CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: A social network-based, status-neutral intervention in Kenya that successfully promoted testing among men did not impact PrEP adherence or viral suppression, although we demonstrate preliminary indications of intervention effect at a relaxed alpha of 0.2. Given the small number of men on PrEP and ART, an adequately powered study is required to evaluate whether social-network-based interventions can improve these outcomes among fishermen and other hard-to-reach populations. 1224 Hopefulness as a Predictor of Viral Suppression in Patients Newly Diagnosed With HIV Marie Flore Pierre 1 , Fabienne Homeus 1 , Jean Bernard Marc 1 , Vanessa Rivera 1 , Manasi Mohan 2 , Nakul Vij 2 , Samuel Pierre 1 , Nancy Dorvil 1 , Dominique Lespinasse 1 , Maria Linda Aristhomène 1 , Guirlaine Bernadin 1 , Alianne Julien 1 , Jean W. Pape 1 , Serena Koenig 3 1 GHESKIO, Port-au-Prince, Haiti, 2 Analysis Group, Inc, Boston, MA, USA, 3 Harvard Medical School, Boston, MA, USA Background: In the context of the COVID-19 pandemic, and the major political instability and gang violence in Haiti, it is optimal to minimize the number and duration of patient visits. Methods: We conducted a pilot randomized trial of immediate fast-track vs. standard care among patients newly diagnosed with HIV in Port-au-Prince, Haiti. Patients were randomized in a 1:1 ratio to immediate fast- track care (expedited nurse-led visits with pre-packaged, point-of-care dispensing of ART) vs. standard care. The primary outcome was the proportion of patients with HIV-1 RNA <200 copies/mL at 48 weeks after enrollment. We also administered multiple questionnaires to assess predictors of viral suppression. Results: From January 3, 2019 to April 15, 2020, 103 participants were enrolled in the trial (48 standard; 55 immediate fast-track). The median age was 38 years (IQR: 32, 47), 46.6% were female, and median CD4 count was 330 cells/ mm 3 (IQR: 227, 520). In the standard group, 42 (87.5%) were retained, 2 (4.2%) died, and 4 (8.3%) were LTFU; 37/42 (88.1%) retained patients received 48-week viral load testing, and 32 had HIV-1 RNA <200 copies/mL (86.5% among those tested; 66.7% among those enrolled). In the immediate fast-track group, 52 (94.5%) were retained, 1 (1.8%) died, and 2 (3.6%) were LTFU; 44/52 (84.6%) retained patients received 48- week viral load testing, and 40 had HIV-1 RNA <200 copies/mL (90.9% among those tested; 72.7% among those enrolled). There was no difference in the primary outcome between the two groups (p=0.65). In multivariable analysis, the only predictor of virologic suppression was a higher score on the State Hope Scale, indicating a higher degree of hopefulness about the future. Conclusion: Retention and viral suppression rates were high in both the immediate fast-track and standard groups. Hopefulness was the most important predictor of retention in care with viral suppression. Further study is necessary to determine if this finding is reproduced in other cohorts. The figure, table, or graphic for this abstract has been removed. 1225 Homelessness and Antiretroviral Use Among MSM in the Context of Varying Levels of Federal Funding Amrita Rao 1 , Yuanqi Mi 1 , Katherine Rucinski 1 , John Mark Wiginton 2 , Carrie Lyons 1 , Kalai Willis 1 , Tiara Willie 1 , Travis H. Sanchez 3 , Stefan Baral 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 University of California San Diego, La Jolla, CA, USA, 3 Emory University, Atlanta, GA, USA Background: Homelessness is associated with poor health outcomes among people living with HIV(PLHIV); gay men and other men who have sex with men (MSM) account for over 50% of PLHIV in the United States and over 70% of new diagnoses. The Housing Opportunities for Persons With AIDS (HOPWA) Program is operated by HUD to fund initiatives addressing the housing needs of PLHIV. There is limited research examining the relationship between homelessness and HIV-related outcomes in varying policy and funding contexts. Methods: 3,636 cisgender MSM who participated from 2017-2021 in the American Men's Internet Survey (AMIS) and self-reported a prior HIV diagnosis were included in analyses. Homelessness in the survey was defined as living on the street, in a shelter, in a Single Room Occupancy hotel, or in a car in the past 12 months. We used a multilevel mixed-effects logistic regression model to assess the association between homelessness and current antiretroviral therapy (ART) use, adjusting for age, race, education, recruitment year, injection drug use, and state-level Ryan White Part B funding. Analyses were stratified by state-level HOPWA funding per person: state-level HOPWA funding was divided

by the number of sheltered and unsheltered people experiencing homelessness (Point-in-Time Count) multiplied by the 2021 HIV prevalence for each state. Results: Overall, experiencing homelessness was associated with decreased likelihood of current ART use (aOR: 0.53, 95%CI [0.32, 0.88]). Among states who received at or below the median level of HOPWA funding per person (~$300K), homelessness remained associated with ART use (aOR: 0.49, 95%CI [0.27, 0.89]), while there was no association among states who received above the median (aOR: 0.72, 95%CI [0.26, 2.00]), suggesting effect measure modification by funding level. Conclusion: Homelessness impedes ART use among MSM living with HIV. In states that received a greater level of per-person funding, this relationship was attenuated, providing preliminary evidence that housing supports and interventions to address basic needs can have important impacts on community-level HIV service uptake and subsequent outcomes. Further research is needed to document the immediate and long-term impacts of this Program. The figure, table, or graphic for this abstract has been removed. 1226 Violence and HIV Sexual Risk Behaviours Among Adolescent Girls and Young Women: Eswatini Experience Siphiwe M Shongwe-Gama 1 , Cebisile Ngcamphalala 1 , Mabutho C. Mamba 1 , Harrison Kamiru 2 , Poppy M. Sithole 3 , Bonisile Nhlabatsi 4 , Choice Ginindza 5 , Michelle Li 6 , Kaye Seya Marie 7 , Francis B. Annor 7 , Luara Chiang 7 , Ruben Sahabo 1 1 ICAP at Columbia University, Mbabane, Eswatini, 2 ICAP at Columbia University, New York, NY, USA, 3 Deputy Prime Minister's Office, Mbabane, Eswatini, 4 Ministry of Health, Mbabane, Eswatini, 5 Central Statistical Office, Mbabane, Eswatini, 6 US Centers for Disease Control and Prevention Mbabane, Mbabane, Eswatini, 7 Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Experience of violence is reported as a precursor to multiple risk behaviors including HIV sexual risk behaviors (SRB). HIV SRB remains a public health concern as a possible cause of HIV, impacting progress towards achieving HIV epidemic control. However, there are limited contemporaneous national level assessments of HIV prevalence, magnitude and impact of violence. We explored HIV SRB associated with history of violence among females ages 13-24 years in Eswatini Methods: Data from the 2022 Eswatini Violence Against Children and Youth Survey (VACS) was analyzed. VACS is a nationally representative household survey using a multi-stage sampling approach for males and females ages 13-24 years. Participants completed a questionnaire on demographics, sexual behaviors and practices, HIV/AIDS services history, and experience of any violence (physical, emotional, and sexual), and conducted HIV testing. The current study was limited to only females (N=6,318), aged 13-24 years. Using stepwise logistic regression with forward selection approach, we assessed the association between experience of any violence and HIV SRB. We controlled for HIV SRB: multiple sexual partners (two or more sexual partners in the past 12 months); infrequent condom; transactional sex; HIV status; history of STIs and age. Results: The prevalence of any violence (sexual, physical or emotional) was 25.5% (95% CI=23.3-27.7) from the 6,318 females interviewed. In the logistic regression all the following variables were significantly associated with experience of any violence; transactional sex (AOR 2.7, 95% CI 2.0 – 3.7) compared to none, STI history (AOR 2.1, 95% CI 1.5 – 3.2) compared to those with no history of STIs, multiple sexual partners (AOR 1.7, 95% CI 1.2 – 2.3) compared to having one partner or none; infrequent condom use (AOR 2.0, 95% CI 1.5 - 2.6) and never using a condom (AOR 1.4, 95% CI 1.2 – 1.7) compared to always using a condom; age group of 13- 17 years (AOR 1.5, 95% CI 1.1 – 1.9) compared to 18-24 years and HIV positive status (AOR 1.3, 95% CI 1.0 – 1.8). Conclusion: Experience of any violence was associated with HIV SRBs among adolescent girls and young women. Targeted multi-pronged interventions including violence and HIV prevention, sexual reproductive health education services need to be intensified to address sexual risk behaviors among females in Eswatini.

Poster Abstracts

CROI 2024 401