CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

over 12 month ( HR = 0.60; CI95% = [0.39 - 0.92] vs < 6 months) influenced transition from being not pregnant to an unintended pregnancy. Conclusions: Reliable pregnancy incidence estimates were obtained thanks to systematic and regular pregnancy tests. However, pregnancy incidence was much higher than anticipated and we are facing challenges with unintended pregnancies despite the provision of reproductive care services.

1254 Effect of Antiretroviral Regimen on Contraceptive Failure Among Women Using Injectable Contraception Karen Diepstra 1 , Daniel Westreich 1 , Agatha Bula 2 , Clara Lemani 2 , John Chapola 1 , Katie Mollan 1 , Jill Hagey 3 , Sam Phiri 4 , Jane Chiwoko 4 , Lameck Chinula 2 , Mina Hosseinipour 2 , Mackenzie Cottrell 1 , Audrey Pettifor 1 , Mollie E. Wood 1 , Jennifer H. Tang 1 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 University of North Carolina Project– Malawi, Lilongwe, Malawi, 3 Duke University School of Medicine, Durham, NC, USA, 4 Lighthouse Trust, Lilongwe, Malawi Background: Drug-drug interactions (DDIs) between antiretroviral therapy (ART) and hormonal contraceptives deserve attention, as effective contraception is essential for women living with HIV (WLWH) who do not desire pregnancy. One hormonal contraceptive commonly used among WLWH in sub Saharan Africa is the 3-monthly, injectable depot medroxyprogesterone acetate (DMPA). Evidence is mixed regarding DDIs between MPA and ART medications, particularly efavirenz. Here, we estimated the effect of ART regimen type on pregnancy incidence among Malawian WLWH who were using DMPA contraception and ART as prescribed. Methods: Using longitudinal data from the Family Planning and Antiretroviral administrative censoring. We examined the time-varying exposure ART regimen type (either efavirenz or dolutegravir in combination with tenofovir disoproxil fumarate and lamivudine). The outcome was conception (with dating typically done by ultrasound). We used inverse probability weights to estimate the effect of always using efavirenz-based ART versus always using dolutegravir-based ART if, counter to fact, everyone were taking ART and DMPA as prescribed, and if there were no study dropout. Specifically, we used inverse probability weights to fit marginal structural Poisson regression models to estimate incidence rate ratios (IRRs) and robust 95% confidence intervals (CIs). Results: There were 689 participants who initiated DMPA at enrollment. Forty one conception events were captured during 826 person-years of follow-up (crude incidence rate: 5.0 conceptions per 100 person-years). Restricted to person-time where DMPA was taken as prescribed, the crude incidence rate was 4.1 per 100 person-years. The weighted IRR associated with always using efavirenz-based ART (versus dolutegravir-based ART) and everyone taking DMPA as prescribed was 2.04 (95% CI: 0.77, 5.41). Conclusions: In a population of WLWH who were taking DMPA as prescribed, we found a higher-than-expected pregnancy rate and potentially an elevated pregnancy rate with continuous efavirenz-based ART versus dolutegravir-based ART use. Further understanding of the causes of contraceptive failure among WLWH who use DMPA and ART is essential. 1255 PrEP Eligible but Missed: Preliminary Evidence Unlocking the Potential of Family Planning Services Brenice Duroseau 1 , Shemeka Thorpe 2 , Ashleigh Lovette 3 , Jason E. Farley 1 1 The Johns Hopkins University, Baltimore, MD, USA, 2 University of Kentucky, Lexington, KY, USA, 3 Ohio State University, Columbus, OH, USA Background: Black women in the U.S. are disproportionately impacted by STIs/HIV, largely due to political, social, and structural determinants of health. Therapy (FP-ART) prospective cohort study, we identified participants who initiated DMPA at enrollment and followed participants until DMPA discontinuation, discontinuation of ART, study dropout, pregnancy, or

1253 Unmet Need for Family Planning Underestimated Among Women Living With HIV in Kenya Alison Drake 1 , Erica Wetzler 1 , Aparna Seth 1 , Agnes K. Karingo 2 , Nancy Mwongeli 2 , Celestine Atieno 2 , June Moraa 2 , Jenna Udren 3 , Jennifer A. Unger 4 , John Kinuthia 2 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya, 3 University of Washington in Kenya, Nairobi, Kenya, 4 Brown University, Providence, RI, USA Background: Unmet need for family planning (FP) is used to measure gaps in FP access and use, and for women living with HIV (WLWH), risk of vertical HIV transmission. Criterion to assess need for FP are used in FP/HIV integrated services to direct FP service delivery, yet applying the World Health Organization (WHO) definition of need for FP may underestimate the proportion of WLWH whose FP needs are not met. Methods: We used baseline data from WLWH receiving HIV care and enrolled in an ongoing cluster randomized clinical trial evaluating a digital reproductive health intervention (vs. standard of care) in Kenya. Women were enrolled at 10 facilities and completed surveys assessing demographics, reproductive history, fertility and FP use. Need for FP was defined as having no desire for pregnancy for ≥2 years, being sexually active and married/partnered. Unmet need for FP by the WHO definition was calculated as the number of women not using a modern FP method and with a need for FP divided by the number with a need for FP. We compared the WHO definition of unmet need with definitions that used alternate criteria for preferences for birth spacing/limiting, current partners, and sexual activity, and made statistical comparisons using χ 2 tests. Results: Among 3296 WLWH enrolled, median was age 33 years (interquartile range 28-38), 72% had regular partners, 74% were sexually active, and 41% had a desire for future pregnancy. Only 9% of WLWH were planning a pregnancy in ≤2 years. Among WLWH who were not currently sexually active and did not have a regular partner, 36% reported last sex was ≤2 months ago. Overall, 7.8% of WLWH were classified as having unmet need using the WHO definition. Unmet need was 4.0% higher (RR 1.51, 95% CI 1.21-1.88, p<0.001) by including women who did not want to become pregnant now and 3.3% higher (RR 1.42, 95% CI 1.37-1.77, p=0.002) by removing current sexual activity criteria, and 1.2% higher (RR 1.15, 95% CI 0.92-1.45, p=0. 2) by including women without regular partners who were sexually active (Figure). Reducing the desired time to pregnancy to ≤1 year only captured an additional 0.3% of women who would be classified as having unmet need (p>.05). Conclusions: The WHO definition of unmet need may misclassify 1-4% of WLWH as not having a need for FP, which translates to a 15-50% increase in estimates of unmet need for FP and suggests there are missed opportunities to provide FP counseling and services to WLWH who do not present as having a need for FP.

Poster Abstracts

CROI 2025 414