CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1081 Refining Clinical Retention Metrics to Reflect the Realities of HIV Care in North America Amber J. Hackstadt 1 , Elisa S. Yazdani 1 , Alicia R. Rector 1 , Kelly Gebo 2 , Catherine Lesko 3 , Michael Horberg 4 , Lauren Zalla 3 , Heidi M. Crane 5 , Jessie K. Edwards 6 , Joseph J. Eron 6 , M. John Gill 7 , Mona Loutfy 8 , Brenna C. Hogan 9 , Keri N. Althoff 3 , Peter F. Rebeiro 1 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Vanderbilt University Medical Center, Nashville, TN, USA, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 University of Washington, Seattle, WA, USA, 6 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 7 University of Calgary, Calgary, Canada, 8 Women's College Research Institute, Toronto, Canada, 9 The Johns Hopkins University, Baltimore, MD, USA Background: “Retention” in care is a key health monitoring benchmark among people with HIV (PWH). However, not all retention metrics predict important downstream outcomes, particularly with decreasing frequency of clinical monitoring. We therefore assessed the association of multiple retention metrics with mortality in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Methods: Adult (age ≥18 years) PWH in care at NA-ACCORD clinical sites from 2010-2021 were followed from first visit during the study until death or administrative censoring. Retention was defined as ≥2 encounters, >90 days apart, in both of the 2 years following study entry. We excluded PWH deceased in that period and defined “encounters” two ways: 1) HIV care visits only, and 2) either HIV care visits or CD4 or HIV-1 RNA viral load measures. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) for mortality by retention status, adjusted for baseline age, birth sex, race/ethnicity, HIV transmission risk, CD4 count (nearest entry, ≤90 days before to ≤60 days after), viral suppression (HIV-1 RNA <200 copies/mL at final encounter in both of the 2 years following entry), enrollment year, and site, with follow-up starting 2 years after study entry. Though viral suppression during follow-up mediates the retention mortality relationship, baseline adjustment here enabled inferences about retention among PWH with equivalent early suppression status. Results: Among 95,428 PWH contributing 546,805 person-years, median baseline age was 47 (IQR: 37,55) years; 16% were female, 44% non-Hispanic Black, 35% men who have sex with men, 7% people who inject drugs, and 5-year mortality risk was 11.4%. Early retention was 74% by the visit-or laboratory metric, and 69% by the visit-only metric. Retained PWH had higher mortality risk than those not retained under both visit-or-laboratory (HR=1.25, CI:1.16-1.36; Figure, Left) and visit-only (HR=1.17, CI:1.09-1.27; Figure, Right) metrics. Without baseline viral suppression adjustment, the retention-mortality association was null. Conclusions: Despite known benefits of retention in HIV care, frequent interactions with HIV care in the current era may be an indicator of more clinical and non-clinical needs. In order for retention to remain a meaningful target for monitoring quality HIV care, retention metrics should be re-operationalized to better capture patterns of engagement in care that predict key clinical outcomes.

1082 Neighborhood Resources and ARV Adherence Among Partnered US GBMSM: Mediation by Social Determinants Loren Dobkin, Luis Parra, Alison Walsh, Erin Kahle University of Michigan, Ann Arbor, MI, USA Background: Despite advances in the potency of antiretroviral (ARV) medications to treat and prevent transmission of human immunodeficiency virus (HIV), the most common regimens in the United States (U.S.) necessitate daily pill-taking. While there is consensus that social determinants of health (SDoH) hinder adherence, SDoH are typically measured and intervened upon at the individual level. Meanwhile, stark disparities in the geographic distribution of HIV morbidity and incidence suggest neighborhood-level factors may contribute to individual-level SDoH and inform interventions. Methods: By linking U.S. National Neighborhood Data Archive’s neighborhood disadvantage index (NDI) to participant zip codes from a national cohort of partnered gay, bisexual and other men who have sex with men (GBMSM) living with HIV, we analyzed baseline relationships among neighborhood resources (NDI), SDoH (using a validated 10-point scale of adverse exposures), and low ARV adherence (below 90% by visual analog scale). Participants living in the U.S. were recruited and completed the parent study via remote electronic methods. Using multiple logistic regression, we quantified the independent associations of cumulative SDoH exposure and neighborhood disadvantage to low ARV adherence. Mediation analysis was used to test whether neighborhood disadvantage was associated with ARV adherence through SDoH. Results: Among the 368 participants, higher NDI was significantly associated with low adherence (OR 19.30, CI 1.34-278.32) and an average 2.57 increase on the SDoH scale (CI 1.06-4.08). After controlling for age, race/ethnicity, problem substance use and other demographic variables, each additional SDoH exposure corresponded to a significant increase in the odds of low adherence (OR 1.46, CI 1.17-1.82), which mediated the relationship between neighborhood disadvantage and lower adherence (Sobel test statistic 3.18, p<0.01). Conclusions: Consideration of residential neighborhood context together with the minimum adherence level required to achieve viral suppression may help inform clinical ARV regimen selection. Further research on the contribution of neighborhood conditions to SDoH is needed to strategically target interventions to low-resource areas where they may facilitate adherence among exposed residents. 1083 Geographically Diverse National Survey of People With HIV on Grindr Shows High Virologic Suppression Hannah R. Schmidt 1 , Megan J. Heise 1 , Kevin Sassaman 1 , Alexa D'Angelo 2 , Tyler Martinson 1 , Shivani Mahuvakar 1 , Dustin Duncan 3 , Keith J. Horvath 4 , Sabina Hirschfield 5 , Renessa Williams 6 , Mallory O. Johnson 1 , Christian Grov 2 , Adam Carrico 7 , Monica Gandhi 1 , Matthew A. Spinelli 1 1 University of California San Francisco, San Francisco, CA, USA, 2 CUNY School of Public Health, New York, NY, USA, 3 Columbia University Irving Medical Center, New York, NY, USA, 4 SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA, 5 State University of New York Downstate Medical Center Downstate Medical Center, Brooklyn, NY, USA, 6 University of Miami Miller, Miami, FL, USA, 7 Florida International University, Miami, FL, USA Background: Viral suppression (VS) is only 65% among U.S. people with HIV (PWH), which could compromise Ending the HIV Epidemic (EHE) goals. PWH using geosocial networking apps (e.g. Grindr, used primarily by sexual minority men) should know their VS status to enhance the impact of Undetectable=Untransmittable among a population with high rates of sexual activity. We sought to determine the proportion of PWH on Grindr who know their VS status and achieved VS (<200 copies/mL). Methods: U.S. adult PWH were recruited through Grindr to complete a survey from Jan-Sept 2024. We assessed the prevalence and correlates of past-year, self-reported VS using logistic regression adjusted for demographics, substance use, region, and residence in EHE jurisdiction. Those who reported adherence challenges were separately enrolled in a longitudinal cohort where viral loads were drawn, allowing comparison of objective VS to self-report. Results: The final sample consisted of 2,933 geographically diverse participants (Figure 1); 29% were Black, 24% Latine; 4% transgender women, 10% other gender minorities; 32% age 18-34, 19% age 55+; 36% used stimulants. Overall, 95% knew their VS status in the past 12 months. Participants who were younger (i.e. 18-34 vs 55+; OR=0.47, p=0.02, 95% CI=0.24-0.84), Black (OR=0.57, p=0.01, 95% CI=0.36-0.88), and used stimulants (OR=0.56, p<0.001, 95% CI=0.40-0.79) had lower odds of knowing their VS status. Of those who knew their VS status, 94% reported complete VS for the past 12 months. PWH

Poster Abstracts

CROI 2025 349