CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1247 Has Rapid Scale-Up of Dual HIV/Syphilis Testing in Antenatal Care Improved Syphilis Testing Coverage? Aliza Monroe-Wise 1 , David Maman 2 , Olanrewaju Edun 3 , Andrew Storey 4 , Morkor N. Owiredu 1 , Magdalena Barr-Dichiara 1 , Agnes Chetty 5 , Van Thi Thuy Nguyen 6 , Maeve Brito De Mello 1 , Cheryl C. Johnson 1 1 World Health Organization, Geneva, Switzerland, 2 The Global Fund, Geneva, Switzerland, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 Clinton Health Access Initiative, Boston, MA, USA, 5 World Health Organization African Region, Brazzaville, Republic of the Congo, 6 World Health Organization Vietnam, Hanoi, Vietnam Background: In 2022 there were approximately 130,000 child HIV infections and 700,000 cases of congenital syphilis globally. Through concerted effort substantial progress has been made in both HIV and syphilis testing coverage to identify infections in pregnancy and to offer treatment. However, gaps remain, including the gap between HIV and syphilis testing. Dual HIV/syphilis rapid tests can help close this testing gap and are recommended by WHO as the first test in antenatal care (ANC). We hypothesized that global dual test procurement is increasing rapidly, and that countries with dual testing policies for ANC also report higher syphilis testing coverage. Methods: We collected and analyzed procurement data from the Global Fund (GF) to understand recent trends in dual test procurement. We also analyzed country-reported data on HIV and syphilis policy uptake and testing coverage from the Global AIDS Monitoring (GAM) platform to test the association between dual HIV/syphilis test policy uptake and reported syphilis testing coverage in countries consistently reporting between 2021-2023 using a mixed effects logistic regression with a random effect for country to account for repeated measurement. Results: Data from 38 countries were included in the procurement analysis and 52 in the comparison of coverage by policy uptake status. Dual HIV/syphilis test procurement by the GF increased by 192% from 7.5 million tests in 2021 to a forecast 21.9 million in 2024, constituting over 30% of GF’s direct HIV test procurement in 2024 (Figure 1a). In 2023, of the 52 countries that reported to GAM the average HIV testing coverage was 92% and syphilis testing coverage 80% (Figure 1b); countries that reported adoption of dual HIV/syphilis testing in ANC had higher syphilis testing coverage than countries that did not report adoption. Pregnant women in countries that reported dual test uptake from 2021-23 were 28% more likely (odds ratio: 1.28; 1.27-1.29) to be tested for syphilis compared with pregnant women in countries that did not use the dual test (p-value <0.05). Conclusions: Procurement of dual HIV/syphilis rapid tests is accelerating. While gaps between HIV and syphilis testing coverage persist, policy adoption of dual HIV/syphilis testing in ANC is associated with higher reported syphilis testing coverage. Limitations in the data include limited procurement data sources and weak syphilis reporting systems. The figure, table, or graphic for this abstract has been removed. 1248 Monitoring the Success of Public Health Efforts to Reduce Congenital Syphilis, King County, WA Tim W. Menza 1 , Anna Berzkalns 2 , Roxanne P. Kerani 1 , Katie Heidere 2 , Jennifer E. Balkus 2 , Chase Cannon 1 , Julie Dombrowski 1 , Matthew Golden 1 1 University of Washington, Seattle, WA, USA, 2 Public Health–Seattle & King County, Seattle, WA, USA Background: Syphilis in pregnancy and congenital syphilis (CS) are increasing rapidly in the United States. We propose the percentage of potential CS cases averted (%PCA) as a metric to monitor the success of public health efforts to reduce the burden of CS. Methods: We reviewed King County, WA syphilis surveillance data from January 1, 2022 through September 20, 2024. Among people with a known pregnancy outcome, we calculated the %PCA, defined as number of infants without CS/number of pregnant people with syphilis x 100%, overall and by key factors. We excluded people who were currently pregnant, who elected a therapeutic abortion, who had a miscarriage unrelated to syphilis, were lost to follow-up, or who had a missing pregnancy outcome. Results: Of the 107 pregnant people with syphilis, 76 had a known pregnancy outcome. Forty-two infants did not have CS (%PCA=55%). Of the 34 infants with CS, 7 (21%) were stillborn or had a fetal demise. The %PCA declined from 66% in 2022 to 46% in 2023 and 50% in 2024 ( P =0.156). Compared to pregnant people with late/unknown duration syphilis, pregnant people with early syphilis had a lower %PCA (60% v 39%, P =0.092). Native American/Alaska Native and Native Hawaiian/Pacific Islander pregnant people with syphilis had the lowest

%PCA (33% and 13%, respectively) while Black pregnant people had the highest %PCA (69%). Thirty-nine percent of potential CS cases were averted among unhoused pregnant people compared to 62% among stably housed people ( P =0.054). Pregnant people interviewed for partner services had a greater %PCA than those not interviewed (68% v 31%, P =0.001). Pregnant people with ≥1 treated partner had a %PCA of 88% compared to 57% among those with no treated partners ( P =0.026). Among interviewed pregnant people who reported substance use, the %PCA was similar to those who did not report substance use (75% and 66%, respectively; P =0.414). The %PCA was 50% among pregnant people who reported corrections involvement and 85% among those who did not report corrections involvement ( P =0.219). Conclusions: The %PCA is a useful public health metric for monitoring the success of clinical and public health efforts to prevent CS and can identify populations that are disproportionately impacted by CS, particularly Native American/Alaska Native and Native Hawaiian/Pacific Islander people and unhoused people. The figure, table, or graphic for this abstract has been removed. 1249 Risk Factors for Incomplete Treatment for Syphilis in Pregnant Oral PrEP Users in South Africa Kalisha Bheemraj 1 , Dvora L. Joseph Davey 2 , Rufaro Mvududu 1 , Sumaya Dadan 1 , Nafisa Wara 2 , Landon Myer 1 , Alex de Voux 1 , for the SCOPE-PP Study Team 1 University of Cape Town, Cape Town, South Africa, 2 University of California Los Angeles, Los Angeles, CA, USA Background: Understanding the prevalence, risk factors, and barriers to treatment of syphilis in pregnant women is essential to inform the prevention of vertical transmission. Methods: Within a clinical trial of PrEP promotion interventions, we enrolled 750 HIV-negative pregnant women aged >16 years and used medical records to examine syphilis testing and treatment. We report the prevalence of prior syphilis (TPHA+/RPR-) and active syphilis (TPHA+/RPR+), along with the proportion of those who received complete treatment (3 doses of benzathine penicillin per local guidance). We used logistic regression to identify factors associated with active syphilis and incomplete treatment. Results: In 750 participants (median age 26y, median gestational age 29w, IQR 23–35), 57% (n=424) were already on PrEP and 43% (n=326) initiated PrEP. The overall prevalence of syphilis was 11% (n=84), with 6% (n=45) prior syphilis infections and 5% (n=39) active syphilis of which 56% of women had RPR titres ≥ 1:8. Women who were <25 years had 2.6 times the odds of active syphilis compared to older women (OR = 2.59, 95% CI: 1.33–5.29). Alcohol use in pregnancy was associated with a doubling in the odds of active syphilis (aOR=2.00, 1.04–3.88) compared to women who did not report alcohol use. 55% (n=16) of women with active syphilis did not receive complete treatment, while a total of 35% (n=29) of women with prior and active syphilis underwent complete treatment. For each additional year of maternal age, the odds of incomplete treatment increased by 10% (OR=1.10, 1.03–1.19). Women who were unmarried/not co-habiting had 3.9 times the odds of incomplete treatment (aOR=3.86, 1.10–15.8) compared to. Sexual activity during pregnancy was associated with incomplete treatment (aOR=4.78, 1.14–25.3). The mean gestational age of participants’ first positive syphilis test result during pregnancy was at 22 weeks (IQR 16–28); 6% (n=5) of syphilis was detected ≤4 weeks prior to delivery and 3 infants were diagnosed with congenital syphilis. Conclusions: Syphilis is prevalent among pregnant women using oral PrEP. Identifying risk factors for incomplete syphilis treatment during pregnancy is essential for targeted interventions for timely syphilis detection and treatment, ultimately reducing the risk of adverse pregnancy outcomes.

Poster Abstracts

CROI 2025 412