CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: In LMICs transitioning to TLD, an effective EAC would substantially improve ART outcomes among ADLHIV experiencing non-VS. In context, LMICs are encouraged to accompany the transition to pediatric dolutegravir-containing regimens with a robust adherence support strategy for ADLHIV with detectable VL to achieve elimination of pediatric AIDS by 2030. 1059 Differentiated Service Delivery Programme Impact on Clinical Outcomes Among Adolescents With HIV Lara Lewis 1 , Jienchi Dorward 1 , Johan van der Molen 1 , Jennifer A. Brown 1 , Nigel Garrett 1 , Yukteshwar Sookrajh 2 , Lungile Hobe 3 , Mlungisi Khanyile 1 , Thokozani Khubone 2 , Francesca Little 4 , Thulani Ngwenya 5 1 Centre for the AIDS Programme of Research in South Africa, Durban, South Africa, 2 eThekwini Municipality Health Unit, Durban, South Africa, 3 Mseleni Hospital, Mseleni, South Africa, 4 University of Cape Town, Cape Town, South Africa, 5 Bethesda Hospital, Bethesda, South Africa Background: In sub-Saharan Africa, clinical outcomes among adolescents with HIV (AWH) on antiretroviral therapy (ART) remain sub-optimal. Differentiated service delivery (DSD) models for ART may facilitate better outcomes, but evidence on their effectiveness among AWH is lacking. We evaluated DSD uptake and outcomes among AWH living in KwaZulu-Natal (KZN), South Africa, following the introduction of DSD for adolescents in mid-2020. Methods: We analysed routinely collected, de-identified data from 125 primary care clinics. AWH aged 10-18 years, stable-in-care (on ART for >6 months with recent viral load (VL) <50 copies/mL) and on first-line ART in June 2020 were analysed and followed to June 2023. The proportion of AWH enrolling in DSD for external pick-up points (the predominant DSD form in KZN, henceforth referred to as DSD), and the effect of DSD enrolment on time to the composite outcome of viraemia (VL>50 copies/mL) or loss-to-care (>365 days late for a visit) was estimated. The probability of DSD enrolment was modelled using logistic regression with generalized estimating equations and covariates for district, age in 2020, gender, time on ART, regimen, previous exposure to multi-month dispensing, history of viraemia, and a polynomial function for months of follow-up. The hazards of becoming lost or viraemic was modelled using inverse-probability-of-treatment-weighted pooled logistic regression, and risk probabilities were calculated with 95% confidence intervals (CI) estimated using bootstrapping. Results: In June 2020, 5766 AWH were on first-line ART. Of these, 2142 were missing a recent VL, 1181 had a VL>50copies/mL, 6 did not have baseline ART regimen data, 162 had tuberculosis and 52 were pregnant. Of the 2223 AWH included for analysis, median age was 14 years and 60% were female. During follow-up, 758 (34%) enrolled into DSD, thereafter, collecting ART mostly through DSD (69% of follow-up), returning to clinic-based care intermittently (Figure). In total, 5% (2% versus 6% in exposed versus never exposed to DSD) became lost-to-care and 37% (46% versus 20% in exposed versus never exposed) became viraemic, with a median (interquartile range) VL of 465 (150 3970) copies/mL. The estimated 36-month probability (95% CI) of becoming lost or viraemic was 35.2% (31.7-38.8%) among those referred to DSD and 50.9% (48.7-53.0%) among those not. Conclusions: DSD enrolment was associated with lower viraemia/lost-to-care rates, but overall clinical outcomes of AWH remain concerning.

specimens with LLV and those with high-level viremia (HLV), defined as viral load >1000 copies/mL (current WHO viral suppression threshold). Established drug resistance mutations (DRMs) were defined at NGS frequency ≥20%, while minority drug resistance variants were considered at NGS frequency 2-20%. Differences in proportions were estimated using Fisher’s exact test. Results: In 397 participants (median age 20 years; 49% female; median 14 years on antiretroviral therapy and 4 years on dolutegravir), 77% achieved viral suppression. For established DRMs, of 42 LLV specimens, 37 Reverse Transcriptase (RT) and 38 Integrase (INT) sequences were generated (88%-90% genotyping success), demonstrating overall resistance in 71% (NRTI 38%; NNRTI 68%; major INSTI 0%; accessory INSTI 13%). Of 168 HLV specimens, 157 RT and 159 INT sequences were generated (93%-95% genotyping success), demonstrating overall resistance in 54% (NRTI 26%; NNRTI 49%; major INSTI 0%; accessory INSTI 6%). Minority resistance variants were detected in 53% of LLV specimens (NRTI 11%, NNRTI 46%, major INSTI 8%, accessory INSTI 0%); and 60% of HLV specimens (NRTI 36%, NNRTI 39%, major INSTI 10%, accessory INSTI 6%. NNRTI established DRMs were higher in LLV than HLV (68% vs. 49%; p<0.05), and minority NRTI drug resistance variants were lower in LLV than HLV (OR 0.214, 95% CIs 0.052 to 0.647; p<0.005). Other eight tests were non significant. Conclusions: Developing a genotyping protocol for LLV enabled exploration of drug resistance in this challenging and increasingly relevant viral load range. High treatment failure in this vulnerable Kenyan youth population on DTG based regimens and similar overall resistance prevalence in LLV versus HLV are concerning, enhanced by major INSTI minority resistance variants. Longitudinal follow up to determine the impact is ongoing. 1058 Enhanced Adherence Counselling Among Adolescents With Detectable Viremia in Cameroon Alex Durand Nka 1 , Suzie Moyo Tetang 2 , Yagai Bouba 3 , Aude Christelle Ka'e 1 , Lum Forgwei 3 , Davy-Hyacinte Gouissi 3 , Rachel Kamgaing 3 , Anne Esther Njom Nlend 4 , Paul Koki Ndombo 5 , Alexis Ndjolo 3 , Maria Mercedes M. Santoro 6 , Francesca Ceccherini-Silberstein 6 , Carlo-Federico Perno 7 , Joseph Fokam 3 , for the CIPHER ADOLA Study Group 1 Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon, 2 Centre Hospitalier d'Essos, Yaoundé, Cameroon, 3 Centre International de Référence Chantal Biya, Yaoundé, Cameroon, 4 Health Ebene Consulting, Yaoundé, Cameroon, 5 Mother and Child Centre of the Chantal BIYA Foundation, Yaounde, Cameroon, 6 University of Rome Tor Vergata, Rome, Italy, 7 Bambino Gesu Children's Hospital, Rome, Italy Background: In low-and middle-income countries (LMIC), mortality among adolescents living with HIV(ADLHIV) is still concerning, driven by poor viral suppression(VS) in the frame of limited adherence monitoring approaches. We herein evaluated the virological outcomes after enhanced adherence counselling (EAC) among ADLHIV with non-VS and low-level viremia (LLV) in the era of tenofovir-lamivudine-dolutegravir (TLD) in Cameroon. Methods: In the frame of the CIPHER-ADOLA project, we conducted a multicenter facility-based cohort-study among ADLHIV(10-19 years) in Cameroon. Three EAC sessions were provided to ADLHIV with a viral load (VL)≥50 copies/ml for a period of 3-months. VS, low-level viremia (LLV) and virological failure(VF) were defined as VL<1000, 50-999 and ≥1000 copies/ mL, respectively. The outcome after EAC among ADLHIV with LLV and VF was respectively to achieve undetectability and VS. Results: Of 252 ADLHIV enrolled for VL testing, 70 (27.8%) had a VL≥50 copies/ ml (female:58.6%, median [IQR] age: 15 [13-17]). Pre-TLD backbones included ABC+3TC (50.0%), TDF+3TC (41.4%) and AZT+3TC (8.6%); median TLD-duration was 23.5 [±11.6] months. Before EAC, 72.9% (51/70) had poor ART-adherence; 44.6% and 55.4% had VLs 50-999 and ≥1000, respectively. At the end of follow up, 60.7% had good adherence; with higher-rates of adherence associated with being female (22/37 [59.4%]) versus male (15/26 [57.7%];p=0.889) and attending all 3 EAC-sessions (57.1% [32/56] vs 42.9%[24/56],p=0.001). Among the 56 ADLHIV with available VLs post-EAC, 58.9%, 19.6% and 21.4% had VLs<50, 50-999 and ≥1000, respectively, indicating an overall 33% reduction in poor VS. Interestingly, among ADLHIV with VL≥1000 at baseline, 70% achieved VS and 30% experienced VF after EAC. In LLV group at baseline, 74% had a VL<50 and 26% remain in LLV. Despite a non-significant decline in median VL (126[52-1871] post-EAC versus 135[95-8519] at baseline,p=0.945), viral non suppression and LLV significantly declined from 55.4% to 21.4% (p=0.0002) and 44.6% to 19.6% (p=0.0046) respectively after EAC. Overall,73.2% significant decline in VLs (-0.5 log10 RNA) was observed between pre- and post-EAC.

Poster Abstracts

CROI 2025 340