CROI 2024 Abstract eBook

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Poster Abstracts

temporarily changed the validity of "repeat" prescriptions for ART from 6 to 12 months. We evaluated the effect of these changes on HIV viral non-suppression in the private health sector in South Africa. Methods: We analysed routine laboratory and pharmacy claim data between November 1, 2019, and November 30, 2022 from Aid for AIDS (AfA), a large South African medical insurance scheme. Adults living with HIV over the age of 15 years who had received ART for ≥3 months were included. We conducted an interrupted time- series analysis comparing rates of viral non-suppression (viral load (VL) ≥50 copies/mL) during the following periods: November 1, 2019 to April 23, 2020 when conventional 6-monthly script renewal was in place; April 24, 2020 to September 25, 2021 when the 12-monthly script renewal period was implemented; and September 26, 2021 to November 30, 2022, when 6-monthly script renewal was re-instated. Monthly suppression rates were modelled using binomial generalized linear regression models. We measured the slope change in suppression rates between adjacent time periods by including an interaction term between time and a binary indicator for the 12-monthly script renewal period in the model. Inverse probability weighting was used to account for changes in viral load testing during the period. Results: The study population included 73884 in January 2019, increasing to 76321 in May 2020 and 72026 in November 2022. The proportion with unknown VL increased during the study. (Figure A) Compared to the period prior to lockdown, the odds of viral non-suppression was lower among patients when 12-monthly script renewal was in place [adjusted odds ratio (aRR) 0.99, 95% confidence interval (CI) 0.99-0.99, p<0.001]. When 6-monthly script renewal was re-introduced the odds of viral non-suppression increased [aOR 1.02 (95%CI 1.02- 1.02, p<0.001). (Figure B) Conclusion: Our results show longer script renewal period was associated with slight improvements in viral suppression. Measures implemented during COVID-19 to ensure continued access to chronic medication in South Africa provided a unique opportunity for evidence to guide efficient ART delivery models involving less frequent visits to healthcare providers without negatively affecting treatment outcomes.

1245 Access to Long-Acting Injectable ART Through State AIDS Drug Assistance Programs Lauren C Zalla 1 , Tim Horn 2 , Catherine Lesko 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 National Association of State and Territorial AIDS Directors, Washington, DC, USA Background: Long-acting injectable (LAI) antiretroviral therapy (ART) may help address barriers to treatment adherence among people with HIV. Due to cost and operational issues, low-income individuals, including clients of the federal Ryan White HIV/AIDS Program (RWHAP), may face greater challenges in accessing LAI ART. Of 1.09 million people with diagnosed HIV in the US, 301K (28%) access treatment through state AIDS Drug Assistance Programs (ADAPs) funded by the RWHAP. State ADAPs are required to cover at least one drug from each therapeutic class of HIV antiretrovirals (ARVs). They are not required to cover long-acting formulations of drugs from existing therapeutic classes, such long-acting cabotegravir/rilpivirine (Cabenuva). We sought to determine the extent of access to Cabenuva through state ADAPs, and to describe the population of ADAP clients without access to Cabenuva. Methods: Data on state ADAP medication formularies were collected by the National Association of State and Territorial AIDS Directors (NASTAD) in January 2023. Data on the characteristics of ADAP clients were obtained from the 2020 RWHAP ADAP Annual Client-Level Report. Data on the characteristics of all people with diagnosed HIV were obtained from the US Center for Disease Control and Prevention's AtlasPlus Tool. We compared the characteristics of ADAP clients in states with and without ADAP coverage of Cabenuva, and of ADAP clients vs. non-clients in states without ADAP coverage of Cabenuva. Results: In contrast to the 2 oral ARVs most recently approved by the US Food and Drug Administration, which were listed on 92-98% of state ADAP medication formularies in January 2023, Cabenuva (approved in January 2021) was covered by 78% of state ADAPs. Nearly two thirds (64%) of the 56,020 ADAP clients in states without ADAP coverage of Cabenuva were living at or below the federal poverty level, compared to 43% of the 221,539 ADAP clients in states that did cover Cabenuva. In states that did not cover Cabenuva, ADAP clients were more likely than non-clients to be Black (36% vs. 34%) or Hispanic (30% vs. 26%). Conclusion: Gaps in coverage of Cabenuva affect large numbers of people who access ART through state ADAPs, and disproportionately affect low-income and racially minoritized people with HIV. States should consider expanding access to Cabenuva, including working to reduce supply and payment chain barriers, to promote equitable access to LAI ART. Future work should examine access to Cabenuva using patient-level data. 1246 Effect of Changes in Script Renewal Period on HIV Viral Non-Suppression Among Insured South Africans Gabriela E. Patten 1 , Mary-Ann Davies 1 , Gary Maartens 1 , Naomi Folb 1 , Andreas Haas 2 1 University of Cape Town, Cape Town, South Africa, 2 University of Bern, Bern, Switzerland Background: Evidence is needed to inform antiretroviral therapy (ART) delivery models which allow people with HIV to attend health facilities less frequently. While COVID-19 lockdown measures were in place, South Africa

Poster Abstracts

CROI 2024 409