CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1141 Couples-Based Homophily in HIV Testing and Treatment Engagement: A Multicountry Analysis Kathryn Risher 1 , Patrick Janulis 2 , Augustine T. Choko 3 , Stéphane Helleringer 4 , Michelle Birkett 2 1 Pennsylvania State University, Hershey, PA, USA, 2 Northwestern University, Chicago, IL, USA, 3 Malawi Liverpool Wellcome Trust, Blantyre, Malawi, 4 New York University Abu Dhabi, Abu Dhabi, United Arab Emirates Background: Household couples represent a population wherein there is a clear unit to intervene for HIV testing and treatment, and numerous couples driven interventions exist (e.g. couples HIV testing and counseling, partner provided HIV self-tests). However, it is unknown the extent to which there is homophily (like partnered with like) among household couples by HIV testing and treatment engagement. Methods: We analyzed data from 18 Population-based HIV Impact Assessment surveys (PHIAs) conducted in Cameroon, Cote D’Ivoire, Ethiopia, Mozambique, Kenya, Lesotho, Malawi, Namibia, Rwanda, eSwatini, Tanzania, Uganda, Zambia, and Zimbabwe between 2015-2021. Heterosexual household couples with self-reported HIV testing history and biological data on HIV status, presence of ART, and viral load suppression (VS) were analyzed. Each survey was given equal weight and survey design was accounted for in analysis. Among serostatus groups, homophily was assessed by comparing couples’ observed mixing patterns to that expected under random mixing, with bootstrapped confidence intervals. Results: There were 62,639 couples, representing 123,856 individuals, with 86.4% seroconcordant negative, 7.0% seroconcordant positive, 3.5% serodiscordant with a female partner living with HIV (LHIV), and 3.1% serodiscordant with a male partner LHIV. Among seroconcordant couples LHIV, more couples than expected (Figure) were both positive but unaware of their status (4.30 times greater than under random mixing, 95% CI=4.01 4.63), aware of status but not on ART (3.26, 95% CI=2.66-3.93), or on ART but not virally suppressed (VS) (2.34, 95% CI=1.55-3.10). Among seroconcordant HIV-negative couples, never tested individuals were over twice as likely to be coupled together than expected by random chance (2.54, 95% CI=2.52-2.64). Similarly, among serodiscordant couples, more couples between individuals LHIV but unaware of status with HIV-negative and never tested were observed than expected by random chance (1.76, 95% CI=1.55-1.96 when female partner LHIV; 1.95, 95% CI=1.67-2.33 when male partner LHIV). Conclusions: We find evidence of homophily in HIV testing behaviors and treatment engagement in household couples in sub-Saharan Africa, supporting couples-based interventions when reaching individuals that have been previously unengaged. Furthermore, HIV testing and treatment interventions that target household couples as a unit may be efficient in increasing reach. The figure, table, or graphic for this abstract has been removed. 1142 HIV Prevalence in Intersecting Subgroups of Southern African Women: Insights From PHIA Craig J. Heck 1 , Daniela Quigee 1 , Sara Wallach 1 , Jason Zucker 1 , Kavitha Ganesan 2 , Shanyah L. Mitchell 1 , Sarah Wiant 1 , Shannon Farley 3 , Magdalena E. Sobieszczyk 1 , Andrea Howard 3 , Jessica E. Justman 3 , Wafaa El-Sadr 3 , Delivette Castor 1 1 Columbia University Irving Medical Center, New York, NY, USA, 2 Columbia University, New York, NY, USA, 3 ICAP at Columbia University, New York, NY, USA Background: In southern Africa, women are disproportionately affected by HIV. Age, pregnancy, migrancy, and sex work typically increase women’s HIV risk. While studies often examine these factors independently, few have examined how their intersection impacts HIV burden. Among southern African women, we describe HIV prevalence by individual and overlapping risks. Methods: Using data from Population-based HIV Impact Assessment (PHIA) surveys collected after 2019 in Eswatini (ES), Lesotho (LS), Malawi (MW), Mozambique (MZ), and Zimbabwe (ZW), we classified known risk groups and estimated the pooled HIV prevalence of women (15-49 years) who self-reported ever having sex. Risk subgroups included adolescent girls and young women (AGYW, aged 15-24 years); currently pregnant/breastfeeding women (PBFW); recent (<2 years) internal/external migrants (RM); Lesbian, Gay, or Bisexual (LGB, >1 same-sex partner); and engaged in sex work (SW, purchased/sold sex). HIV status was assessed via PHIA testing. UpSet plots were used to visualize data and calculate unweighted descriptive statistics. Results: Among 33,882 women, the HIV prevalence was 22% (ES: 37%, LS: 31%, ZW: 19%, MZ: 18%, MW: 14%), and 48%, 33%, and 19% respectively belonged

to zero, one, and multiple (2+) subgroups. HIV prevalence varied among women classified into no (29%, N=6189) and one subgroup: 63% in SW (N=27), 33% in RM (N=2452), 30% in LGB (N=87), 18% in PBFW (N=3963), and 8% in AGYW (N=4645). In women belonging to two subgroups, HIV prevalence was 62% in RM + SW, 33% in AGYW + SW and PBFW + SW, 22% in PBFW + RM, 12% in AGYW + LGB and RM + LGB, 10% in AGYW + RM, and 6% in AGYW + PBFW (Fig. 1). The HIV prevalence of women in three subgroups was 67% in AGYW + PBFW + SW, 14% in AGYW + PBFW + LGB, and 6% in AGYW + PBFW + RM (Fig. 1). For those within four subgroups, HIV prevalence was 50% in AGYW + PBFW + RM + SW and 33% in AGYW + PBFW + RM + LGB (Fig. 1). Conclusions: HIV was prevalent in all subgroups. Compared with those in no or one subgroup, women in multiple subgroups often had higher HIV prevalence, but most of these high-prevalence multi-groupings were relatively small, particularly those including SM. AGYW were commonly classified with other subgroups, and HIV prevalence was greater in AGYW and PBFW characterized by multiple subgroups rather than one. Although representing fewer women, RM + SW and AGYW + PBFW + SW had exceptionally high HIV prevalence, highlighting the need for tailored interventions.

Poster Abstracts

1143 Utilization of Assisted Partner Notification Services and Outcomes: A Population-Based Study Nakawooya Hadijja 1 , Victor Ssempijja 1 , Robert Ssekubugu 1 , Fredrick E. Makumbi 2 , Tom Lutalo 1 , Larry W. Chang 3 , David Serwadda 1 , Steven J. Reynolds 4 , Gertrude Nakigozi 1 , M. Kate Grabowski 5 , Godfrey Kigozi 1 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 Makerere University College of Health Sciences, Kampala, Uganda, 3 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA, 5 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: Assisted Partner notification (APN) services provide HIV testing, prevention, and treatment services to sex partners of persons living with HIV. However, coverage of APN services at a population level is poorly understood. Methods: We analyzed cross-sectional data from the Rakai Community Cohort Study (RCCS) survey conducted between December 2020 to March 2023, to evaluate reach of APN services, PrEP uptake among participants without HIV and HIV treatment among participants with HIV. RCCS includes 34 agrarian, semi urban and Lake Victoria fishing communities in South Central Uganda. All RCCS participants were asked to self-report if they had ever been contacted by APN services for HIV testing, whether they tested because of APN, and about history of and current use of PrEP or ART use. We used modified Poisson regression methods to identify factors that characterized participants contacted by APN services. Results: A total of 495 (2.98%) among the 16,591 RCCS interviewed participants, reported to have ever been contacted by partner notification services. 383 (77.4%) reported having HIV tested because of APN. 217(43.8%) were living with HIV of whom 198 (91.2%) were virally suppressed (<1000 copies/ml). Among the 278(56.16%) that were HIV negative, only 36(16.9%) reported ever using PrEP. Of those with a history of PrEP use, 18(50.0%) reported current use of PrEP. Conclusions: PrEP use among HIV-negative partners contacted by APN is extremely limited while HIV treatment coverage was high. Targeting PrEP services to this important group of individuals may improve HIV epidemic control.

CROI 2025 372