CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

pharmacy-initiated PrEP in 10 states (including California) but has not yet been legalized in Maryland. Our objective was to assess the capacity of pharmacies in Baltimore and San Diego for initiating clients on PrEP. Methods: We conducted a census of all licensed pharmacies in Baltimore, Maryland and San Diego, California, and administered brief surveys via phone, assessing capacity for PrEP initiation and the status of any pharmacy-initiated PrEP programs in place. We then conducted semi-structured interviews with a subset of pharmacists to explore perceptions of pharmacy-initiated PrEP and contextual determinants of implementation success. Survey data were analyzed descriptively; interview data were analyzed using qualitative content analysis and the Consolidated Framework for Implementation Research (CFIR). Results: We contacted 418 pharmacies; 256 (61%) completed the survey. Chain pharmacies were the most predominant in Baltimore (41%) and San Diego (63.5%), followed by independent community pharmacies (33.5%; 19.3%). Most pharmacies could offer HIV-related counselling services (81%), with around 58% having a private space available for counselling. Ten pharmacies (5.5%) reported offering pharmacy-initiated PrEP in San Diego, with an average of 4 clients initiated per pharmacy. Limited ability to conduct point-of care testing for HIV, STIs, and liver function was observed. Interviews revealed substantial enthusiasm among pharmacists, with respondents feeling the program would reduce stigma and foster closer patient relations. However, barriers such as lack of awareness, prescribing status, staffing shortages, and insufficient financial compensation were highlighted. Pharmacists identified adequate training, advertisement to clients, and systems integration as essential for offering PrEP initiation. They also emphasized the need for proper workflow and protocols, reimbursement channels, and leadership support. Conclusions: Adoption of pharmacy-initiated PrEP by pharmacies may improve PrEP accessibility, though additional implementation supports will be critical to expand the number and size of pharmacy-based PrEP programs. 1316 Evaluating Spatially Targeted HIV and Harm Reduction Strategies Among People Who Inject Drugs Jasmine Wang 1 , Steven J. Clipman 2 , Shruti H. Mehta 1 , A. K. Srikrishnan 3 , Shobha L. Mohapatra 3 , Muniratnam S. Kumar 3 , Gregory M. Lucas 2 , Carl A. Latkin 1 , Sunil S. Solomon 2 , Amy Wesolowski 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: People who inject drugs (PWID) continue to experience high HIV incidence in a number of settings, including India; however, HIV is not homogeneously distributed in PWID and varies across social (injection partners) and spatial (injection venues) networks. To maximize impact of evidence-based interventions for PWID, it is critical to identify novel delivery points, including injection venues, to deliver HIV (testing & treatment) and harm-reduction services (medication for opioid use disorder (MOUD) and syringe service programs (SSP). Methods: 2512 PWID (10 index and 2502 recruits) were enrolled between 2017-19 in Delhi, India using a sociometric design (named injection partners). Based on network and behavior data, we constructed an individual-based transmission model of the dynamic injection network and injection venue attendance of the cohort with an exponential random graph model (ERGM) from 2017 to 2023. HIV incidence (baseline = 7.3 per 100 person-years) was simulated for each spatial targeting strategy and with increased service coverage corresponding to 50%, 75% or 100% of their respective UNAIDS/UNODC goals to quantify the impact of spatially targeted strategies on HIV epidemic control. Results: 110 injection venues with >10 visitors were identified at baseline, forming 3 spatial clusters of highly aggregated venues visited by PWID roughly based on their residence. In models targeting the same number of venues (between 1 to 12), prioritizing the most visited venues stratified by spatial clusters covered more individuals vs. prioritizing the overall most visited venues until the total targeted venues surpassed 9 (Figure). Simulation results showed that HIV incidence decreased with increasing service and venue coverage. With all services reaching 50% of their respective coverage goals, HIV incidence decreased to between 4.8 per 100PY [4.7, 4.9, 95%CI] (1 venue) and 3.7 per 100PY [3.6, 3.9] (when targeting 1 and 12 venues, respectively). Impact was greater (reduced to 3.0 per 100PY for 1 venue [2.9, 3.1] and 1.8 per 100PY for 12 venues [1.7, 1.9]) when all service goals were completely reached. Conclusions: In settings with limited resources, these findings suggest that targeting venues that are spatially distinct with minimal overlap of PWID has

a larger impact on reducing HIV incidence than targeting the most highly populated venues which may cluster together limiting reach of PWID in a community. However, as coverage across venues expands the two approaches tend to overlap.

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1317 Traditional Healers: A Nontraditional Gateway to Engagement in HIV Care in Rural Uganda Radhika Sundararajan 1 , Suzanne McCluskey 2 , Denis Nansera 3 , Winnie Muyindike 3 , Juliet Mwanga-Amumpaire 3 , Misha Hooda 1 1 Weill Cornell Medicine, New York, NY, USA, 2 Massachusetts General Hospital, Boston, MA, USA, 3 Mbarara University of Science and Technology, Mbarara, Uganda Background: Only 23% of people living with HIV (PLWH) in rural Uganda are virally suppressed, which falls far short of the 95% suppression target set by UNAIDS. This illustrates the need for tailored strategies to engage PLWH in rural settings and retain them in care. Traditional healers (TH) are often the first point of contact for healthcare in rural communities, including for PLWH. In our cluster-randomized clinical trial (NCT 05943548), we trained Ugandan TH to identify PLWH receiving care at their practices who were not engaged in HIV care. Methods: In August 2023, we trained TH in Mbarara, Uganda, to screen for adult PLWH at their practices through 1) facilitation of HIV self-testing for people who had not been tested for HIV in the past 12 months and did not have a known prior HIV diagnosis and 2) evaluation of adherence among known PLWH using the CASE Adherence Index Questionnaire (CAIQ). TH clients with a reactive HIV self-test or CAIQ score <10 underwent further screening involving measurement of HIV-1 viral load (VL). All virally unsuppressed PLWH (VL >200 copies/mL) were referred to a local HIV clinic to (re-)initiate care. Results: Between September 2023 and September 2024, 200 PLWH were identified at participating TH practices. 106 PLWH were newly diagnosed via self-testing at the TH location; for 57% (n=60) of these PLWH, the TH-facilitated test was the first lifetime HIV test that they received. Among participants who underwent HIV self-testing, prevalence of HIV was 2% (n=96/4732). TH identified 94 known PLWH who met the criteria for ART non-adherence; among these, 56% (n=53/94) had unsuppressed HIV VL. Conclusions: Our data highlights the untapped potential of TH in reaching rural Ugandan people living with HIV who are not engaged in HIV care. Over half of newly diagnosed individuals received their first HIV test at a TH practice, suggesting that TH can complement formal health services and play a crucial role in advancing progress toward the UNAIDS 95% testing target. We also identified many PLWH with high VL who are at high risk of HIV-related complications and contributing to onward transmission. Future research should explore how some PLWH maintain viral suppression despite disengagement, assess the long-term impact of TH interventions, and identify effective ways to support TH in delivering HIV care.

Poster Abstracts

CROI 2025 438