CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1115 Changes of Racial Disparities in Viral Suppression in People With HIV, 2013-2020 Xueying Yang, Cuihong Huang, Chen Zhang, Fanghui Shi, Jiajia Zhang, Bankole

1116 Effect of the Ending the HIV Epidemic (EHE) Initiative on Racial/Ethnic Disparities in HIV Incidence Lauren Zalla 1 , Melissa Schnure 2 , Andrew Zalesak 2 , Zoe Dansky 2 , David W. Dowdy 2 , Maunank Shah 2 , Catherine Lesko 1 , Anthony Todd Fojo 2 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Reducing HIV-related disparities is one of the four goals of the National HIV/AIDS Strategy. The Ending the HIV Epidemic (EHE) initiative, a key component of the Strategy, focuses on scaling up prevention and treatment services in priority jurisdictions. It is unclear what effect the EHE initiative may have on racial and ethnic health disparities related to HIV. Methods: We used the Johns Hopkins Epidemiological and Economic Model, a dynamic compartmental model of HIV transmission in US cities, to project HIV incidence in 2035 in Baltimore, MD. The model is stratified by age, sex, transmission risk factor, and race/ethnicity: non-Hispanic Black (representing 75.5% of prevalent HIV diagnoses in Baltimore in 2022), Hispanic (5.5%), and other racial/ethnic groups – predominantly non-Hispanic White (12.5%). We calibrated the model to local surveillance data. We estimated the impact of increasing testing, viral suppression, and pre-exposure prophylaxis (PrEP) uptake, starting in 2025, to achieve EHE target levels by 2030: 95% status awareness, 95% viral suppression among those diagnosed with HIV, and 50% PrEP initiation among those eligible for PrEP. The intervention was race-neutral: testing rates were scaled by the same factor in each model stratum, as were the proportion unsuppressed and proportion not on PrEP. We report HIV incidence rates, differences, and ratios comparing Black and Hispanic vs. other racial/ ethnic groups, with 95% credible intervals (CrI) from 100 independent model simulations. Results: Under current epidemic trends and in the absence of additional intervention, we predicted the overall HIV incidence rate to fall only slightly from 19 incident HIV infections per 100,000 population in 2025 to 18 in 2035. Achieving target levels of testing, viral suppression, and PrEP by 2030 was projected to reduce incidence in 2035 by 22%, to 14 per 100,000 (95% CrI: 9, 64). Racial and ethnic disparities in HIV incidence persisted under the intervention compared to current epidemic trends (Table). Specifically, even with this intervention, HIV incidence remained 5 times as high among Black individuals and 4 times as high among Hispanic individuals compared to other racial/ethnic groups in Baltimore. Conclusions: The EHE initiative alone is unlikely to significantly reduce existing racial and ethnic disparities in HIV incidence in Baltimore. More targeted interventions are likely needed to ameliorate entrenched HIV-related health disparities in high-burden cities across the United States.

Olatosi, Sharon Weissman, Xiaoming Li University of South Carolina, Columbia, SC, USA

Background: Limited research evaluates the degree and tendency of racial disparities of viral suppression (VS) among people with HIV(PWH) across the Southern US. This study aims to examine the spatiotemporal trend and structural social determinants (e.g., socioeconomic and structural environment factors) of racial disparities in VS. Methods: A statewide population-based retrospective cohort study was conducted using the South Carolina (SC) HIV registry system from 2013 to 2020. The county-level viral suppression percentage was defined as the percentage of PWH with a viral load < 200 copies/ mL at most recent test per county per year. Racial disparities in the county-level percentage of VS were measured by four indexes: Black to White Ratio (BWR), Index of Disparity (ID), Weighted Index of Disparity (Weighted ID), and Gini coefficient. Linear mixed-effect models were used to assess the association between different contextual factors and these indexes. Linear trend test was further employed to explore the temporal trend of the disparity indexes. Results: VS rates across the 46 counties in SC increased from 75.01% in 2013 to 82.60% in 2020. However, an increasing trend of the changes of racial disparity in VS was observed, measured by ID and Weighted ID ( P <0.01). In contrast, the results of BWR and Gini coefficient showed a decreased trend ( P <0.01). When using ID as an outcome, counties with higher institutional health ( β =1.2, P <0.05) were at a higher risk of racial disparities in VS. For Weighted ID, counties with worse socioeconomic status ( β =-0.64, P <0.05) were at a higher risk of racial disparities in VS. For Gini coefficient, counties with more Ryan White HIV centers ( β =-0.004, P <0.05) and higher disability rates ( β =-0.005, P <0.05) had lower risk of racial disparities in VS. Comparing to Lowcountry region, counties in PEE DEE region existed lower risk of racial disparities in VS across multiple indices, including ID, Weighted ID, and Gini coefficient ( β =-3.12, -0.88, and -0.01, respectively, P <0.05). Conclusions: The choice of disparity measures may affect the interpretation of changes in health disparities. More comprehensive and standardized indicators are needed to provide a clear picture of racial disparity change. Nevertheless, structural factors such as higher institutional health and worse socioeconomic status may exacerbate the racial disparities, which underscores the importance of addressing these factors that contribute to poor HIV outcomes, particularly among marginalized populations.

Poster Abstracts

1117 Studying Medication Adherence for Black People Living With HIV: An Intersectional Lens Anais Mahone 1 , Ayse Akincigil 2 1 University of Alabama at Birmingham, Birmingham, AL, USA, 2 Rutgers University, Piscataway, NJ, USA Background: In a US Midwestern state, the Black community living with HIV is subject to disparities. Investigations into laws and public policies that govern society as structural barriers to ending the epidemic are vastly under researched. As such, this study examined the racial gap in ART adherence outcomes among Midwestern PWH contextualized within structural drivers of disparities, hypothesizing that reported experiences with social determinants of health negatively affect ART adherence PWH in a state with punitive HIV criminalization policies.

Methods: This study utilized local Medical Monitoring Project surveillance data to investigate medication adherence outcomes among a midwestern population of PWH, n=716. The outcome of interest was a binary outcome indicating

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