CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: By linking clinical and surveillance data we were able to more accurately assess PWH’s care status in the Cohort. While 24% of participants were thought to be OOC, 64% of those were found to have transferred and most had evidence of VS after transfer. Individual and structural level factors were associated with being OOC and interventions aimed at addressing these factors may help improve sustained engagement in care.

the cumulative number of PLHIV on ART; Gini coefficients were calculated to quantify disparities. Results: During the study period, Haiti’s HIV treatment cohort expanded from 115,895 to 123,639 individuals. Across all SNUs, the average quarterly IIT was 2.1%, with the greatest absolute IIT occurring in FY 2024 Q2. IIT rates across SNUs varied between 0.1% and 10.9%; Lorenz curves demonstrated variability in IIT distribution, with significantly less inequality across SNUs at the end of the study period compared to the start (FY 2024 Q3 Gini coefficient = 0.18 vs. FY 2022 Q1 Gini coefficient = 0.40; Z-score 4.5, p-value <0.0001). Conclusions: This analysis highlights disruptions in treatment continuity across SNUs in Haiti during a period of socio-political instability, with larger SNU treatment cohorts disproportionately affected by IIT. Decreasing inequality over time may suggest strategies to mitigate IIT have been successful. However, the inability to account for ‘silent migration’ between SNUs is a limitation, and further analyses are warranted. Nonetheless, these findings underscore the need to strengthen IIT preventive efforts and support for vulnerable populations.

1336 Does Retention in Care Still Correlate With HIV Viral Suppression: Do We Need Different Strategies? Joshua Craft 1 , Olivia Benda 2 , Elton Tang 2 , Shannon Galvin 1 1 Northwestern University, Chicago, IL, USA, 2 Northwestern Memorial Hospital, Chicago, IL, USA Background: “Ending the HIV Epidemic in the US Initiative” strategies include supporting retention and re-engagement in care for people with HIV (PWH) (CDC EHE pillars). As part of a multidisciplinary initiative to enhance retention in care among PWH at our clinic, we hypothesized that we could identify demographic differences between patients who are and are not retained in care to inform targeted outreach efforts. Methods: This is a single-center, retrospective, observational study using data collected during routine clinic visits between November 2021 and October 2023. We collected demographic, healthcare utilization, and viral load data for all PWH seen at least once in our clinic during the study period. Based on CMS Quality ID #340, retention in care was defined as seen at least two times between November 2022 and October 2023 and one additional time between November 2021 and October 2022. Viral suppression was defined as most recent viral load less than two hundred copies per milliliter. We compared characteristics of PWH retained or not using chi-squared tests. Results: We found that compared to PWH not retained (n=406), those who are retained (n=977) were more likely to be over 55 years old, the median age of the study population, (61% vs 51%, p<0.001) and to live within 8 miles of clinic, the median distance of the study population, (68% vs 56%, p<0.001), but were not more likely to be virally suppressed (94% vs 92%, p=0.058). Among those not retained, we found no differences in demographics between those virally suppressed (n=372) or not (n=34). Among those retained, we found that compared to those who are virally suppressed (n=922), those who are not (n=55) are more likely to identify as Black or African American (AA) (55% vs 37%, p=0.011) or to live in an under-resourced ZIP (56% vs 42%, p=0.042). Conclusions: Our results show different demographic factors are associated with retention in care and with viral suppression among PWH seen in our clinic. We also found retention was not associated with viral suppression, suggesting that in an era of well tolerated ART, some PWH likely achieve virologic success without semiannual medical encounters. Furthermore, our results suggest historically marginalized populations may not achieve optimal health outcomes with traditional healthcare delivery targets and may be better served with alternative strategies.

Poster Abstracts

1335 Clinical and HIV Surveillance Data to Determine Care Status for People With HIV in Washington, DC Shannon Hammerlund 1 , Lauren O'Connor 2 , Lisa Mele 2 , Maria Jaurretche 2 , DeMarc Hickson 3 , Rachel Denyer 4 , Alan Greenberg 2 , Amanda D. Castel 1 , Anne Monroe 1 , for the DC Cohort Executive Committee 1 The George Washington University, Washington, DC, USA, 2 DC Health, Washington, DC, USA, 3 Us Helping Us, People Into Living, Inc, Washington, DC, USA, 4 Veterans Affairs Medical Center, Washington, DC, USA Background: Poor retention in HIV care has been associated with adverse clinical outcomes. We sought to understand barriers to care and factors related to being out of care (OOC) in the DC Cohort, a longitudinal cohort of PWH in Washington, DC, using data from clinical care sites and linked data from the DC Department of Health (DC Health). Methods: We evaluated the status of DC Cohort participants from 1/1/11 to 12/31/23. Participants were considered OOC if they did not have an HIV care encounter or lab in the 18 months prior. We used DC Health HIV Surveillance lab data and manual clinical chart review to determine whether participants initially deemed OOC had died, transferred to another site, had evidence of care elsewhere in DC, or were truly OOC. Logistic regression models were used to describe the OOC population and evaluate associations between participant characteristics and being OOC. Results: We evaluated 12,563 DC Cohort participants. Overall, 1,418 (11%) died, 41 (0.3%) withdrew, 1,893 (15%) transferred care, 517 (4.1%) statuses could not be determined, and 2,101 (24%) were considered OOC. Linked DC Health data showed 1,353 (64%) of the OOC participants had evidence of care elsewhere at least 6 months after their last Cohort contact. Of those with known labs, 82% were virally suppressed and 63% had CD4 ³ 500 cells/mL. This left 748 participants OOC and 6,557 participants in care. Among those OOC, 64% were non-Hispanic Black, 79% male, and the mean age was 52. OOC participants were more likely to be non-Hispanic White, (aOR (95% CI): 1.7 (1.4, 2.2)), 10 years older (aOR: 1.2 (1.1, 1.3)), not virally suppressed (aOR: 3.5 (2.8, 4.5)), not have AIDS (aOR: 1.7 (1.4, 2.1)), be unemployed (aOR: 1.6 (1.2, 2.1)), and receive care at a Ryan White clinic (aOR: 1.5 (1.2, 1.9)). Being female (aOR: 0.7 (0.5, 0.8)), perinatally infected (aOR: 0.3 (0.1, 0.6)), having a CD4 ³ 500 cells/mL (aOR: 0.5 (0.4, 0.8)), public insurance (aOR: 0.4 (0.4, 0.6)), hypertension (aOR: 0.6 (0.5, 0.7)), and hyperlipidemia (aOR: 0.4 (0.3, 0.4)) were associated with a lower likelihood of being OOC.

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CROI 2025 445