CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Frequent Risk group, 10% (40/412) in the Infrequent Risk group, and 5% (19/413) in the No Risk group. The estimated HIV incidence was 4/100 person-years (PY) (95% CI: 0-13) in the Frequent Risk group, 11/100 PY (5-17) in the Infrequent Risk group, and 4/100 PY (0-7) in the No Risk group. Data at the time of HIV diagnosis are provided in the Table. Conclusions: HIV prevalence and incidence were high among MSM reporting infrequent or no risk, two categories with substantial numbers of individuals. Regardless of the accuracy of self-reporting, this suggests that MSM reporting infrequent or no risk of HIV should be prioritized for event-driven PrEP, which offers greater flexibility and may better accommodate individual needs.

1227 The County-Level Analysis of PrEP-to-Need Ratio With HIV Diagnosis in the US, 2012-2021

Guohan Xia, Xueying Yang, Fanghui Shi, Xiaoming Li University of South Carolina at Columbia, Columbia, SC, USA

Background: The scale up of Pre-exposure Prophylaxis (PrEP) has been associated with reduced community HIV transmission. The population-level impact of PrEP coverage, particularly the extent to which PrEP needs were met, on HIV incidence, is still not well understood. This study aims to explore the longitudinal associations between PrEP-to-Need Ratio (PNR) and changes of HIV incidence rates across all the counties in the United States. Methods: Several publicly available data sources were linked by county level Federal Information Processing Standards (FIPS) code and used for analysis. The PNR, which was retrieved from AIDSVu, was calculated as the ratio of PrEP prescriptions (numerator) to new HIV diagnoses (denominator) in each county per year between 2012 and 2021. Our outcome of interest was change in HIV incidence between two consecutive years. Correlation analyses were performed to assess the relationship of percent change of PNR with change of HIV incidence overall and HIV incidence racial disparities between 2012 and 2021. Linear mixed effects (LMM) models were performed to use PNR value in one calendar year to predict the HIV incidence change in the subsequent year in both “Ending the HIV epidemic initiative” (EHE) areas and across the US, adjusting social determinants of health. Results: The correlation analysis from the 48 EHE counties revealed that percent change of PNR between 2012 and 2021 was negatively associated with the overall HIV incidence change (β=-0.34, P=0.0165) and positively associated with the change of racial disparities of HIV incidence between Hispanic and White populations (β=0.31, P=0.0304), but not associated with the change of racial disparities of HIV incidence between White and Black populations (β=0.23, P=0.1124). LMM models showed that PNR has a significant negative impact on changes in HIV incidence rates in all areas implementing the EHE initiative (β=-0.1297, P=0.0018) and across the entire United States (β=- 0.0876, P<0.0001). Conclusions: The results of this study highlighted the protective effect of PrEP use in reducing HIV incidence but also alarmed us about the wider HIV incidence disparity between Hispanic and White populations. To further promote the widespread use of PrEP and achieve health equity, future research should focus on developing and implementing more targeted intervention strategies.

1226 The Influence of Racialized Economic Segregation on Unmet HIV Prevention Needs in the Real World Li Tao, Juan Yang, Chris Nguyen, Joshua Gruber, Kristin Baker, Woodie Zachry Gilead Sciences, Inc, Foster City, CA, USA Background: Racialized economic segregation significantly affects health outcomes by exacerbating disparities in disease prevalence and access to healthcare among marginalized communities. However, the impact of socioeconomic segregation on access to HIV pre-exposure prophylaxis (PrEP) across various socioeconomic groups remains unexplored in the US. Methods: The Index of Concentration at the Extremes (ICE) quantifies segregation by measuring the concentration of individuals at opposite ends of the socioeconomic spectrum. Four ICE scores were calculated for >32,000 US Zip Code Tabulation Areas (ZCTAs) using American Community Survey data: race (White vs Black), income (high vs low), combined race/income (White/ high-income vs Black/low-income), and education (high vs low). ZCTAs were categorized into quintiles, ranging from the most deprived (Q1) to the most privileged (Q5). PrEP prescription data and new HIV-1 diagnoses (2019–2023) were obtained from the IQVIA pharmacy claims database. Unmet PrEP needs were evaluated using the PrEP-to-Need Ratio (ratio of PrEP users to new HIV diagnoses from the previous year). Logistic regression was used to compare the odds of PrEP claims being dispensed in deprived versus privileged communities. Results: Over 500,000 new PrEP prescriptions were linked with ICE indices. From 2019 to 2023, PrEP uptake increased steadily, but showed slower growth in deprived communities (predominantly Black and/or low-income, low-education neighborhoods). Unmet PrEP needs were greatest in the most deprived communities and lowest in the most privileged. Despite overall improvements, disparities driven by social segregation persisted, with the gap between Q1 and Q5 widening over time (Figure). In 2019, predominantly Black/low-income communities had 2.7 times greater unmet needs versus predominantly White/high-income communities; this ratio increased to 3.2 in 2023. Individuals in socioeconomically deprived communities were less likely to have PrEP claims dispensed versus those in privileged communities (odds ratios [95% CI] for combined race/income Q1 vs Q5 = 0.78 [0.77–0.79]; Q4 vs Q5 = 0.95 [0.94–0.96]). Conclusions: This study highlights the significant association between racialized economic segregation and PrEP uptake, and the widening disparities in unmet needs for HIV prevention in the US. It is essential that efforts are targeted to reduce disproportionate unmet needs in marginalized communities and ensure equitable PrEP access across diverse populations in real-world settings.

Poster Abstracts

CROI 2025 404