CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

948

Modelling the Contribution of Incarceration to TB Transmission in Ukraine Jack Stone 1 , Adelina Artenie 1 , Frederick Altice 2 , Peter Vickerman 1 1 University of Bristol, Bristol, UK, 2 Yale University, New Haven, CT, USA Background: People who inject drugs (PWID) experience high incarceration rates, with prior incarceration associated with HIV and TB infection. We evaluated the contribution of incarceration to TB transmission in Ukraine and the impact of reductions in incarceration since probation was introduced in 2015. Methods: A dynamic model of incarceration, HIV and TB transmission was developed for PWID and the general population. The model was parameterized and calibrated using national TB data and 7 bio- behavioural surveys among PWID or incarcerated persons from 2011-2019. The model incorporates different HIV and TB transmission risks in prison than the community, increased injecting risk following prison release, increased TB activation and transmission among PWID, and greater TB activation with HIV infection which is reduced by ART. We projected the proportion of new TB infections averted over 10 years (‘contribution’) from 2000/2010/2020 if the forementioned effects of injecting drug use (IDU), incarceration or HIV were removed. We also evaluated the impact of probation, which has substantially reduced the prison population size since 2015, on new HIV and TB infections. Results: Model projections suggest TB incidence in 2024 was 15.4 (95% credibility interval: 11.6-20.3) and 42.9 (22.8-86.0) times higher among PWID and prisoners than national levels. Over 2020- 2029, 3.9% (1.7-8.6) of all new TB infections can be attributed to incarceration, 15.1% (6.4-29.7) among PWID. Due to recent large reductions in incarceration, its contribution to new TB infections has reduced from 25.3% (15.0-36.6) of all new TB infections over 2000-2009 and 56.0% (38.9-64.1) among PWID. The introduction of probation is estimated to have averted 10.1% (5.4-17.0) and 10.0% (5.0-17.2) of all new TB and HIV infections, respectively, over 2015-2024; 29.9% (19.8-39.9) and 23.3% (17.1-29.8) among PWID. Conclusions: Incarceration can contribute substantially to TB transmission, particularly amongst PWID. Findings emphasise the potential public health impact of decarceration policies such as probation. Mental and Physical Health of People With TB in Southern Africa at the Start of Treatment and Beyond Guy K. Muula 1 , Nicolas Banholzer 2 , Denise Evans 3 , Jacqueline Huwa 4 , Idiovino Rafael 5 , Marie Ballif 2 , Cordelia Kunzekwenyika 6 , Carolyn Bolton-Moore 1 , Gunar Günther 7 , Andreas D. Haas 7 , Annika Sweetland 8 , Matthias Egger 7 , Lukas Fenner 2 , for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration - Southern Africa 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, 2 Institute of Social and Preventive Medicine, Bern, Switzerland, 3 University of the Witwatersrand, Johannesburg, South Africa, 4 Lighthouse Trust, Lilongwe, Malawi, 5 SolidarMed Mozambique, Cabo Delgado, Mozambique, 6 SolidarMed Zimbabwe, Masvingo, Zimbabwe, 7 University of Bern, Bern, Switzerland, 8 Columbia University, New York, NY, USA Background: Tuberculosis (TB) affects psychological, physical, and social well-being. We determined how changes in mental and physical components of quality-of-life (QoL) affect specific patient groups. Methods: We recruited and followed-up people with TB aged ≥15 years between October 2022 and August 2024 in five ongoing cohorts in Malawi, Mozambique, South Africa, Zambia, and Zimbabwe. At the beginning (baseline), at the end, and six months post TB treatment, we measured mental and physical QoL scores (SF12-MCS, SF12-PCS), depressive symptoms score (PHQ-9-S), physical fitness (6-minute walk test distance, 6MWT-D; sit-to-stand test repetitions, STST-R), and overall health, daily life and well-being (St. George’s respiratory questionnaire, SGRQ-TS). Using multivariate imputation by chained equations, we imputed QoL outcomes and estimated their association with patient characteristics using Bayesian multivariable regression models. Results: We enrolled 1,424 participants; 986 (69%) completed treatment, and 629 (44%) had a post-treatment visit. Median age was 39 years (interquartile range [IQR]: 30–50), 471 (33%) were female, 557 (39%) living with HIV, 245 (17%) with a history of TB, and 493 (35%) were smokers. At baseline, 19% of participants screened positive for depression (PHQ-9 ≥10). Mental and physical SF-12 scores were 44 (IQR 38–50) and 35 (IQR 27–42) out of 100, respectively, with scores below 42 and 50 suggesting impairments. Physical fitness in participants was lower than in healthy adults (6MWT 322, IQR 150–407 and STST 15, IQR 10–19). SGRQ-TS was 39 (IQR 27–52) out of 100, with scores above

25 suggesting impairment. The proportion of patients with impaired QoL decreased until end of treatment for all outcomes (Figure). Mental outcomes remained low post-treatment and physical outcomes improved further. Female sex and TB history were overall associated with lower QoL scores (86% and 88% probability). Age<30 was associated with higher QoL scores (82% probability). Living with HIV was overall associated with lower QoL scores at baseline (95% probability), but not at the end of treatment (62%) and post-treatment (24%). Conclusions: QoL in people with TB was often impaired at baseline, but both physical and mental outcomes improved during treatment and tended to improve only slightly thereafter. QoL should be monitored and integrated into the clinical management of people with TB, especially for groups more likely to have impaired mental and physical health.

Poster Abstracts

950

HIV and Tuberculosis Stigma Affecting Individuals With Pulmonary Tuberculosis in East Africa Kirsten K. Prabhudas-Strycker 1 , Lameck Diero 2 , Winnie Muyindike 3 , Helen Byakwaga 4 , Neelima Navuluri 5 , Sylvia Kitur 6 , Joseph Mining'wo 6 , Bob Ssekyanzi 7 , Alexis Byaruhanga 7 , Suzanne Goodrich 1 , Harold Kooreman 1 , Constantin T. Yiannoutsos 8 , Aggrey Semeere 9 , Kara K. Wools-Kaloustian 1 , Leslie A. Enane 1 , for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration - East Africa Region 1 Indiana University, Indianapolis, IN, USA, 2 Moi University, Eldoret, Kenya, 3 Mbarara University of Science and Technology, Mbarara, Uganda, 4 Infectious Disease Institute, Kampala, Uganda, 5 Duke University School of Medicine, Durham, NC, USA, 6 Academic Model Providing Access to Healthcare, Eldoret, Kenya, 7 Mbarara Regional Referral Hospital, Mbarara, Uganda, 8 Indiana University, Bloomington, IN, USA, 9 Infectious Diseases Institute, Kampala, Uganda Background: HIV and TB stigma may undermine TB care and outcomes. We investigated HIV and TB stigma and reported influences of TB stigma on care access among individuals with pulmonary TB in Eldoret, Kenya, and Mbarara, Uganda. Methods: The Tuberculosis Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS is a global prospective study of people aged ≥15 with pulmonary TB, with and without HIV. East Africa sites conducted stigma questionnaires (adapted from Van Rie and the Stop TB stigma assessment) 1 month into TB treatment, March 21-September 12, 2023. We described responses for stigma domains (felt HIV, community HIV, and TB) and influence of TB stigma on care access. HIV stigma scales employed third-person phrasing for use regardless of HIV status. Standardized domain scores (mean score among all items) ranged 0-4 (0=strong disagreement, 2=no opinion, 4=strong agreement with stigma statements). We assessed stigma scores for associations with sociodemographic/clinical variables in multivariable regression analysis. Results: Among 177 participants—118 (67%) male, median age 33 years (IQR 25 to 44), 58 (33%) with HIV, and 36 (20%) with recurrent TB—standardized scores for felt HIV stigma were higher than for community HIV stigma and TB stigma (Table). For TB stigma, respondents agreed with, “I am afraid to tell those outside my family I have TB” (54%); “I choose carefully who I tell about having TB” (77%); and “I keep my distance from others to avoid spreading TB” (80%). Among 85 (49%) who endorsed felt TB stigma, none reported it inhibited

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