CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1119 WITHDRAWN

antiretroviral dose adherence of 90% or more. Multiple nested logistic regression models were estimated. The models included unadjusted racial differences, the impact of discrimination and stigma, health status variables, and structural and individual experiences of social determinants of health. Results: In the full model, identifying as Black (OR=.63, 95% CI= .44 - .91) and experiencing discrimination in healthcare settings (OR=.52, 95% CI= .36 - .77) were significantly associated with lower odds of ART adherence. When analyzing the social determinants, food insecurity was significantly associated with lower ART adherence (OR=.60, 95% CI= .41 - .88). Overwhelmingly, the results show that individuals who identified as Black had significantly lower odds of optimal ART adherence in all models. These outcomes, when considered with the results from the key variables, align with previous research demonstrating that racism and discriminatory experiences have harmful effects on ART adherence. While the findings related to HIV-related discrimination were robust, those associated with HIV-related stigma were explained away when controlling for age. Models indicated that older age was a protective factor in medication adherence outcomes. Conclusions: Research identifies racism as the facilitator of social determinants of health, including social and economic disparities, transportation issues, stigma, and discrimination. This study makes an important contribution to the literature by investigating how structural determinants impact adherence in the Midwest, particularly for Black PWH, contextualized in a state that, despite robust HIV resources, exists under HIV criminalization laws that place at increased risk for adverse outcomes. 1118 HIV Testing Barriers in Structurally Vulnerable Communities in St Louis: Best-Worst Scaling Survey Noelle Le Tourneau 1 , Emmanuel Tettah 1 , Mckenzie Swan 1 , Greg Gross 1 , Todd Combs 1 , Tyrell Manning 2 , Virginia McKay 1 1 Washington University in St Louis, St Louis, MO, USA, 2 City of St Louis Department of Health, St Louis, MO, USA Background: Significant gaps remain in ending the HIV epidemic in the US, calling for the need for community tailored evidence-based HIV testing strategies. Methods: To understand perceptions and underlying beliefs around HIV testing, particularly among Black, queer, and young people, we conducted a Best-Worst Scaling (BWS) survey among adults (16+) in the St. Louis, Missouri region. We recruited at community events, collected data electronically, and provided $25 incentives for survey completion. BWS was used to quantify the relative importance of 13 potential barriers (attributes) to HIV testing (e.g., stigma, structural barriers, perceived HIV risk) selected from the literature and reviewed by community members. BWS scores, calculated from participants' most and least selected relevant barriers among 4 options across 13 choice sets, were rescaled using Hierarchical-Bayes estimation (out of 100). To explore preference heterogeneity among participants, we fit latent class conditional logit models. Results: Among 152 participants surveyed, 52.7% identified as women, 38.8% as men, and 6.6% as non-binary. 49.3% identified as Black with a median age of 29 years (IQR 23-37). 49.4% identified as gay or lesbian, bisexual, and other non-heterosexual sexual orientations. Across the BWS, the most relevant barrier to HIV testing was that participants did not think they were at risk for HIV (BWS Score: 13.86, 95% CI 12.54-15.19). Black participants selected lacking trust in testing organization and peers not suggesting testing as more relevant barriers compared to White participants (p=0.03, 0.003, respectively). Queer respondents selected stigma associated with HIV positivity, access to testing, and fear of a positive result as more relevant barriers compared to heterosexual participants (p<0.001, 0.023, 0.004). Using latent class models, two underlying groups emerged including 1) “Low-risk perceivers” (67%) for whom the most salient attributes were low perceived risk for HIV (16.74, 15.41-18.07) and that testing had not been recommended by a health care worker (11.94, 10.68-13.21), and 2) “Fearful avoiders” (33%) who were worried they would be stigmatized if HIV positive (17.14, 16.03-18.26) and were afraid of being HIV positive (16.14, 14.46-17.82). Conclusions: This best–worst scaling study informs our understanding of barriers to HIV testing around St. Louis, identifying that most believe they were not at risk for HIV nor need an HIV test. We should tailor testing strategies to all community members.

Poster Abstracts

1120 Racial/Ethnic and Regional Disparities in HIV Testing Before, During, and After COVID-19 in the US Haishan Yang 1 , Jerrod Anzalone 2 , Eric G. Hurwitz 3 , Bohdan Nosyk 4 , Rena C. Patel 5 , Zang Xiao 1 1 University of Minnesota, Minneapolis, MN, USA, 2 University of Nebraska Medical Center, Omaha, NE, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 Simon Fraser University, Burnaby, Canada, 5 University of Alabama, Tuscaloosa, AL, USA Background: The COVID-19 pandemic has caused major disruptions to healthcare globally, potentially affecting the delivery of HIV care and prevention services. Using data from the National COVID Cohort Collaborative (N3C), this study aimed to provide a comprehensive analysis of HIV testing rates and trends before, during, and after the COVID-19 pandemic, highlighting geographic and racial/ethnic variations. Methods: We employed an interrupted time series analysis using segmented linear regression models to examine the effects of the COVID-19 pandemic on monthly HIV testing rates using data from 16 million patients across 66 clinical sites obtained from the N3C, 01/2018-12/2022. A three-phase model assessed pre-pandemic (01/2018–02/2020), early pandemic (03/2020–08/2020), and late pandemic HIV testing rates (09/2020–12/2022), calculated as any HIV screening lab per calendar month per individuals with a visit recorded that month, alongside counterfactual projections estimating testing rates. We conducted subgroup analysis by three racial/ethnic groups (White/others, Black/non-Latine, and Latine) and four geographic regions (Northeast, South, West and Midwest). Results: HIV testing rates were relatively stable during the pre-pandemic, averaging around 45 tests per 10,000 people, with variations marked by racial/ ethnic groups and regions. During the early pandemic, Black/non-Latine individuals in the Northeast experienced the most significant declines in testing, with 43.57 fewer tests per 10,000 people (95% CI: -61.384 to -25.756). In contrast, White/Others individuals in the Midwest saw one of the smallest

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CROI 2025 363