CROI 2025 Abstract eBook

Abstract eBook

Oral Abstracts

129

Associations of Dolutegravir and the COVID-19 Pandemic on Viral Suppression in South African Adults Haroon Moolla 1 , Reshma Kassanjee 1 , Renee de Waal 1 , Patience Nyakato 1 , Jonathan Euvrard 1 , Gary Maartens 1 , Hans W. Prozesky 2 , Matthew P. Fox 3 , Catherine Orrell 1 , Geoffrey Fatti 2 , Gilles Wandeler 4 , Mary-Ann Davies 1 , Leigh F. Johnson 1 , for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration - Southern Africa 1 University of Cape Town, Cape Town, South Africa, 2 Stellenbosch University, Cape Town, South Africa, 3 Boston University, Boston, MA, USA, 4 Bern University Hospital, Bern, Switzerland Background: Viral suppression estimates are essential for monitoring progress towards the UNAIDS 95-95-95 targets. We sought to generate updated estimates of viral suppression rates in South African adults on antiretroviral treatment (ART) to understand changes in viral suppression following the introduction of dolutegravir and the COVID-19 epidemic. Methods: This retrospective cohort study included adults (15 years or older) starting ART between 2005 and 2023 from seven South African sites of the International epidemiology Databases to Evaluate AIDS collaboration. We excluded those with no recorded baseline CD4 count or who were virologically suppressed before starting ART. Participants were censored at the earliest of death, transfer to another facility, 180 days after the last recorded visit (“lost to follow-up”), or 31 December 2023. After starting ART, viral load testing was scheduled at 6 months, 1 year, and yearly thereafter. Missing viral loads were imputed using multivariate imputation by chained equations. Viral suppression was defined as less than 1000 copies/ml. Multivariable logistic regression was used to estimate associations with viral suppression. Results: 187 624 participants contributed 986 348 person-years of observation. The proportion virologically suppressed reached a low of 86.4% in the 2011 calendar year, and then increased steadily to 94.8% in 2022. Virological failure was less likely amongst those starting ART on dolutegravir-based regimens than those starting on other regimens (adjusted odds ratio [aOR] 0.45, 95% CI 0.42-0.50). The odds of virological failure was lower amongst females (aOR 0.80, 95% CI 0.78-0.82), and decreased with increasing baseline CD4 count, duration on ART, and age (Figure 1). The odds of virological failure during the height of the COVID-19 pandemic (2020-2021) did not differ from other years (aOR 1.03, 95% CI 0.99-1.07). Those with a history of previous care interruptions, defined as gaps in contact longer than 180 days, were more likely to be virally unsuppressed (aOR 1.88, 95% CI 1.82-1.95). Conclusions: Viral suppression rates in South Africa are on a promising trajectory toward the 95% UNAIDS target. The introduction of dolutegravir has likely contributed positively to the ongoing success of the national HIV programme. Viral suppression was not adversely affected by the COVID-19 pandemic, highlighting the resilience of the health system.

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A Multistage Sampling Approach to Refine HIV Mortality Estimates in KwaZulu-Natal, South Africa Alastair VanHeerden 1 , Franco Musiello 1 , Aaloke Mody 2 , Buyisile Chibi 1 , Kombatende Sikombe 3 , Alfred Keter 4 , Zaynab Essack 1 , Anjali Sharma 3 , Candice Groenwald 1 , Collins Iwuji 5 , Elvin H. Geng 2 , Lindsey Filiatreau 2 1 Human Sciences Research Council, Pretoria, South Africa, 2 Washington University in St Louis, St Louis, MO, USA, 3 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 4 Aga Khan University, Nairobi, Kenya, 5 Brighton and Sussex Medical School, Brighton, UK Background: As the global response to HIV intensifies toward the goal of ending the epidemic by 2030, accurate estimates of mortality among people with HIV are needed to appropriately allocate limited resources. Standard patient monitoring approaches frequently lead to misclassification of patient outcomes, including vital status. In South Africa, the national HIV electronic health record system, TIER.net, fails to link patient-level outcomes across clinics, further complicating estimation of true patient outcomes. To address this, we used a multistage sampling strategy to systematically capture and verify vital status of people with HIV in KwaZulu-Natal Province (KZN). Methods: We employed a stratified, multi-stage sampling approach to obtain representative estimates of vital status across all 11 districts in KZN. Clinics were selected from among all government-funded clinics providing HIV treatment services in KZN using probability proportional to size sampling. Random sampling was then employed to select up to 125 patients who had accessed HIV care in the prior two years but were 90+ days late for their most recent scheduled clinic visit using TIER.net. Trained teams conducted phone-based and in-person tracing to verify patient vital status. Inverse-probability weighting was used to obtain a provincial estimate of mortality among people with HIV with a current clinical lapse. Results: Across 36 sampled clinics, a total of 4,482 individuals were randomly selected from 33,581 individuals who had at least one clinic visit in the prior two years but were 90+ days late for their most recent scheduled visit. Of the 33,581 individuals eligible for sampling,~4% had a documented death in TIER.net. Of sampled individuals, 3,156 (70.4%) were successfully traced; 2,737 (61.1%) were alive and 419 (9.3%) had died. Clinic-level estimates of mortality ranged from 5.0% to 19.3%. After weighting, an estimated 11.0% of the 33,581 individuals seeking HIV care in KZN who were late for their most recent scheduled clinic visit had died. Conclusions: These findings indicate that relying solely on national health record data substantially underestimates mortality in people with HIV, emphasizing the importance of tracking efforts to obtain accurate estimates of HIV-related deaths. Moreover, our results underscore the potential of sampling based approaches to refine mortality and other HIV care estimates, thereby informing strategies that bolster re-engagement pathways and mitigate overall mortality. Genotypic Characterization of Mpox and a Tale of 2 Co-Circulating Viruses in Uganda Nicholas Bbosa 1 , Stella E. Nabirye 2 , Hamidah S. Namagembe 1 , Ronald Kiiza 1 , Danstan D. K. Kabuuka 2 , Alfred Ssekagiri 2 , Henry K. Bosa 3 , Robert G. Downing 2 , Stephen Balinandi 2 , Julius Lutwama 2 , Moffat Nyirenda 1 , Pontiano Kaleebu 2 , Deogratius Ssemwanga 2 1 London School of Hygiene & Tropical Medicine, London, UK, 2 Uganda Virus Research Institute, Entebbe, Uganda, 3 Ministry of Health Uganda, Kampala, Uganda Background: The Africa CDC and the WHO declared Mpox a Public Health Emergency of Continental Security and of International Concern respectively. The first Mpox-positive cases in Uganda were reported in July 2024 from Kasese District, Bwera Hospital by the Uganda Virus Research Institute (UVRI) and MRC/ UVRI & LSHTM Uganda Research Unit. In light of ongoing Mpox virus (MPXV) transmission and an increasing number of cases reported in the neighboring DRC, we heightened surveillance for MPXV infections in Uganda to mitigate against the increased public health risk of cross-border spillover. Methods: In this cross-sectional study, we tested samples collected from suspected Mpox cases on real-time PCR using different platforms to increase accuracy. All Mpox-positive samples were subsequently genotyped using targeted enrichment next-generation sequencing (NGS) while unbiased metagenomic NGS was performed on the Mpox-negative samples from clinically suspected cases to characterize other pathogens. Phylogenetic analysis was performed using IQTREE. Results: As of 24-09-2024, 24 specimens tested positive for Mpox virus (MPXV) on real-time PCR out of the 597 samples collected from clinically suspected

Oral Abstracts

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CROI 2025