CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

687

Distance to Care Measures Predict Injection Visit No-Shows Among Cabotegravir/Rilpivirine Recipients Nimish Patel 1 , Lucas Hill 2 , Jeffrey Yin 2 , Inmaculada Hernandez 1 , Kari Abulhosn 2 , Elvia Suarez 2 , Afsana Karim 2 , Laura Bamford 2 1 University of California San Diego, La Jolla, CA, USA, 2 University of California San Diego Medical Center, La Jolla, CA, USA Background: Various distance to care (DTC) measures exist. It is unclear which most accurately predicts injection visit adherence for persons with HIV receiving long acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV). Objectives were to: i) identify which DTC measures were associated with injection visit no-shows (IVNS) and ii) compare the strength of association of each DTC measure when evaluated as an independent predictor of IVNS among recipients of LAI CAB/RPV. Methods: A retrospective cohort study was performed among recipients of LAI CAB/RPV between 05/2021 and 08/2023 at an urban HIV medicine clinic. Inclusion criteria were: i) age ≥18 years, ii) received CAB/RPV for ≥6 months, and iii) availability of address in electronic medical record. Individuals with a post office box as their address were excluded. Five measures were estimated to measure distance between home address and clinic address: i) door-to-door mileage, ii) driving time, iii) public transit time, iv) walking time and v) biking time. All analyses were restricted to those with a door-to-door mileage of <15 miles as the non-driving DTC measures would not be realistic without a motor vehicle. Classification and regression tree (CART) analyses were performed to identify breakpoints in each of these continuous DTC measures associated with no shows. Each of these DTC variables were entered into a Cox proportional hazards regression model to determine the strength of association after controlling for other potential predictor variables. Results: Among the 202 individuals evaluated, median age (interquartile range, IQR) was 43 (34 – 54) and median (IQR) time on CAB/RPV was 451 (356 – 552) days. Most (91%) were assigned male sex at birth. The Table displays the CART-derived breakpoints for each DTC variable. For each DTC measure, there was a significantly higher proportion of IVNS for persons above the breakpoint than below. In multivariate analyses (Table) adjusting for other potential predictor variables, each DTC measure was independently associated with IVNS with the exception of driving time ≥ 19 minutes. Walking time ≥ 117 minutes (Hazard ratio, HR: 2.33) had the strongest measure of association with IVNS. Conclusions: Several DTC measures with CART-derived breakpoints were independently associated with IVNS among recipients of LAI CAB/RPV. Future studies should consider incorporating CART into the DTC measure used to predict injection visit adherence.

up to 24 weeks was 91.4% and 94.8%, up to 48 weeks was 90.6% and 96.2%, and using the most recent documented VL was 91.9% and 95.9%, respectively. Conclusions: In those who discontinued LAI CAB/RPV, returned to oral ART, and remained engaged in care, a high rate of ongoing viral suppression was observed.

686

Implementation of LA-CAB/RPV in US Clinic Settings: A Survey of Front-Line Clinicians William R. Short 1 , Michelle Ogle 2 , Eric Farmer 3 , Angela Kapalko 4 , Bruce Packett 5 , Angela Riley 5 , Amanda Binkley 1 1 University of Pennsylvania, Philadelphia, PA, USA, 2 Albert Einstein College of Medicine, Bronx, NY, USA, 3 Indiana University Health, Indianapolis, IN, USA, 4 AbsoluteCARE, Philadelphia, PA, USA, 5 American Academy of HIV Medicine, Washington, DC, USA Background: Long-acting Cabotegravir and Rilpivirine (LA-CAB/RPV), approved in January 2021, is the first complete injectable regimen for virologically suppressed patients with HIV-1 without a history of resistance. The availability of LA-CAB/RPV offers a significant opportunity to expand the landscape of care for people with HIV. However, data on its implementation outside of early phase clinical trials remain limited, often excluding adolescents. The objective of our survey was to assess implementation strategies, barriers, and practices with LA-CAB/RPV among front-line HIV clinicians who are members of and/or credentialed by the American Academy of HIV Medicine (AAHIVM). Methods: A 25-question survey was distributed electronically to 5223 members and/or credentialees of AAHIVM through the weekly newsletter as well as two standalone emails sent out biweekly from July 8 to August 1, 2024. Data was collected using Research Electronic Data Capture (RedCap) and statistical analysis was conducted with Stata 17. Results: A total of 325 responses were received. Respondents included physicians (37 %), pharmacists (29%), nurse practitioners (24 %), and physician assistants (10%). Most (91%) had implemented LA-CAB/RPV and worked primarily in Academic Health Centers (33%) and Federally Qualified Health Centers (34%). The main barrier to implementation was insurance and third-party approval processes. Of the clinicians caring for adolescents (62%), half had prescribed LA-CAB/RPV in this population, with just 26% prescribing it to cis-gender females. For patients with resolved Hepatitis B (defined by anti-HBs, anti-HBc, HBsAg -), 77% of clinicians would prescribe LA-CAB/RPV; however, if the patient had isolated anti-HBc, only 54% would prescribe it. For cis-gender females of child-bearing age not on contraception, half of clinicians would not use LA-CAB/RPV. Regarding patients with elevated BMI, clinicians were comfortable (91%) using LA-CAB/RPV for patients with a BMI of > 30 kg/ m2 but that decreased to 65% and 42% with BMI ≥40 kg/m2 and > 50 kg/m2, respectively. Conclusions: While most clinicians surveyed have incorporated LA-CAB/RPV into their practices, key challenges remain, particularly among adolescents, cis-gender female patients, those with resolved Hepatitis B, and those with higher BMIs. Addressing barriers related to insurance and approval processes, along with continued education, is crucial to expanding access and optimizing the use of LA-CAB/RPV.

Poster Abstracts

688

First Year of Lenacapavir Long-Acting Injectable Use in the OPERA Cohort Laurence Brunet 1 , Karam Mounzer 2 , Ricky K. Hsu 3 , Philip C. Lackey 4 , Michael Sension 5 , Michael B. Wohlfeiler 6 , Joshua Gruber 7 , Megan S. Dunbar 7 , Seojin Park 7 , Jennifer S. Fusco 1 , Gregory P. Fusco 1 1 Epividian, Inc, Durham, NC, USA, 2 Philadelphia FIGHT, Philadelphia, PA, USA, 3 AIDS Healthcare Foundation, New York, NY, USA, 4 Wake Forest University, Winston-Salem, NC, USA, 5 CAN Community Health, Fort Lauderdale, FL, USA, 6 AIDS Healthcare Foundation, Miami, FL, USA, 7 Gilead Sciences, Inc, Foster City, CA, USA Background: Lenacapavir (LEN), a first in class capsid inhibitor approved by the FDA (22DEC2022) as a twice yearly long-acting injectable used with an optimized background regimen (OBR), is indicated for heavily treatment experienced individuals with multidrug resistant HIV-1 infection who are failing their current antiretroviral therapy (ART) regimen due to resistance, intolerance, or safety concerns. We describe LEN use during its first-year post-approval in a US-based cohort using electronic health record data.

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