CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

994

Evaluating and Revising an Adapted Scale for Antiretroviral Therapy (ART) Adherence Self-Efficacy Lauren Sheu 1 , Austin Wesevich 2 , Maganizo B. Chagomerana 3 , Wiza Kumwenda 3 , Jacob N. Phulusa 3 , Madalitso Maliwichi 3 , Kate Burrows 1 , Mina Hosseinipour 3 1 University of Chicago, Chicago, IL, USA, 2 University of Chicago Medical Center, Chicago, IL, USA, 3 University of North Carolina Project–Malawi, Lilongwe, Malawi Background: Adherence to anti-retroviral therapy (ART) is essential for HIV management, and self-efficacy (i.e., one’s confidence in adhering to their medication regimen) correlates to adherence and viral load (VL) suppression. We developed ASES-Chichewa, a 10-item adherence self-efficacy scale (ASES) for Malawi, where lifelong ART is provided to pregnant/breastfeeding women living with HIV to reduce vertical transmission; ASES-Chichewa was created through formal translation and adaptation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). We aimed to evaluate ASES-Chichewa’s ability to estimate ART adherence and VL suppression for its target population. Methods: ASES-Chichewa measured the antenatal ASES of 1470 pregnant women living with HIV at Bwaila Hospital in Lilongwe, Malawi from 2015-19, 399 of which were enrolled and followed for 3 years (NCT02249962). The proportion of participants achieving VL suppression by 6-month follow-up was compared between perfect (100%) and imperfect (<100%) self-efficacy survey scores using chi-square tests. Results: VL suppression did not differ between ASES-Chichewa self-efficacy groups. 79% and 81% of participants with ASES-Chichewa perfect and imperfect self-efficacy, respectively, achieved VL suppression by 6-month follow-up (p = 0.6). Principal components analysis identified one item of ASES Chichewa as a major contributor to ASES variance; this item, ASES-Chichewa-1, asked participants: “How confident are you that you can continue with your treatment (ART) even when your daily routine is disrupted?” When using ASES Chichewa-1 to define perfect and imperfect self-efficacy, significant differences in VL suppression were found between self-efficacy groups. 82% and 52% of participants with ASES-Chichewa-1 perfect and imperfect self-efficacy, respectively, achieved VL suppression by 6-month follow-up (p = 0.02). Conclusions: After reducing ASES-Chichewa from a 10-item questionnaire to single-item self-efficacy screener (ASES-Chichewa-1), there were significant associations between self-efficacy and VL suppression at 6 months for pregnant women living with HIV. Further study on prospective screening with ASES Chichewa-1 is warranted to identify Malawian women at risk for not achieving VL suppression prior to delivery. Interventions to improve ART self-efficacy and adherence are critical to achieve VL suppression and prevent vertical transmission. The Impact of Care Transitions on Pregnant Youth Living With HIV in Kisumu, Kenya Rabbia Imran 1 , Arnold Muhinji 2 , Dorothy Mangale 3 , Edwin Nyagesoa 2 , Gladys Ontuga 2 , Elvin H. Geng 3 , Lisa Abuogi 4 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 2 Kenya Medical Research Institute, Kilifi, Kenya, 3 Washington University, St Louis, MO, USA, 4 University of Colorado Denver, Denver, CO, USA Background: Pregnant adolescents and young adults living with HIV (AYALWH) in low-middle-income countries (LMIC), where the transition from HIV to antenatal care (ANC) is required, have poor clinic attendance and retention in HIV care. Little is known about the impact of this pregnancy-associated transition (PAT). This sub-study of the Adapt for Adolescents (A4A) trial evaluates the impact of PAT in AYALWH on HIV care engagement. Methods: In the A4A study, AYALWH aged 14-24 years were enrolled at three public facilities in Kisumu Country, Kenya, between April, 2021—March, 2022. Female participants with a PAT included those who were pregnant at enrollment (excluding new diagnoses of HIV) and those who became pregnant during the study. Those with PAT were compared to female participants without a PAT during two years of study follow-up. This analysis explored care engagement, defined as missed clinic visit (at least 14 days late for a scheduled visit) or viral suppression (viral load <200 copies/ml). The pre-post transition condition for the pregnant group was compared. A chi-square test was used to compare viral suppression at year two for both groups, with subsequent multivariable logistic regression analysis to identify any cofounders. Results: Of the 591 female AYALWH, we identified 130 (22.0%) experiencing a PAT, while 238 (40.3%) did not. The median age of participants with PAT was 21 years (interquartile range 19-23) compared to 17 years (interquartile range 15-22) for those without (Table 1). Among participants with a PAT, 78

(60.0%) had sustained viral suppression before transition, which increased to 119 (91.5%) after transition. Visit attendance declined post-transition, with 80 (61.5%) transitioned participants having no missed visits pre-transition, decreasing to 50 (38.5%) post-transition. Comparison of viral suppression at year 2 between those with PAT and those without transition was not statistically significant (adjusted odds ratio [aOR: 1.07, 95% confidence interval (CI) 0.45 - 2.55]. Increasing age was independently associated with increased viral suppression at two years (aOR 1.216, 95% CI 1.029, 1.438, p = 0.022). Conclusions: This preliminary analysis indicates that pregnancy among AYALWH may be a motivating factor in achieving viral suppression. However, AYALWH with PAT show an increased number of missed visits post-transition. Further evaluation of the effect of transition due to pregnancy on HIV care engagement in AYALWH is needed.

Poster Abstracts

996

HIV Drug Resistance Patterns Among Pregnant Women After Dolutegravir Scale-Up in Sub-Saharan Africa Linda Stoeger 1 , Maria Casadellà 2 , Anete Mendes-Muxlhanga 3 , Ghyslain Mombo-Ngoma 4 , Johannes Mischlinger 5 , Michael Ramharter 5 , Meral Esen 6 , Mariona Parera 2 , Antía Figueroa-Romero 1 , Sergi Sanz 1 , Roger Paredes 2 , Tacilta Nhampossa 7 , Clara Menéndez 1 , Raquel González 1 1 Barcelona Institute for Global Health, Barcelona, Spain, 2 IrsiCaixa, Badalona, Spain, 3 Centro de investigação de Saúde de Manhiça, Maputo, Mozambique, 4 Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon, 5 Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, 6 Eberhard Karls University of Tübingen (EKUT), Tübingen, Germany, 7 Manhiça International Research Center, Manhiça, Mozambique Background: In sub-Saharan Africa (SSA), rates of HIV drug resistance (HIVDR) among patients with antiretroviral treatment (ART) failure are high for non nucleoside reverse transcriptase inhibitors (NNRTIs), with implications for the risk of HIV mother-to-child transmission among pregnant women. Since 2019, the WHO recommends dolutegravir (DTG), an integrase strand transfer inhibitor (INSTI), in first-line regimens due to its high barrier to resistance. We aimed to describe HIVDR mutations among pregnant women living in SSA at the time of DTG scale-up. Methods: This observational study is nested in a malaria prevention clinical trial among pregnant women with HIV conducted between 2019 and 2023 in Gabon and Mozambique. Available samples from women with virological failure (HIV viral load >400 copies/mL) at the first antenatal care (ANC) visit were analysed for HIVDR mutations using Illumina MiSeq®. Drug susceptibility was predicted using the Stanford HIVdb scoring system. Characteristics of participants were compared by the presence of HIVDR. Results: A total of 99 women contributed to this study and 39 had at least one HIVDR mutation at their first ANC visit. Participant’s median age was 25 years [IQR 22-31], which was higher in women with HIVDR mutations compared to those without (29 vs 24 years; p=0.009). At the time of the first ANC visit, 38 (38.4%) women were on ART, with a higher proportion in the group with HIVDR mutations compared to the group without (64.1% vs 21.7%; p<0.001). NNRTI mutations were detected in 36 (36.4%) women and INSTI mutations in 6 (6.1%) women. In one ART-experienced but INSTI-naïve participant two INSTI mutations, H51Y and R263K (at frequencies of 17.8% and 99.8% respectively), were detected, indicating intermediate resistance to DTG. Another participant

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CROI 2025 316