CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

were less likely to be suppressed (age 18-34 OR=0.45, p<0.01, 95% CI=0.25 0.77; age 35-54 OR=0.48, p<0.01, 95% CI=0.27-0.79). The Midwest had lower VS (OR=0.54, p=0.02, 95% CI=0.32-0.91) compared to the West. PWH who use stimulants also had lower VS (OR=0.47, p<0.001, 95% CI=0.34-0.65). Of the longitudinal cohort (n=930), 90% of those who reported being virologically suppressed were suppressed on study labs. Residing in an EHE priority jurisdiction was not associated with VS or knowing VS status. Conclusions: This remote U.S. national cohort showed high rates of VS among PWH on Grindr, with high concordance with objective VS in a sub-sample. However, rates of stimulant use were higher than prior studies among PWH, with lower VS among this population, which should be addressed through targeted adherence interventions. Disparities in awareness of VS status among younger, Black, and stimulant-using PWH should be ameliorated through targeted care reengagement interventions, potentially via Grindr.

were associated with non-VS in the unadjusted analysis. These results can inform both primary and secondary prevention measures targeted towards those age 40 and older.

1085 Changes in the HIV Care Cascade and Prevalence From 2013 to 2023 in Rural Kenya and Uganda in SEARCH Gabriel Chamie 1 , Colette Aoko 2 , Helen Sunday 3 , George Agengo 4 , Wafula E. Mugoma 4 , Matt Hickey 1 , Douglas Black 1 , John Schrom 1 , Elijah Kakande 3 , Jane Kabami 3 , James Ayieko 2 , Maya Petersen 5 , Diane V. Havlir 1 , Moses Kamya 6 , Laura Balzer 5 , for the SEARCH Consortium 1 University of California San Francisco, San Francisco, CA, USA, 2 Kenya Medical Research Institute, Kilifi, Kenya, 3 Infectious Diseases Research Collaboration, Kampala, Uganda, 4 KEMRI Kenya, Nairobi, Kenya, 5 University of California Berkeley, Berkeley, CA, USA, 6 Makerere University College of Health Sciences, Kampala, Uganda Background: We sought to understand how the HIV epidemic is evolving over time by evaluating HIV prevalence and changes in status awareness and antiretroviral therapy (ART) use over 10 years in two high-prevalence, rural regions in East Africa. Methods: In 2013 and 2023 in rural communities (~5,000 adults/community) in western (W) Kenya and southwestern (SW) Uganda, we conducted universal HIV screening of adult (≥15 years) residents at enrollment in two SEARCH population-level cluster randomized trials (NCT01864603; NCT05768763). Using TMLE and accounting for clustering by community, we estimated age- and sex specific HIV prevalence, status awareness among persons with HIV, and ART use if living with HIV and aware of status. Results: In 2013, in 22 communities (12 W-Kenya, 10 SW-Uganda), we ascertained HIV status among 90,467/101,200 (89%) residents. In 2023, among 8 different communities from the same regions (4 W-Kenya, 4 SW-Uganda), we ascertained HIV status among 38,360/42,866 (89%) residents. In W-Kenya, HIV prevalence decreased from 18.7% in 2013 to 12.7% in 2023 (p<0.001). From 2013 to 2023, there were large, significant reductions in HIV prevalence among women aged 15-44 and men aged 20-49 years (Figure), but significant increases among women ≥45. Overall, from 2013 to 2023, HIV status awareness increased from 64% to 90% (p<0.001), and ART use from 81% to 94% (p<0.001), with large, significant increases across all age-sex strata, and greatest gains among men and youth. In contrast, in SW-Uganda, HIV prevalence increased from 6.4% in 2013 to 7.3% in 2023 (p=0.007). There were small, significant reductions in prevalence among women aged 15-29, and men 20-39 (Figure), but prevalence increased among women and men ≥40 years. Overall, from 2013 to 2013, HIV status awareness increased from 57% to 68% (p<0.001), and ART use from 82% to 87% (p=0.002); however, these improvements were not uniform by age and sex in SW-Uganda. Conclusions: Population-level prevalence data are consistent with a substantial decline in HIV incidence in W-Kenya, particularly among young adults, but not SW-Uganda. Persistently low status awareness, well below the 95% target, over the past 10 years in SW-Uganda may explain this disparity and suggests that efforts to improve status awareness are needed to achieve further reductions in HIV incidence.

Poster Abstracts

1084 Viral Nonsuppression Among PWH Diagnosed at an Older Age: Implications for Secondary HIV Prevention Lauren O'Connor 1 , Anne Monroe 1 , Rachel Denyer 2 , Amanda D. Castel 1 , Manya Magnus 1 , for the DC Cohort Executive Committee 1 The George Washington University, Washington, DC, USA, 2 Veterans Affairs Medical Center, Washington, DC, USA Background: Older adults are at increased risk of HIV acquisition, yet few studies examine correlates of their HIV prevention. It is important that we understand correlates of being diagnosed at an older age, as well as factors associated with viral non-suppression (non-VS) among those diagnosed at an older age for U=U prevention efforts. However, there is no universal cut-off for classifying a person as “older” at the time of their HIV diagnosis. Our objective was to determine a cut-off for older age at HIV diagnosis and use that cut-off to evaluate correlates of non-VS among those diagnosed above that cut-off. Methods: The DC Cohort is a longitudinal cohort of people with HIV (PWH) in Washington, DC. We evaluated cohort participants enrolled from 2011-2024 who were diagnosed with HIV in the year prior to enrollment. We used logistic regression to determine the direction of the relationship between age and each demographic variable. The direction was used to predict the demographics of participants diagnosed with HIV after age cut-offs from 20-70 years old. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of predictions. We used generalized estimating equations to evaluate correlates of non-VS, defined as a viral load > 200 copies/mL, among those diagnosed with HIV above the age cut-off with the best predictive accuracy. Results: We evaluated 1,240 DC Cohort participants who were newly diagnosed with HIV in the year prior to enrollment. Participants were mostly non-Hispanic Black (78%), male (71%), heterosexual (37%), and the mean age was 37 (SD: 13.5). We found that an age 40 cut-off had the best predictions across demographics. Therefore, we evaluated the 487 participants diagnosed with HIV at age ≥ 40. We found that females (OR (95% CI): 1.8 (1.1, 2.8)), those with public insurance (OR: 1.6 (1.0, 2.4)), and heterosexual mode of HIV acquisition (OR: 1.7 (1.1, 2.7)) were more likely to be non-VS. These relationships were not significant in the adjusted model. Transgender participants were less likely to be non-VS in both the unadjusted and adjusted models (aOR: 0.2 (0.1, 0.7)). Conclusions: An age cut-off for HIV diagnosis of 40 years or older resulted in the most accurate predictions of participant demographics. Among those diagnosed age 40 or older, gender, mode of HIV transmission, and insurance

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