CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1304 Low-Barrier HIV Care Outcomes in the Context of Homelessness, Substance Use, and Mental Illness Julie Dombrowski, Fredericka Albertina T. Sesay, Chase Cannon, Meena Ramchandani, Raaka Kumbhakar, Jimmy Ma, Maria Corcorran, Elaine Thomas, Tim W. Menza, Brian Flaherty University of Washington, Seattle, WA, USA Background: Low-barrier care (LBC) improves viral suppression (VS) among persons with HIV (PWH) who have complex needs. We extend prior analyses of LBC effectiveness and identify patient characteristics associated with greater benefit. Methods: This retrospective cohort analysis included PWH enrolled in the Max Clinic in Seattle, WA from Dec 2014–Dec 2023 who had ≥6 months of observation time pre-and post-enrollment. Patient characteristics were drawn from electronic health records and viral load (VL) results from HIV surveillance. Observation periods were divided into 6-month intervals from the earliest analysis date or, if later, HIV diagnosis date. VS (<200 copies/mL) in each interval was defined by the last VL in the interval. Intervals missing VLs carried forward VS status from the prior window once, if suppressed, or until the next result if unsuppressed. Max enrollment in each interval was either pre- or post- (one way entry), with the first post- interval having ≥3 months of enrollment. Due to data clustering, generalized estimating equations were used to estimate VS probabilities. Predictors included Max enrollment, gender, and 3 dichotomous risk factors: homelessness/unstable housing (HUH), substance use (SU; methamphetamine, opioids, or cocaine), and severe mental illness (SMI; psychotic, bipolar, or personality disorder) at enrollment. Interactions among variables and sensitivity analyses were run to identify a properly specified predictive model. Predicted probabilities of VS across risk combinations illustrate Max effects. Results: 398 persons with 6928 6-month intervals were included; 76% cisgender men, 21% cisgender women, and 4% transgender women. 309 (78%) had HUH, 292 (73%) SU, and 112 (28%) SMI; 58 (15%) had none of these. Max Clinic enrollment was associated with an increase in VS [RR 1.78 (95% CI: 1.61-1.96; p<0.001)], with overall VS probabilities of 36% pre- and 60% post enrollment. In bivariate analysis, VS was more likely among patients with HUH (RR 1.13, p=0.05), SMI (RR 1.13, p=0.04), and older age, but not SU (RR 1.14, p=0.09). A 5-way interaction of Max enrollment, HUH, SU, SMI, and gender was needed to fit the data, yielding risk profile and gender specific Max enrollment effects (Figure). Median VS in PWH with all 3 risks (pooled across gender) increased from 30% pre- to 70% post-enrollment vs. 38% to 52% among those with no risk factors. Conclusions: VS increased with LBC enrollment across risk categories; PWH with multiple risk factors had the most improvement.

risk were greater in those with ≤12 years of education (16.1% and 12.5%, respectively) compared to >12 years (9% and 8.4%, respectively). Suicide risk was highest among ages 18-20 (21.8%), compared to 21-24 (10.5%) and 25-30 (7.5%) (Table). Conclusions: Our findings reveal high rates of moderate to severe depression and suicide risk among young SGMs enrolled in ImPrEP CAB-LA, especially among transgender persons, younger participants, and those with lower education levels. These results underscore the critical need to integrate mental health interventions into PrEP programs.

1303 Effects of a Cash Transfer Intervention on Internalized HIV Stigma Among ART Initiates in Tanzania Emmanuel Katabaro 1 , Matilda Mlowe 1 , Janeth Msasa 1 , Kassim Hassan 1 , Babuu Joseph 1 , Hamza Maila 1 , Agatha Mnyippembe 1 , Solis Winters 2 , Lila Sheila 3 , Amon Sabasaba 1 , Prosper Njau 4 , Anthony Kapesa 5 , Evelyne Konje 5 , Laura Packel 3 , Sandra I. McCoy 2 1 Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania, 2 University of California Berkeley, Berkeley, CA, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 National AIDS, STIs and Hepatitis Control Program (NASHCoP), Dodoma, Tanzania, 5 Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania Background: Retention in care remains a significant challenge for People Living with HIV (PLHIV) in Tanzania, possibly worsened by internalized HIV stigma and other factors leading to lower clinic attendance and treatment failure despite existing interventions. Financial incentives have emerged as a promising intervention for addressing social determinants of health potentially mitigating internalized HIV stigma by increasing autonomy and enhancing health promoting behaviors; drivers to conforming to social norms including health care and social support seeking behaviors which contribute to averting internalized HIV stigma. Methods: We conducted a secondary analysis of a cluster randomized controlled from May 2021 to March 2023 across 32 Care and Treatment Centers (CTCs) with new ART initiates randomized 1:1 to receive 22,500 Tsh (~10 USD) conditional on clinic attendance for up to six months in addition to standard of care services or to the standard of care group. Using Chi square and Generalized Linear Model, we examined the effect of an intervention on stigma and change of stigma with time in the two groups using the validated HIV/AIDS Stigma Instrument for People Living with HIV/AIDS (HASI-P) at six and twelve months since ART initiation. Results: Overall, 1795 study participants were balanced in the two study arms with the intervention arm having 983 (54.76%) participants, median [IQR] age of 35 [27-43] and more than half 1081 (60.22%) being females. Internalized HIV stigma prevalence varied within the two arms each achieving a more than 10% stigma decrease at 12 months. Chi square values of 32.79 with a P-value <0.001 and 51.81 with a P-value <0.001 in the control and intervention groups respectively, indicate significant change in stigma at 6 and 12 months and the intervention arm being superior with a significant adjusted coefficient (ACOEF) of -0.44 (95% CI: -0.64 - -0.23, < 0.001) (GLM) confirming a significant impact in the intervention arm at 12 months. Conclusions: Internalized HIV stigma is still prevalent even in the presence of an intervention but decreasing with time calling for a multidimensional approach to address internalized HIV stigma including other forms of stigma e.g. external stigma. Cash transfer interventions for internalized HIV stigma should be used with intention to effect long term internalized HIV stigma reduction, a call for further studies evaluating the impact beyond the 12 months mark.

Poster Abstracts

Keywords: Internalized HIV stigma, cash transfers, care outcomes

CROI 2025 433