CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

positive Hepatitis B surface antigen (HBsAg) status, missed HIV infection, severe pain, other side effects, pregnancy, relocation, parental influence, late beyond forgiveness window, and no longer at risk of HIV Results: Out of 1,121 clients initiated on CAB LA, 164 (15%) discontinued CAB-LA (101 female and 63 male). The primary reasons for discontinuation included severe pain (55), positive HBsAg status (25), and other side effects (22). Additional reasons included missed HIV infections (4), pregnancy (6), relocation (24), parental influence (6), Late beyond forgiveness window (16), and no longer at risk of HIV (6, ). The remaining 957 clients have continued on CAB-LA giving a continuation rate of 85%. Conclusions: The majority of CAB-LA discontinuations were due to manageable factors such as pain and relocation suggesting opportunities for specific interventions to improve retention. Positive HBsAg status also emerged as a significant reason for discontinuation, highlighting the need for comprehensive screening before CAB-LA initiation. Addressing these barriers can help increase retention and optimize the long-term success of CAB-LA for HIV prevention.

to patient throughput, more research is needed on efficient strategies for identifying and linking PLWH who are OOC while they are accessing care in the ED.

1331 HIV Treatment Interruptions: A Lorenz Curve Analysis of Countries Achieving the 95-95-95 Targets Michael J. A. Reid 1 , Matias Grande 1 , Ingrid Katz 2 , Jasmine Buttolph 1 , Emily K. Dokubo 1 , Kiran Rodrigues 1 , Hilary Wolf 1 , Rituparna Pati 1 , for the PEPFAR GHSD Research Collaboration 1 PEPFAR, Washington, DC, USA, 2 Harvard Medical School, Boston, MA, USA Background: Despite reaching the UNAIDS 95-95-95 targets, many countries continue to face significant challenges with Interruption in Treatment (IIT). This analysis examines IIT rates from Fiscal years (FY) 2021 to 2024 across nine PEPFAR-supported countries—Botswana, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Zambia, and Zimbabwe—that have achieved or are nearing these targets. We explore IIT trends in the context of high treatment coverage (Tx_CURR) and viral load suppression (VLS) to identify persistent disparities and inform targeted interventions. Methods: We conducted a longitudinal analysis of quarterly PEPFAR Monitoring, Evaluation, and Reporting (MER) data from FY2021 Q1 to FY2024 Q3 for nine aforementioned countries. We calculated percent IIT (defined as the proportion of the treatment cohort with no clinical contact or antiretroviral therapy pick-up > 28 days since the last expected encounter), Tx_CURR and VLS percentages for each quarter, stratified by sex. To assess disparities, we generated Lorenz curves to visualize the distribution of IIT across subnational regions within each country and collectively across all nine countries over time. Additionally, Gini coefficients were calculated to quantify the level of inequality in IIT distribution. Results: The treatment cohort across nine countries increased from 5,252,596 individuals (64.2% female) in FY2021 Q2 to 5,932,928 (64.9% female) in FY2024 Q3, with VLS proportion remaining stable at 95.7%. During the study period, overall IIT decreased from 1.9% in FY2021 Q2 to 1.6% in FY2024 Q3. Throughout the duration analyzed, IIT was greater among men than women (2.02% vs. 1.72%, p<0.001). Lorenz curves indicated that IIT distribution was unequal but Gini coefficient decreased from 0.22 in Q2 FY2022 to 0.08 in Q3 FY2024 (Z score 5.04, p<0.001) (Figure), reflecting a substantial reduction in inequality. Conclusions: While the overall volume of IIT and its distribution disparities decreased during the evaluated period, IIT remains a significant challenge in these nine countries. Our analysis using Lorenz curves and Gini coefficients underscores the importance of targeted interventions to maintain high continuity of treatment and prevent IIT. Specifically, tailored strategies are crucial in countries with significant inequalities in treatment continuity and among sub-populations with high IIT, such as men.

Poster Abstracts

1330 Detection and Linkage of PLWH Who Are Out of Care in 94 Emergency Departments Across the US Jamie L. Mignano 1 , Hilary Armstrong 1 , Angelique Griffin 1 , Monique Rucker 1 , Carol Vincent 1 , Starr West 2 , Derek Spencer 1 1 Gilead Sciences, Inc, Foster City, CA, USA, 2 ICF International, Reston, VA, USA Background: Emergency Departments (EDs) are a major source of medical care for people living with HIV (PLWH) in the United States. PLWH who are out of care (OOC) experience poorer health outcomes and contribute to more than 40% of HIV transmissions. Gilead Sciences’ FOCUS program is a public health initiative that supports healthcare institutions to implement routine blood-borne virus (HIV, HCV, HBV) screening, diagnosis, and linkage to a first appointment in accordance with CDC guidelines. We examined data collected from US FOCUS ED-based HIV screening programs to determine the proportion of PLWH who were previously diagnosed and OOC and describe the geographic and demographic distribution of these patients. Methods: From 2021 – 2023, data from 94 ED-based HIV screening programs were reviewed for HIV testing volume, HIV test results, previous HIV test result, and linkage status.Previously diagnosed persons were identified through routine screening or alternative mechanisms, including electronic medical record (EMR) flags. Previously diagnosed persons who were OOC were defined as those with a previous positive HIV test result not reported as in care through EMR abstraction, surveillance records or patient interview. Outcomes include the proportion of persons identified with HIV infection who were previously diagnosed and OOC, distribution across U.S. regions and demographic characteristics of those identified and linked to care. Results: ED programs conducted 1,561,517 HIV tests. Of persons identified with HIV infection, 22% were newly diagnosed, 69% were previously diagnosed, and 9% had an unknown previous HIV status. Of those who were previously diagnosed or had an unknown previous HIV status, 50% were OOC. Two-thirds (67%) of all previously diagnosed OOC persons were identified in the South. Of all previously diagnosed persons who were OOC, 71% were male, 38% were 50 years or older, 57% were Black/African American, and 76% were non-Hispanic. Overall, 71% of persons previously diagnosed and OOC were linked to care. Linkage to care rates were highest among males (72%), persons aged 20 -29 (73%) and 50 years or older (73%), White persons (74%) and Hispanic persons (77%). Conclusions: EDs play a critical role in identifying and linking PLWH who are OOC. Given that EDs face resource constraints and must consider impact

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