19th EUROPEAN AIDS CONFERENCE October 18–21, 2023 Warsaw, Poland ABSTRACTS www.eacs-conference2023.com
ABSTRACTS SORTED BY TOPIC 3 LATE BREAKERS SORTED BY TOPIC 772 CLINICAL CASES 776 2 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
ABSTRACTS SORTED BY TOPIC
EACS2023: 30 Barriers to HIV testing and possible interventions to improve healthcare among migrants, especially migrant women, in Europe D.C. Krankowska , P. Lourida , S. Quirke , M. Woode-Owusu , N. Weis Medical University of Warsaw, Hospital for Infectious Diseases, Department of Infectious and Tropical Diseases and Hepatology, Warsaw, Poland, Evaggelismos General Hospital, Department of Infectious Diseases and HIV, Athens, Greece, Galway University Hospital, Respiratory Department, Galway, Ireland, University College London, Institute for Global Health, London, United Kingdom, University of Copenhagen, Copenhagen University Hospital, Department of Clinical Medicine, Department of Infectious Diseases, Copenhagen, Denmark General data Abstract category: Access and delivery of care Abstract body Purpose: According to ECDC reports, women and migrants are more likely to have delayed HIV diagnosis (CD4 <350 cells/mm3). Inequalities persist in access to and use of healthcare amenities by migrants. The aim of this study was to identify barriers to HIV testing and possible interventions to improve healthcare access among migrants in Europe, with emphasis on migrant women, based on opinions of employees within non-governmental organizations (NGOs) and other stakeholders working with migrants. Method: Between November 2021 and February 2022 an online survey, consisting of 20 questions, was forwarded to 178 stakeholders and NGOs working with migrant populations in 33 countries from the WHO European Region. Results: Forty-three responses from 14 countries were analyzed. Most respondents (70%) judged migrants’ access to healthcare worse compared to the resident population. Only 2/12 prevention interventions were available to all, in at least 50% of participating countries (Table 1). The three main barriers to accessing healthcare by migrants and reasons for late HIV diagnosis were stigma and discrimination, language barrier and cultural barrier (Table 2). Possible interventions to improve migrant women’s access to healthcare included more education about HIV, universal free healthcare for all and more community involvement. Table 2. Top barriers to accessing healthcare which migrant women face according to 27 respondents from 11 countries. Barrier Number of Respondents who included in Top 5 Number of Respondents who ranked 1st (Most Important) Stigma and discrimination 19/27 (70.4%) B, CH, D, ES, FR, IR, IT, PL, UK 3/27 (11.1%) CH, ES, FR Language Barrier 16/27 (59.2%) CH, D, ES, FR, IR, IT, PL, T, UK 5/27 (18.5%) CH, D, FR, IR, UK Cultural Barrier 15/27 (55.5%) CH, ES, FR, IR, IT, P, UK 5/27 (18.5%) FR, IR, IT Lack of Knowledge about HIV 14/27 (51.8%) CH, D, ES, FR, IR, IT, P, PL, UK 2/27 (7.4%) D, ES Uncertainty about entitlement to healthcare in host country 14/27 (51.8%) D, ES, FR, IR, IT, PL 1/27 (3.7%) IR Illegal Status 13/27 (48.1%) D, IR, IT, P, PL, T, UK 5/27 (18.5%) IT, P, PL, T, UK B- Belgium, CH- Switzerland, D- Germany, ES- Spain, FR- France, GR- Greece, IR- Ireland, IT- Italy, P- Portugal, PL- Poland, RO- Romania, RUS- Russia, T- Turkey, UK- United Kingdom Conclusions: Many HIV prevention interventions are not free of charge within Europe. Stigma, discrimination, and cultural /language differences were common barriers to healthcare access and lead to late HIV diagnosis amongst migrant women. Healthcare education, universal access to free healthcare and enhanced community involvement are suggested interventions to improve healthcare for migrant women in Europe. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 2 3 4 5 1 2 3 4 5 4 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 32 Screening of HPV-related anogenital cancers in women living with HIV in Europe: results from a systematic review D.C. Krankowska , M. Mazzitelli , H. Albayrak , E. Orviz , H. nur Karakoç , H. Mortimer , K. Aebi-Popp , Y. Gilleece Medical University of Warsaw, Hospital for Infectious Diseases, Department of Infectious and Tropical Diseases and Hepatology, Warsaw, Poland, Padua University Hospital, Infectious and Tropical Diseases Unit, Padua, Italy, CPL Life Science, Hurley, United Kingdom, Centro Sanitario Sandoval, Hospital Clinico San Carlos, Madrid, Spain, Karadeniz Technical University School of Medicine, Trabzon, Turkey, Brighton & Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom, Bern University Hospital, University of Bern, Department of Infectious Diseases and Department of Obstetrics and Gynecology, Bern, Switzerland General data Abstract category: Access and delivery of care Abstract body Purpose: Women living with HIV (WLWH) are at increased risk of HPV-related cancers. Throughout Europe, there is heterogeneity among screening programs, access to HPV testing and HPV vaccination. This review aims to summarize available data on screening and prevention measures for HPV-related ano-genital cancers in WLWH across the WHO European Region (WER). Method: The systematic review followed the PRISMA guidelines and was registered on Prospero. Pubmed, Embase and Web of Science databases were searched to identify available studies, written in English, and published between 2011 and 2021. A metanalysis was conducted using random-effects models to calculate pooled prevalence of HPV. Subgroup analyses were conducted according to country and HPV testing. Results: Thirty-four articles involving 10,336 WLWH met the inclusion criteria. Studies were heterogenous in their methodology and presentation of results: 73.5% studies focused on cervical cancer prevention, 4.4% on anal cancer. 76.5% studies conducted HPV testing as part of screening. The prevalence of hr-HPV was 30.5-33.9%. 77% of WLWH had cervical cytology results reported. Six studies reported a positive association of CD4+ cell count <200/mm with HPV prevalence and cervical abnormalities. Anal HPV testing was conducted in <8% of participants. HPV vaccination was completed in 5.6% of women with known vaccination status. There was no information about the vaccination status of the majority of women in the analyzed studies. Conclusions: Data about screening of HPV-related anogenital cancer in WLWH in Europe are heterogenous and lacking, especially about anal cancer. HPV DNA testing is not routinely done as part of screening for HPV-related cancer. Low CD4+ cell count is a risk factor for HPV infection and cytological abnormalities. HPV vaccination data is poor and vaccination rates are very low among WLWH in Europe. This review concludes that significant improvements are required for data and consistency on guidelines for HPV screening, prevention and vaccination in WLWH. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 2 3 4 5 6 7 6 1 2 3 4 5 6 7 3 5
EACS2023: 47 Association between depression and consistency of condom use among female sex workers in Blantyre: the case of a commercial city of Malawi O.D. Mbekwani-Kalata Malawi Liverpool Wellcome Trust, Health Policy Unit, Blantyre, Malawi General data Abstract category: Access and delivery of care Abstract body Purpose: The prevalence of Sexually Transmitted Infections (STIs) including HIV is 13 times higher in female sex workers (FSWs) than their counterpart women. Depression poses a risk for inconsistent condom use among this population and could therefore increase the risk of HIV transmission to the general population. Therefore this study was aimed at investigating the association between depression and condom use among FSW of Blantyre urban, Malawi. Method: Female Sex Workers 18 years or order, who had been conducting sex work for at least 6 months in Blantyre, were enrolled after giving a written informed consent. A questionnaire that included standardised Self Reporting Questionnaire (SRQ) translated into a vernacular language was administered to assess symptoms of depression and condom use. Adjusted odds ratios were calculated using multivariate logistic regression to compare consistency of condom use between FSW showing depression symptoms and those who do not. Results: A total of 224 FSW were enrolled in the study, with a mean duration of sex work of 3 years 6 months. The prevalence of depression as determined by the depression score was 47.8% (107/224), while inconsistent condom use was reported by 43.3% (97/224). The prevalence of HIV was 69.3% (151/224). The odds of consistent condom use among those with depression symptoms were 40% less than in those that did not report symptoms (0.6; 95% CI 0.3-1.1, p=0.04). After adjusting for confounders (age, marital status and duration of sex work), there was weak evidence of an association between depression and inconsistent condom use (p=0.07) in this population. Conclusions: The study revealed that female sex workers were vulnerable to depression. Similarly, self-reported HIV positive status was high. There was weak evidence of an association between depression and inconsistent condom use in this population. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 6 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 59 Formation of public health policy on HIV treatment issues: Asian perspectives S. Pal , B. Gupta , T. Roy HPSI, Meerut, India, TNM Hospital, Mumbai, India General data Abstract category: Access and delivery of care Abstract body Purpose: This is advocacy paper for PLWHIV. People living with HIV needs price discounts anti-HIV drugs, human-rights protection & proper nursing care. Controversy is rang over euthanasia for terminal cases. These are some burning issue for HIVpatients from resource-constrained countries. Appropriate public health program incorporating NGO’s in healthcare set-up are necessary. Method: Cost/availability of oncology drugs is debatable. Over 82% patients in rural India cannot afford Anti-HIV-therapies, so life with HIV is granted as end-game. Since September 1996 various community initiatives are implemented to reduce therapy cost. NGO’s need to facilitate development of sound & sustainable nursing care programs in marnalised communities. Various national & international programs offer drugs, technical assistance. Establish Uniform public health policy to develop of sound/sustainable HIV-care-programs. Results: therapy is out of reach for > 90% patients. Rehabilitation/palliative care plans are non-existent. Concrete proposals done only by 4 NGOs , 13 governments & 11private entities . Of these 9 supported by WHO, 10 NGOs (56%), 2 government (6%) & 5 private entities (38%) & 6 corporate/Pharma sector initiatives. HIV-nursing-care-services implemented together with low-cost-drugs show more positive outcome. Nursing care in rural/tribal areas is abysmal. Conclusions: Community participation of non-proft-organisations in administration of nursing-care/therapeutic-RX is very effective in terms of cost-management, better-compliance. Community mass intervention & low-cost drug-supply-projects has proven useful in rural communities of resource poor-nations. Barcelona-conference-participants can collaborate with NGO-activist to address this issue. Uniform public health policy needed to implement & expand cost-cutting measures to include a broader range of HIV care services. Recommendations: Promoting dialogue between health services & nurses accelerates HIV-care efforts. NGO-health-workers participation increases more compliance they must be involved in Public-health-policy issues. This would reduce difficulties faced by patients from resource poor southern countries. It is essential that we form common guideline manual on this issue affecting Asian countries. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 2 1 2 7
EACS2023: 81 Prevalence and impact of mental health disorders on people living with HIV/AIDS in Nigeria: a systematic review Y. Hassan Wada , O Anjorin , I. Tonye Leggjack , O Anjorin , R Hassan , O. Idogho , J. Anyanti Society for Family Health, Abuja, Nigeria, Kings College, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom, University of Ilorin, Kwara, Nigeria General data Abstract category: Access and delivery of care Abstract body Purpose: Mental health disorders faced by people living with HIV/AIDS (PLWHA) is common and associated with comorbidities that affect individual health related quality of life (HRQoL). This systematic review examines the prevalence and impact of mental health disorders on PLWHA in Nigeria, to inform clinical and public health measures. Method: A systematic review of research was conducted for research papers published between 2000 and 2022 which evaluate prevalence and impact of mental health disorders on people living with HIV in Nigeria. PRISMA guideline was followed and systematically searched databases including MEDLINE, CINAHL, Embase PubMed, PsyschINFO, Web of Science, Scopus and Goggle Scholar. Data were extracted on study designs and settings, sample size, diagnostic or screening measures, prevalence, risk factors and outcomes and subsequently appraised using critical appraisal skills programme (CASP) and appraisal tool for cross-sectional studies (AXIS) checklists. Results: The PRISMA-guided search strategy identified a total of 234 articles and only 9 studies met criteria for inclusion. Majority of the studies emanated from the South western region (n=7; 77.8%), predominantly assessing depression (n=6; 66.7%), anxiety (n=5; 55.6%) and other psychological distress. Notably, depression was assessed using multiple scales with diverse scoring systems and a reported prevalence range of 7% -55%. The majority of studies reported risk factors such as poor level of social support, being a female and widowed or unmarried, unemployed, lower education, perceived stigma and discrimination, and advanced stage of the disease for their mental health challenges. Conclusions: We find evidence that there is a high prevalence of mental health disorders among PLWHA. Depression, anxiety, and other psychological distress evidently affects the HRQoL of PLWHA coupled with many modifiable risk factors. This can further help to develop and pilot delivery model of mental healthcare, and to advocate for mental health advancement in HIV policy integration. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 2 1 1 3 1 1 1 2 3 8 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 120 Demand for HIV prevention, treatment and care services in a developing country like India R. Bansal Max Hospital, Infectious Diseases, Ghaziabad, India General data Abstract category: Access and delivery of care Abstract body Purpose: Demand for HIV prevention, treatment and care services in a developing country like India continues to increase putting additional stress on an already overburdened healthcare sector. There is a dearth of expertise, knowledge and experience among medical staff when HIV is talked about. Similar was the case at Hospital eight years back. Here, initial fifteen years back almost 80% case had gone undetected and for the diagnosed 20% struggle didn’t end, even after diagnosing a patient with HIV there was a question as to where the patient should be sent for treatment. So in the thirst of ameliorating the condition, Pushpanjali Crosslay Hospital established a centre . The aim of this centre is to equip doctors with the knowledge of HIV/AIDS so that the condition of HIV in the community could be improved. This centre has worked extensively to identify various psychosocial factors in HIV transmission. It has organized various conferences, workshops, lectures for doctors as well as in the community to sensitize people. In last 5 years, almost 35 such programmes have been organized by this centre. And the result could be manifested with the increase in the number of diagnosis, follow ups and medicines adherence by the patients Method: HIV Prevention: Organizing workshops, conference, seminars, lectures at various schools, colleges to sensitize community on safer sex practices, behavioral changes, and diminishing social stigma. HIV Diagnosis: Training medical staff especially doctors with the knowledge of HIV/AIDS so that they could incorporate HIV testing as a part of their daily clinical practices to make early diagnosis. HIV Testing: Proper and timely HIV testing of the patient and providing discounts for people who belong to low socio economic status. HIV Treatment: Results: Conclusions: Access of care and facility of treatment of all OI and other problems it was unbiased facility for all PLHA. YEARS No. of DIAGNOSIS Follow ups (total) Medicine Adherance 2008 10 10 2009 40 150 2010 45 185 2011 52 300 2012 60 375 2013 50 450 General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 9
EACS2023: 129 Assessing the landscape and implementation of HIV-relevant policies on uptake of prevention and testing services among key populations in the WHO European Region P.J. Campbell , K.A. Nogales Crespo , J. Rocha , A. Fernandez , K.L. Nelson , A. Attwill Merck & Co., Inc., Rahway, United States, Policy Wisdom, LLC, Quebradillas, Puerto Rico General data Abstract category: Access and delivery of care Abstract body Purpose: To analyze policies relevant to HIV prevention and testing for key populations and published evidence on policy implementation in the WHO European Region. Method: A sample of 15 countries was selected to represent a variety of contexts within the region (see Figure 1). A targeted search of policy targets was conducted to identify policies that directly or indirectly impact HIV prevention and testing. A targeted review of peer-reviewed literature was conducted to contextualize findings of the policy search. Databases were constructed using a standardized coding scheme and data were reviewed by a second researcher for accuracy. Figure 1. Approach Results: Most countries have testing guidelines and policies for self-testing (see Table 1). However, guidelines are not always followed, and awareness and uptake of self-testing is low in some countries. Most countries have national policies to make PrEP available to people vulnerable to sexual transmission of HIV and men who have sex with men (MSM) and transgender people are often listed as policy targets. There is, however, limited awareness and knowledge of the benefits and availability of PrEP in some countries (e.g., Germany, Spain) and among certain key populations (e.g., MSM). Most countries have harm reduction programs for people who inject drugs (e.g., syringe exchange, opioid substitution). All countries have policies on sex work, and in most cases, it is not criminalized. There are laws that provide protection against discrimination, which were found to indirectly facilitate access to HIV prevention and testing. Table 1. Findings Conclusions: Several structural policies are in place to directly and indirectly facilitate HIV prevention and testing for key populations in the European region. Policies vary across countries, providing an opportunity for cross-country learning about barriers or facilitators to successful policy implementation. It is imperative that health systems address barriers faced by key populations in order to achieve UNAIDS targets. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 2 2 2 1 2 1 2 10 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 144 Role of the Advanced Pharmacist Practitioner (APP) H. Mohammed , N. Naous , E. Dwyer , M. Boffito , R. Jones Chelsea & Westminster Hospital NHS Trust, London, United Kingdom General data Abstract category: Access and delivery of care Abstract body Purpose: Pharmacists are medicines experts and momentum exists in the UK for enhanced clinical roles. Delivery of pharmacist-led care within the UK varies and usually supplements the routine physician appointment. To preserve continuity of our services, a pharmacist was recruited to a vacant nurse practitioner role. The APP worked independently to deliver clinics for PLWH and manage an entire episode of care. Method: Prospective data collection of consultations conducted over a 12 month period. Online surveys were distributed to capture MDT opinion of the APP role. In order to assess feasibility of this model, a separate survey was distributed to HIV pharmacists via UK networks to understand drivers, barriers and appetite for the role. Satisfaction survey data was collected from PLWH. Results: The APP conducted 500 consultations during the 12 month period: 93% in-person. Overall, 435 PLWH were reviewed (table 1). Table 1: characteristics of PLWH reviewed by the APP (n=435) Median age (range) % female Mean number of co-morbidities (range) Mean number of co-medications (range) % virologically suppressed (VL <50 c/ml) 53 (26-91) 28% 2 (0-14) 3 (0-24) 90% Of those with viraemia (VL >200 c/ml), 15/25 demonstrated a one log VL drop at subsequent attendance. Senior advice was sought for 5% of consultations. Table 2 illustrates breakdown of interventions made by the APP. Table 2: Interventions made by the APP Intervention n (PLWH) Imaging requested (BMD/CT CACS/liver USS) 116 (93) Referral to other specialities 99 (90) Initiate or switch ARVs 83 (82) Medicines optimisation (e.g. initiate/titrate non-ARVs, deprescribing) 58 (56) Vaccine prescribed (Hep A/B, HPV, MPV) 55 (45) A total of 30/55 HCPs responded to the survey: 97% strongly agreed that APPs should be included in future business planning. Of the pharmacists surveyed, 78% (21/27) expressed interest in working in an APP role. Amongst PLWH respondents (n=18), 72% felt the APP exceeded care expectations. Conclusions: We demonstrate the successful utilisation of a novel role within HIV services. The APP delivered holistic care, encompassing medically complex PLWH and those with viraemia. The unique skillset of HIV specialist pharmacists should be harnessed to consolidate MDTs and address EU workforce shortages. With rising polypharmacy, APPs are well positioned to deliver medicines optimisation and co-morbidity management to an ageing cohort of PLWH. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 1 1 1 1 10 11
EACS2023: 161 Access to care among asylum seekers living with HIV P. Ryan , S. Manzano , D. Rahampour , G. Cuevas , J. Valencia , L. Martin , S. Navarro , J.I. Lazo-Alvarez , S. Rodriguez , A. Gonzalez-Baeza , B. Fernandez-Gomez , M. Fernández Ollero , J.V Lazarus , M. Sanchez-Conde Hospital Universitario Infanta Leonor, Madrid, Spain, Universidad Complutense de Madrid (UCM), Madrid, Spain, Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain, Fundación Estatal, Salud, Infancia y Bienestar Social, F.S.P (FSCAI), Madrid, Spain, Hospital General Universitario Gregorio Marañón, Madrid, Spain, Universidad Autónoma de Madrid (UAM), Madrid, Spain, Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, Spain, CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, United States, Servicio de Enfermedades Infecciosas, Hospital Ramon y Cajal, Madrid, Spain General data Abstract category: Access and delivery of care Abstract body Purpose: To describe the sociodemographic profile of asylum seekers living with HIV upon their arrival in a European city and investigate how the challenges they face in accessing the healthcare system impact their overall well-being. Method: This was a prospective study carried out in 2022/2023, with a 6-month follow-up period. HIV positive asylum seekers were recruited from NGOs and referred to an HIV clinic in a hospital in Madrid. Each participant underwent a comprehensive evaluation by an infectious disease’s specialist and a social worker. Data on demographic, social, and clinical variables were collected for subsequent analysis. Results: 653 HIV positive asylum seekers were attended at the HIV clinic. The mean age was 33.6 (SD±8) years, 571(87%) were cisgender males, 552(84%) reported a homosexual orientation, 294(51%) were university educated and 584 (89%) were Hispanic. Upon arrival, 394(49%) had no social support network and 56(9%) were homeless. Overall, 476(87%) faced barriers in accessing the healthcare system. The median duration of HIV infection was 5 (3-8) years and 304(48%) had been diagnosed with a sexually transmitted infection (STI) in the past year. In total, 555(85%) were ART-experienced and 98(15%) were naïve. Upon their arrival in Spain, 500(77%) participants were taking ART, but this number decreased to 398(61%) when they were assessed at the HIV-clinic. Therefore, 217(33%) participants had a detectable HIV viral load at baseline visit. Six months after initial assessment, 99% continued ART and 98% had an undetectable VL. Conclusions: In Madrid, HIV positive asylum seekers are predominantly young males of Latin American origin. Upon arrival, they engage in risky sexual practices and face barriers in accessing the healthcare system, which hinders access to ART. Despite utilizing direct referral pathways (NGOs), one-third of the individuals evaluated in the clinic had detectable HIV viral load. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1,2,3 1 4 1 1 5 2 1 1 6 1 6 7,8 9,3 1 2 3 4 5 6 7 8 9 12 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 249 Statutory health insurance-covered pre-exposure prophylaxis in Germany: changing trends in nationwide tenofovir disoproxil/emtricitabine prescriptions during the COVID-19 pandemic H. Prins , A. Dörre , D. Schmidt Robert Koch Institute, Berlin, Germany General data Abstract category: Access and delivery of care Abstract body Purpose: In 2019, Germany introduced a law to reimburse high-incidence populations for pre-exposure prophylaxis (PrEP), prescribed as tenofovir-disoproxil/emtricitabine (TDF/FTC), via statutory-health-insurance (SHI). We studied changes in TDF/FTC-prescriptions after the implementation of this law and during the COVID-19 pandemic. Method: We performed an interrupted time series analysis with monthly prescriptions per defined time period as the outcome. We considered the introduction of SHI-covered PrEP (09/2019) as an interruption, and four COVID-19 waves and two national lockdowns (2020-2021) as explanatory variables. We extrapolated prescriptions had the lockdowns not occurred, and compared this to the actual prescriptions during the same period of time. We performed sub-analyses based on stratification by five federal states with the highest proportion of PrEP users (Berlin-Brandenburg combined, Bavaria, Hamburg, Hesse, North Rhine-Westphalia). We assessed the models’ goodness-of-fit based on the adjusted R-squared using RStudio. Results: The best fitting linear regression model included SHI-covered PrEP and the first COVID-19 lockdown (04/2020) (Table 1). The decrease in prescriptions during the first lockdown was significant nationally (Figure 1), and in the five federal states for single-month prescriptions (Figure 2). The first lockdown resulted in reductions of 57.7% (95% prediction interval (PI): 23.0–92.4%) for single-month prescriptions, while 17.4% (95% PI: 0.28–34.5%) nationally, and 13.9% (95% PI: -3.67– 31.5%) for three-month prescriptions. Table 1. Results of two linear regression models with the best fit to the actual data, based on the estimate and p-value per variable, and adjusted R-squared Variable in linear regression model Estimate Adjusted R-squared First wave First lockdown First wave First lockdown Intercept 8473.0*** 8473.0*** 0.9661 0.9668 Shift directly after SHI coverage of PrEP 7101.3*** 6972.3*** Monthly change before SHI PrEP -72.1 -72.1 Monthly change after SHI PrEP 401.0*** 406.5*** Monthly change after first wave/first lockdown -1345.8 -2496.5* Significance codes: ***: 0–0.001; **: 0.001–0.01; *: 0.01–0.05. PrEP: pre-exposure prophylaxis; SHI: statutory health insurance. Conclusions: The introduction of SHI-covered PrEP resulted in a doubling of TDF/FTC-prescriptions nationwide in the first month alone. A drop in prescriptions was most apparent after the first lockdown, and particularly affected PrEP initiations, possibly due to reduced healthcare access and behavioural changes. Ongoing monitoring of TDF/FTC-prescriptions is needed to safeguard access to preventative care such as PrEP and particularly PrEP initiation during public health crises like COVID19. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 1 1 13
EACS2023: 256 Pregnancy in women living with HIV in Latin America: a multi-centre cross-sectional analysis across seven countries P. Zitko , J. Ballivian , A.-P. Celi , C. Beltrán , A. Manzo , S. Sabato , E. Objeta , S. Lupo , N. Esquivel , O. Lopez , M. Lasso , R. Galvez , C. Chahin , E. Barthel , L. Montero , E. Delgado , W. Bosques , C. Mazariegos , R. Pinzon , S. Pereira , M. Morales , O. Sussmman , I. Cassetti Hospital Barros Luco Trudeau, Unite of Healthcare Research, Santiago, Chile, Hospital Braulio Moyano, Buenos Aires, Argentina, Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador, Centro de Especialidades Médicas Ambulatorias, Mar del Plata, Argentina, Fundación del Centro de Estudios, Buenos Aires, Argentina, Hospital de Boulogne, Buenos Aires, Argentina, Centro de Asistencia e Investigación Clínica Integral, Rosario, Argentina, Hospital Ernesto Torres Galdámez, Iquique, Chile, Hospital Dr Sotero Del Rio, Santiago, Chile, Hospital Dr. Juan Noé, Arica, Chile, Hospital Doctor Hernán Henríquez Aravena, Temuco, Chile, Hospital Carlos Van Buren, Valparaiso, Chile, TODOMED, Cali, Colombia, Vivir Bien IPS, Cartagena, Colombia, Hospital Monseñor Sanabria, El Roble, Costa Rica, Hospital Regional De Zacapa, Zacapa, Guatemala, Hospital Roosevelt, Guatemala, Guatemala, Asociación Española, Montevideo, Uruguay, Ambulatorio La GuairaVargas, La Guaira, Venezuela, Infectoclinicos, Bogota, Colombia, Helios Salud Ambulatory AIDS Care Centre, Buenos Aires, Argentina General data Abstract category: Access and delivery of care Abstract body Purpose: To describe relevant features of pregnant care of Women Living With HIV (WLWH) in the Latin American Workshop Study Group on HIV (LAWSG) initiative. Method: We performed a cross-sectional analysis using aggregated administrative data from the LAWSG centres. Outcomes were defined as pregnancies that ended in 2019. Random-effects meta-analyses were conducted to account for variability between centres (I centres) and countries (I countries). Results: A total of 17 of the 101 centres from seven Latin American countries completed the data collection, gathering information from 194 pregnancies. The pregnancy rate in women undergoing HIV treatment was 1.7% (95% confidence interval [CI]=0.7–2.6%). In 42.0% (95%CI=24.6–59.5%; I for centre=9.5%; I for country=52.7%) of the cases, HIV was diagnosed after pregnancy confirmation. A total of 30.0% (95%CI=18.8–41.2%; I centre=29.2%, I country=0.0%) of the WLWH had a first CD4+ count of <350 cells/mL. Antiretroviral therapy (ART) was discontinued in 8.2% (95%CI=2.4–14.0%; I centre and I country=0.0%) of the cases. By the last trimester of pregnancy, 76.4% (95%CI=53.6–99.3%; I centre=43.2%, I country=40.2%) of the WLWH had an undetectable viral load. The ART regimes mainly included TDF/xTC as a backbone plus various options for a third drug. Most pregnancies ended by term caesarean section (87.8%; 95%CI=65.8–109.8%; I centre=36.9%, I country=48.4%), maintaining control until the third month after delivery. Among those who visited the centre three months after delivery, 95.3% (95%CI=90.8–99.9%; I2centre=17.1%, I2country=0.0%) avoided breastfeeding. Conclusions: Increasing HIV detection among women of reproductive age and ensuring continuity of care for WLWH to avoid pregnancies outside of ART are necessary. Continuity of care should be safeguarded, including during postpartum visits. Healthcare services should be particularly sensitive to women’s needs during pregnancy. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 2 3 1 4 5 6 7 8 8 9 10 11 12 13 14 15 16 17 18 19 20 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 2 2 2 2 2 2 2 2 2 2 2 2 14 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 258 Evaluation of the information level and attitude of people living with HIV, towards conduction of tele-health systems in healthcare, and its relationship with their sociodemographic attributes H. Kumbasar Karaosmanoğlu , M. Sönmezışık SBÜ Bakırköy Dr. Sadi Konuk Training and Research Hospital, Infectious Diseases and Clinical Microbiology Outpatient Clinic, Istanbul, Turkey General data Abstract category: Access and delivery of care Abstract body Purpose: While tele-health technologies have been used as an alternative to face-to-face examination in the world for many years, their use has become widespread with the COVID-19 pandemic. The main aim of this study is to search if tele-health technologies can be integrated to our outpatient clinic that follows people living with HIV, in order to prevent disruptions in patients’ follow ups and treatments in cases of extraordinary situations such as a pandemic or natural disasters and also to facilitate the access to health care in daily life. Method: 230 people living with HIV aged over 18, who visited Bakırköy Dr. Sadi Konuk Hospital, Infectious Diseases outpatient clinic between June 2022 and December 2022, were included to the study. A questionnaire composed of 34 questions was applied to the participants, questioning sociodemographic characteristics, tele-health knowledge and experience level, predisposition to use tele-health. Statistical analysis were conducted with R software. Results: %70 of the participants were under the age of 50, 84% were male, 54% were heterosexual, 53% were married, 41% were primary school graduate, 28% had a university degree. 67% of the cases were working actively, 96% used a smart phone. 66,5% of the participants stated that they would prefer to conduct their appointments with their doctor over video call. 80,9% of the cases thought that tele-health could be useful for them by preventing them to be seen in front of the HIV clinic, whereas 58% found it to be helpful for eliminating transportation problems. Conclusions: Following the evaluations of the participants’ knowledge levels and predispositions to use tele-health, it is thought that tele-health technologies can be integrated to the healthcare of the people living with HIV, in order to prevent problems that can appear in extraordinary situations such as a pandemic, and to increase the comfort and compliance of patients to treatment. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 1 15
EACS2023: 277 Patients’ and healthcare providers’ views on screening for cognitive impairment in people living with HIV: a qualitative study K. Alford , S. Sidat , K. Bristowe , N. St. Clair-Sullivan , G. Parteger , M. Maddocks , D. Yi , R. Harding , T. Levitt , S. Bremner , J.H Vera Brighton and Sussex Medical School, Department of Global Health and Infection, Brighton, United Kingdom, King's College London, Cicely Saunders Institute, London, United Kingdom, Lunch Positive, Brighton, United Kingdom, Brighton and Sussex Medical School, Department of Medicine, Brighton, United Kingdom, Brighton and Sussex Medical School, Department of Primary Care and Public Health, Brighton, United Kingdom, University Hospitals Sussex NHS Foundation Trust, HIV and Sexual Health, Brighton, United Kingdom General data Abstract category: Access and delivery of care Abstract body Purpose: People living with HIV are an ageing population with an increased risk of cognitive impairment. Although cognitive impairment is dependent upon assessment, the acceptability of screening for cognitive impairment is unknown. This study aimed to explore the views of people living with HIV and healthcare providers regarding routine screening for cognitive impairment. Method: In-depth individual qualitative interviews were conducted with purposively sampled people living with HIV and focus groups of healthcare providers from a UK HIV service. Verbatim pseudonymised transcripts were analysed using reflexive thematic analysis supported by NVivo. Results: 20 people living with HIV were interviewed and 12 healthcare providers participated in three focus groups. People living with HIV were concerned about developing cognitive issues and welcomed routine screening. Screening was seen as relevant and an important part of managing health in older age. Healthcare providers expressed concerns regarding the capacity of HIV services to implement routine screening and questioned the validity of screening measures used. People living with HIV felt that screening and subsequent detection of cognitive impairment, if present, may help them to prepare for future issues, and promote active management strategies and care pathways which would support cognitive health. People living with HIV felt screening should be brief, delivered by the HIV service and they should be given a choice of administration method. Indications of cognitive impairment should be discussed face-to-face and followed up with a comprehensive cognitive assessment. Conclusions: People living with HIV are concerned about cognitive impairment and would welcome regular screening for this as part of the holistic care provided by the HIV team. Both people living with HIV and staff would like more information on cognitive impairment, its screening and ways to support cognitive health. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 2 1 3 2 2 2 4 5 1,6 1 2 3 4 5 6 16 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
EACS2023: 303 Impact of Rapid ART initiation amongst people newly diagnosed with HIV on retention in care and time to HIV viral load suppression in a diverse London cohort J. Shaw , I. Mallik , M. Anil , R. Dhairyawan , N. Matin , J. Thornhill Barts Health NHS Trust, Infection & Immunity, London, United Kingdom General data Abstract category: Access and delivery of care Abstract body Purpose: Rapid initiation of antiretroviral therapy (ART) is a strategy to improve clinical outcomes for people with HIV (PWH). Data supporting this model of care in high resource settings is lacking. We present comparisons of outcomes of newly diagnosed PWH before and after introducing a new outpatient Rapid ART Pathway, to delineate impact of ART initiation timing on retention in care and time to HIV viral load (VL) suppression. Method: Clinical data was collected using electronic records for all newly diagnosed PWH from February 2018-February 2022. Rapid ART defined as ART initiation within 7 days of confirmed HIV diagnosis. Retention in care was defined as a composite of HIV VL <200/ml and attendance between 1-2 years from initiation of ART. Non-parametric tests were used for comparisons. Time to and Cox regression analysis explored factors associated with time to undetectable VL. Data analysed with SSPS. Results: 215 people were newly diagnosed with HIV in outpatient setting in London, UK: 52 prior to the Rapid ART Pathway (02/2018-02/2019) and 164 after (02/2019-02/2022). Clinical characteristics shown in Table1 and Figure1. Comparing pre and post Rapid ART Pathway, median (IQR) time from diagnosis to ART offer was 18 (8,40) and 7 (2,14) days (p <0.001) respectively, with 25% compared to 61% starting as per rapid ART definition. Reasons for delayed ART initiation in Rapid ART Pathway group included logistical/administrative (44%), clinical OI concerns (20%) and patient disengagement (20%). Median time (IQR) from diagnosis to VL suppression <200 copies/ml was shorter in the Rapid ART Pathway group: 42 (29, 99) compared to 81 (44,120) days (p 0.009). Similar proportion of PWH were retained in care pre- and post-introduction of rapid ART (87% and 84%; P=0.8, respectively). TABLE 1. Overall n (%) or (IQR) Pre- Rapid ART Pathway Group (02/2018-02/2019) n (%) or (IQR) Post – Rapid ART Pathway Group (02/2019 – 02/2022) n (%) or (IQR) P Value Median Age at diagnosis (IQR) 36 (27,48) 40 (29, 51) 34 (27, 47) 0.45 Gender: Male at birth Transfemale 171 (80%) 2 (1%) 41 (80%) 1 (2%) 130 (80%) 1 (0.5%) 0.85 0.40 MSM 116 (54%) 32 (62%) 84 (52%) 0.26 Median Baseline CD4 (IQR) 391 (233,622) 375 (253, 622) 393 (253,622) 0.63 Baseline HIV VL Log (IQR) 4.6 (3.9, 5.3) 4.6 (3.6, 5.1) 4.7 (3.9, 5.4) 0.29 Clade B 76 (35%) 15 (29%) 61 (37%) 0.32 Evidence of Transmitted Drug Resistance 44 (21%) 9 (18%) 35 (22%) 0.56 Evidence of HIV Seroconversion 32 (15%) 4 (8%) 28 (13%) 0.12 HIV-2 8 (4%) 2 (4%) 6 (4%) 1.00 Offered ART 212 (99%) 52 (100%) 160 (98%) 1.00 Accepted ART 203 (94%) 49 (94%) 154 (95%) 1.00 Rapid ART (<7d from confirmed diagnosis) 112 (52%) 13 (25%) 99 (61%) <0.05 Median Time to HIV VL<50 (IQR) 88 (38,165) 105 (54,190) 81 (36,149) 0.58 Median Time to HIV VL<200 (IQR) 48 (31, 102) 81 (44, 120) 42 (29, 99) <0.05 CD4<200 42 (20%) 16 (31%) 26 (16%) <0.05 CD4<350 92 (43%) 23 (44%) 69 (42%) 0.87 Retained in care 182 (85%) 45 (87%) 137 (84%) 0.8 Achieved VL<50 197 (92%) 47 (90%) 150 (92%) 0.77 Achieved VL<200 205 (95%) 51 (98%) 154 (95%) 0.46 TABLE 1. (CONT) Overall n (%) or (IQR) Pre- Rapid ART Pathway Group (02/2018-02/2019) n (%) or (IQR) Post – Rapid ART Pathway Group (02/2019 – 02/2022) n (%) or (IQR) P Value eGFR<60 11 (5%) 3 (6%) 8 (5%) 0.73 ALT X4 Upper limit of Normal 4 (2%) 1 (2%) 3 (2%) 1.00 TB IGRA positive 11 (6%) 2 (6%) 9 (5%) 0.59 HBsAg positive 11 (5%) 1 (2%) 10 (6%) 0.30 Syphilis Serology: RPR ≥ 1:8 17 (8%) 6 (12%) 11 (7%) 0.25 Initiated on 2-drug regimen ART 12 (6%) 1 (0.5%) 11 (7%) 0.3 Initiated Integrase inhibitor as third ART agent 134 (62%) 31 (60%) 103 (63%) 1.0 Initiated Protease inhibitor as third ART agent 57 (27%) 13 (25%) 44 (27%) 1.0 Initiated on 4-drug ART regimen 9 (15%) 68 (15%) 1 (0.5%) <0.05 Conclusions: Rapid ART Pathway led to faster time to ART initiation and VL suppression. However, no improvement in retention in care was observed. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 1 1 1 1 1
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