CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1295 Ending the HIV Epidemic Among Men Who Have Sex With Men in the United States: A Modeling Analysis Justine A. Scott 1 , Hailey Spaeth 1 , Kyu-young (Kevin) Chi 1 , Pamela Pen-Erh Pei 1 , Nattanicha Wattananimitgul 1 , David P. Holland 2 , Emily Hyle 1 , Kenneth A. Freedberg 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Emory University, Atlanta, GA, USA Background: The Ending the HIV Epidemic (EHE) program was launched in 2019 with the goal of reducing HIV transmission in the US by 75% by 2025 and 90% by 2030. Men who have sex with men (MSM) are a priority population in this effort. Our objective was to model the impact of improvements across the HIV prevention and care continuum on HIV transmissions and to quantify the improvements needed to reach EHE goals among MSM. Methods: We used the CEPAC model of HIV disease to assess the scale of prevention, diagnosis, linkage, retention, and virologic suppression needed to meet EHE goals for MSM in the US. We projected HIV transmissions over time given the current HIV care continuum ( Status quo ) and for 11 individual and combination intervention strategies with improvements in HIV testing frequency, 30-day linkage, virologic suppression, retention in care, and/or PrEP coverage. MSM were stratified into higher (HR MSM) and lower (LR MSM) HIV transmission risk groups using published data. Status quo inputs included HIV testing frequency (mean every 6.8y), 30-day HIV care linkage (77%), ART virologic suppression (81%, first-line), 2y retention in care (78%), and PrEP coverage (57% for HR MSM and 7.5% for LR MSM). Outcomes included annual HIV transmissions through 2030 and % reduction in transmissions compared to 2017. In sensitivity analysis, we examined the % of population achieving virologic suppression and % PrEP coverage for HR MSM. (n=16,285). Improving retention in care to 98% at 2 years had the largest individual impact on transmissions, with 63% reduction by 2030. Combined testing and treatment interventions at very high levels (HIV testing every 6 months, 30-day linkage of 98%, retention in care at 2y of 98%, and ART effectiveness of 98%) would decrease transmissions 85% by 2030 (n=3,763). Adding expanded PrEP for HR MSM (PrEP coverage 90%/effectiveness 96%), would decrease transmissions 90% by 2030 (n=2,530, Figure). In sensitivity analysis, increasing the % of all MSM with virologic suppression had a greater impact on transmissions than increasing PrEP coverage in HR MSM. Results: We estimated 24,278 transmissions to have occurred in 2017, matching CDC estimates. In Status quo , transmissions would be reduced 33% by 2030 Conclusions: With substantial and rapid improvements across the HIV testing, treatment, and prevention continuum, meeting EHE goals for MSM in the US would be possible. Improving retention in care is especially important for reducing transmissions and moving towards EHE goals.

South Africa each year. Our objective was to estimate the optimal distribution of resources to HIV testing, ART, and PrEP to reduce HIV transmission in South Africa. Methods: We developed an optimization model to determine what combination of testing, ART, and PrEP would lead to the minimum number of HIV transmissions over 5y in South Africa, parameterized with budget constraints ($9.1 billion/5y), intervention costs, and projected HIV transmissions from the CEPAC microsimulation model. We projected HIV transmissions in CEPAC based on varying uptake of 3 domains: HIV testing, ART coverage, and oral PrEP coverage. We modeled 3 sub-cohorts: high-incidence adolescent girls and young women (HI-AGYW), high-incidence men who have sex with men (HI-MSM), and the remaining general population >15y (GEN). HI sub-cohorts were defined as having HIV incidence of 3%/year and were offered PrEP (effectiveness: 41% AGYW, 50% MSM). Current HIV transmissions and domain levels were calibrated to UNAIDS/Thembisa projections: testing every 14m, 14m, and 29m for HI-AGYW, HI-MSM, and GEN; and coverage for ART (76%), and PrEP (HI-AGYW: 7%, HI-MSM 24%). Costs were $10/HIV test, $285/person-year (py) for ART, and $72/py for PrEP with scale-up costs for ART ($204/py) and PrEP ($50/py). We varied budget constraints, PrEP effectiveness, and ART scale-up costs in sensitivity analyses. Results: With current levels of HIV testing, ART, and PrEP, we projected 705,400 incident HIV infections over 5y (Table 1). Optimizing allocation of the current HIV budget in South Africa could avert 126,500 infections. This allocation included substantially decreasing testing frequency in GEN (to every 10y) and using those resources to increase testing frequency among HI-AGYW and HI-MSM (to every 3m), increase ART coverage (to 84%), and increase PrEP coverage (to 50%) among HI-MSM. These conclusions were sensitive to budget constraints, PrEP effectiveness, and ART scale-up costs. Conclusions: Prioritizing HIV testing and PrEP coverage among high-incidence groups and increasing ART coverage while decreasing HIV testing in the general population could avert over 125,000 HIV infections in South Africa over the next 5y without increased investment. As global HIV funding faces mounting pressure, policymakers and program planners should optimize existing resources to continue working towards ending the HIV epidemic.

Poster Abstracts

1297 Impact of Rapid Long-Acting PrEP Scale-Up Among MSM: Closing the Unmet Needs and Towards Ending HIV Haoyi Wang 1 , David Van de Vijver 2 , Jon Tosh 3 , Melanie Schroeder 3 , Kai J. Jonas 1 1 Maastricht University, Maastricht, Netherlands, 2 Erasmus University Medical Center, Rotterdam, Netherlands, 3 ViiV Healthcare, Brentford, UK Background: Long-acting injectable cabotegravir (CAB-LA) is superior to oral pre-exposure prophylaxis (PrEP) regimens. The slow scale-up of oral PrEP has left significant gaps in HIV prevention among men who have sex with men (MSM), and global HIV prevention targets have been missed. The introduction of CAB-LA could facilitate broader prevention choices and help reach these targets. We modeled the potential impact of expanding PrEP coverage to reduce unmet PrEP needs by offering CAB-LA among MSM and studied the impact of rapid and delayed CAB-LA scale-up in the Netherlands. Methods: The National PrEP Program (NPP) in the Netherlands has reached its maximum capacity of 8500 slots. However, data from the PROTECT survey suggested around 75% of HIV-negative Dutch MSM intend to use

1296 Optimizing Investment in HIV Testing Services, ART, and PrEP to Reduce HIV Incidence in South Africa Caitlin Dugdale 1 , Anneke L. Claypool 1 , Linda-Gail Bekker 2 , Munashe Machoko 1 , Daniel Otero-Leon 1 , Catherine Orrell 3 , Pamela Pen-Erh Pei 1 , Katherine Gill 2 , Xinwen Xu 1 , Anne M. Neilan 1 , Prakriti Shrestha 1 , Justine A. Scott 1 , Robin Wood 2 , Mohammad S. Jalali 1 , Kenneth A. Freedberg 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Desmond Tutu HIV Foundation, Cape Town, South Africa, 3 University of Cape Town, Cape Town, South Africa Background: Despite scale-up of HIV testing, ART, and pre-exposure prophylaxis (PrEP), there continue to be over 140,000 new HIV infections in

CROI 2025 430