CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1227 Older Adults Living With HIV Have Low Expectations Regarding Aging, Despite Improved Survival Alice Zhabokritsky 1 , Darrell H. Tan 2 , Marianne Harris 3 , Graham Smith 4 , Julian Falutz 5 , Nisha Andany 1 , Silvia Guillemi 3 , Gordon Arbess 1 , Mona Loutfy 1 , Ron Rosenes 6 , Sharon Walmsley 1 , for the CHANGE HIV Study Team 1 University of Toronto, Toronto, Canada, 2 St Michael's Hospital, Toronto, Canada, 3 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 4 Maple Leaf Medical Clinic, Toronto, Canada, 5 McGill University Health Centre, Montreal, Canada, 6 University Health Network, Toronto, Canada Background: The life expectancy among people living with HIV approaches that of the general population but little is known about the expectations people living with HIV have regarding aging. Studies suggest that an individual's perception of aging can have a significant impact on their personal health behaviors, healthcare utilization and quality of life. We set out to evaluate what expectations older adults living with HIV have regarding aging and whether expectations differ according to sociodemographic and clinical factors, hypothesizing that those living longer with HIV have lower expectations regarding aging. Methods: We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV age 65 and older. Participants completed the Expectations Regarding Aging Survey (ERA-12) at cohort entry; subscale (physical health, mental health and cognitive function) and total scores were calculated on a scale of 0-100 with lower scores indicating lower expectations regarding aging. Multivariable linear regression was used to estimate the association between ERA- 12 score, duration of HIV infection, and sociodemographic and clinical factors selected a priori (age, gender, race, depression, social support). Results: 320 participants were included in the analysis, of whom 91% identified as men and 78% as white, with a median (interquartile range [IQR]) age of 69 [67,73]. The median [IQR] ERA-12 score was 47 [33,58]. Expectations regarding mental health (median [IQR] score 58 [42, 83]) were higher than those for physical health (median [IQR] score 33 [17,50]) and cognitive function (median [IQR] score 42 [25,58]). In multivariable analysis, ERA-12 scores did not differ according to age, race, or duration of HIV infection. After accounting for other factors, women (β -9.87, 95% CI -18.39, -1.38, p 0.023), persons experiencing depression (β -15.96, 95% CI -22.34, -9.59, p <0.001) and those with greater degree of social isolation (β -0.05, 95% CI -0.22, -0.04, p 0.007) had lower expectations regarding aging. Conclusion: Older adults living with HIV seem to have have low expectations regarding their physical health and cognitive function, regardless of how long they've been living with HIV. Gender-specific differences in expectations persist after taking into account demographic factors, depression and lack of social supports. This reinforces the need to address physical and cognitive health concerns among persons aging with HIV.

which interventions provide the most effective path towards eliminating r/e disparities in HIV incidence. Methods: We considered a baseline Scenario A, which assumed continuation of HIV continuum of care and prevention efforts (pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs) at 2022 levels from 2023-2035. We considered three r/e groups: Black, Hispanic/Latino (H/L), and the remaining mostly White population grouped as Other. The primary outcome is the incidence-rate-ratio (IRR) compared to Other, with the goal of IRR≤1 for both Black and H/L by 2035. We considered four intervention scenarios, B through E, by adjusting input values from 2023-2027, then we observed outcomes from 2027-2035: •Scenario B: Continuum- only - HIV testing, linkage to care and viral suppression among Black and H/L brought to parity with Other by 2027 •Scenario C: Prevention-only – PrEP and SSP uptake among Black and H/L brought to parity with Other by 2027 •Scenario D: Continuum+Prevent- Combined B and C •Scenario E: Max reach- Black and H/L populations reach 98% awareness, linkage to care, and viral suppression coupled with increases in PrEP and SSP uptake by 2027 Results: Scenario B was more effective in reducing incidence in 2035 (9.1 new infections per 100,000) than Scenario C (12.1) compared with baseline Scenario A (13.3) (Table). The combined Scenario D resulted in only slight improvements (8.4 new infections per 100,000) compared to Scenario B. All scenarios reduced IRRs, but only Scenario E eliminated incidence disparities by 2035, with respective IRRs of 0.9 and 1.1 among the H/L and Black populations. Conclusion: With no changes, disparities in IRR will persist through 2035. Eliminating r/e disparities in the continuum-of-care by 2027 can reduce, but not eliminate, incidence disparities by 2035. Prevention-based interventions are less effective than continuum-based interventions in reducing both overall incidence and r/e incidence disparities; and provide only small added benefit when supplementing continuum-of-care intervention parity. Elimination of r/e incidence disparities by 2035 is only possible if Black and H/L populations reach highest possible care and prevention levels by 2027.

Poster Abstracts

1229 Cost-Effectiveness of Differentiated HIV Treatment Delivery in Sub-Saharan Africa: A Modeling Study

Shiying You 1 , Hae-Young Kim 1 , Daniel T. Citron 1 , David Kaftan 1 , Andrew Phillips 2 , Loveleen Bansi-Matharu 2 , Valentina Cambiano 2 , Brooke Nichols 3 , Youngji Jo 4 , Anna Bershteyn 1 1 New York University Langone Medical Center, New York, NY, USA, 2 University College London, London, United Kingdom, 3 FIND, Geneva, Switzerland, 4 University of Connecticut, Farmington, CT, USA Background: Differentiated service delivery (DSD) for HIV treatment is rapidly expanding in Sub-Saharan Africa (SSA). Current evidence suggests that DSD leads to enhanced patient retention but is associated with higher costs compared to the standard of care (SoC) of clinic-based HIV treatment. We conducted a cost- effectiveness (CE) analysis to assess the health and economic implications of DSD in SSA. Methods: We adapted two pre-validated mathematical models (EMOD-HIV and Synthesis) to project health outcomes (disability-adjusted life years, DALYs) and costs (2021 USD) of DSD relative to SoC from 2022 to 2062, with a 3% discount rate. We covered four settings: South Africa/EMOD, Malawi/EMOD, Zambia/ EMOD, and SSA low- and middle-income countries (LMICs)/Synthesis; and three DSD modalities for people with HIV aged 15+: community adherence groups (CAG), urban adherence groups (UAG), and home ART delivery (HomeART). Retention was defined as consistent engagement in care with no loss to follow up (i.e., missing for > 28 days since last scheduled visit) or death. Model inputs were sourced from published literature. The effectiveness of DSD was modeled as percentage increases in annual retention rates, with values set at 25% for CAG, 38% for HomeART, and 50% for UAG for all settings. Country-specific costs included SoC and DSD visits, medications, and lab tests. We calculated incremental cost-effectiveness ratios (ICERs) of DSD versus SoC from the

1228 Strategies for Eliminating Racial/Ethnic Disparities in HIV Incidence in the United States Evin Jacobson 1 , Alex Viguerie 1 , Katherine Hicks 2 , Laurel Bates 2 , Amanda Honeycutt 3 , Justin Carrico 2 , Paul Farnham 1 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 RTI Health Solutions, Durham, NC, USA, 3 RTI International, Research Triangle Park, NC, USA Background: Elimination of racial/ethnic (r/e) disparities is a goal of the Ending the HIV Epidemic in the U.S. (EHE) initiative. Despite progress in HIV prevention and treatment, large r/e disparities in HIV incidence remain. We used the HIV Optimization and Prevention Economics (HOPE) model to analyze

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