CROI 2025 Abstract eBook

Abstract eBook

Oral Abstracts

184

Most With HIV Viremia Are Not in Care Despite High ART Coverage: A Population-Based Study in Uganda Silas Odiya 1 , Michelle Moffa 2 , Grace Kigozi 1 , Gertrude Nakigozi 1 , Joseph G. Rosen 3 , Larry W. Chang 2 , Caitlin E. Kennedy 4 , Anthony Ndyanabo 1 , Nakawooya Hadijja 1 , Thomas C. Quinn 5 , Godfrey Kigozi 1 , Ronald Galiwango 1 , Steven J. Reynolds 6 , Joseph Kagaayi 1 , M. Kate Grabowski 4 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 3 Brown University, Providence, RI, USA, 4 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5 The Johns Hopkins University, Baltimore, MD, USA, 6 National Institute of Allergy and Infectious Diseases, Baltimore, MD, USA Background: As ART coverage expands in Africa, a greater proportion of persons remaining with viremia are predicted to be HIV serostatus aware and treatment-experienced, potentially reducing the need for population surveillance and community outreach. However, population-level data on the care status of persons with viremia remains limited in African settings achieving “95-95-95” treatment targets. Methods: The Rakai Community Cohort Study (2021–23), a population-based study in Uganda, was leveraged to assess the care status of persons with viremia (>1000 copies/ml) in an African epidemic achieving “95-95-95”. Residents aged 15-49 self-reported HIV testing, diagnosis, and ART use history. Among those HIV seropositive, viral load testing was conducted. Participants with viremia were initially classified as: 1) newly diagnosed; 2) previously diagnosed but never treated; 3) treatment-experienced but not in care; or 4) treatment experienced and in care. Those with viremia received their viral load results, underwent counselling and were asked to reconfirm their HIV testing history, ART use, and care location. Clinical records were also abstracted. Based on updated self-reports, clinical records, and plasma ARV drug screening, participants were reclassified. ART initiation for newly diagnosed and untreated individuals was tracked ~3 months post-survey. Results: Of 17,841 participants, 3,170 (17.8%) were HIV seropositive. Among 3,134 persons with viral load results, 316 (10.1%; 95%CI: 9.1-10.1) exhibited viremia. As shown in the Figure, the care status of 102 (32.3%) persons was eventually reclassified, including 55% of those who self-reported being in care. Men were 1.67 times (95%CI: 1.18-2.55) more likely to misreport their care status than women. Among those previously in care, the median time from last clinic visit was 2.79 years [IQR: 1.80-4.61]. Overall, 82.9% (n=262; 95%CI: 78.2-86.8%) of persons with viremia were not actively in care at time of survey, and 64.6% (n=204; 95%CI:59.0-69.8%) were ART naïve. Only 55% (n=75/135) of newly diagnosed individuals and 39.1% (n=27/69) of naïve persons initiated ART by follow-up. Conclusions: In this setting with high population HIV suppression, >80% of individuals with viremia were not in care, with frequent misreporting of care status. Ongoing population surveillance and novel outreach strategies are essential to understand and engage underserved populations with viremia and achieve epidemic control in evolving African epidemics.

185

Low-Cost Counseling Achieves Positive Outcomes for Malawi Men Disengaged From Care: Randomized Trial Kathryn L. Dovel 1 , Kelvin Balakasi 2 , Isabella Robson 3 , Bruce Larson 4 , Chi-Hong Tseng 1 , Khumbo Phiri 2 , Sam Phiri 5 , Stanley Ngoma 6 , Khumbo Namachapa 6 , Morna Cornell 7 , Thomas Coates 1 , Augustine T. Choko 8 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Partners in Hope, Lilongwe, Malawi, 3 University of California Los Angeles Medical Center, Los Angeles, CA, USA, 4 Boston University, Boston, MA, USA, 5 Lighthouse Trust, Lilongwe, Malawi, 6 Government of Malawi Ministry of Health, Lilongwe, Malawi, 7 Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa, 8 Malawi Liverpool Wellcome Trust, Blantyre, Malawi Background: Men's suboptimal HIV treatment outcomes hinder epidemic control efforts and jeopardize men's health. Interventions tailored to men’s unique needs are essential, although rarely tested. We tested the effect of person-centered care interventions on ART engagement among men living with HIV but not in care in Malawi. Methods: We conducted an individually randomized control trial at 13 health facilities (IDEaL Study, NCT05137210). Adult (15y+) men living with HIV but never not in care were randomized (1:1:1) to: 1) male-specific counseling (MC) delivered in communities by male lay-cadre; 2) MC Arm + home-based ART initiation by trained nurses (HB); and 3) stepped intervention (Stepped) that increased in intensity overtime until ART initiation was achieved (chronological steps were MC Arm -> ongoing psychosocial support from high-level mental health professionals -> HB Arm). Primary outcome was composite: ART initiation <90days after trial enrollment and 6month retention in HIV care (i.e., <28days out of care at 6months). Secondary outcomes were cost effectiveness and days with ART coverage. Outcomes were measured via medical records and community tracing. At endline clients whose facility medical records showed they did not initiate ART within 90 days or were >28days out of care 6months after initiation were traced and personal records ascertained. Intention-to-treat analyses were conducted. We compared the lowest cost arm (MC) against the highest cost (HB) and Stepped arms. Results: Of 743 men screened, 569 (77%) were enrolled between Sept 2021-May 2023. Arms were balanced. Overall mean age was 39y (SD:12), 393/569 (69%) were married, and only 49/569 (9%) were ART naïve. Outcome ascertainment did not differ by arm. Primary outcome (initiation and 6month retention) was met by 147/193 (76%) in MC, 132/183 (71%) in HB, and 154/181 (84%) in Stepped arms (Table1) – no difference by arm. MC arm was more cost effective compared to both the HB and the Stepped arms. ART initiation was high across arms 514/557 (92%). MC performed slightly better than HB for retention: 6month retention after initiation (aRR:0.90; CI 95%:0.81,0.98) and optimal days covered with ART (aRR:0.88; CI 95%:0.78,0.99) were significantly worse in HB vs MC arms. Conclusions: Male-specific interventions can achieve positive ART engagement outcomes. Men's counseling provided by lay-cadres performed similar to more costly approaches, offering feasible solutions for men's HIV care at scale.

Oral Abstracts

50

CROI 2025