CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1005 Incident HIV Infection Among Pregnant Women in Botswana Has Decreased Since 2022 Aamirah Mussa 1 , Gloria K. Mayondi 1 , Modiegi Diseko 1 , Judith Mabuta 1 , Mompati Mmalane 1 , Joseph Makhema 1 , Shahin Lockman 2 , Jeffrey W. Imai-Eaton 2 , Sikhulile Moyo 1 , Chelsea Morroni 1 , Rebecca Zash 1 , Roger Shapiro 2 1 Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana, 2 Harvard TH Chan School of Public Health, Boston, MA, USA Background: Women who acquire HIV during pregnancy are at increased risk for vertical HIV transmission. Major intervention efforts have sought to rapidly reduce HIV incidence in Botswana over the past decade. The Tsepamo Study captures data on ~70% of all deliveries in Botswana including HIV test dates and results during antenatal care. We assessed whether HIV incidence among pregnant women in Botswana is declining by comparing data collected 2017 2021 and 2022-2024. Methods: We used data collected from women who gave birth at 16 public maternity wards. HIV seroconversion was measured as having an initial negative/indeterminate HIV test in pregnancy followed by a positive test during the same pregnancy or at delivery. To calculate the HIV incidence rate, seroconversion date was approximated as the mid-point between last negative/ indeterminate test and first positive HIV test. Logistic regression was used to identify factors associated with incident HIV during pregnancy. Results: Among 51,013 women who delivered September 2022-September 2024 and had an initial negative/indeterminate test in pregnancy, 45,110 (88%) had ≥2 known HIV test dates in the same pregnancy and were included in this analysis. There were 75 seroconversions (1.67/1000 pregnancies, 0.17%) among 45,110 women with ≥ 2 known HIV test dates during pregnancy, yielding an incidence rate of 0.43/100 person-years (38% lower than 0.69/100 person years among women who delivered May 2017-August 2021). Infections were highest among the 20–24-year age group with an incidence rate of 0.61/100 person-years. Factors associated with greater risk for seroconversion during pregnancy included being aged 20-24 (unadjusted odds ratio [uOR] vs. age >35 = 3.09, 95% CI 1.09-8.79), being unmarried (uOR = 4.32: 95% CI 1.06-17.62), not having salaried/self-employment (uOR = 1.91, 95% CI 1.11-3.29) and having less than a tertiary level of education (uOR = 2.16, 95% CI 1.11-4.21). There were no significant differences in risk for seroconversion by geographic region or by urban vs. rural delivery site. Conclusions: Compared with 2017-2021, the rate of seroconversions during pregnancy among pregnant women in Botswana between 2022-2024 has declined. However, HIV incidence remains high among younger women with less education and without salaried employment, presenting opportunities for targeted PrEP. Long-acting injectable options, which can prevent both maternal and subsequent infant infection, could strengthen HIV prevention efforts in this critical population. 1006 Social Determinants Associated With Recent HIV Infection in Treatment Naive Pregnant Women in Malawi Shuntai Zhou 1 , Rachel Burdorf 1 , Nathan Long 1 , Gerald Tegha 2 , Maganizo B. Chagomerana 2 , Allan Jumbe 2 , Madalitso Maliwichi 2 , Shaphil Wallie 2 , Yijia Li 3 , Ronald I. Swanstrom 4 , Mina Hosseinipour 2 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 University of North Carolina Project–Malawi, Lilongwe, Malawi, 3 University of Pittsburgh, Pittsburgh, PA, USA, 4 CIDRZ / University of North Carolina, Chapel Hill, NC, USA Background: Young women in sub-Sahara Africa face a high risk of acquiring HIV. Antiretroviral therapy (ART) is prioritized for pregnant women with HIV to treat the infection and prevent transmission to newborns. Assessing recency of infection in women who initiated ART during pregnancy and the associated social determinants are pivotal to monitor the epidemic in this vulnerable population. Methods: ART-naïve participants were enrolled through an antenatal clinic in Lilongwe, Malawi, between 2015-2019. We used a multiplexed Primer ID next generation sequencing based recency assay to predict recent HIV infection on entry plasma specimens by measuring intra-host diversity on pol (RT) and env (V1V3). Both the qualitative recency using a 9-month cutoff and the quantitative days post infection (DPI) were reported for each participant. Demographics characteristics, clinical characteristics and social determinants were collected at study entry. Results: A total of 203 participants were successfully analyzed by the recency assay; 8.9% were considered recent infection by 9-month cutoff, 15.3% were considered as borderline recent infection, and 75.9% were considered as chronic

infection. In the quantitative assessment of DPI, 5% were within 6 months of infection at study enrollment, 18% within one year of infection, and 45% within two years of infection. A majority (76%) of the participants were in their 2nd trimester of pregnancy at enrollment. Recent and borderline recent infections were combined for the following analyses. Participants with recent infection were younger (median age 23 y/o vs. 27 y/o in chronic group, p<0.01), had higher CD4+ T cell counts (median 482 cells/uL vs. 307 cells/uL in the chronic group, p<0.01), had lower income (p=0.04), were more likely to be in their first pregnancy (p=0.002), and more likely to have a partner with confirmed HIV positive status (p=0.03). In the multivariant analysis, participant’s age (OR: 0.9 per year, 95%CI: 0.83-0.97) and partner with HIV (OR: 3.3, 95%CI: 1.24-8.79) were associated with recent infection at ART initiation. We also identified a significant association between self-reported domestic violence and recent HIV infection (p=0.01). Conclusions: A majority of study participants acquired HIV before the current pregnancy and did not initiate ART until second trimester. Our data suggest that increasing access to HIV testing for the women and their partners, and initiating ART early in the pregnant women are pivotal in this study population. 1007 STI Testing Is Associated With Lower PrEP Discontinuation Among Women Initiating PrEP in Pregnancy Jerusha Mogaka 1 , Felix Abuna 2 , Eunita Akim 2 , John Kinuthia 2 , Lauren A. Gomez 1 , Mary Marwa 2 , Chelsea Morroni 3 , Aamirah Mussa 3 , Nancy Ngumbau 2 , Celestine Adogo 2 , Peter Okoth 2 , Salphine Watoyi 2 , Barbra Richardson 1 , Grace John Stewart 1 , Jillian Pintye 1 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya, 3 Botswana Harvard AIDS Institute Partnership, Gabarone, Botswana Background: Sexually transmitted infections (STIs) in pregnancy contribute to adverse birth outcomes and increased HIV acquisition during pregnancy and the postpartum period. Yet, few studies evaluate how STI testing influences HIV PrEP use among pregnant women who initiate HIV PrEP. Methods: We analyzed data from a randomized trial conducted between February 2022-July 2023 among pregnant women who newly initiated daily oral HIV PrEP during routine antenatal care and were followed through 9 months postpartum in western Kenya (NCT04472884). Women were tested for syphilis per national guidelines. At two of the five study sites, women were offered Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing at enrollment using Xpert® CT/NG assays starting September 2022. Women tested received same-day results, and directly observed treatment (DOT) was offered to women diagnosed with CT/NG. We evaluated the association between CT/NG testing and time to HIV PrEP discontinuation using Cox proportional hazards models. Results: Overall, 260 pregnant women initiating HIV PrEP enrolled in the two study sites at a median gestational age of 26 weeks (IQR 24-29). The median age was 26 years (IQR 22-30), most women (80%) were married, and 92% had partners of unknown HIV status; 2% tested positive for syphilis. Overall, 39 (15%) enrolled before commencement of CT/NG testing procedures; 221 (85%) women were offered CT/NG testing in pregnancy — all of whom accepted. Only 19 (7%) reported STI symptoms (e.g., abnormal vaginal discharge and/or vulvar burning/itching). Prevalence of CT and/or NG was 19/260 (7.3%): 4% CT, 3% NG, and 1% CT/NG co-infection. The median time to HIV PrEP discontinuation for all women was 331 days from initiation in pregnancy (IQR 144-366). By 9 months postpartum, women who tested for CT/NG in pregnancy were less likely to discontinue HIV PrEP compared to those not tested in pregnancy (51% vs. 77%, p=0.003). Testing for CT/NG in pregnancy was associated with a 45% longer time to HIV PrEP discontinuation (hazard ratio[HR] 0.55, 95%CI: 0.38-0.80, p=0.002). Having STI symptoms or testing positive for CT/NG was not associated with HIV PrEP discontinuation (HR 0.98, 95% CI 0.38-2.52, p=0.975) and (HR 1.01, 95% CI 0.64-1.58, p=0.978) respectively. Conclusions: Co-offering CT/NG testing to women initiating HIV PrEP in pregnancy could increase HIV PrEP continuation through postpartum, regardless of test results and represents an opportunity for addressing HIV/STI in this priority population

Poster Abstracts

CROI 2025 320