CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

reconstructed time-varying rates of transmission using the number weekly hospitalizations and infections by age and region in Washington State from January 1st, 2020 to December 31st, 2022 and Oregon from January 1st, 2020 to August 31st, 2022. Results: We estimate that 74.3% (95% credible interval 68.5 – 78.3) of hospitalizations were averted due to COVID-19 vaccination in Washington and Oregon through the end of 2022 (see figure for regional breakdown). During the Alpha and Delta waves vaccination averted 90.4% (87.8 – 92.6) and 87.0% (81.9 – 89.8), respectively. Booster doses averted 24.0% (11.8 – 34.0) of Omicron hospitalizations starting December 2021. To isolate the impact of vaccinating individual age groups, we calculated the number of hospitalizations averted by observed vaccination program relative to a program that excluded a given age group. Vaccinating individuals ages 18-49, 50-64 or 65+ averted 167K (116 – 215), 40K (28 – 49), or 46K (40 – 53) hospitalizations, respectively. Conclusions: The COVID-19 vaccination campaign was highly effective, particularly during the Alpha and Delta waves. Despite limited uptake, booster doses also averted a significant number of hospitalizations during the Omicron Wave. Due to indirect effects, vaccinating adults ages 18-49 proved to be just as important at vaccinating individuals 50 years or older.

72% of NH Black PWH were vaccinated, the lowest proportion of any racial/ ethnic group (unadjusted RR 0.96 vs NH White; [0.93-1.00]). PWH with HIV viral load (VL) ≥50 copies (aRR 0.86 [0.82-0.91]), off ART (aRR 0.66 [0.62,0.71]), or unstably housed (aRR 0.89 [0.81-0.98]) were less likely to receive any vaccine, while those with higher CD4 were more likely to be vaccinated (aRR 1.02 per 100 cells/mm3, [1.01-1.02]). Concurrent use of meth, cocaine, opioids, and/or heavy alcohol) were not associated with vaccination. 62% of PWH completing the initial vaccine series before 2022 received ≥1 additional COVID-19 vaccine after 2022, which was associated with older age and ethnicity: Hispanic vs. NH White were more likely to receive ≥1 additional dose (aRR 1.20 [1.10-1.30]). Conclusions: Although initial uptake of COVID-19 vaccination in US PWH was very high, subsequent vaccination dropped dramatically. PWH at highest risk of poor outcomes of COVID-19 including those with decreased HIV care engagement (off ART, detectable VL) and Black race were less likely to receive vaccination. Clinical vigilance is required during and after periods of care disruption to ensure the most vulnerable PWH access recommended vaccines.

Poster Abstracts

1211 Self-Reported PrEP Use Is Associated With Short- and Long-Term Pharmacologic Metrics in Kenyan Women Jennifer Velloza 1 , Deepalika Chakravarty 1 , David Glidden 1 , Gakuo Maina 2 , Charlene Biwott 2 , Catherine Kiptinness 2 , Matthew A. Spinelli 1 , Hideaki Okochi 1 , Purba Chatterjee 1 , Erica Sedlander 1 , Nelly Mugo 2 , Kenneth Ngure 2 , Monica Gandhi 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Partners in Health and Research Development, Thika, Kenya Background: Self-reported adherence to PrEP may be inaccurate due to social desirability and recall biases. Although biomarkers can provide more reliable information on pill-taking, the knowledge of biomarker collection can itself increase the accuracy of self-report. Methods: We explored correlations between self-reported PrEP adherence and biomarker data in the PUMA trial in Kenya. HIV-uninfected women ≥18 years using oral tenofovir (TFV)-based PrEP for three months were enrolled (N=100) from 2021–2022 and randomized 1:1 to a urine point-of-care assay with drug level feedback or standard-of-care. Adherence was measured at enrollment, 3-, 6-, 9- and 12-months via urine and hair assays and self-report. Short-term PrEP adherence was defined as a positive urine assay result (TFV>1500 ng/mL). Long-term PrEP adherence was defined as detectable TFV in hair (>0.002 ng/ mg). Self-reported adherence was calculated as the mean score (range: 0-100) on a 2-item modified Wilson scale assessing percentage of doses taken in the prior month and adherence rating. We used t-tests to explore differences in mean score by biomarkers at Month 12. Generalized estimating equations estimated longitudinal associations between the self-reported adherence score and the biomarkers – a positive urine assay or detectable TFV in hair – adjusting for study arm. Results: At enrollment, 68% had a positive urine assay, 72% had detectable TFV in hair, and the mean self-reported adherence score was 90 (standard deviation [SD]=18). At Month 12, 86 were retained, of whom 59% had a positive urine assay, 69% had detectable TFV in hair, with a mean adherence score of 79 (SD=28); mean adherence score was higher in the groups with a positive urine assay (mean score of 91 vs. 62 for those with a negative assay; p<0.01) and detectable TFV in hair (mean score of 87 vs. 62 for those with undetectable TFV;

1210 Epidemiology and Predictors of COVID-19 Vaccine Uptake Among People With HIV in the US, 2020-23 Adrienne E. Shapiro 1 , Rachel A. Bender Ignacio 1 , Bridget M. Whitney 1 , Robin M. Nance 1 , Bryan Lau 2 , April C. Pettit 3 , Michael Saag 4 , Katerina Christopoulos 5 , Jeffrey M. Jacobson 6 , Laura Bamford 7 , Sonia Napravnik 8 , Richard Moore 2 , Kenneth Mayer 9 , Heidi M. Crane 1 , Mari Kitahata 1 , for the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) 1 University of Washington, Seattle, WA, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Vanderbilt University Medical Center, Nashville, TN, USA, 4 University of Alabama at Birmingham, Birmingham, AL, USA, 5 University of California San Francisco, San Francisco, CA, USA, 6 Case Western Reserve University, Cleveland, OH, USA, 7 University of California San Diego Medical Center, La Jolla, CA, USA, 8 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 9 The Fenway Institute, Boston, MA, USA Background: People with HIV (PWH) have higher risk of severe outcomes from COVID-19 and were prioritized when COVID-19 vaccines first became available in the US. Many factors influenced access, willingness to receive COVID-19 vaccines, and receipt of subsequent vaccination doses. Methods: We examined trends in uptake of COVID-19 vaccination among PWH at 9 sites in the CNICS cohort, 2020-23. At 7 sites with patient-reported outcome (PRO) data available including substance use and housing, we evaluated predictors of initial vaccination and subsequent doses. Relative risks were estimated using Poisson regression, adjusted for age, gender, race/ethnicity, and geographic region. Results: 17,626 (72%) PWH received ≥1 COVID-19 vaccine and 15,492 (64%) received ≥2 vaccines between 2020-23; 93% received a first vaccine before Jan 2022 (Figure). Among 17,667 PWH in care at 7 sites contributing PRO data (20% female, 45% Non-Hispanic [NH] Black, mean age 50 [SD 13]), 13,082 (74%) received ≥1 COVID-19 vaccine by 12/31/22. Vaccination (≥1) was associated with older age (aRR 1.06 [95%CI 1.05,1.0] per decade), gender (aRR 0.96 [0.92-1.005] female vs. male), and region (highest in Northeast (aRR 1.13 [1.05-1.20]), similar in the South and Midwest/Mid-Atlantic (aRRs 0.99-1.07, [0.95-1.15] vs. West).

CROI 2025 398