long-term infection. Methods: We analyzed longitudinal data on newly diagnosed adults (>15 years old) enrolled in a cohort study conducted across 60 facilities in Rwanda from August 2021 to October 2022. Per study procedures, all participants received both rapid testing for recent infection (RTRI) and viral load at baseline and were classified as recent (RTRI-recent and baseline viral load >1000 copies/mL) or long-term (RTRI-long-term and baseline viral load >1000); participants with baseline viral load <1000 were presumed previously diagnosed and on ART and excluded from analyses. Demographic and clinical HIV data were abstracted from Rwanda's case-based surveillance system at baseline, and monthly through 6 months follow-up. We compared 6-month ART retention and viral suppression outcomes by recency status using Fisher's exact and Wilcoxon rank tests. Results: A total of 1,238 newly diagnosed persons were identified from the study. Overall, 99.4% (n=1,231) of clients initiated ART. Of these, 8.0% (n=98) were classified as recent. ART initiation was same-day on average (median=0 days [interquartile range: 0-1 days]), and did not differ by recency status (p=0.159). Among the 98.5% (n=1,219) of persons who initiated ART and had longitudinal data available, 78.2% (953) persons were retained on ART at 6 months, and retention did not differ by recency status (p=0.618). Among those retained on ART, 86.1% (n=821) were virally suppressed at 6 months (<1000 copies/mL), and viral suppression did not differ by recency status (p=0.766). Conclusion: Our findings suggest that ART initiation and 6-month longitudinal outcomes do not differ between clients classified as recent or long-term. Regardless of population trends in recent infections among persons newly diagnosed over time, programmatic efforts to continue to ensure timely ART initiation and retention will be needed. 1205 Impact of Natural Disasters on HIV Risks and Viral Suppression in Ugandan Fishing Village Hadijja Nakawooya 1 , Victor Ssempijja 2 , Anthony Ndyanabo 1 , Fred Nalugoda 1 , Maria J. Wawer 1 , David Serwadda 1 , Ronald H. Gray 1 , Joseph Kagaayi 1 , Steven J. Reynolds 1 , Tom Lutalo 1 , Godfrey Kigozi 1 , Ping T. Yeh 1 , Larry W. Chang 1 , Mary Kate Grabowski 1 , Robert Ssekubugu 1 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 Leidos Biomedical Research, Inc, Frederick, MD, USA Background: Understanding the impact of natural disasters on the HIV epidemic in populations with a high HIV burden is critical for effective control efforts. We assessed HIV outcomes in a high-HIV prevalence Lake Victoria fishing community before and after COVID-19 pandemic and a severe lake flooding event in 2020. Methods: We used data from the largest Lake Victoria fishing community in the Rakai Community Cohort Study, a population-based HIV surveillance cohort in south-central Uganda, collected prior to (September- December 2018) and after (October-December 2021) COVID-19 pandemic and a severe flooding event, to evaluate the impact of natural disasters on population-level HIV outcomes including HIV risk behaviors, seroprevalence, and viral suppression among people living with HIV. Households impacted by flooding were identified using drone images and through consultation with community health workers.

Poster Abstracts

CROI 2024 394