CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: Most patients remained on LAI ART with favorable clinical outcomes, regardless of suppression at initiation. EHR data identified LAI ART initiators with high accuracy; lower accuracy in identifying initiation date could affect analyses of LAI ART exposure, presumed clinical effectiveness, and implementation outcomes, and should be considered in future studies. 1340 Prevalence of Unsuppressed Viral Load: Comparison of 2016-17 and 2022-23 Tanzania HIV Impact Surveys Abbas Ismail 1 , Damian Damian 1 , Prosper Njau 2 , Tepa Nkumbula 3 , Emilian Karugendo 4 , Fahima Issa 5 , Rebecca Laws 6 , Malewo Optatus 1 , George S. Mgomella 1 , Mahesh Swaminathan 1 , Alexander Kailembo 1 , Nicolas Schaad 1 , Sarah Porter 1 1 US Centers for Disease Control and Prevention Dar es Salaam, Dar es Salaam, Tanzania, 2 National AIDS, STIs and Hepatitis Control Program (NASHCoP), Dodoma, Tanzania, 3 ICAP at Columbia University in Tanzania, Dar es Salaam, Tanzania, 4 National Bureau for Statistics (NBS), Dodoma, Tanzania, 5 Office of Chief Government Statistician (OCGS), Zanzibar, Tanzania, 6 Centers for Disease Control and Prevention, Atlanta, GA, USA Background: Antiretroviral therapy (ART) improves clinical outcomes of people living with HIV (PLHIV) and achieving viral suppression through ART can prevent HIV transmission. We compared prevalence and correlates of unsuppressed viral load among PLHIV from two Tanzania HIV Impact Surveys (THISs). The first (survey 1 [S1]) was conducted from October 2016-August 2017; the second (survey 2 [S2]) was conducted from November 2022-March 2023. Methods: THISs were independent, cross-sectional household surveys with a stratified cluster design. Consenting participants aged ≥15 years were administered a questionnaire and tested for HIV in the household. HIV-positive specimens were tested for viral load (VL). We used chi-square tests and pooled sampling weights to assess the change in prevalence of unsuppressed VL (VL ≥1000 copies/mL) among PLHIV between surveys. Logistic regression models were used to assess factors associated with unsuppressed VL for each survey. We report results as prevalence (%) or adjusted odds ratio (aOR) with 95% confidence intervals (CI); analyses are weighted and account for complex survey design. Results: We analyzed data from 1,830 (S1) and 1,849 (S2) participants aged ≥15 years living with HIV. The proportion of PLHIV with unsuppressed VL decreased significantly from 48.1% (95%CI: 44.9-51.4%) in S1 to 22.0% (95%CI: 19.6 24.6%) in S2. Prevalence of unsuppressed VL decreased in all age and sex groups; the decrease was greatest in males aged 15-24 years (77.8% [52.9-91.6%] in S1 to 28.5% [13.0-51.4%] in S2) and smallest in females aged 15-24 years (52.9% [43.1-62.4%] in S1 to 45.5% [33.4-58.0%] in S2) (Figure). In both surveys, male sex (S1 aOR 2.1 [1.6-2.7]; S2 aOR 1.8 [1.3-2.5]) and younger age (15-24 years S1 aOR 3.2 [1.9-5.1]; S2 aOR 4.1 [2.1-8.1]) were significantly associated with increased odds of unsuppressed VL, compared to females and those aged ≥50 years, respectively. Alcohol use was associated with unsuppressed VL in S1 only (aOR 1.4 [1.1-1.9]). Education and wealth were not significantly associated with unsuppressed VL in either survey. Conclusions: Prevalence of unsuppressed VL among PLHIV decreased by over half in the 6-year period between THIS surveys, demonstrating progress towards the UNAIDS global target of 95% of PLHIV on ART are virally suppressed. Targeted approaches to address unsuppressed VL among young females (aged 15-24 years) and males (aged ≥25 years) may help achieve the third UNAIDS 95 target among all age and sex groups in Tanzania.

1341 A Comparative Analysis of Access and Retention of Oral PrEP and CAB-LA at 1 Month in Zambia Damian J. Phiri, Mwaka Musonda, Mutinta Nyumbu, Adamson P. Ndhlovu, Lackeby Kawanga, Jemmy Musangulule, Martha Mulenza John Snow, Inc, Lusaka, Zambia Background: Pre-exposure prophylaxis (PrEP) is pivotal in HIV prevention. The recent introduction of long-acting injectable PrEP, alongside oral PrEP. The USAID DISCOVER-Health project, implemented by JSI, has layered injectable PrEP onto its existing oral PrEP service delivery platform. This study examines how layering injectable PrEP onto existing oral PrEP services affects initiation and retention at one month, comparing data from periods before and after its implementation. Methods: A retrospective cohort analysis was conducted using routine data from four health facilities offering both oral and injectable PrEP in Kitwe and Chibombo district. Data from six months prior to the introduction of injectable PrEP, August 2023 to January 2024 (pre-implementation period) was compared with data from six months post-implementation, February to July 2024 (implementation period) for the same facilities. Average monthly PrEP initiation were calculated to assess changes in access, and retention at one month, measured as the proportion of individuals returning for follow-up after initiation. Independent T-tests were used to statistically compare differences in initiation and retention between the two periods. Results: During the implementation period, 2,752 individuals started PrEP (oral 1,639 and injectable 1,113), with a one-month retention rate of 86.0% (oral 81% and injectable 96%). In contrast, during the pre-implementation period, 2,191 individuals started oral PrEP, with a one-month retention rate of 65.4%. During the implementation period, monthly PrEP initiations (mean=458.7, SD=448.6) were higher compared to the pre-implementation period (mean=365.2, SD=161.1), though this difference was not statistically significant (t=0.48, p=0.64). Retention at one month was also higher in the implementation period (mean=0.818, SD=0.078) than in the pre-implementation period (mean=0.691, SD=0.182), the difference was statistically significant (t=2.57, p<0.05). Conclusions: Layering injectable PrEP significantly improved one-month retention rates compared to oral PrEP alone, with retention being highest among those on injectable PrEP. While the number of PrEP initiations increased during the implementation period, this difference was not statistically significant but a very important change in PrEP scale up. These findings suggest that injectable PrEP can enhance adherence and retention, especially in the early stages of use. 1342 Patterns of PrEP Use Among Rural South Africa Youth Given Choice: Process Data From the LAPIS Trial Maryam Shahmanesh 1 , Jacob Busang 2 , Thembelihle Zuma 2 , Carina Herbst 2 , Nonhlanhla Okesola 2 , Natsayi Chimbindi 2 , Nqobile Ngoma 2 , Jaco Dreyer 2 , Theresa Smith 2 , Lucky Mtolo 2 , Willem Hanekom 2 , Limakatso Lebina 2 , Janet Seeley 3 , Andrew Copas 1 , Kathy Baisley 2 , for the LAPIS Study Group 1 University College London, London, UK, 2 Africa Health Research Institute, Mtubatuba, South Africa, 3 London School of Hygiene & Tropical Medicine, London, UK Background: In southern Africa the provision of pre-exposure prophylaxis (PrEP) has not translated into population-level impact due to the challenges of taking a daily oral pill. Injectable PrEP provides an opportunity to overcome this barrier. Using clinical process data from the Long-Acting PrEP Integrated with Sexual and Reproductive Health (LAPIS) trial, we explore changes in patterns of PrEP use amongst adolescents and young adults (AYA) following introduction of choice in a high HIV burden setting in rural KwaZulu-Natal (KZN), South Africa. Methods: We nested LAPIS (NCT066250504) a cluster randomized controlled trial of offering a choice of oral PrEP, two monthly (long-acting) injectable cabotegravir, dapivirine vaginal ring or packs of 28 days of post-exposure prophylaxis (PEP) within a larger trial testing the population impact of community-based delivery of PrEP through sexual reproductive health (SRH) services in rural KZN (NCT05405582). PrEP is offered alongside SRH and testing for sexually transmitted infections, including GeneXpert testing on self-taken samples for gonorrhoea and chlamydia to AYA aged 15-30 years. Here we describe the pattern of PrEP use before and after the introduction of PrEP/PEP choice. Uptake is defined as proportion of participants eligible and offered who initiate PrEP/PEP. Results: Prior to the introduction of choice (June 2022-May 2024), 3150 AYA attended the mobile SRH clinics. Among 1586 eligible/offered oral PrEP, 1015

Poster Abstracts

CROI 2025 447