CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1318 Home CAB/RPV Provides Novel Approach to Achieve Viral Suppression in PWH With Adherence Challenges Megan E. Dieterich, Rupa Patel, Monica E. Gouzoulis, Keyerra Richardson, Erin E. Kelley, Robert E. Bangert, David A. Fessler, Sarah Henn, Stephen E. Abbott, Namrata P. Shah, Rachel E. McLaughlin, Meghan Davies, H. Jonathon E. Rendina Whitman-Walker Health, Washington, DC, USA Background: Cabotegravir/Rilpivirine (CAB/RPV) demonstrated superiority to oral ART in persons living with HIV (PWH) with adherence challenges. We evaluate an innovative support services program, including home administration of injections, to support CAB/RPV adherence in PWH. Methods: In 2016, Whitman-Walker Health initiated the Mobile Outreach Retention and Engagement Program (MORE) to support adult PWH with adherence challenges (viremia and/or no medical visits in 6 months). The MORE program offers mobile care navigators, transportation and Physician Assistant-led home medical/phlebotomy visits. In 2023, MORE integrated home administration of maintenance CAB/RPV injections. To evaluate this strategy, we are conducting an effectiveness-implementation hybrid type-2 study comparing the MORE group to a 2:1 matched comparison group of PWH receiving CAB/RPV without MORE support. The primary outcome is viral suppression at 4 months with a secondary outcome of 4-month injection adherence (+/-7 day window). Data was collected from EHR extraction and medical chart review. Results: To date, 44 PWH have initiated CAB/RPV through MORE and 33/44 have >4 months since initiation. Median age is 44 years, 39% female, and 93% Black. The comparison group (n=88) was matched for age, race and sex other factors and has similar rates of public insurance (76% control vs. 82% MORE), but significantly fewer PWH with baseline viremia (≥200 c/mL) than MORE (6% vs. 27%), χ 2 (1, n=17) = 12.1, p14d late), due to insurance lapse with restart. The comparison group had 4 late injections, 3 missed injections with restart, and 4 missed injections with discontinuation. At 4 months, 100% (33/33) of PWH in MORE and 98% (65/66) of PWH in the comparison group had maintained or achieved viral suppression. Conclusions: Among a population of PWH with adherence challenges, we demonstrate that an enhanced care navigation program offering home CAB/ RPV administration can achieve acceptability, high adherence and 100% viral suppression, during early the early phases of this study. Implementation strategies including at-home ART injections can help achieve national goals to end the HIV epidemic.

ordered an HIV self-test (HIVST) at $9.2/ $11 or a provider-administered rapid diagnostic test (RDT) for $6. Those testing HIV-negative received a 30-day supply of free-of-charge government donated PrEP/PEP. HIVST and PrEP/PEP were delivered to the client’s preferred location for $1.1. Clients who refilled PrEP at Month-1 received a 90-day supply. We conducted a descriptive analysis of PrEP/PEP service delivery data and fitted Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between user characteristics and PrEP outcomes. Results: From January-September 2024, we screened 1,621 clients of whom 75 and 1140 were eligible for PrEP and PEP, respectively. Among these, 55 (73%) initiated PrEP and 835 (73%) initiated PEP. Most PrEP and PEP clients (n=890) were male (65.7%), ≥25 years (77.7%), unmarried (88.2%), PrEP (98.9%) and PEP (97%) naïve. Most clients (79%) opted for provider-administered RDT, while 21% purchased an HIVST. PrEP continuation was 31/48 (64.6%) at one month, 5/38 (13.2%) at 3 months, and 7/17 (41.2%) at 6 months. A total of 14.6% of clients who initiated PrEP discontinued and restarted, while 2.28% transitioned from PEP to PrEP. Male users were less likely to continue PrEP (HR 0.01, 95% CI 0.0002-0.70) while those with >1 partner were more likely to continue (HR 19.04, 95% CI 1.51-239.76). Having multiple partners was also associated with PEP to PrEP transition ( p =0.0250). Conclusions: Our findings suggest that online delivery can expand access to PrEP/PEP for clients not previously engaged with biomedical prevention, and that these clients are willing to pay for HIV testing and delivery. Persistent PrEP use among men remains a challenge, but high demand for online PEP and low transitions from PEP to PrEP suggest opportunities to expand access to PEP, which has been underutilized in HIV prevention efforts. 1320 Community-Based Versus Facility-Based Services to Improve HIV Care in the Gold Mining Zones of Mali Marion Fiorentino 1 , François M. Cavaro 1 , Moussa Guindo 2 , Aliou Kamissoko 2 , Fodé Traore 2 , Gwenaëlle Maradan 3 , Michel Bourrelly 1 , Marion Mora 1 , Fodié Diallo 2 , Zoumana Diarra 2 , Mamadou Cisse 2 , Bintou Dembele Keita 2 , Bruno Spire 1 , Luis Sagaon Teyssier 1 1 Aix-Marseille Université, Marseille, France, 2 ARCAD Santé PLUS, N'Tomikorobougou, Mali, 3 Observatoire Régional de la Santé Provence-Alpes Côte d'Azur, Marseille, France Background: In Mali, the HIV cascade is 59-53-unknown. People in artisanal small-scale gold mining zones (ASGMZ) are highly exposed to HIV and represent a potential “bridge” for infectious diseases including HIV. We aimed to assess the effects of proximity community-based HIV services on access, retention in care and health. Methods: The ANRS-12392/Sanu Gundo non-randomized interventional trial was conducted in 2021-2022 in the Malian ASGMZ of Diassa (control) and Kofoulatiè (intervention). Community-based HIV testing was offered in both sites. People newly diagnosed in the intervention site received proximity community-based services including ART; whereas those in the control site were referred to conventional public hospitals. Individual and clinical characteristics including viral load (VL) were collected at different time points (J0, M1, M3, M6, M9 and M12). Outcomes were: time to linkage-to-care (i.e. time to ART initiation); retention in care at M12 (i.e. time to last visit); availability of VL assessment (yes/no); VL evolution at M12; and perceived health status (good/ excellent vs. bad). Cox’s model was used for linkage-to-care and retention in care. VL assessment and perceived health status were analyzed using random effects model to control for repeated measures. Sampling bias between arms was corrected using inverse propensity score weighting. All analyses compared arms (control/intervention) and were adjusted for individual characteristics. Results: 9786 HIV tests were carried out (control site: 56.7% and intervention site: 43.2%). The control group included 81 HIV+ participants, and 89 were in the intervention group. HIV prevalence of 1.5% 95%CI[1.2-1.9] and 2.2% 95%CI[1.8-2.6] were estimated for the control an intervention sites, respectively (0.8%[0.7-1.1] at national level). Linkage-to-care was faster in the intervention group (aHR:1.8; 95%CI:1.03-3.2). Retention in care at M12 was shorter in the intervention group (aHR:2.1; 95%CI:1.3-3.5). No difference was found between arms concerning VL assessment (p=0.4), nor the evolution of VL (p=0.5). Participants in the intervention group were less likely to perceive good/excellent health status (aOR:0.41; 95%CI:0.23-0.73). Conclusions: Community-based services improved HIV testing and linkage-to care in ASGMZ. Retention and availability of viral load assessment did not differ between groups. Coordination of community-based and conventional public

Poster Abstracts

1319 Uptake of Online HIV PrEP and PEP in Kenya After Removal of Subsidies: A Pilot Extension Study Daniel K. Were 1 , Albert Tele 1 , Linda U. Nzabamwita 2 , Rouella Mendonca 3 , Geoffrey Odhyambo 1 , Salima Saidi 4 , Samira Abdulrashid 4 , Elizabeth Irungu 1 , Kelly Curran 5 , Kaitlyn Atkins 2 1 Jhpiego - Nairobi, Nairobi, Kenya, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 Audere, Hauser, ID, USA, 4 MYDAWA, Nairobi, Kenya, 5 Jhpiego, Silver Spring, MD, USA Background: Kenya is experiencing rapid growth of e-pharmacy and telemedicine, which could be leveraged for delivery of HIV pre- and post exposure prophylaxis (PrEP and PEP) to groups not reached through traditional models. We conducted a pilot study in partnership with MYDAWA, a Kenyan online pharmacy, to evaluate a modified online PrEP & PEP delivery model in which HIV tests are not subsidized and includes a service fee, in Nairobi and Mombasa Counties. Methods: Interested clients completed a teleconsultation to assess for eligibility based on Kenya national guidelines for PrEP/PEP; those eligible

CROI 2025 439