CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1337 Uptake of Injectable Cabotegravir/Rilpivirine for Treatment of HIV Infection in US, 2021-2023 Jesse O'Shea, James P. Henson, Abigail Derton, Athena Kourtis, Kate Buchacz Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Cabotegravir/rilpivirine (CAB/RPV), the first complete long acting injectable (LAI) antiretroviral therapy (ART) regimen, was approved by the FDA in January 2021 and offers a convenient monthly to bimonthly alternative to daily oral ART with the potential to improve adherence and viral suppression. To understand the degree of uptake of CAB/RPV, we assessed trends of and characteristics associated with prescriptions for injectable CAB/ RPV, compared with oral ART. Methods: Using HealthVerity Marketplace™, a national administrative dataset consisting of medical and pharmacy open/closed claims from public and private entities, inpatient and outpatient billing data, and laboratory test results from all US states and major payer types, we estimated the number of persons with HIV (PWH) prescribed oral ART regimens and CAB/RPV with closed claims, by month from January 2021 to August 2023. Among PWH prescribed ART, we assessed demographic characteristics stratified by prescription for oral ART or CAB/RPV. Patient- and prescription-level characteristics were compared across the two treatment groups using chi-squared and two-proportion Z-tests. Results: During the study period, 208,196 PWH were prescribed only oral ART for a total of 3,469,191 prescriptions, while 4,087 unique PWH were prescribed CAB/RPV for a total of 21,698 prescriptions. The number of prescriptions for CAB/RPV increased from 1,410 in 2021 (January to December 2021) to 11,051 in 2022 (January to December 2022). From January 2023 to August 2023, there were 9,237 prescriptions for CAB/RPV. Older age groups (55+) were less frequently prescribed CAB/RPV compared with oral ART (16.0% vs 21.6%; p <0.001). Substance use disorder diagnoses were more common among persons prescribed CAB/RPV than oral ART (47.7% vs. 40.1%; p <0.001). Southern regions (40.4% vs. 33.3%) and commercial payers (32.1% vs. 13.8%) were more common among oral ART prescriptions than CAB/RPV (p <0.001). However, Medicaid payers were more common among prescriptions for CAB/RPV (76.2% v. 53.8%; p <0.001). Conclusions: Relatively few PWH were prescribed CAB/RPV since its recent approval, however the proportion is increasing. Better understanding is needed of reasons for modest CAB/RPV uptake overall, including possibly cost and operational barriers to its implementation. Studying the factors associated with CAB-RPV use among specific regions in the US, such as the South, and in persons aging with HIV or those with adherence challenges, can inform implementation efforts.

with surveillance data, and pharmacy records of late medication pick-up from one HIV specialty pharmacy. Criteria for D2C investigation varied by source but included persons with no evidence of recent care [no CD4 or viral load (VL) result reported in the past 12-15 months], persistent viremia, or late antiretroviral medication refills (35-65 days). Health department staff investigated cases using public health databases and medical records, attempted to directly contact PWH to help with re-engagement in HIV care and treatment, and recorded investigation dispositions and contact outcomes in standardized fields in an electronic database. PWH could be identified more than once or through multiple sources; investigations were the unit of analysis. We defined the number of records from each source for which the investigation confirmed or suggested the PWH was truly out-of-care, viremic or off medications and living in King County (“candidates for support”) and, separately, the number that led to a successful health department contact with identified persons. Results: A total of 2,812 records were identified for investigation (Table). Compared to eHARS data alone, all other sources yielded a higher percentage of candidates for support (4% vs. 38-54%). Hospital alerts generated the most records, but only 6% led to successful contact, largely because many persons identified through that source were already enrolled in low-barrier HIV care. Pharmacy records yielded the highest number of persons successfully contacted. Conclusions: Using surveillance data alone for D2C is an inefficient way of identifying out-of-care PWH, but in combination with other data sources, D2C programs can reach more people who may benefit from support relinking to care. Since jail booking records are publicly available, incorporating jail records into D2C programs is likely to be broadly feasible. 1339 Developing Analytic Strategies to Investigate Long-Acting Injectable Antiretroviral Effectiveness Thibaut Davy-Mendez, Valerie Lucas, Joseph J. Eron, Claire Farel, Barbera Jean Turner, Angela Perhac, Sonia Napravnik, Sarah E. Rutstein University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Monitoring implementation, effectiveness, and longer term outcomes of long-acting injectable antiretroviral therapy (LAI ART) in health systems and diverse populations will be enhanced if critical data, including initiation, injection times, and discontinuation, can be reliably ascertained from electronic health records (EHR). cabotegravir/rilpivirine, their first injection date, and LAI discontinuation from clinic records. We used EHR procedure (HCPCS code J0741), lab, and encounter data to characterize the frequency of injections, viral suppression (<50 cp/mL), and clinic visits after LAI initiation. We also validated use of EHR data to identify LAI initiators, first injection date, and discontinuation against clinic records. Results: Among 1951 patients, 138 initiated LAI ART per clinic records. LAI ART initiators were 75.4% cisgender men, 64.5% non-Hispanic Black, and a median of 42 years old. At initiation, 84.8% were virally suppressed (VS) and median viral load (VL) of patients virally not-suppressed (VNS) was 16,474 cp/mL (IQR 78, 50,465). Median time from LAI prescription to injection was 26 days (IQR 16, 47). Procedure codes were 100% sensitive and 99.9% specific to identify LAI ART initiators, and 84.1% sensitive and 100% specific to correctly classify a first injection date (+/- 7 days). Outpatient prescription data alone were 92.8% sensitive and 98.1% specific to identify LAI ART initiators. In the 6 months after first injection (N=111 with sufficient follow-up), patients had a median of 4 clinic visits (IQR 3, 5). Of these 111, 96.8% of those VS at initiation remained VS, and 76.5% of those VNS at initiation became VS. Per clinic records, LAI ART was discontinued in 30 (21.7%) of all 138 initiators. A 90-day gap in injection procedure codes was 70.0% sensitive and 91.4% specific to identify persons who discontinued. Among persons with >90-days between injection procedure codes, 6.9% were VNS (median VL 2192 cp/mL) at next available assessment. Methods: Among persons receiving HIV care at a large clinic in the southeastern US from 1/2021-5/2024, we identified those initiating LAI

Poster Abstracts

1338 Comparative Yield of Data Sources for Health Department Data to Care Services Julie Dombrowski 1 , Richard Lechtenberg 2 , Jennifer E. Balkus 2 1 University of Washington, Seattle, WA, USA, 2 Public Health–Seattle & King County, Seattle, WA, USA Background: The public health impact of data to care (D2C) programs has been limited by difficulty identifying and reaching out-of-care persons with HIV (PWH) using HIV surveillance data alone but may be improved by incorporating other data sources. Methods: We compared the following sources used for D2C in King County, WA during 9/2023-9/2024: the enhanced HIV/AIDS Reporting System (eHARS, CDC surveillance database), jail booking records matched with surveillance data, hospital alerts (emergency department visits or inpatient admissions) matched

CROI 2025 446