CROI 2025 Abstract eBook

Abstract eBook

Oral Abstracts

190

SEARCH Integrated HIV/Hypertension Community Health Worker-Led Intervention in Rural East Africa Matt Hickey 1 , Asiphas Owaraganise 2 , Sabina Ogachi 3 , Colette Aoko 4 , Jane Kabami 5 , Elijah Kakande 5 , Wafula E. Mugoma 3 , Nicole Sutter 1 , Gabriel Chamie 1 , Maya Petersen 6 , Laura Balzer 6 , Diane V. Havlir 1 , Moses Kamya 7 , James Ayieko 4 1 University of California San Francisco, San Francisco, CA, USA, 2 Infectious Disease Research Collaboration, Kampala, Uganda, 3 KEMRI Kenya, Nairobi, Kenya, 4 Kenya Medical Research Institute, Kilifi, Kenya, 5 Infectious Diseases Research Collaboration, Kampala, Uganda, 6 University of California Berkeley, Berkeley, CA, USA, 7 Makerere University College of Health Sciences, Kampala, Uganda Background: Clinic-based hypertension screening and treatment for people with and without HIV depends on consistent clinic engagement. Retention is challenging in rural areas, especially for people with severe hypertension which typically requires more frequent visits than stable HIV. We hypothesized that Ministry of Health (MoH) community health workers (CHWs) could be leveraged to improve hypertension outcomes through an integrated hypertension/HIV intervention. Methods: In rural Uganda and Kenya, we added HIV testing and a status-neutral hypertension intervention to CHW workflow in an ongoing cluster-randomized population-level study (SEARCH:NCT05768763). Trained CHWs screened all adults aged ≥40 years in intervention communities for hypertension, referring those with blood pressure (BP) ≥140/90mmHg to MoH HIV/primary care clinics. After initial in-clinic evaluation, adults with BP ≥160/100mmHg were offered choice of clinic-based or telehealth (CHW home visit, clinician telehealth evaluation, medication delivery) follow-up care. Telehealth used a MoH-compatible CHW smartphone app that syncs with electronic clinic records, prompts CHW follow-up visits, and facilitates clinician telehealth assessment/medication prescribing. We report i) hypertension control achieved through implementation of CHW-supported screening and telehealth and ii) resulting change in population prevalence of uncontrolled hypertension from baseline to 1 year. Results: Across eight communities, 198 CHWs measured BP in 13,760/15,121 (91%) adults aged ≥40 yrs at baseline and 13,349/15,121 (89%) after 1 year; 55% were female and 19% living with HIV. Population prevalence of BP ≥140/90mmHg decreased from 17% at baseline to 7% at year 1 (p<0.001) and prevalence of BP ≥160/100mmHg decreased from 7% to 2% (p<0.001). Among people with HIV aged ≥40 yrs (n=2,643), prevalence of BP ≥140/90mmHg decreased from 11% to 4% (p<0.001) and prevalence of BP ≥160/100mmHg decreased from 4% to 1% (p<0.001). In the subset with BP ≥160/100 who enrolled in the telehealth intervention (n=958), 96% received hypertension medication, 94% had ≥1 follow-up visit, 81% were retained in care at 1 year, and 79% achieved BP control; people with HIV (n=111) had similar retention (84%) and BP control (82%). Conclusions: Leveraging existing community health workers in an integrated HIV/hypertension model reduced population-level prevalence of uncontrolled hypertension by 59% among people with and without HIV, extending health services into the community at scale. Long-Acting Cabotegravir PrEP Uptake and Persistence in a Large US Healthcare System Michael Traeger 1 , Wendy Leyden 2 , Jonathan Volk 3 , Michael Silverberg 2 , Michael Horberg 4 , Teaniese Davis 5 , Kenneth Mayer 6 , Douglas Krakower 1 , Jessica Young 7 , Samuel Jenness 8 , Julia Marcus 1 1 Harvard Pilgrim Health Care Institute, Boston, MA, USA, 2 Kaiser Permanente Northern California, Oakland, CA, USA, 3 Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 Kaiser Permanente Georgia, Atlanta, GA, USA, 6 The Fenway Institute, Boston, MA, USA, 7 Harvard Medical School, Boston, MA, USA, 8 Rollins School of Public Health, Atlanta, GA, USA Background: Long-acting cabotegravir (CAB-LA) was approved as HIV preexposure prophylaxis (PrEP) in the U.S. in December 2021, but data are limited on use in clinical practice. We evaluated CAB-LA uptake and persistence in an integrated healthcare system and compared early CAB-LA adopters to individuals dispensed oral PrEP only. Methods: We extracted electronic health records of adults receiving PrEP during December 2021-June 2024 in Kaiser Permanente Northern California. We compared characteristics of CAB-LA users and oral-PrEP-only users using chi-square tests. Among CAB-LA users still enrolled in the health plan at 28 and 60 weeks after initiation, we evaluated CAB-LA persistence, defined as the proportion with an injection within 10 weeks prior to each time point. We also assessed time to bimonthly CAB-LA injections after the lead-in injections (weeks 0 and 4) and HIV incidence following CAB-LA initiation.

at 12-months after return. Overall, PCCi increased the proportion of individuals in care 12-months after a TI from 51.5% to 60.1% (RD +8.7% [CI 8.2–9.1%]). Conclusions: PCCi improved rates of return to care after TIs, sustained reengagement after return, and overall retention among individuals with TIs. Strategies targeting caring aspects of HCW behavior and client experience may help lower barriers to and address persistent challenges with reengagement in care. Systems Analysis and Improvement Approach to Optimize Hypertension Care for People Living With HIV Onei A. C. Uetela 1 , Ana Olga Mocumbi 2 , Kristjana Asbjornsdottir 1 , Orvalho Augusto 1 , Amanda Brumwell 1 , Amido Charama 3 , Maxinel Chidacua 3 , Joana Coutinho 3 , Ruth Etzioni 4 , Akash Malhotra 1 , Kenneth Sherr 1 , Sarah Gimbel 1 1 University of Washington, Seattle, WA, USA, 2 Instituto Nacional de Saúde, Maputo, Mozambique, 3 Comité para a Saúde de Moçambique, Maputo, Mozambique, 4 Fred Hutchinson Cancer Center, Seattle, WA, USA Background: High blood pressure (≥90mmHg/140mmHg) is associated with ~35% of sub-Saharan Africa deaths. In Mozambique, 3% of hypertensive adults achieve controlled blood pressure (BP). Systems engineering strategies applied at the health facility level, like the Systems Analysis and Improvement Approach (SAIA), have been shown effective in improving quality and continuity of health service delivery in resource-constrained settings. We present results of a trial designed to assess SAIA’s application to optimize hypertension (HTN) care quality and continuity for HIV-infected individuals in Mozambique. Methods: A hybrid type III cluster randomized controlled trial compared HTN outcomes between intervention and control facilities (n=16), where intervention sites implemented SAIA – a bundled, clinic-led strategy of cascade analysis, process mapping, and monthly continuous quality improvement cycles to identify, prioritize and iteratively test context-appropriate, low-cost solutions. Control sites delivered care as usual. All clinics received BP machines, batteries and educational tools reflecting national norms and used patient-level forms to report HTN care. A three-month baseline period (07-09/2020) preceded a 24-month intensive phase of the trial and a 12-month sustainment phase without study team support. Generalized Estimating Equations assuming an exchangeable correlation structure and a log-binomial regression model in R statistical package estimated the risk ratio of controlled BP between study arms, adjusting for study phase and whether clients were newly recruited or retained from a previous phase. Results: The study included 65,625 unique clients (53% in intervention sites). HTN Screening rose from 34% at baseline to ~100% in intensive and sustainment phases in both arms. In intervention sites 74% (vs. 68 in control) HTN clients received a prescription, 81% (vs. 77%) accessed the prescribed medication and 21% (vs. 6%) attained controlled BP. The risk ratio of controlled BP was 1.88 (95% CI: 1,75 – 2.02) intervention:control sites, and was higher in intensive (2.7, 95% CI: 1.9 – 4.1) and sustainment (3.41, 95% CI: 2.38 – 5.16) phases, compared to baseline. Retained clients experienced 29% (95% CI: 1.18 – 1.42) higher risk of controlled HTN compared to newly recruited. Conclusions: The SAIA-HTN strategy improved performance of integrated HIV-HTN services, resulting in a significant and sustained increase in controlled BP among PLHIV with HTN.

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Oral Abstracts

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CROI 2025