CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

visits within 12 months, separated by ≥ 90 days. Secondary end points included missed visits in adult care, completed first time HCT visits, viral suppression, and care engagement during COVID. We used descriptive statistics to characterize the study population. Results: 102 patients enrolled in STEP during the study period. 84 transitioned from P/A to adult care. The cohort was 58% male, 97% African American, and 53% acquired HIV perinatally. The median age at transition was 29 and 49% carried a mental health diagnosis. 75 transitioned to the UMB THRIVE Program and 10 transitioned elsewhere. Retention in care was 89.3% (N=75) at 12 months, 75.8% at 24 months (N= 58), 85.4% at 36 months (N= 41), 72.7% at 48 months (N=33) and 68% at 60 months (N= 25). HIV viral suppression was 62.3% pre-transition. Post-transition it increased to 68.2% at 12 months, 71.7% at 24, 77.8% at 36, 78.6% at 48, and 84.2% at 60. In 2020, 76.6% (N=30) of patients met retention criteria. Mean new HIV HCTs from 2017-2019 were 1.15 per month. From 3/2020 to 1/2021 there were none. From 1/2021-6/2023, mean new HCTs increased to 1.07 per month. Conclusions: Retention in adult care was highest in the first 12 months post-transition with a 23% decrease by 60 months. Rates of viral suppression increased with highest rates of suppression at 60 months. New HIV HCTs ceased for the first 9 months of COVID, however rates of transition soon returned to pre pandemic levels. Retention in care and viral suppression did not significantly change before and during COVID time-period. Overall, these results support the durability of a multi-disciplinary, pediatric/adult-integrated comprehensive retention service-based health care transition program.

cause mortality and LTFU were compared using hazard ratios from the Cox proportional hazard regression model. Results: Of 1,000 PLHIV, 980 had ≥1 follow-up and were included in the analysis. Median age was 45 years (IQR: 40-51), 62% were female, and 95% had a suppressed viral load at baseline. Baseline QoL was 90.1% in any DSD vs 89.2% in SOC. After eight years of follow-up, weighted mean QoL was higher in participants enrolled in DSD models than the SOC (90.4% vs 89.1%; weighted mean ratio 3.66, 95% CI 2.10-6.37, p-value <0.001); there were no statistical differences across DSD models. Participants in DSD models were more likely to have sustained viral suppression (weighted odds ratio 1.69, 95% CI 1.24-2.31), lower mortality (weighted hazard ratio 0.08, 95% CI 0.03-0.20) and lower LTFU rates (weighted hazard ratio 0.08, 95% CI 0.02-0.31). Conclusions: These findings support the broader adoption of DSD models in HIV care programs to enhance the QoL, well-being, and clinical outcomes of PLHIV. 1326 Trends in HIV Viral Nonsuppression and Drug Resistance Among PWID on Dolutegravir ART in Kenya Loice W. Mbogo 1 , Ceejay L. Boyce 2 , Stephen E. Hawes 2 , Betsy C. Sambai 3 , Brandon L. Guthrie 2 , William Sinkele 4 , David K. Njenga 5 , Bhavna H. Chohan 2 , Aliza Monroe-Wise 6 , Esther Gitau 4 , Sarah Masyuko 2 , Geoffrey S. Gottlieb 2 , Paul Drain 2 , Lisa M. Frenkel 7 , Carey Farquhar 2 , for the DREAM Kenya Programme 1 Emory University, Atlanta, GA, USA, 2 University of Washington, Seattle, WA, USA, 3 University of Washington in Kenya, Nairobi, Kenya, 4 Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya, 5 Aga Khan University, Nairobi, Kenya, 6 World Health Organization, Geneva, Switzerland, 7 Seattle Children's Research Institute, Seattle, WA, USA Background: Data are limited on effectiveness of dolutegravir (DTG)-based regimens among people living with HIV who inject drugs (PWID) in sub-Saharan Africa. We longitudinally studied PWID in Kenya taking DTG and assessed viral non-suppression and drug resistance. Methods: Kenyan PWID on DTG for >6 months were enrolled, and plasma HIV RNA viral load (VL) was measured every 6 months for 2 years (May 2021-September 2023). Non-parametric survival estimations of interval censored data assessed covariates associated with time to non-suppression (VL>200 cp/ml) considering left and right-censored observations. Viremic plasma RNA was genotyped for resistance, including minority variants, using a lab-developed PacBio sequencing assay and was assessed using the Stanford HIV Database. Results: Among 250 enrolled participants, 125 were on methadone, 70% were male and median age was 39. Four follow-up visits were completed by 194 (77%) participants over 2 years. Of those with complete follow-up, 118 (61%) were virally suppressed at all visits, 71 (37%) experienced intermittent suppression, including 32 who were left censored (non-virally suppressed at enrollment), and 5 (3%) were always not suppressed. The odds of non suppression for those on methadone versus not on methadone were 0.53 (p<0.05), for those living in improvised shelter/in the open versus those living at home/with a relative were 2.72 (p <0.01) and were reduced by 6% (p <0.001) per year of increased age. Genotyping of viremic samples was successful for 93/94 (99%). Resistance to NNRTIs was common (~30-45% at each visit), but major resistance to drugs in their DTG-based regimens was relatively infrequent, with resistance to tenofovir in 4/93 (4%), lamivudine in 7/93 (8%) and major DTG resistance in 2/93 (2%) participants only observed as minority variants - S153F and Q148K detected at 1% each. DTG-mutations classified as “accessory resistance mutations” were observed at higher frequency in 34/93 (37%), including T97A (n=7), E138K (n=7), and L74M (n=6). Conclusions: This longitudinal study among PWID living with HIV in Kenya shows that more than 1 in 3 participants on DTG-containing regimens had viral non-suppression at least intermittently. Still, resistance to DTG-containing therapy was rare across two years of follow-up. Identifying ways to mitigate barriers that may hinder viral suppression among the marginalized population will help ensure adherence to HIV care and treatment.

Poster Abstracts

1325 Impact of Differentiated HIV Service Delivery Models on Quality of Life in Uganda Benson Nasasira 1 , Grace Banturaki 1 , Nelson Kalema 1 , Joseph Musaazi 1 , Aidah Nanvuma 1 , Joanita Kigozi 1 , Nancy Kiarie 2 , Joash Ntenga Moitui 2 , Joseph Kabanda 3 , Arthur Fitzmaurice 3 , Noela C. Owarwo 1 , Damazo Kadengye 2 , Jonathan Izudi 2 , Barbara Castelnuovo 1 1 Infectious Diseases Institute, Kampala, Uganda, 2 African Population Health and Research Center, Nairobi, Kenya, 3 US Centers for Disease Control and Prevention Dar es Salaam, Dar es Salaam, United Republic of Tanzania Background: Differentiated service delivery (DSD) models have reduced strain on health services and improved client experience, retention and viral suppression, but little is known about the impact of HIV DSD models on quality of life (QoL), which is essential for optimizing person-centered care. This study assessed the impact of DSD models on QoL, loss to follow-up (LTFU), and mortality among persons living with HIV (PLHIV) on ART over time at a large urban HIV clinic in Uganda. Methods: We retrospectively reviewed records of all the 1,000 PLHIV enrolled in a conveniently sampled 10-year cohort at the PEPFAR-funded Infectious Diseases Institute (IDI) clinic in Kampala, Uganda. Participants were on ART for 10 years at enrollment in 2014 or 2015. We scored QoL with an adapted Medical Outcomes Study (MOS-HIV) tool. We determined and compared QoL scores (summed scores from 10 questions expressed as a percentage), sustained annual viral suppression (<200 copies/mL), all-cause mortality and LTFU (missing clinic visits for ≥3 months) for PLHIV in any of three DSD models for ≥6 consecutive months—fast-track drug refill (FTDR), facility-based groups (FBG), and composite model combining these two—versus facility-based individual management (FBIM), the standard of care (SOC). Using inverse probability treatment weighting mixed effects models, we estimated QoL scores as weighted mean ratios and checked robustness of results using G-computation analysis. Sustained viral suppression was compared using odds ratios; all

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