CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1332 Point-of-Care Urine Self-Testing Feasibility to Measure TFV Adherence and Predict Viral Suppression Renata Buccheri 1 , Megan J. Heise 2 , Kevin Sassaman 2 , Tyler Martinson 2 , Hannah R. Schmidt 2 , Alexa D'Angelo 3 , Dustin Duncan 4 , Keith J. Horvath 5 , Sabina Hirschfield 6 , Renessa Williams 7 , Mallory O. Johnson 2 , Christian Grov 3 , Adam Carrico 8 , Monica Gandhi 2 , Matthew A. Spinelli 2 1 Vitalant Research Institute, San Francisco, CA, USA, 2 University of California San Francisco, San Francisco, CA, USA, 3 CUNY School of Public Health, New York, NY, USA, 4 Columbia University Irving Medical Center, New York, NY, USA, 5 SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA, 6 State University of New York Downstate Medical Center Downstate Medical Center, Brooklyn, NY, USA, 7 University of Miami Miller, Miami, FL, USA, 8 Florida International University, Miami, FL, USA Background: Only 68% of U.S. men-who-have-sex-with-men (MSM) living with HIV have achieved virologic suppression (VS), sufficiently low to compromise Ending the HIV Epidemic goals. Objective monitoring of antiretroviral therapy (ART) adherence via drug-level testing can inform interventions. A rapid, low-cost urine point-of-care (POC) tenofovir (TFV) assay has been developed by our group as an objective adherence metric. However, self-administration of the urine TFV assay among people with HIV (PWH) outside of the clinical setting has not been previously studied. Methods: We assessed the association between a self-administered POC urine TFV rapid assay and VS in MSM with HIV on TFV-based ART, all of whom reported adherence challenges or virologic non-suppression. Participants, oversampled for stimulant users, were recruited using the Grindr app, received mailed urine tests, and provided plasma at a certified laboratory for viral load testing. Logistic regression examined the effect of TFV detection in urine on the likelihood of achieving VS. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the urine assay compared to VS were calculated. Results: Of 727 MSM living with HIV, 88% completed and uploaded a photo of the urine test to the study. Among the analytic sample (n=596), the average age was 42.7 years (SD ± 11.02). 50% identified as White, 27% Black, 17% multiracial/other, 3% Asian, 2% Native American; 22% Hispanic. Nearly all (99%) were on ART with TFV alafenamide (TAF), and 61% reported stimulant use in the past 3 months. Of the 86% of participants that achieved VS, 10% of those had low adherence measured via the urine test. TFV detection was significantly associated with VS (OR=9.39, 95% CI5.62-15.84, p< .001). Among participants with no detectable TFV in urine, 13% of those without VS and 61% with VS reported adherence >80% in the past month. Conclusions: These results are the first to show the feasibility of self monitoring of adherence using a POC urine test. TFV presence in urine strongly predicted VS with a PPV of 92%, opening the potential for self-testing as an adherence check in-between viral load testing in the clinic. Non-suppression despite TFV detection suggests suboptimal adherence or drug resistance, and low TFV with VS may herald future treatment failure; both situations should prompt further monitoring. POC TFV testing offers a real-time strategy to identify adherence challenges and timely interventions on TFV-based ART.

antiretroviral therapy (ART). We aimed to evaluate whether the COVID-19 pandemic “period” affected (i) the number of ART initiations, (ii) the proportion of timely ART initiations in people with HIV (PWH) aged 18 years and older. Methods: Within the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration, we analyzed routinely collected data from PWH enrolled in 361 clinics across 31 countries (n) in the Asia-Pacific (n=9), Central Africa (4), Latin America (3), East Africa (2), Southern Africa (6), West Africa (5) and North America (2). The onset of the pandemic period was defined for each country by the peak Oxford Coronavirus Government Response Tracker Stringency Index (composite measure of 9 response metrics from 0-100 [most severe]) occurring between January and June 2020. We defined ART start within 7 days of enrolment as “timely”. We estimated changes in the average number of ART initiations per week and the proportion of timely initiations (expressed in points p and percentage points pp respectively) using regression discontinuity design during the study period, from 104 weeks before to 52 weeks after the pandemic onset for each country. Results: A total of 197,668 PWH initiated ART during the study period. The number of initiations per period and country ranged from 44 to 48,497 and the proportions of timely initiations from 7.0% to 99.3%. Numbers of ART initiations remained stable in 25 countries and decreased significantly in 6 countries during the pandemic period (Figure): India (-5.0p, 95%CI: -9.2 to -0.7), Rwanda (-10.0p, -18.6 to -1.4), Malawi (-33.4p, -54.1 to -12.3), South Africa (-139.8p, -198.9 to -80.6), Zimbabwe (-12.9p, -20.0 to -5.8), Togo (-19.6p, -39.1 to -0.1). The proportion of timely initiations was stable in 29 countries and increased significantly in Kenya (+4.2pp, 95%CI: +0.3 to +8.1) and Mozambique (+2.7pp, +0.5 to +4.9) during the pandemic period. Conclusions: In most countries, we found no difference in ART initiations or timeliness after the onset of the pandemic. This suggests that contributing clinics maintained a “test and treat” approach despite strict pandemic measures. Research should examine the pandemic’s impact on case finding (first 95) and viral suppression (third 95), especially in countries with observed disruptions.

Poster Abstracts

1334 HIV Treatment Continuity in Haiti: Lorenz Curve Analysis of IIT, 2022-2024 Michael J. A. Reid, Tiana Jaramillo, Lorin Letcher, Hamfrey Sanhokwe, Linda Mattocks PEPFAR, Washington, DC, USA Background: In recent years, Haiti has faced escalating civil unrest characterized by a complex mix of political crises and internal conflicts. This instability has significantly disrupted healthcare services, including HIV treatment programs, reducing the overall capacity of the healthcare system to respond effectively and exacerbating the vulnerability of already marginalized groups. Interruption in Treatment (IIT) poses a severe risk to people living with HIV (PLHIV), increasing the potential for higher HIV-related morbidity, mortality, and transmission. This analysis aimed to describe IIT trends within PEPFAR supported HIV programs from 2022 to 2024, focusing on subnational variability, including regions heavily impacted by socio-political crises. Methods: We utilized aggregated program data from reported quarterly to PEPFAR’s Panorama platform to examine IIT trends across seven quarters, from Fiscal Year (FY) 2022 Q1 to FY 2024 Q3, stratified by Subnational Units (SNUs). IIT was defined as no clinical contact or antiretroviral therapy (ART) pick-up for more than 28 days since the last expected encounter. We calculated the percentage of IIT for each quarter, stratified by Subnational Units (SNUs). Lorenz curves were used to assess inequalities in distribution of IIT relative to

1333 Effect of COVID-19 Pandemic on ART Access and Timely Initiation in Adults With HIV in 31 Countries Ben Farhat Jihane 1 , Safari Mbewe 2 , Helen Byakwaga 3 , Denis Nash 4 , Eugène Messou 5 , Valdilea Gonçalves Veloso 6 , Sarita Shah 7 , Rohidas Borse 8 , Metsekae Madimabe 9 , Denna Michael Mkwashapi 10 , Gad Murenzi 11 , Oliver Ezechi 12 , Diana Barger 13 , Antoine Jaquet 14 1 Epicentre, Paris, France, 2 Lighthouse Trust, Lilongwe, Malawi, 3 Infectious Disease Institute, Kampala, Uganda, 4 CUNY School of Public Health, New York, NY, USA, 5 PAC-CI Program, Abidjan, Côte d'Ivoire, 6 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 7 Rollins School of Public Health, Atlanta, GA, USA, 8 Byramjee Jeejeebhoy Government Medical College, Pune, India, 9 Desmond Tutu HIV Foundation, Cape Town, South Africa, 10 National Institute of Medical Research, Mwanza, United Republic of Tanzania, 11 Rwanda Military Hospital, Kigali, Rwanda, 12 Nigerian Institute of Medical Research, Lagos, Nigeria, 13 Université Clermont Auvergne, Clermont-Ferrand, France, 14 University of Bordeaux, Bordeaux, France Background: The COVID-19 pandemic threatened global efforts to ensure that people with HIV were diagnosed early, linked to care, and treated with

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