EACS2023: 466 Marginalization related to material deprivation and ethnic concentration among patients receiving injectable ART at academic HIV clinics in Toronto A. Wijesinghe , A. Arulananthan , A. Chan , A. Tseng , D.H.S. Tan University of Toronto, Temerty Faculty of Medicine, Toronto, Canada, St. Michael's Hospital, MAP Centre for Urban Health Solutions, Toronto, Canada, Sunnybrook Health Sciences Centre, Toronto, Canada, University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada, Toronto General Hospital, Toronto, Canada, St. Michael's Hospital, Division of Infectious Diseases, Toronto, Canada, University of Toronto, Department of Medicine, Toronto, Canada General data Abstract category: Antiretroviral therapy – observational studies Abstract body Purpose: Long-acting injectable cabotegravir and rilpivirine (CAB/RPV-LA) is a maintenance regimen for people living with HIV (PLWH), offering potential adherence, convenience and privacy-related advantages over oral antiretroviral therapy (ART). We examined the degree to which the distribution of CAB/RPV-LA utilization differed, with respect to racial and economic marginalization, from that of oral ART within the 12-month period after its inclusion in the Ontario Drug Benefit formulary (Dec2021-Nov2022). Method: Using the RE-AIM implementation framework, we analysed the Reach (characteristics and proportion of users) of CAB/RPV-LA at three hospital-based HIV clinics in Toronto, Canada. Included individuals had to be on standard 2/3-drug ART regimens; have HIV RNA<200copies/mL, no contraindications/resistance to CAB/RPV-LA, and known postal code. Clinical and demographic data for patients were extracted from clinic charts/databases. Using postal codes, participants were categorized into quintiles according to two dimensions of the Ontario Marginalization Index (ON-Marg): Material Deprivation (capturing income, education, family structure) and Ethnic Concentration (reflecting visible minority and immigrant status), where 1=least and 5=most marginalized. Results: Of 1467 eligible PLWH, mean age was 50.8±12.8 years, 72.3% were male, 35.2% were white, 52.4% were MSM, and n=71 (5.4%) accessed CAB/RPV-LA. In the Material Deprivation analysis, both groups showed comparable proportions of individuals facing high levels of marginalization (Figure 1). However, there was an over-representation of CAB/RPV-LA users compared to Q5 (40.4% vs 30.3%, OR=3.54, 95%CI=1.89-6.82, p<0.01). The distribution of Ethnic Concentration quintiles was similar between groups, with a substantial proportion of individuals in the high-marginalization quintiles. Conclusions: Initial findings indicate that CAB/RPV-LA is being accessed by a greater proportion of individuals experiencing lower levels of material deprivation compared to those receiving oral ART. Further efforts to ensure equitable access to CAB/RPV-LA are needed. Table 1: Demographics and HIV risk factors of included patients Oral ART CAB/RPV-LA Total p-value n 1396 71 1467 Age (mean (SD)) 51.06 (12.78) 46.46 (12.63) 50.84 (12.81) 0.003 Gender (%) 0.131 Female 392 (28.1) 11 (15.5) 403 (27.5) Male 998 (71.6) 60 (84.5) 1058 (72.3) Race (%) 0.97 White 453 (35.1) 26 (37.7) 479 (35.2) Black 472 (36.6) 22 (31.9) 494 (36.4) Asian 177 (13.7) 9 (13.0) 186 (13.7) Indigenous 9 (0.7) 0 (0.0) 9 (0.7) Latinx 107 (8.3) 7 (10.1) 114 (8.4) Middle Eastern 29 (2.2) 2 (2.9) 31 (2.3) Mixed 2 (0.2) 0 (0.0) 2 (0.1) Other 41 (3.2) 3 (4.3) 44 (3.2) HIV Risk Factors (%) 0.064 Vertical Transmission 4 (0.2) 1 (1.5) 4 (0.3) MSM & IDU 15 (1.2) 2 (3.0) 17 (1.2) MSM 651 (50.3) 46 (68.7) 697 (51.2) IDU 17 (1.3) 0 (0.0) 17 (1.2) From Endemic regions 108 (8.3) 2 (3.0) 110 (8.0) Heterosexual contact 474 (36.7) 16 (23.9) 490 (36.0) Other 24 (1.9) 0 (0.0) 24 (1.8) Figure 1: Distribution of included patients according to levels of marginalization 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 1,3 4,5 1,2,6,7 1 2 3 4 5 6 7 122 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
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