Unsuppressed viral load after intensive adherence counselling in rural eastern Uganda; a case of Kamuli district, Uganda

Abstract Background The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district. Methods We reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January – December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established independently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical significance level using STATA version 15. Results We reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The majority of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC. Conclusion Despite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC.

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1318. Examining Multimorbidity as a Moderating Effect on the Relationship Between Substance Use and Viral Suppression Among People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1181 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S476-S476

Author(s):

Timothy N Crawford ◽

Alice Thornton

Keyword(s):

Substance Use ◽

Viral Load ◽

Chronic Conditions ◽

Viral Suppression ◽

Moderating Effect ◽

Multiple Chronic Conditions ◽

People Living With Hiv ◽

Substance Users ◽

Living With Hiv ◽

The Relationship

Abstract Background Substance use and multimorbidity (≥2 chronic conditions) are highly prevalent among people living with HIV (PLWH). However, their impact on achieving viral suppression are not well understood. The purpose of this study was to examine the relationship between substance use and viral suppression and the potential moderating effect of multimorbidity. Methods A retrospective cohort study was conducted at an academic Ryan White Funded clinic in central Kentucky. Individuals were included if they were diagnosed with HIV, seeking care between 2010 and 2014, had at least one year of follow-up, and did not have a chronic condition at the time they entered care. The primary independent variable was substance use which included alcohol, nicotine use, and/or illicit drug use; the moderating variable was multimorbidity (0, 1, ≥2 chronic conditions); and outcome was viral suppression (≤50 copies/mL). A logistic regression model was developed to examine the interaction between substance use and multimorbidity on achieving viral load suppression. The model controlled for medication adherence, insurance status, age, and CD4+ cell counts. Results A total of 941 individuals were included in the study, with an average age of 43.9 ± 11.7 years. Approximately 67.0% reported substance use; 54% had ≥2 chronic conditions diagnosed. The three most prevalent conditions diagnosed were hypertension (34.6%), mental health (33.9%), and diabetes (21.5%) Approximately 61.0% of substance users had ≥2 conditions. Those with viral suppression were less likely to be substance users, but were more likely to have ≥2 conditions compared with their counterparts. There was a significant interaction between substance use and multimorbidity (P = 0.037). Stratified by multimorbidity, substance use was associated with unsuppressed viral loads; among those with ≥2 chronic conditions substance users had lower odds of achieving viral suppression compared with nonusers (OR=0.24; 95% CI=0.10–0.55). Conclusion Substance use may impede the opportunity for PLWH to achieve viral suppression, increasing their risk of transmission and progression of disease. More research is needed to understand the role substance use plays in impacting viral load, specifically among those with multiple chronic conditions. Disclosures All authors: No reported disclosures.

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Vulnerability of the Brazilian LGBT population in HIV treatment

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13707 ◽

2021 ◽

Vol 15 (10) ◽

pp. 1481-1488

Author(s):

Thaisa Fernanda Lourenção Tauyr ◽

Luciano Garcia Lourenção ◽

Maria Amélia Zanon Ponce ◽

Francisco Rosemiro Guimarães Ximenes Neto ◽

Maria de Lourdes Sperli Geraldes Santos ◽

...

Keyword(s):

High School ◽

Viral Load ◽

Hiv Transmission ◽

Sexual Transmission ◽

Undetectable Viral Load ◽

Cross Sectional Study ◽

Hiv Treatment ◽

People Living With Hiv ◽

Cross Sectional ◽

Lgbt People

Introduction: Human immunodeficiency virus (HIV) infection affects the lesbian, gay, bisexual, transvestite, and transsexual (LGBT) population. We aimed to identify the indidual vulnerability profile of the LGBT population ling with H/acquired immunodeficiency syndrome (AIDS) and correlate it with the treatment situation. Methodology: This cross-sectional study included 510 LGBT people living with HIV (PLHIV)/AIDS who attended the Complex of Chronic Communicable Diseases of the municipality of São José do Rio Preto, São Paulo, Brazil, between 2008 and 2015. Results: There was a predominance of indiduals who were white (70.2%), male (98.4%), single (87.1%), aged 25–44 years (70.0%), educated up to high school (47.7%), economically acte (91.2%), under treatment (80.8%), having CD4 > 350 cells/mm3 (77.1%), and having undetectable viral load (53.3%). HIV transmission was mainly sexual (97.0%) and most people used drugs (76.5%). There was a weak correlation between the variables ‘in treatment’ and acte occupation (r = 0.148, p = 0.001), single marital status (r = 0.128, p = 0.004), white race/colour (r = 0.117, p = 0.008), high school education (r = 0.111, p = 0.012), sexual transmission (r = 0.222, p = 0.000), drug use (r = 0.087, p = 0.049), and CD4 > 350 cells/mm3 (r = 0.118, p = 0.008); and strong correlation between the variables ‘in treatment’ and undetectable viral load (r = -0.937, p = 0.113). Conclusions: The characteristics of the indidual vulnerability of LGBT people involve, among other aspects, issues of gender and social exclusion, a situation that is part of the daily life of PLHIV/AIDS in many scenarios and territories. This can be alleviated with a network of social and health support and effecte and efficient, protecte, attitudinal, and behavioural public policies.

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Gaps in the continuum of care among people living with HIV in Afghanistan

International Journal of STD & AIDS ◽

10.1177/09564624211055299 ◽

2021 ◽

pp. 095646242110552

Author(s):

Mohammad Zubair Harooni ◽

Abdul Alim Atarud ◽

Ehsanullah Ehsan ◽

Ajmal Alokozai ◽

Willi McFarland ◽

...

Keyword(s):

Viral Load ◽

Viral Suppression ◽

Demographic Data ◽

Load Test ◽

P Value ◽

People Living With Hiv ◽

Aged Patients ◽

Art Initiation ◽

Viral Load Test ◽

Living With Hiv

Background Afghanistan adopted a “test and treat” strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. Methods We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. Results Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35–44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. Conclusion Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.

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Point-of-care viral load testing among adolescents and youth living with HIV in Haiti: a protocol for a randomised trial to evaluate implementation and effect

BMJ Open ◽

10.1136/bmjopen-2019-036147 ◽

2020 ◽

Vol 10 (8) ◽

pp. e036147

Author(s):

Lindsey K Reif ◽

Marie Elmase Belizaire ◽

Grace Seo ◽

Vanessa Rouzier ◽

Patrice Severe ◽

...

Keyword(s):

Viral Load ◽

Viral Suppression ◽

Point Of Care ◽

Randomised Trial ◽

Art Adherence ◽

Test Results ◽

Standard Laboratory ◽

Adherence Counselling ◽

Youth Living With Hiv ◽

Living With Hiv

IntroductionAdolescents living with HIV have poor antiretroviral therapy (ART) adherence and viral suppression outcomes. Viral load (VL) monitoring could reinforce adherence but standard VL testing requires strong laboratory capacity often only available in large central laboratories. Thus, coordinated transport of samples and results between the clinic and laboratory is required, presenting opportunities for delayed or misplaced results. Newly available point-of-care (POC) VL testing systems return test results the same day and could simplify VL monitoring so that adolescents receive test results faster which could strengthen adherence counselling and improve ART adherence and viral suppression.Methods and analysisThis non-blinded randomised clinical trial is designed to evaluate the implementation and effectiveness of POC VL testing compared with standard laboratory-based VL testing among adolescents and youth living with HIV in Haiti. A total of 150 participants ages 10–24 who have been on ART for >6 months are randomised 1:1 to intervention or standard arms. Intervention arm participants receive a POC VL test (Cepheid Xpert HIV-1 Viral Load system) with same-day result and immediate ART adherence counselling. Standard care participants receive a laboratory-based VL test (Abbott m2000sp/m2000rt) with the result available 1 month later, at which time they receive ART adherence counselling. VL testing is repeated 6 months later for both arms. The primary objective is to describe the implementation of POC VL testing compared with standard laboratory-based VL testing. The secondary objective is to evaluate the effect of POC VL testing on VL suppression at 6 months and participant comprehension of the correlation between VL and ART adherence.Ethics and disseminationThis study is approved by GHESKIO, Weill Cornell Medicine and Columbia University ethics committees. This trial will provide critical data to understand if and how POC VL testing may impact adolescent ART adherence and viral suppression. If effective, POC VL testing could routinely supplement standard laboratory-based VL testing among high-risk populations living with HIV.Trial registration numberNCT03288246.

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883. Evidence from a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans Results in Viral Suppression

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.042 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S19-S20

Author(s):

Kathleen A McManus ◽

Bianca B Christensen ◽

V P Nagraj ◽

Elizabeth T Rogawski McQuade ◽

Renae Furl ◽

...

Keyword(s):

South Carolina ◽

Viral Load ◽

Affordable Care Act ◽

Low Income ◽

Viral Suppression ◽

Healthcare Delivery ◽

Hiv Care ◽

People Living With Hiv ◽

Health Plans ◽

Assistance Program

Abstract Background In individual states, the Patient Protection and Affordable Care Act has been associated with improved viral suppression (VS) rates for AIDS Drug Assistance Program (ADAP) clients or low-income people living with HIV (PLWH). This study aims to assess whether this association is consistent in multiple states (Nebraska, South Carolina, Virginia). Methods The multistate cohort included ADAP clients who were eligible for ADAP-funded Qualified Health Plans (QHPs). Data were collected from 2014 through 2015. A log-binomial model was used to estimate the association of demographics (age, race/ethnicity, sex, AIDS, rurality, HIV risk factor, previous VS) and healthcare delivery factors (income, previous ADAP plan, previous HIV care engagement) with QHP enrollment prevalence and 1-year risk of VS. Results For the cohort (n = 7,800; 5% NE, 36% SC, 59% VA), 52% enrolled in ADAP-funded QHPs with enrollment ranging from 35% to 63% by state. Enrollment in ADAP-funded QHPs in 2015 was higher for those who had ADAP-funded QHPs in 2014 (adjusted prevalence ratio [aPR] 3.28; 95% confidence interval [CI] 3.21–3.35) and those who were engaged in care in 2014 (aPR 1.16; 95% CI 1.05–1.27), and it was lower for those with a rural residence (aPR 0.91; 95% CI 0.81–1.00). Of those who were consistently engaged in care (n = 4,597), as defined by one viral load in 2014 and one viral load in 2015 separated by at least 180 days, those who received medications from Direct ADAP had a VS rate of 80.2% and those with ADAP-funded QHPs had a VS rate of 86.0%. The number needed to enroll in ADAP-funded QHPs for an additional PLWH to achieve VS is 18. Those who achieved VS in 2014 (adjusted risk ratio [aRR] 1.39, 95% CI 1.30–1.48) and those who enrolled in QHPs in 2015 (aRR 1.06, 95% CI 0.99–1.13) were more likely to achieve/maintain VS. Conclusion Additional efforts should be made to reach rural PLWH for QHP enrollment. State ADAPs, especially those in the South and those in states without Medicaid expansion, should consider investing in purchasing QHPs for PLWH because increased enrollment could improve VS rates. This evidence-based intervention could be a part of “Ending the HIV Epidemic.” Once ADAP clients are enrolled in ADAP-funded QHPs, they stay enrolled, and QHP enrollment is associated with VS across states and demographic groups. Disclosures All Authors: No reported Disclosures.

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Virological failure among HIV infected individuals on antiretroviral therapy in Pune, India: a cross-sectional study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20212866 ◽

2021 ◽

Vol 8 (8) ◽

pp. 1193

Author(s):

Pallavi Shidhaye ◽

Nilima Lokhande ◽

Smita Kulkarni ◽

Shraddha Gurav ◽

Pramod Deoraj ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Virological Failure ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Load Testing ◽

First Line ◽

Cross Sectional ◽

Art Initiation ◽

Adherence Counselling

Background: It is important to identify and manage determinants of virological failure among HIV infected individuals on treatment for achieving viral suppression. This study aimed to identify proportion and factors associated with virological failure among HIV infected individuals receiving first line antiretroviral therapy (ART).Methods: A total of 2670 adult HIV infected individuals attending ART centre at ICMR-National AIDS Research Institute, between January 2005 and June 2019 and having their recent viral load done after implementation of guidelines on routine viral load testing were included. Data were reviewed and analysed.Results: Of the 2670 people living with HIV (PLHIV) on first line antiretroviral therapy, 48% were male and 69% were more than 40 years of age. Mean baseline CD4 count at ART initiation was 252 cells/mm3 (SD:210, IQR 116-313) Overall, 13% (340/2670) of the participants showed virological failure. In multivariate analyses, participants with younger age and males retained significant association. Those with baseline CD4 counts of less than or equal to 500 cells/mm3 at treatment initiation (adjusted OR 1.71; 95% CI 1.08-2.70; p=0.022) and ART adherence ≤95% within last three months of recent viral load determination (adjusted OR 1.55, 95% CI of AOR 1.04-2.32; p=0.031) had higher risk for virological failure as compared to others. PLHIV with ART substitution due to various reasons were almost twice as likely to have virological failure (adjusted OR 1.83, 95% CI 1.44-2.33; p<0.001).Conclusions: It is crucial to focus on factors leading to virological failure among HIV infected individuals attending ART centre. Early linkage to treatment and ART initiation along with adherence counselling at every follow up visit play an important role in mitigating virological failure.

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Viral Load Monitoring for People Living with HIV in the Era of Test and Treat: Progress Made and Challenges Ahead – A Systematic Review

10.21203/rs.3.rs-1091142/v1 ◽

2021 ◽

Author(s):

Minh D. Pham ◽

Huy V. Nguyen ◽

David Anderson ◽

Suzanne Crowe ◽

Stanley Luchters

Keyword(s):

Systematic Review ◽

Viral Load ◽

Viral Suppression ◽

Search Strategy ◽

People Living With Hiv ◽

Community Based ◽

Viral Load Monitoring ◽

Load Monitoring ◽

Living With Hiv

Abstract Background Treatment of HIV with antiretroviral therapy (ART) can improve the health of people living with HIV (PLHIV), stop onward transmission of HIV and effectively prevent the spread of the virus. In 2016, we conducted a systematic review to assess the feasibility of treatment monitoring for PLHIV on ART in low and middle-income countries (LMICs), in line with the 90-90-90 treatment target. By 2020, global estimates suggest the 90-90-90 target remains unattainable in many LMICs. This study aims to review the progress and identify needs for public health interventions to improve viral load monitoring and viral suppression for PLHIV in LMICs. Methods A literature search was conducted using an update of the initial search strategy developed for the 2016 review with key search terms relevant to HIV treatment and care, decentralization and viral load monitoring. Electronic databases (Medline and PubMed) were searched to identify relevant literature published in English between Dec 2015 and August 2021. The primary outcome was initial viral load (VL) monitoring (the proportion of PLHIV on ART and eligible for VL monitoring who received a VL test). Secondary outcomes included follow-up VL monitoring (the proportion of PLHIV who received a follow-up VL after an initial elevated VL test), confirmation of treatment failure (the proportion of PLHIV who had two consecutive elevated VL results) and switching treatment regimen rates (the proportion of PLHIV who switched treatment regimen after confirmation of treatment failure). Results The search strategy identified 1984 non-duplicate records, of which 34 studies were included in the review. More than 85% (29/34) of included studies were conducted in 11 sub-Saharan African countries (SSA) using routinely collected program data; two studies were conducted among key populations (KPs) attending research clinics. Sixty per cent (20/34) of these studies were designed to evaluate VL monitoring and/or VL cascade among PLHIV on ART, and most were published in 2019–2021. Marked variations in initial VL monitoring coverage were reported across study settings/countries (range: 12–93% median: 74% IQR: 46-82%) and study populations (adults (range: 25–96%, median: 67% IQR: 50-84%), children, adolescents/young people (range: 2–94%, median: 72% IQR: 47-85%), and pregnant women (range: 32–82%, median: 57% IQR: 43-71%)). Community-based models reported higher VL monitoring (median: 85%, IQR: 82%-88%) compared to decentralised care at primary health facility (median: 64%, IRQ: 48%-82%). Suboptimal uptake of follow-up VL monitoring and low regimen switching rates were observed. Conclusions There was a marked increase in the number of studies of VL monitoring for PLHIV on ART in LMICs over the past five years. Substantial gaps in VL coverage across study settings and study populations were evident, with limited data availability outside of SSA and in KPs. Further research is needed to fill the data gaps. Development and implementation of innovative, community-based interventions are required to improve VL monitoring and address the “failure cascade” in PLHIV on ART who fail to achieve viral suppression.

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Determinants of viral load non-suppression among people living with HIV on antiretroviral therapy in Kumasi, Ghana

Ghana Medical Journal ◽

10.4314/gmj.v55i2.3 ◽

2021 ◽

Vol 55 (2) ◽

pp. 111-117

Author(s):

David Ansah ◽

Emmanuel Kumah ◽

Vitalis Bawontuo ◽

Peter Agyei-Baffour ◽

Emmanuel K Afriyie

Keyword(s):

Viral Load ◽

Educational Level ◽

Viral Suppression ◽

Outcome Measure ◽

People Living With Hiv ◽

Viral Load Suppression ◽

Cross Sectional ◽

Factors Associated ◽

Comorbidity Status ◽

Living With Hiv

Objectives: To determine the rate and factors associated with viral load non-suppression among adults living with HIV/AIDS on active anti-retroviral therapy (ART).Design: A retrospective cross-sectional studySetting: Three ART clinics in Kumasi, GhanaParticipants: All HIV-infected adults who were ≥18 years and on active ART for 12 months and whose viral loadnhad been estimated were included.Main outcome measure: Unsuppressed viral load among patients on ARTResults: In all, 483 HIV patients were included in the study, with 369 (76.4%) achieving viral load suppression. Gender, educational level, comorbidity status, and duration on ART were independently associated with viral nonsuppression (p < 0.05).Conclusions: This study has revealed that the rate of viral suppression in the study area is lower than the UNAIDS 90% target. The findings have implications on designing new and stemming up implementation of existing interventions to improve the rate of viral suppression among patients in the study area. It is also necessary that more of such studies are replicated in other parts of the country to identify risk factors for virological failure among patients on ART.

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Factors Associated with the Effectiveness of National Free Antiretroviral Treatment Program in HIV Infected Patients of Yi Nationality from Southwest China: Evidence from A Cohort Study to Provide Clues for Improvement

10.21203/rs.3.rs-98257/v1 ◽

2020 ◽

Author(s):

Liyu Chen ◽

Shuang Kang ◽

Lingyao Du ◽

Fanghua Ma ◽

Changmin Li ◽

...

Keyword(s):

Cohort Study ◽

Viral Load ◽

Treatment Program ◽

Antiretroviral Treatment ◽

Viral Suppression ◽

Fasting Blood Glucose ◽

Cd4 Count ◽

People Living With Hiv ◽

Immune Recovery ◽

Limited Region

Abstract Background: Despite the current achievements of HIV management in the source-limited region of Liangshan Autonomous Prefecture, a small population remains with unsatisfactory virologic outcomes and suboptimal immune recovery. This cohort study aimed to identify potential risk factors of suboptimal clinical outcomes and to provide clues for improvement in people living with HIV (PLWH) from China’s National Free Antiretroviral Treatment Program (NFATP) in Zhaojue County, Liangshan Autonomous Prefecture of Yi nationality. Results: A total of 608 HIV infected adult patients in NFATP at the median age of 35(31, 40) were enrolled for analysis. During the 2.15(1.54, 4.00)-year follow-up, 502 (82.6%) patients achieved the viral load of <1000 copies/mL after over 6 months of antiretroviral therapy(ART). Among them, 398 (65.5%) cases achieved complete viral suppression with viral load <50 copies/mL while 104 (17.1%) cases remained with low level viremia (LLV, 50≤ viral load ≤1000 copies/mL). Patients with longer infection duration (OR =1.017 [95%CI: 1.002-1.033], p = 0.026), male gender (OR =1.632 [95%CI: 1.053-2.53], p = 0.028), positive hepatitis C virus antibody (OR =1.687 [95%CI: 1.093-2.604], p = 0.018) or infection through injecting drug use (IDU) (OR =1.584 [95%CI: 1.022-2.455], p = 0.04) were more likely to experience the undesirable outcome of LLV. Moreover, 254 (63.8%) of 398 patients with viral suppression achieved optimal immune recovery with the CD4 count ≥ 350 cells/μL. Patients with lower body mass index (BMI) (21.00±2.94 Kg/m 2 , OR=0.921 [95%CI: 0.854-0.994], p = 0.034) and higher fasting blood glucose (4.99±1.01 mmol/L, OR=1.343 [95%CI: 1.087-1.658], p = 0.006) were less likely to achieve the CD4 count ≥ 350 cells/μL after viral suppression. Conclusions: In this long-term cohort study of PLWH from Zhaojue County, Liangshan, most patients achieved virologic success on ART provided by NFATP but optimal immune recovery was yet to be expected. Approaches including strict control of illegal drug deal, patient education, and nutritional status management could be conducive to better prognosis for this population.

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896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1091 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S539-S539

Author(s):

Michelle Zhang ◽

Sharlay Butler ◽

Jason Kennedy ◽

Molly McKune ◽

Ghady Haidar ◽

...

Keyword(s):

Viral Load ◽

Viral Suppression ◽

Retention In Care ◽

Hiv Treatment ◽

Hiv Care ◽

Viral Load Suppression ◽

Sti Prevention ◽

Prevention Services ◽

The Impact ◽

Non Parametric

Abstract Background We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results 1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth. Disclosures Ghady Haidar, MD, Karuys (Grant/Research Support)

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