CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1247 High Viral Load Suppression Rates Among People Living With HIV Receiving Multi- Month Dispensing Andrew Mugisa 1 , Christopher Bwanika 1 , Josephine Nakakande 1 , Jane Nakaweesi 2 , Peter Amutungire 1 1 Makerere University, Kampala, Uganda, 2 Makerere University College of Health Sciences, Kampala, Uganda Background: The World Health Organization (WHO) recommended differentiated service delivery (DSD) with multi-month dispensing (MMD) as a way of improving care for people living with HIV (PLHIV). Uganda adopted MMD in the 2020 consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda. We sought to determine the likelihood of viral load (VL) non suppression among PLHIV on MMD in Mubende region, central Uganda. Methods: A cross sectional review of Uganda Electronic Medical Records (Uganda EMR) System program data was conducted at 10 purposively selected high volume facilities in eight districts of central Uganda. We included PLHIV who had one recent documented VL result from January 2022 to February 2023 at last visit. Data on history of advanced HIV disease status and frequency of MMD were retrieved from information over the 13 months of patient care. Logistic regression models were used to assess the effect of MMD on VL suppression among PLHIV. Analysis included PLHIV switched to MMD after being determined stable i.e., on ART for more than 6 months, with a suppressed VL, absence of Advanced HIV Disease (AHD) and not pregnant or not lactating for less than 6 months. PLHIV who didn't fall in these criteria were considered as non-MMD. Results: We reviewed records for 19,455 PLHIV for whom 67% were women. Median age of the participants was 37 years (Interquartile range- (IQR): 29-47) with 10% of the participants being <20 years. 97% (18,960/19,455) of the participants had a suppressed VL of less than 1,000 copies/mL Median duration on ART for clients initially not on MMD but switched to MMD was 74 months (IQR: 45-105) and 52 months ((IQR): 21.5-89.5) for non MMD. Participants on MMD had significantly lower odds of VL non suppression compared to those on non-MMD (Adjusted Odds Ratio (aOR) of 0.09 (95% CI: 0.07-0.12). However, participants on MMD but with a history of AHD and those on MMD on 2nd line ARV regimen had increased odds of attaining VL non suppression, aOR of 4.71 (95% CI: 2.82-7.86) and 2.31 (95% CI: 1.69-3.16) respectively compared to those with no history of AHD and those on 1st line ARV regimen. Conclusion: PLHIV on MMD with history of AHD and PLHIV on MMD on second line ARVs have increased likelihood of VL non suppression and therefore need to be monitored closely monitored. An in-depth qualitative study may be helpful to understand other factors that contribute to increased odds of suppression among clients on MMD. 1248 HIV Care Retention in 3 Multi-Month ART Dispensing: A Retrospective Cohort Study in Mozambique Anna Saura-Lázaro 1 , Orvalho Augusto 2 , Sheila Fernández-Luis 1 , Elisa López Varela 1 , Laura Fuente-Soro 1 , Dulce C. Bila 3 , Milagre Tovela 3 , Nello Macuacua 3 , Paula Vaz 3 , Aleny Couto 4 , Carmen Bruno 5 , Denise Naniche 1 1 Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain, 2 Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, 3 Fundação Ariel Glaser Contra o SIDA Pediátrico, Maputo, Mozambique, 4 Programa Nacional de Controle de ITS, HIV/SIDA, Maputo, Mozambique, 5 Direcção Provincial de Saúde, Maputo, Mozambique Background: In Mozambique, enrolment of people living with HIV (PLHIV) into three multi-month dispensing (3MMD) of antiretroviral therapy (ART) has been contingent on clinical stability and ≥6 months on ART. As a COVID-19 control measure, the required time on ART was shortened to ≥3 months. We assessed the effect of 3MMD on the retention in care of PLHIV considering their time on ART prior to enrolment. Methods: A retrospective cohort study of routine patient data was conducted including PLHIV ≥10 years who started ART between January 2018 and March 2021 in Manhiça District. PLHIV were followed until December 2021. Attrition included lost to follow-up, death and transfer out. Kaplan-Meier estimates were used to calculate cumulative retention in care probabilities after ART initiation. Cox proportional-hazards models, with inverse probability weights of 3MMD enrolment, were used to compare attrition between 3MMD and monthly ART dispensing, stratifying by "established enrollers" (≥6 months on ART) and "early enrollers" (<6 months on ART). Analyses were stratified by adolescents and youth (AYLHIV) (10-24 years) and adults (≥25 years). Results: A total of 7,378 PLHIV were included, 25% AYLHIV (86% female and median age of 21) and 75% adults (57% female and median age of 35), of

whom 59% and 62% were enrolled in 3MMD. Over 90% of early enrolments occurred after COVID-19 measures. Median follow-up time was 11.3 (IQR: 5.7 21.6) and 10.2 (IQR: 4.8-20.9) months in AYLHIV and adults, respectively. Both established and early 3MMD enrollers showed higher retention rates compared to individuals on monthly dispensing (p-value <0.001, Figure). Likewise, the attrition risk was lower for both established (aHR AYLHIV=0.65; 95%CI: 0.54-0.78 and aHR adults=0.50; 95%CI: 0.44-0.56) and early enrollers (aHR AYLHIV=0.70; 95%CI: 0.58-0.85 and aHR adults=0.63; 95%CI: 0.57-0.70). Lastly, among individuals in 3MMD, male gender (aHR=1.30; 95%CI: 1.18-1.44) and receiving care in a medium/low-volume healthcare facility (aHR=1.18; 95%CI: 1.03-1.34) increased attrition risk. Conversely, longer ART time before 3MMD enrolment (aHR=0.93; 95% CI: 0.92-0.94 per one-month increase) and age ≥45 years (aHR= 0.77, 95%CI: 0.67-0.89) reduced risk. Conclusion: 3MMD improves retention in care compared to monthly dispensing among established and early enrollers, although to a lesser extent among the latter. To reap maximum benefits, shortening the required time on ART prior to 3MMD enrolment should be accompanied by additional support services. The figure, table, or graphic for this abstract has been removed. 1249 Using Best-Worst Scaling Experiments to Identify Profiles of Client & Provider Preferences in Zambia Njekwa Mukamba 1 , Musunge Mulabe 1 , Marksman Foloko 1 , Noelle Le Tourneau 2 , Kombatende Sikombe 1 , Sandra Simbeza 1 , Anjali Sharma 1 , Laura K. Beres 3 , Jake M. Pry 1 , Carolyn Bolton 1 , Elvin H. Geng 2 , Izukanji Sikazwe 1 , Aaloke Mody 2 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Washington University in St Louis, St Louis, MO, USA, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: People living with HIV (PLWH) who reengage after falling out of care remain high risk for repeat disengagement, but few tailored reengagement strategies exist to support sustained engagement in this diverse. We used best worst scaling (BWS) experiments to understand client and health care worker (HCW) preferences for features of reengagement strategies. Methods: We conducted BWS surveys among clients returning to care after being >30 days late to an appointment without ART as well as HCWs at 4 public HIV clinics in Lusaka, Zambia. Participants identified the statements about varied reengagement care features and services that they most and least preferred across multiple choice sets. For both groups, we used multinomial logit models to quantify relative preference scores, scaled from 0-100, and latent class analysis to identify unique preference profiles for strategies. Results: We administered BWS surveys among 144 PLWH returning to care (55% female, median age 38 [IQR 19-81]) and 171 HCWs (8% clinical officers,16% nurses, 46% lay HCWs, 30% other). Overall, clients preferred rapid ART reinitiation (normalized score 14.9), longer ART refills (12.0), kind reception at return (11.1),empathy for care challenges (10.9),timely viral load (VL) monitoring (10.2) and coordinating drug pick-ups at other clinics when travelling (9.8).HCWs prioritized timely VL monitoring (11.2), longer drug refills (8.8), flexible ART access after unexpected life events (ULEs) (8.8), kind receptions (8.6), and rapid ART restart (8.3).We identified 3 unique preference profiles for each group.46% of clients preferred improved reengagement experiences (e.g.,rapid ART restart, kind receptions),27% desired easier ART access for travel/ULEs (e.g.,longer refills, travel drug pick-ups, flexible ART access), and 27% sought more convenient clinic experiences (e.g.,longer refills, rapid ART restart, flexible ART access). Amongst HCWs, 41% prioritized improving client experience (e.g.,flexible appointments, kind receptions), 30% focused on ART access and client outreach (e.g., longer refills, community ART delivery), and 29% prioritized clinical needs (e.g.,rapid ART restart,VL monitoring) (Figure). Conclusion: Although clients and HCWs had similar overall preferences, there are unique preferences profiles that differentially prioritize improvements to client experience, access to medications, or addressing clinical needs. Multipronged, tailored reengagement strategies are needed to address the needs for all returning PLWH

Poster Abstracts

CROI 2024 410