CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

and HIV acquisition among persons without HIV. We sought to determine if person-centered care/prevention can mitigate these risks. Methods: Within the intervention arm of the ongoing SEARCH trial (NCT05768763), we evaluated associations between alcohol use and HIV care/ prevention outcomes at baseline and after 1 year. In 8 rural communities (~6000 adults each) in Kenya and Uganda in 2023, we conducted population level HIV screening and asked about past 3-month alcohol use. PWH with/ at-risk of viremia (defined as pregnant/breastfeeding, 15-24 years, not on ART, or viremic (≥200 c/mL)/no VL in past year) were referred to “life events assessment” person-centered care (LEAP): LEAP was designed to assess for issues that may impact ART use and included brief alcohol counseling for PWH with unhealthy alcohol use. Persons without HIV and reporting risk were referred to dynamic choice HIV prevention (DCP), which offered flexibility and choice of PrEP/PEP, clinic/off-site visits, and clinic/self-HIV testing. Results: Of 47,844 adults screened, 8380 (18%) reported recent alcohol use. Of 4716 (10%) PWH, 661 (14%) enrolled in LEAP: 149/661 (23%) reported alcohol use and 256/628 (41%) had VL≥200. At LEAP baseline, alcohol use was associated with increased risk of untreated HIV (RR:1.6 [95%CI:1.1-2.3]) and viremia (RR of VL<200: 0.6[0.5-0.9)). One year into LEAP, 431 (66%) participants were retained and 210/234 (90%) with VL results were suppressed: there were no significant associations between alcohol use and retention (RR:1.0[0.8-1.2]), or alcohol use and viremia (RR of VL<200: 0.8[0.5-1.2]). Of 43,128 adults without HIV at baseline, 11% reported HIV risk: alcohol use was associated with HIV risk (RR:1.5[1.3-1.6]). Of 2,260 DCP participants, 1076 (48%) were retained at 1-year: there was no significant association between alcohol use and reported risk (RR:1.0[0.8-1.2]) or retention in DCP (RR:1.0[0.9-1.1]) at 1-year. Conclusions: One year into SEARCH person-centered care/prevention interventions, baseline associations between alcohol use and poor outcomes were no longer observed. These results suggest that the SEARCH interventions may mitigate risks of alcohol use among PWH and adults reporting risk of HIV. 1302 Depression and Suicide Risk Among Sexual and Gender Minorities: Insights From the ImPrEP CAB Brasil David Richer Araujo Coelho 1 , Carolina Coutinho 2 , Brenda Hoagland 2 , Alessandro S. Farias 3 , Jose Valdez Madruga 4 , Josué Lima 5 , Maria Paula Mourão 6 , Cristina Pimenta 7 , Cristina Moreira Jalil 2 , Marcos Benedetti 7 , Monica Derrico 2 , Thiago Silva Torres 2 , Valdilea Gonçalves Veloso 2 , Beatriz Grinsztejn 2 , for the ImPrEP CAB Brasil Study Group 1 Massachusetts General Hospital, Boston, MA, USA, 2 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 3 Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, Brazil, 4 Centro de Referência e Treinamento DST/AIDS-SP, Sao Paulo, Brazil, 5 Centro de Referência em Infecções Sexualmente Transmissíveis, Vitória, Brazil, 6 Fundação de Medicina Tropical Heitor Vieira Dourado, Manaus, Brazil, 7 Oswaldo Cruz Foundation, Rio de Janeiro, Brazil Background: Mental health plays an important role in the effectiveness of HIV prevention strategies, as poor mental health can lead to decreased adherence and increased vulnerability to HIV infection. Long-acting PrEP modalities can help overcome barriers related to PrEP persistence and adherence, and should be considered for those with mental health challenges. We explored the association between sociodemographic factors, depression and suicide risk among young sexual and gender minorities (SGMs) participating in the ImPrEP CAB study. This is the first study to evaluate CAB-LA PrEP implementation in Latin America, a region where scaling up PrEP is urgently needed. Methods: ImPrEP CAB Brasil is an implementation study to assess PrEP choice, feasibility, acceptability, and effectiveness of CAB-LA for SGMs (18-30 years) in public health PrEP services in 6 Brazilian cities. Depression and suicide risk were assessed at baseline, prior to the first CAB-LA injection, using the PHQ-9 (no/mild [0-9] vs. moderate/severe [10-27]) and C-SSRS (no risk vs. suicide risk), respectively, with ongoing monitoring during the study. Participants with positive screenings were referred for on-site psychiatric evaluation. Sociodemographic factors were analyzed using Chi-square or Fisher’s exact tests, with Bonferroni adjustments for multiple comparisons. Results: Between Oct 2023 and Sep 2024, 1200 participants were enrolled and received the first CAB-LA injection. Most were cisgender men who have sex with men (MSM) (91%), aged 25-30 (62%), non-White (61%), and had >12 years of education (72%). Overall, 11% had moderate/severe depression and 9.6% suicide risk. Transgender women/travestis had higher rates of depression (24.2%) and suicide risk (16.7%) compared to cisgender MSM (9.9%; 8.9%, respectively). Transgender men had the highest rates of both outcomes (30.8%), while non-binary/queer participants had 13.3% for each. Depression and suicide

1300 Addressing Alcohol Use and Depression as a Strategy to Reduce HIV in KwaZulu-Natal, South Africa Mellesia Jeetoo 1 , Dyanna Charles 1 , Yao-Rui Yeo 1 , Jasmine Su 1 , John K. Mbaya 2 , Sheela Shenoi 3 , Neo Morojele 4 , Tony Moll 5 , R. Scott Braithwaite 1 1 New York University Langone Medical Center, New York, NY, USA, 2 KwaZulu-Natal Department of Health, Hilton, South Africa, 3 Yale University, New Haven, CT, USA, 4 University of Johannesburg, Johannesburg, South Africa, 5 Philanjalo, uMsinga, South Africa Background: KwaZulu-Natal (KZN) has the highest burden of HIV infections in South Africa, with continually high rates across the province. Conditions of Alcohol, Substance, and Mood disorders (CASM) substantially increase HIV risk behaviors, especially for high-risk groups. We identified the impact and cost effectiveness of screening and treatment for alcohol use disorder (AUD) and major depressive disorder (MDD), as a potential strategy to reduce HIV burden in KZN. Methods: We used an HIV compartmental transmission model to simulate the impact of CASM screening and treatment interventions on HIV diagnosis, treatment, and viral load suppression. We compared prevention as usual (PAU) with a scale-up of screening and treatment for AUD and MDD, using AUDIT-C and PHQ-9 for screening. Treatment included culturally tailored interventions such as motivational interviewing and problem-solving therapy for AUD, and cognitive-behavioral therapy for MDD. High-priority risk groups, identified with public health stakeholders, included adolescent girls and young women ages 15-24 (AGYW), adolescent boys and young men ages 15-24 (ABYM), female sex workers (FSW), men who have sex with men (MSM), and men ages 25-34. Outcomes were infections averted through 2030, quality-adjusted life-years (QALYs) gained, cost/infection averted, and cost/QALY gained. Analyses were based on causal components of HIV-risk associations, using a modified societal perspective with a 3% discount rate and 2022 $US costs. Results: AUD accounts for 28.3%, MDD accounts for 11.8%, and combined they account for 33.6% of new HIV infections in KZN. Screening and treatment for AUD can reduce new infections by 14.3% at $2000/infection averted and $2900/QALY. Screening and treatment for MDD can reduce new infections by 5.8% at $1900/infection averted and $2600/QALY. Combined, AUD and MDD interventions can reduce new infections by 25.8% at $1600/infection averted and $2250/QALY. The most efficient way to scale up both AUD and MDD interventions is to first target AGYW at $950/infection averted and $1,300/QALY, followed by FSW at $1,000/infection averted and $1,350/QALY, MSM at $1,050/ infection averted and $1,450/QALY, men ages 25-34 at $1,650/infection averted and $2,300/QALY, and last, ABYM at $2,250/infection averted and $3,100/QALY. Conclusions: Scale-up of integrated AUD and MDD screening and treatment on targeted risk groups has the potential to substantially reduce the number of HIV infections in KZN with very favorable cost effectiveness. 1301 Impact of SEARCH Person-Centered Care/Prevention on Clinical Outcomes by Alcohol Use in East Africa Gabriel Chamie 1 , Matt Hickey 1 , Joshua Schwab 2 , Florence Mwangwa 3 , Janice Litunya 4 , Sabina Ogachi 4 , Judith A. Hahn 1 , Jennifer Temple 1 , Elijah Kakande 3 , Jane Kabami 3 , Laura Balzer 2 , Maya Petersen 2 , Diane V. Havlir 1 , Moses Kamya 5 , James Ayieko 6 , for the SEARCH Consortium 1 University of California San Francisco, San Francisco, CA, USA, 2 University of California Berkeley, Berkeley, CA, USA, 3 Infectious Diseases Research Collaboration, Kampala, Uganda, 4 KEMRI Kenya, Nairobi, Kenya, 5 Makerere University College of Health Sciences, Kampala, Uganda, 6 Kenya Medical Research Institute, Kilifi, Kenya Background: Person-centered HIV care and prevention that provide low barrier access and non-judgmental interactions may address poor outcomes among persons with alcohol use. Alcohol use is a risk factor for: a) non-retention in care and viremia among PWH, and b) non-retention in biomedical prevention

Poster Abstracts

CROI 2025 432