CROI 2024 Abstract eBook

Abstract eBook

Oral Abstracts

195

Demographics Are Crucial to Interpret 95-95-95 Targets in African Populations With High ART Coverage Andrea Brizzi 1 , Joseph Kagaayi 2 , Robert Ssekubugu 2 , Alexandra Blenkinsop 1 , Mélodie Monod 1 , Gertrude Nakigozi 2 , Larry W. Chang 3 , Thomas C. Quinn 4 , Fred Nalugoda 2 , Godfrey Kigozi 2 , Ronald M. Galiwango 2 , Oliver Laeyendecker 4 , Mary Kate Grabowski 3 , Steven J. Reynolds 4 , Oliver Ratmann 1 Institutions: 1 Imperial College London, London, United Kingdom, 2 Rakai Health Sciences Program, Kalisizo, Uganda, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA Background: Characterising the shifting dynamics of HIV unsuppressed populations in Africa is crucial to tailor cost-effective interventions necessary to end AIDS by 2030. Methods: We analyzed HIV testing and viral load data collected between 2013 and 2019 from four consecutive surveys of the Rakai Community Cohort Study (RCCS), an open population census and HIV surveillance cohort in Uganda, to estimate HIV seroprevalence and population viral load (VL) suppression over time by location, gender, and one-year age bands. Eligible participants were individuals aged 15 to 49 years old, resident in 40 communities under RCCS surveillance, four of which were hyperendemic Lake Victoria fishing communities. Surveys coincided with the implementation of Universal Test and Treat (UTT), starting in 2014 in fishing communities, and in 2017 elsewhere. All estimates were standardized to population level using census data and compared to UNAIDS 95-95-95 targets. Results: Following UTT, viraemia decreased from 4.9% (4.6 - 5.3) at baseline to 1.9% (1.7 - 2.2) in 2019 in inland communities and from 19.2% (18.0 - 20.4) at baseline to 4.7% (4.0 - 5.5) in 2019 in fishing communities. Crucially, reflecting population pyramids and the age and gender profile of HIV burden, population-level viral load did not concentrate in the age groups furthest from achieving UNAIDS 95-95-95 targets (Figure 1). For example, by 2019, in inland communities, women aged 15-19 and men aged 20-24 were furthest from achieving 95-95-95 targets but contributed only 4.7% (2.9-7.2) and 5.5% (3.8-7.8) to population-level viraemia. In contrast, women aged 25-29 and men aged 30-34, who were close to or had achieved the 95-95-95 targets, each contributed approximately 10% to population-level viraemia in 2019. Conclusion: While 95-95-95 targets provide a useful benchmark for HIV control, they do not take into consideration the underlying population structures and may direct interventions towards groups which contribute marginally to the unsuppressed population. In this cohort, targeting men aged 25-34 rather than men aged 15-24 would result in larger reductions in the number of unsuppressed individuals, despite larger suppression rates in the former age-group. The figure, table, or graphic for this abstract has been removed. High Prevalence of Advanced HIV Disease in Sub-Saharan Africa: An Analysis of 11 Household Surveys Dominik Stelzle 1 , Ajay Rangaraj 1 , Joseph N. Jarvis 2 , Nirina H. Razakasoa 3 , Daniel Low-Beer 1 , Meg Doherty 1 , Nathan Ford 1 , Shona Dalal 1 1 World Health Organization, Geneva, Switzerland, 2 London School of Hygiene & Tropical Medicine, London, United Kingdom, 3 World Health Organization, Brazzaville, Republic of the Congo Background: Advanced HIV Disease (AHD) among adults is defined as a CD4 count <200 cells/mm 3 or a World Health Organization HIV clinical stage 3 or 4. Estimates of the burden of AHD in sub-Saharan Africa are still scarce. Methods: We analysed data from eleven Population-based HIV impact assessment (PHIA) household surveys conducted between 2015 and 2020 to determine the proportion of adults living with HIV who have a CD4 count <200 cells/mm 3 stratified by demographic factors and the HIV treatment cascade. We then estimated the number of individuals with AHD in sub-Saharan Africa by combining these proportions with the latest HIV estimates from UNAIDS. Results: A total of 21,826 people living with HIV (PLHIV) were included in this study of which 15,012 (64%) were female and the median age was 38 years (interquartile range 30–46). Pooled across the eleven countries, 11.6% (95% CI 11–12.2%) of PLHIV had a CD4 cell count <200cells/mm 3 – ranging from 6.1% in Côte d'Ivoire to 14.7% in Tanzania (Figure A). AHD was more common among males than females (15.6% versus 9.5%) and more common in urban than rural areas (12% versus 11.3%). Overall, 16.1% of people who did not know their HIV status had a CD4 count <200cells/mm 3 , as did 21.4% of people who knew their status but were not on ART, 35.6% of people who were on ART but not virally suppressed, and 5.1% of people who were virally suppressed. Among all people with a CD4 count <200cells/mm 3 , 26% (95%CI 23–28%) were virally

suppressed (Figure B). Extrapolating these results to sub-Saharan Africa yielded an estimated 2.1 million people living with AHD (1.8– 2.5 million); 1 million females and 1.1 million males. Conclusion: Despite advances in ART that have transformed HIV into a manageable chronic condition, a significant number of people continue to develop AHD, even as conservatively calculated from household surveys which do not capture data from health facilities. A considerable proportion of people with AHD have a suppressed viral load; this includes people who might have recently initiated ART or have re-engaged in ART care after treatment interruptions. These figures highlight the need for urgent and innovative programmatic improvements in monitoring, prevention and diagnosis of AHD in the context of well-established and maturing ART programmes.

Oral Abstracts

197

Low-Level Viremia Trends Among Persons With HIV: A 5-Country Analysis From 10 PHIA Surveys Jessica E Justman 1 , Giles A. Reid 1 , Shannon M. Farley 1 , Helen Chun 2 , Hetal Patel 2 , Kyle Milligan 2 , Harriet Nuwagaba-Biribonwoha 3 , Felix Ndagije 4 , Nzali G. Kancheya 5 , Wilford Kirungi 6 , Owen Mugurungi 7 , Rejoice Nkambule 8 , Rose K. Nyirenda 9 , Tapiwa Tarumbiswa 10 , Wafaa El-Sadr 1 1 ICAP at Columbia University, New York, NY, USA, 2 Centers for Disease Control and Prevention, Atlanta, GA, USA, 3 ICAP at Columbia University, Mbabane, Eswatini, 4 ICAP at Columbia University, Maseru, Lesotho, 5 Centers for Disease Control and Prevention, Lusaka, Zambia, 6 Ministry of Health Uganda, Kampala, Uganda, 7 Ministry of Health and Child Care, Harare, Zimbabwe, 8 Ministry of Health, Mbabane, Eswatini, 9 Government of Malawi Ministry of Health, Lilongwe, Malawi, 10 Ministry of Health, Maseru, Lesotho Background: The World Health Organization defines HIV viral load (VL) suppression as <1,000 copies/mL (c/mL). However, low-level HIV viremia (LLV) has been associated with drug resistance mutations and virologic failure. Limited data are available on population-based prevalence of LLV in low and middle-income settings, especially following the expansion of dolutegravir containing regimens. Methods: We examined temporal trends in prevalence of LLV, defined as HIV RNA >50 and <999 c/mL, among persons with HIV (PWH) aged 15y+ who reported ≥12 months of ART use, by analyzing data from five African countries (Eswatini, Lesotho, Malawi, Uganda and Zimbabwe) which conducted two sequential, nationally representative population-based HIV impact assessments (PHIA1 [2015-19] and PHIA2 [2020-21]). VL values of 'target not detected', <20, <40 and <50 c/mL were all categorized as '<50 c/mL'. Dolutegravir was qualitatively measured in PHIA 2 blood samples using analytic methods. Weighted prevalence and distribution of LLV by demographic characteristics and use of dolutegravir were assessed. Results: Among 185,552 individuals enrolled across the 10 surveys, 27,202 were PWHIV. Of these, 17,347 (58%) reported ≥12 months of ART use; of these, 15,978 (91%) had VL <1,000 c/mL. Among those with VL <1,000 c/mL, 14,386 (89.2%) had VL < 50 c/mL and 1,519 (10.8%) had LLV. LLV varied by survey from 2.6% to 22.2% but was largely stable over time in each country. LLV was similar among younger (age <30 y) adults vs older adults (13.1% [95% confidence intervals (CI):10.8, 15.8] vs 10.5% [9.7, 11.3]). Four of five countries had a similar distribution of LLV (Figure). Overall, 70.4% of the 1,519 individuals with LLV had values >50 and < 200 c/mL, with little variation by country or survey year. In the PHIA2 surveys, across all five countries, LLV was similar among those with and without detectable dolutegravir (10.3% [8.8, 12.0] and 10.5% [9.0, 12.3]). LLV was significantly less common, however, among those with vs without dolutegravir in Eswatini (9.2% [7.9, 10.8] vs 18.1% [13.4, 24.0]) and Malawi (1.9% [1.2, 2.9] vs 7.4% [4.6, 11.6])

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CROI 2024