CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1207 COVID-19–Associated ART Disruptions and HIV Suppression: A Population-Based Study in Uganda Charles Ssuuna 1 , Hadijja Nakawooya 1 , Caitlin E. Kennedy 2 , Joseph G. Rosen 2 , Ronald M. Galiwango 1 , Aggrey Anok 1 , Fred Nalugoda 1 , Arthur G. Fitzmaurice 3 , Victor Ssempijja 4 , Joseph Kagaayi 1 , Godfrey Kigozi 1 , Larry W. Chang 5 , Thomas C. Quinn 6 , Mary Kate Grabowski 7 , Steven J. Reynolds 8 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Centers for Disease Control and Prevention, Kampala, Uganda, 4 Leidos Biomedical Research, Inc, Fredrick, MD, USA, 5 The Johns Hopkins University, Kalisizo, Uganda, 6 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA, 7 The Johns Hopkins University, Baltimore, MD, USA, 8 National Institute of Allergy and Infectious Diseases, Kalisizo, Uganda Background: Following confirmation of SARS-CoV-2 in Uganda, a national lockdown was imposed. Subsequent movement restrictions limited access to HIV services, including antiretroviral therapy (ART). We assessed the population burden of COVID-19-associated ART disruptions and their impacts on viral load suppression (VLS) among people living with HIV in Uganda. Methods: We used cross-sectional data collected between October 2020 and March 2023 from the Rakai Community Cohort Study (RCCS), a population based HIV surveillance cohort in south-central Uganda, to assess occurrence of COVID-19-related ART disruptions and impact on VLS (<1,000 RNA copies/ ml). Participants reported ART disruptions in the year preceding COVID-19 emergence (March 2019 to March 2020) and after its emergence (March 2020 to interview date). Disruptions included missed HIV care appointments, running out of ART before the next refill, and reducing ART use to conserve medication supply. Proportions of participants reporting ART disruptions before and after the lockdown were compared using chi-squared tests. We used modified Poisson regression models to estimate prevalence ratios for two outcomes: COVID-19-associated ART disruptions and VLS Results: Overall, 2,634 of 2,786 (94.5%) people living with HIV self-reported being on ART, of whom 4.8% (n=126) and 13.5% (n=355) respectively reported ART treatment disruptions prior to COVID-19 emergence and 13.5% (n=355) following it. All ART disruption types increased significantly following COVID-19 emergence: missed HIV care appointments (3.3% to 9.8%, p<0.001), running out of ART medications before the next refill (2.3% to 5.4%, p<0.001), and reducing ART use to conserve medication supply (1.1% to 2.5%, p<0.001). Females (aPR=1.89 95%CI: 1.32-2.71), fishing community residents (aPR=1.97 95%CI: 1.42-2.71), and persons aged 25-34 years (aPR=1.85 95%CI: 1.31-2.59) exhibited significant increases in ART disruption. The overall VLS following COVID-19 emergence was 94.5%, differing significantly between people who did (91.0%) and did not (95.1%) report ART disruptions (aPR=0.96; 95%CI: 0.93-1.00). Conclusion: ART disruptions, especially missed HIV care appointments, increased significantly following COVID-19 emergence in Uganda. VLS was significantly lower among individuals who experienced COVID-19- related ART disruptions. Developing interventions effective in maintaining HIV patients in care is crucial to mitigate treatment disruptions during future pandemics. 1208 WITHDRAWN of COVID-19 Vaccine Among Persons Living With HIV on Antiretroviral Therapy, Siaya, Kenya Philip Opere 1 , Benard Onguche 2 1 Ministry of Health, Nairobi, Kenya, 2 Ministry of Health, Mbabane, Eswatini Background: Vaccination against SARS-CoV-2 has played a large role in efforts towards bringing the COVID- 19 pandemic under control. People living with HIV (PLHIV) are at increased risk of COVID-19 infection, severe disease, poor outcomes, and more comorbidities. Hesitancy to accept vaccines remains common while little is known about COVID-19 vaccination uptake among PLHIV in high HIV burden counties, such as Siaya County, western Kenya. Methods: Data on vaccination status, HIV viral suppression, and time on antiretroviral therapy (ART) among the PLHIV receiving care at 22 supported health facilities within Siaya County was abstracted for the period between October 2021 and January 2023. Electronic patient medical records (EMR) at the facilities were verified against the national data warehouse reports. Descriptive summaries were used to describe the data, while logistic regression was used to determine association between immunization status and demographic characteristics. Results: Of the 12,330 PLHIV active on ART, data for 91% (11,110) was verified. Of these, 91% (10,096) were fully vaccinated, 4.6% (524) partially vaccinated, 3.0% (335) not vaccinated, while 1.4% (155) had unknown vaccination status. The median age was 42 years (interquartile range [IQR]: 34,52). There was

greater uptake among ages 25-49 years, (Odds Ratio (OR): 2.42; 95% Confidence Interval (CI) 1.86-3.14; p-value <0.001), and 50+ yrs. (OR: 2.77; 95% CI 2.09 3.67; p-value <0.001). Males had lower uptake (OR: 0.62; 95% CI 0.55-0.71; p-value <0.001). Among the verified, 9.2 % (1,023) were not virally suppressed, of whom 85.6% (876) were fully vaccinated, 6.3% (64) partially vaccinated, 5.6% (57) not vaccinated, and 2.5% (26) had unknown vaccination status. There was no significant association between time on ART and COVID- 19 vaccination uptake (AOR:1.02; 95% CI 1-1.04; p-value -0.056). Conclusion: More client-focused and targeted approaches may be needed to increase vaccine uptake needs by age and sex among PLHIV. While the majority of the non-suppressed VL had been fully vaccinated against COVID-19, the results indicate that PLHIV who are not vaccinated and those with unknown vaccination status may benefit with adequate information, access to vaccines, and targeted reviews to identify their gaps and needs. 1209 Scaling Up COVID-19 Vaccine Uptake Among PLHIV: Insights & Lessons From Kigoma, Shinyanga, and Pwani John Roman 1 , Julius Zelothe 1 , Amos Scott 1 , Damian Laki 1 , Alexander Christopher 1 J. Christopher 1 , Frederick Ndossi 1 , Yudas Ndugile 2 , Kokuhabwa Mukurasi 3 , Eva Matiko 1 , Redempta Mbatia 1 1 Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania, 2 Ministry of Health and Social Welfare, Shinyanga, United Republic of Tanzania, 3 Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania Background: People with underlying and chronic medical conditions continue to be at greater risk of severe Coronavirus disease 2019 (COVID-19) and its sequelae. Specifically, people living with HIV (PLHIV) with severe COVID-19 have a greater risk of dying compared to those without HIV. Despite evidence of COVID-19 vaccination reducing serious illness and death, and the availability of free vaccines across the country since July 2021, uptake in Tanzania was initially low. Despite PLHIV being treated as a priority group, by end of October 2021, less than 1% of the eligible PLHIV in the Pwani, Shinyanga, and Kigoma regions of Tanzania were fully vaccinated. We described changes in COVID-19 vaccine uptake among PLHIV within the three regions, from 0.2% in October 2021 to 99.8% by September 2022. Methods: A total of 110,733 PLHIV aged 20 years and older, from high-volume PEPFAR-supported health facilities were eligible for COVID-19 vaccination (Shinyanga 60,986; Pwani 36,033; and Kigoma 13,714). Planning meetings with the regional and district health management teams were held, aiming to vaccinate 90% of PLHIV by September 2022. Sensitization meetings with grassroots influential leaders were conducted using the available information, education, and communication materials (IEC) provided by the government of Tanzania. Vaccination points were added to outpatient departments, reproductive and child health clinics, and HIV care and treatment clinics. Community vaccination outreach services were conducted with the support of expert clients as peer educators and vaccine champions to reach PLHIV on 3 and 6 multi-month ART dispensing. Results: By 31 December 2022, 110,544 (99.8%) age-eligible PLHIV enrolled in care and treatment were fully vaccinated against COVID-19 across the three regions: Pwani 35,848 (99.5%), Kigoma 13,710 (99.9%), and Shinyanga 60,986 (100.0%). Conclusion: Data insights from the routine program monitoring indicate that nearly all age-eligible PLHIV have been fully vaccinated in these three regions. Collaboration with local health authorities, political leaders, and grassroots leaders coupled with the availability of vaccines and community outreach services enabled the scaling up of COVID-19 vaccination to PLHIV. 1210 COVID-19 Vaccine Effectiveness Against Different Variants Among a Population-Based HIV Cohort Ziang Liu , Xueying Yang, Bankole Olatosi, Sharon Weissman, Xiaoming Li, Jiajia Zhang University of South Carolina at Columbia, Columbia, SC, USA Background: COVID-19 vaccine effectiveness among people with HIV (PWH) was understudied as they were not representatively included in clinical trials. Using a test-negative design, we estimated vaccine effectiveness (VE) against the SARS-CoV-2 infection in different periods of circulating variants of concern (VOC) among a statewide cohort of PWH in South Carolina (SC), USA. Methods: A population-based cohort was retrieved from the integrated statewide HIV electronic health record (EHR) data up to December 31, 2020 in SC. The adult PWH dataset was linked to COVID-19 vaccination dataset with

Poster Abstracts

CROI 2024 395