CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

993

Rapid Return of Viral Load (VL) Results to Pregnant/Postpartum Women via Mentor Mothers in Kenya Pam Murnane 1 , Sharon Ouma 2 , Raphael Onyango 2 , Nita Mukand 1 , Francesca Odhiambo 2 , Jane Kabami 3 , Elizabeth A. Bukusi 2 , Craig R. Cohen 1 , James Ayieko 2 1 University of California San Francisco, San Francisco, CA, USA, 2 Kenya Medical Research Institute, Kilifi, Kenya, 3 Infectious Diseases Research Collaboration, Kampala, Uganda Background: Perinatal HIV transmission has not meaningfully declined in Kenya since 2015. VL monitoring can both reinforce good adherence and enable timely intervention if viremia is detected early. However, in routine care in Kenya, time from sample collection to results to patients is often weeks when VL is detected and months when suppressed. We assessed the feasibility of engaging Mentor Mothers (peer counselors) in rapid return of VL results and factors associated with time required for this approach. Methods: From May-Dec 2023 we enrolled women between 27 weeks gestation and 6 months postpartum from 4 facilities in Kisumu Kenya. We tested VL via GeneXpert at 1-2 time points. Mentor Mothers returned results to participants and were reimbursed for phone minutes. We tracked times of sample collection, delivery to lab, test resulted, and result return to study team, mentor mother, and participant. Participant VL histories were collected from records. We assessed factors associated with time from sample collection to result return to participants, via unadjusted and adjusted generalized estimating equations with log-transformed time as the outcome. We exponentiated coefficients to report geometric mean ratios (GMR). Results: From 273 participants (47% pregnant), we tested 422 blood samples of which Mentor Mothers delivered 414 (98%) VL results via phone and 2% in person. VL was ≤40, 41-999, and ≥1000 copies/mL in 90%, 6%, and 4% of samples, respectively. Median time from collection to result return to participants was 27 hours (interquartile range [IQR] 23-55). The slowest step was lab result to study team (median 15 hours, IQR 13-17), as processing was often done after hours. The step with the greatest time variability was Mentor Mother to participant (median 5 hours, IQR 1-25). Study VL results were not associated with time (collection to participant), though VL ≥1000 copies/mL trended towards faster return (GMR 0.8, 95% CI 0.6-1.1; Table). However, viremia in the past year was associated with longer times (GMR 1.3, 95%CI 1.1-1.5). Samples collected on Fridays took 2.0 times (95%CI 1.6-2.6; Table) longer than Monday-Thursday (which were comparable to each other); clinics without GeneXpert on site took 1.8 times longer than when the lab was co-located (95%CI 1.6-2.0). Conclusions: Mentor Mothers delivered VL results to pregnant and postpartum women in just over 1 day on average. This low-cost approach could complement other strategies to enhance VL monitoring and support optimal adherence.

992

Childhood Exposure to Violence and Pregnancy-to-Postpartum Viral Load of US Women With HIV Deborah Kacanek 1 , Jessica Lee 1 , Carly Broadwell 1 , Claire A. Berman 1 , Emily Barr 2 , Ellen Chadwick 3 , Mariam Davtyan 4 , Toinette Frederick 4 , Kathleen Powis 5 , Jennifer Jao 6 , Liz Salomon 1 , Kimbrae Sanders 7 , Renee Smith 8 , Lynn Yee 6 , Kathleen M. Malee 6 , for the Pediatric HIV/AIDS Cohort Study (PHACS) 1 Harvard TH Chan School of Public Health, Boston, MA, USA, 2 University of Texas at Houston, Houston, TX, USA, 3 Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA, 4 University of Southern California, Los Angeles, CA, USA, 5 Massachusetts General Hospital, Boston, MA, USA, 6 Northwestern University, Chicago, IL, USA, 7 Texas Children's Hospital, Houston, TX, USA, 8 University of Illinois at Chicago, Chicago, IL, USA Background: Experiences of childhood physical and sexual assault are prevalent in people living with HIV, yet relationships to antepartum and postpartum viral load (VL) are understudied. We evaluated the relationship of childhood physical or sexual assault (CPA/CSA) to VL during pregnancy and postpartum among participants in the Women’s Health Supplement to the Surveillance Monitoring for ART Toxicities (SMARTT) study. Methods: In this prospective study, women at 21 SMARTT sites in the US and Puerto Rico who were >18 years old, living with HIV and pregnant or up to five years postpartum in 2013-2018 were eligible. CPA/CSA, assessed at one-year postpartum via interview, was defined as an affirmative response to having been physically and/or sexually assaulted in childhood. VL measures from 3 months before the last menstrual period (LMP) date until 15 months after delivery were abstracted from medical records. Pregnancy through postpartum log10 RNA trajectories by CPA/CSA were visualized with LOESS plots. Unsuppressed VL (≥50 copies/mL) at LMP, delivery, and 1 year postpartum and unsuppressed VL during pregnancy and postpartum (any measure ≥50 copies/ mL in these periods) were compared in those with vs. without CPA/CSA. Log binomial regression models with generalized estimating equations were fit to estimate crude and adjusted relative risks and 95% confidence intervals (CI) for unsuppressed VL in those with vs. without CPA/CSA. Results: Among 518 pregnancies (among women mean age: 29 years), 34% were among participants who reported experiencing CPA/CSA (CPA: 23.4%, CSA: 27.6%, CPA and CSA:17.0%). In pregnancies of women with vs. without CPA/CSA the frequency of unsuppressed VL was similar at LMP (49% vs 46%) and delivery (21% vs 18%), but higher at the 1-year postpartum time point in pregnancies of women with CPA/CSA (39%) than in those of women without CPA/CSA (29%). A visual summary of log10VL stratified by CPA/CSA is displayed in the Figure. The frequency of unsuppressed VL during pregnancy was similar among pregnancies of women with vs. without CPA/CSA. However, unsuppressed VL at any point in the first year postpartum period was more frequent in postpartum periods of women with (53%) than in those without (43%) CPA/CSA (aRR:1.22, 95% CI:1.00, 1.50). Conclusions: CPA/CSA was prevalent among women living with HIV and associated with elevated risk of postpartum unsuppressed VL. Trauma-informed approaches are needed and may help sustain care engagement and viral suppression postpartum.

Poster Abstracts

CROI 2025 315