CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: The very high levels of HIV prevalence and recent HIV acquisition among TGW in Midwest Brazil highlight the significant burden of the HIV epidemic and STI in this population, despite the availability of public health prevention strategies. Older TGWs may have a lower perception of risk, leading to behaviors that increase the odds of acquiring HIV. It is crucial to address these gaps to improve targeted interventions and care for TGW, including increasing PrEP access, especially in regions where their vulnerability to HIV is high.

among the two groups. STI history was a common factor associated with HIV in both groups. Therefore, health interventions supported by governmental public policies are urgently needed to mitigate the HIV epidemic in this key population in both large metropolitan and smaller cities in central Brazil. 1110 Time to Antiretroviral Initiation Among Transgender Women Living With HIV in France (1997-2022) Juliette Hemery 1 , Pierre Tattevin 2 , Esaïe Marshall 1 , Margot Annequin 1 , Thibault Chiarabini 3 , Nathalie Dournon 4 , Anaenza Maresca 4 , Jade Ghosn 5 , Valentina Isernia 4 , Florence Michard 4 , Segolene Perrineau 4 , Giovanna Rincon 6 , Bruno Spire 7 , Pierre De Truchis 4 , Sophie Grabar 8 1 French National Institute of Health and Medical Research (Inserm), Paris, France, 2 Centre Hospitalier Universitaire de Rennes, Rennes, France, 3 Hôpital Saint-Antoine, Paris, France, 4 Assistance Publique – Hôpitaux de Paris, Paris, France, 5 Hôpital Bichat-Claude-Bernard, Paris, France, 6 Acceptess-T, Paris, transgender women (TW), some studies have shown that this population often experiences longer time intervals within the continuum of care. This study aims to describe the evolution of these time intervals and analyze the impact of sociodemographic and clinical factors on the time to antiretroviral therapy (ART) initiation after entering care. Methods: Treatment-naive TW living with HIV1 enrolled between 1997 and 2022 in France in the ANRS CO4 FHDH cohort were included in the analyses. Factors associated with the time to ART initiation after enrollment were analyzed for 1997-2004, 2005-2012, and 2013-2022 using a generalized linear model adjusted for age, geographic origin, time between diagnosis and enrollment, immuno-virological status, and year of enrollment. Results: Of 104,348 PWH followed in the cohort between 1997-2022, 876 (0.8%) were TW. Most were from Latin America (67.6%), recruited in the Paris region (70.5%) at a median age of 31 (IQR: 27-37), and followed for a median of 9.1 years. (3.8-15.5). Between 1997-2004, 29.5% of TW accessed to care at an advanced stage (CD4 <200/mm³ or AIDS stage), compared to 21.5% in 2013 2022 (p=0.0023). From 1997-2004 to 2013-2022, the median time between HIV diagnosis and access to care decreased from 1.8 months (IQR: 0.3-24.7) to 0.4 months (0.03-4.6) (p<.0001), the time between access to care and ART initiation decreased from 4.4 months (IQR: 0.03-31) to 0.6 months (0.2-1.5) (p<.0001), and the time from ART initiation to achieving a viral load (VL) <200 cp/mL from 4.7 months (IQR: 2.4-15.5) to 1.7 months (1.1-4.4) (p<.0001). At the most recent follow-up, 98.3% were on treatment, and 89% achieved a VL <200 cp/mL. In multivariable analysis, during 1997-2004, advanced stage at access to care (vs early stage) and a VL ≥100,000 cp/mL at enrollment (vs <100,000) were associated with a shorter time to ART initiation (respectively -32.8 and -10.4 months). In 2013-2022, immuno-virological status was not significantly associated with time to ART initiation, but TW from Africa and Latin America had longer time to ART initiation compared to those born in France (+1.8 and +0.8 months, respectively). Conclusions: Until 2013, time to ARV initiation of TW was mainly influenced by patient's immuno-virological status at care entry. Since the " treat all " policy, delays have been significantly shortened, but disparities related to geographic origin have persisted beyond 2013, hindering rapid access to treatment. 1111 Temporal Variations of Racial Disparities in HIV Incidence in the United States From 2008 to 2021 Jingwen Zuo, Fanghui Shi, Xiaoming Li, Xueying Yang University of South Carolina, Columbia, SC, USA Background: Despite ongoing efforts to address racial disparities in HIV incidence, the Black/African American and Hispanic/Latino populations continue to be disproportionately affected by new HIV diagnoses. The current study aimed to explore the temporal trend of racial disparities in HIV incidence at the county level across the United States from 2008 to 2021, and to identify potential social determinants that contribute to these variations. Methods: We used three measurements to quantify racial disparities in HIV incidence, including rate ratio, disparity index, and population-weighted disparity index. Temporal trends in these indices were analyzed using Joinpoint regression. Linear mixed-effects models were applied to explore the relationship between racial disparities in HIV new diagnosis rates and social vulnerability index (SVI), as well as other social determinants variables. Results: From 2008 to 2021, the Black-to-White rate ratio displayed an overall decreasing trend (Average Annual Percent Change [AAPC] = -1.41, P <0.05), and two turning points were identified in 2012 and 2015. This ratio France, 7 Aix-Marseille Université, Marseille, France, 8 Sorbonne University, Paris, France Background: Despite a global HIV prevalence of nearly 20% among

Poster Abstracts

1109 High HIV Burden Among Transgender Women in the State Capital and Rural Towns in Central Brazil Bruno Vinícius D. Diniz e Silva 1 , Larissa Silva Magalhães 1 , Kamila Cardoso dos Santos 1 , Sylvia L. M. Teixeira 2 , Ingebourg Georg 3 , Karlla Antonieta A. Caetano 1 , Robert L. Cook 4 , Sheila A. Teles 1 , Megmar Aparecida S. Carneiro 1 , for the Núcleo de Estudos em Epidemiologia e Cuidados em Doenças Transmissíveis e Agravos à Saúde Humana (NECAIH) 1 Federal University of Goias, Goiânia, Brazil, 2 Oswaldo Cruz Institute – Fiocruz, Rio de Janeiro, Brazil, 3 Institute Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 4 University of Florida, Gainesville, FL, USA Background: Transgender women (TGW) have an increased risk for HIV due to social exclusion, barriers to access to health care, discrimination, and exposure to higher-risk contexts such as sex work. In fact, there is a lack of studies assessing the dynamics of the HIV epidemic among TGW in rural cities. This is a cross-sectional study that aimed to estimate the prevalence and factors associated with HIV acquisition and compared the characteristics among TGW in the state capital vs. rural towns of Goiás, which are regions far from the HIV epicenter in Brazil. Methods: From 2018 to 2019 a total of 440 transgender women were recruited, 285 in the capital of Goiás (Goiânia) and 155 in the state's rural towns (Jataí and Itumbiara). All participants were interviewed about sociodemographic characteristics and sexual risk behaviors. The blood samples were tested by rapid test (Bioclin HIV Tri line, Quibasa, BH, Brazil; R DPP® HIV 1/2, Bio Manguinhos, RJ, Brazil) and retested by ELISA (Genscreen™ ULTRA HIV Ag-Ab, Bio-Rad, Marnes-la-Coquette, France). Samples positive in both tests were considered positive. Prevalence was estimated with a 95% confidence interval. We performed bivariate and multiple Poisson regression analyses with 95% confidence intervals (CI). Results: TGW from the state capital reported higher monthly income, more sexual partners, more engagement in sex work, more group sex, less insertive anal sex, and more sex with men and women compared to TGW who lived in rural towns. Those in rural towns reported more sex with men only (p< 0.05). HIV prevalence was 32.9% (95% CI: 27.6% – 38.6%) in the capital and 33.8% (95% CI: 26.7-41.6) in the rural towns, some participants were unaware of their serological status. Among the TGW from the capital, STI history (self-reported) was associated with HIV (Adjusted Prevalence Rate [APR] 1.5; 95% CI: 1.04-2.1), while among those from rural towns, STI (self-reported) was associated with HIV (APR: 2.2; 95% CI: 1.3-3.8) as well as group sex (APR: 2.5; 95% CI: 1.1-5.6). Conclusions: Despite a higher proportion of risk behaviors found among TGW in the capital vs. rural cities, the high burden of HIV among TGW was similar

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