CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

that clinical features alone cannot accurately identify patients with CD4 count <200 cells/ µL, resulting in underdiagnosis of AHD. Methods: We collected data from a prospective cohort study of adults attending a clinic in Soweto, Johannesburg following a positive HIV test. A logistic regression model was used to determine clinical features associated with low CD4 count (<200 cells/µL). A clinical scoring system was devised using model coefficients as weights and the Youden index to calculate optimal cut off. Results: Data were available for 733 participants: age range 17-73 years, 60% female (442/733), median CD4 count 231 cells/µL, 44% (325/733) had CD4 counts <200 cells/µL. 12/14 assessed variables were crudely associated with CD4 <200/µL, though following adjustment, only cough, weight loss, male sex and age remained significant (Table 1). Weight loss and cough interacted; presence of cough without weight loss did not increase odds of CD4 <200 cells/µL (OR 0.91, 95%CI 0.45-1.89, p=0.80), whereas cough with weight loss increased odds significantly (OR 2.03, 95%CI 1.24-3.32, p=0.005). The final adjusted model included age, sex, weight, cough, diarrhoea, fever and weight loss, but was a poor fit: pseudo R 2 =0.08. Including self-reported WHO stage 3-4 OIs(7/733) to create a predictive model, the optimal score identified had specificity of 82% but poor sensitivity of 48%. Of those identified by this model, 156/230 (68%) had CD4 count <200 cells/µL; 169/325 (52%) with CD4 <200 cells/µL were not identified by the score. At one month follow up, all deaths occurred in those with CD4 counts <200 cells/µL (5/318, 1.6%; 7 lost to follow up). Conclusions: Clinical features are associated with CD4 count <200 cells/µL in patients newly diagnosed with HIV, but cannot reliably identify AHD, even when combined with WHO staging. A clinical scoring system without CD4 count would result in underdiagnosis of AHD in around a half of patients with low CD4 counts, and inappropriate diagnosis in around a fifth of patients with CD4 counts of >200 cells/µL.

measured the additional time spent on facility-based and laboratory-based HRIS by HCW per new HIV-positive patient in Rwanda and Eswatini. Methods: Trained data collectors used time-motion methodology to observe HCW workflows with new HIV-positive patients and recorded HCW’s time spent on HRIS-specific activities that are not conducted in parallel with routine activities at selected facilities and laboratories over 3 months. In Rwanda, HRIS is implemented as part of HIV case surveillance that takes place in HTS. For those who are diagnosed with HIV and provide consent and completes a case report form, an additional blood draw is done for ARRA at the facility or the laboratory. Results are returned to patients after viral load (VL) testing of ARRA recent samples. In Eswatini, HRIS is implemented using an opt-out approach during pre-test counseling and ARRA is run in parallel with the confirmatory HIV diagnostic test and a HRIS-specific questionnaire at the facility level. ARRA recent samples are sent to laboratories for VL testing. Results are not returned to patients. Time spent on routine HTS in Eswatini and on case surveillance activities in Rwanda for HIV-positive patients not undergoing ARRA served as controls. Data were summarized and stratified by ARRA results (recent (R) vs long-term (LT)), and implementation model (facility-based vs laboratory based). Results: Data were collected from 84 and 76 new HIV-positive people in Rwanda (10 R, 70 LT, and 4 controls) and Eswatini (5 R, 68 LT, and 3 controls), respectively. Overall, HRIS added an average of 17 minutes to HCW duties per patient (Figure 1). In Rwanda, the average added time ranged from 13 minutes (LT) to 20 minutes (R) at facilities and from 18 minutes (LT) to 21 minutes (R) at laboratories. In Eswatini, the average added time for HRIS ranged from 10 minutes (LT) to 16 minutes (R). Return of results in Rwanda (up to 16 minutes) and HRIS-specific questionnaire (~10 minutes) in Eswatini added the most time; ARRA added no time in Eswatini and ~1 min in Rwanda. Conclusions: ARRA is well integrated into HTS. Fully integrating HRIS into HIV case surveillance and dropping HRIS-specific questionnaires may further reduce added time.

Poster Abstracts

1189 Missed Opportunities: HIV Screening Deficits in Japanese Syphilis Patients Toshibumi Taniguchi, Kazutaka Yamagishi, Misuzu Yahaba, Hiroshi Yoshikawa, Hidetoshi Igari Chiba University, Chiba, Japan Background: The rising incidence of STIs and HIV in Japan necessitates comprehensive testing strategies. This study analyzed syphilis testing, subsequent HIV screening, and HIV diagnosis patterns across age groups using a sampling dataset from the National Database of Health Insurance Claims (NDB), which represents 1% of all outpatient Japanese health insurance claims, and AIDS Surveillance Committee data. Methods: NDB sampling data (2011-2020) was used for syphilis and HIV testing analysis, focusing on patients who received antibiotic treatment for syphilis. AIDS Surveillance Committee data (2012-2020) provided HIV diagnosis and AIDS case information, stratified by age. Results: Of 295,853 patients tested for syphilis, only 13,353 (4.5%) underwent HIV screening. Among 251,692 syphilis-tested patients, HIV screening rates varied by age: Under 20 (8.25%), 20-29 (7.44%), 30-39 (7.08%), decreasing to Over 70 (4.68%) (Fig.1). The Over 70 group had the highest number of syphilis

1188 HIV Recent Infection Surveillance Adds 17 Minutes to HIV Testing Services per Patient With HIV Kiely Flynn 1 , Suzue Saito 1 , Eugenie Poirot 1 , Jean Claude Irabona 1 , Collins Kamanzi 1 , Vusumuzi Maliwa 1 , Cebisile Ngcamphalala 1 , Samkelo Simelane 1 , Tom Oluoch 2 , Pasipamire Munyaradzi 3 , Monita Patel 4 , Gallican N. Rwibasira 5 , Lenhle Dube 6 , Harriet Nuwagaba-Biribonwoha 1 1 ICAP at Columbia University, New York, NY, USA, 2 US Centers for Disease Control and Prevention Kigali, Kigali, Rwanda, 3 US Centers for Disease Control and Prevention Mbabane, Mbabane, Eswatini, 4 Centers for Disease Control and Prevention, Atlanta, GA, USA, 5 Rwanda Biomedical Centre, Kigali, Rwanda, 6 Eswatini National AIDS Programme, Mbabane, Eswatini Background: Cost and implementation complexity of using HIV-1 Asanté rapid recency assays (ARRA) in routine HIV Testing Services (HTS) are previously cited concerns in scaling and sustaining HIV-1 recent infection surveillance (HRIS) in settings where workload of health care workers (HCW) remains high. We

CROI 2025 390