CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1362 Disposition of Referrals for Long-Acting Antiretrovirals at the Ward 86 HIV Clinic in San Francisco Chesa Cox 1 , Francis Mayorga-Munoz 1 , Anthonia Chimezie 1 , Janet Grochowski 1 , Diana Gleyzer 2 , Matt Hickey 1 , Katerina Christopoulos 1 , Mary Shiels 1 , Jon Oskarsson 1 , Monica Gandhi 1 1 University of California San Francisco, San Francisco, CA, USA, 2 Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA Background: Ward 86, a safety-net HIV clinic in San Francisco for ~2,600 publicly insured patients, has been using long-acting antiretroviral therapy (LA ART) for people living with HIV (PWH) with adherence challenges to oral ART. Since the approval of cabotegravir/rilpivirine (CAB/RPV) in 2021 and lenacapavir (LEN) in 2022, PWH have been referred to the Special Program on Long-Acting Antiretrovirals to Stop HIV (SPLASH) through a centralized, pharmacist-led process, regardless of viral suppression status. This retrospective study evaluates the disposition of referrals to Ward 86’s LA ART program over its first 3.5 years to guide future implementations. Methods: Disposition (started, did not start, discontinued, etc.) and demographic data for PWH referred to the SPLASH program from January 2021 to August 2024 were extracted from electronic medical records and verified by clinician review. Results: Of 699 PWH referred, 390 started LA ART (55.8%). The median referral age was 45; 81.6% identified as cisgender male, 69.0% non-Hispanic, 38.2% White, 34.2% unstably housed, and 41.9% reporting substance use. Among those that started LA ART, 74.1% (289/390) remained in the SPLASH program while 6.2% (24/390) continued LA ART after transferring clinics. Most participants are on CAB/RPV (89.6%), with smaller proportions on LEN+CAB (5.2%), LEN+CAB/RPV (4.8%), and LEN alone (0.3%). Seventy-seven (77/390, 19.7%) PWH stopped LA ART due to death (20), loss to follow-up (16), and switching to oral ART (41), with 4.9% (19/390) experiencing adverse effects on LA ART. Of the 308 (44.1%) PWH who did not start LA ART, 13 were found ineligible, and 7 were lost to follow-up or deceased, while 288 are awaiting clinical review (68), have yet to complete initial injection appointment (83), or are on hold due to various barriers, such as difficulty with patient engagement, lack of access, or fear of side effects (137) (Figure). Conclusions: Approximately 25% of PWH at Ward 86 have been referred to the SPLASH program, indicating increasing acceptance of LA ART among PWH and their providers. Despite this, a significant portion of referrals (290/699, 41.5%) remain on hold due to various system and patient -level factors. In a clinic of publicly insured PWH with several barriers to oral ART adherence, comfort with LA ART is increasing among patients and clinicians, further demonstrating that LA ART is effective among a diverse population of PWH struggling with daily adherence.

1363 Impact of 6-Monthly ART Dispensing on Retention in Malawi: A Target Trial Emulation Study Khumbo Shumba 1 , Idah Mokhele 1 , Elizabeth Kachingwe 1 , Lise Jamieson 2 , Matthew P. Fox 3 , Sydney Rosen 3 , Timothy Tchereni 4 , Wyness Phiri 4 , Stanley Ngoma 5 , Rose Nyirenda 5 , Sophie J. S. Pascoe 1 , Amy Huber 1 1 Health Economics and Epidemiology Research Office, Johannesburg, South Africa, 2 University of the Witwatersrand, Johannesburg, South Africa, 3 Boston University, Boston, MA, USA, 4 Clinton Health Access Initiative - Malawi, Lilongwe, Malawi, 5 Government of Malawi Ministry of Health, Lilongwe, Malawi Background: Malawi implemented 6-multi-month dispensing (6MMD) of antiretroviral therapy (ART) for clinically stable clients on HIV treatment during 2019 and scaled-up implementation in 2020. We compared retention for clients who received 6MMD to those who did not receive 6MMD and assessed predictors of retention. Methods: We applied a target trial emulation (TTE) approach using routine clinical data from Malawi's Electronic Medical Record (EMR) system to identify ART clients eligible for 6MMD in 27 districts from 01/2020-12/2021. Eligible participants were non-pregnant adults ≥18 and on ART for ≥6 months with no prior 6MMD exposure. We created four six-month trials, defining eligibility at the start of each period and classifying participants as either receiving 6MMD or non-6MMD (dispensing duration of 1-3 months). We defined the follow-up start date as the 6MMD enrollment date for the 6MMD arm and the first visit in the trial enrollment period for the non-6MMD arm. Retention at 12 and 24 months were defined as having a clinic visit within 12-24 (Trial 1-4) and 24-36 (Trial 1-2) months. Using an intention-to-treat approach, we estimated risk differences (RD) with 95% confidence intervals (CI) using a Poisson regression model with an identity link function and robust standard errors. Pooled RD were estimated by accounting for within-subject variation in a Poisson regression model using data from all trials. Results: Of the 287,933 unique individuals eligible for this study (57% female, median age 41), 73% (212,722) were enrolled in 6MMD. Retention at 12 months (Trials 1-4) and 24 months (Trials 1-2) were consistently higher in the 6MMD group than in the non-6MMD group. The pooled risk difference (RD) for retention between the 6MMD and non-6MMD groups was 4.6% (95% CI: 4.4-4.8) at 12 months (Figure 1) and 4.7% (95% CI: 4.4-5.0) at 24 months. Across all trials, retention was higher for females; those aged 25years and older; those with mild HIV disease (WHO Stage 1/2 at ART initiation), those receiving care at primary health care clinics, and those on ART longer at trial start. Conclusions: We observed slightly higher retention in care rates in Malawi at 12 and 24 months among clients on 6MMD compared to those receiving shorter medication dispensing intervals. Future work to assess the impact of 6MMD on visit burden and resource use would offer a comprehensive view of the benefits to both ART clients and the health system.

Poster Abstracts

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