APACC
2024

ASIA-PACIFIC AIDS
& CO-INFECTIONSCONFERENCEHYBRID CONFERENCE
HONG KONG
27-29 JUNE 2024

ABSTRACT BOOK
Asia-Pacific AIDS & Co-infections Conference 2024
27-29 June 2024 | Hong Kong

All meeting materials such as abstracts, presentations, etc
will be posted on www.AcademicMedicalEducation.com

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ORAL ABSTRACT PRESENTATIONSPaper # - Paper Title

Page #

1 - Optimizing real-time data flow from community outreach to public facility HIV confirmatory testing andtreatment for key population clients in Ho Chi Minh City, Vietnam .................................................................... 21
2 - Hybrid Model of Care: Looking at Lessons Learned in Blending In-person and Teleconsultation in an HIV
Clinic in the Philippines through the RE-AIM Framework .................................................................................... 22
3 - Enhancing Same-Day ART Policy and Implementation at a Provincial Level through a National Contest:
Short-Term and Long-Term Results from the Thailand Test and Treat Contest ................................................... 23
4 - Enhancing treatment outcomes, mental health, and quality of life for stable people Living with HIV: a quasiexperimental study of a community-based antiretroviral therapy delivery model in Cambodia ........................ 24
5 - Facilitators and Barriers to Mental Health Service Integration in Outpatient HIV Care: Insights from Women
Living with HIV in Malaysia ................................................................................................................................... 25
6 - Strongly Association of PNPLA3 rs738409 genotype on hepatic steatosis among non-obese people livingwith HIV ................................................................................................................................................................ 26
7 - Noninferior efficacy, reduced weight gain, and improved lipid metabolism of switch to ainuovirine- versus
boosted elvitegravir-based regimen in virologically suppressed people living with human immunodeficientvirus 1: the 48-week results of the SPRINT trial ................................................................................................... 27
8 - Week 96 Asian Sub-Analysis of a Phase 3 Randomized Controlled Trial ofBictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) vs Dolutegravir + Emtricitabine/Tenofovir
Disoproxil Fumarate (DTG + F/TDF) as Initial Treatment in HIV-1/HBV Coinfected Adults (ALLIANCE) ............... 29
9 - Dolutegravir/lamivudine versus bictegravir/emtricitabine/tenofovir alafenamide fumarate: Real-world
Assessment of weight Gain in people living with HIV of Asian OrigiN (DRAGON study) ...................................... 30
10 - Same-day treatment of sexually transmitted infections among people living with HIV: an opportunity toapply lessons learned from community-led clinics in Bangkok, Thailand ............................................................ 31
11 - The Effectiveness of Co-Created Digital Intervention to Improve PrEP Adherence Among Chinese Men Who
Have Sex with Men: A Stepped-wedge Randomized Trial in China ...................................................................... 32
13 - Preferences for accessing pre-exposure prophylaxis among men who have sex in Australia ...................... 34
14 - Impact of changing PrEP regimens on retention among men who have sex with men in Hanoi, Vietnam(2020-2023) .......................................................................................................................................................... 35
15 - Assessing HIV prevention coverage among men who have sex with men (MSM) across 15 countries in Asia:
Results from the PrEP APPEAL Study .................................................................................................................... 36
16 - Fully Integrated Mental Health Management within Routine HIV Adolescent and Young Adult Services
using a Collaborative Care Model in Thailand: Lessons Learned .......................................................................... 37
17 - Enhancing access to HIV, sexual and reproductive health, and gender-based violence services for female
entertainment workers in Cambodia: a cluster randomized controlled trial of a mobile health intervention .... 38
18 - Developing and evaluating an HIV self-testing service with online real-time counselling provided by an
artificial intelligence Chatbot (HIVST-Chatbot) ..................................................................................................... 39

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19 - Integrating strengths from various sources through a digital health platform: an online-to-offline service
model for HIV pre-exposure prophylaxis (PrEP) ................................................................................................... 40
20 - Integrating hepatitis C virus self-testing into HIV and harm reduction services as an approach towards HCV
micro-elimination among key populations and people living with HIV in Vietnam. ............................................ 41
21 - Outcomes from a community-clinic hybrid PrEP approach as part of a clinical trial in China, 2021-2023 ... 42
102 - Machine Learning Algorithms for Predicting HIV Infection among Young Men Who Have Sex with Men in
Thailand. ............................................................................................................................................................... 43
108 - A mobile health approach for facilitating regular HIV testing among men who have sex with men .......... 44

POSTER ABSTRACT PRESENTATIONSPaper # - Paper Title

Page #

22 - Integrated analysis of microbiome and host transcriptome unveils correlations between lung microbiota
and host immune in bronchoalveolar lavage fluid of pneumocystis pneumonia patients with HIV/AIDS........... 46
23 - Withdrawn..................................................................................................................................................... 47
24 - Enhanced immune reconstitution with Albuvirtide in HIV-infected immunological non-responders .......... 48
25 - Altered KEGG pathways are associated with different immunologic responses to antiretroviral therapy in
HIV-infected men who have sex with men ........................................................................................................... 49
26 - Polymorphonuclear Myeloid-Derived Suppressor Cells regulates immune reconstitution during HIV
infection through PD-L1 and TGF-β signaling ....................................................................................................... 50
27 - The potential role of P-selectin glycoprotein ligand-1 in the onset of incomplete immune recovery in HIV
infection ................................................................................................................................................................ 51
28 - An atlas of immune cell transcriptomes in human immunodeficiency virus-infected immunological nonresponders identified marker genes that control viral replications ..................................................................... 52
29 - Diagnostic and prognostic utility of Xpert Ultra in blood and Myco/F Lytic blood culture for TB in
hospitalized patients with advanced HIV disease in Vietnam .............................................................................. 53
30 - Mortality Risk Prediction Model in AIDS Patients with Pneumocystis Pneumonia in China ......................... 54
31 - HCV, HBV and Syphilis Infections Incidence Among People living with HIV in a Thai Cohort ....................... 55
32 - An evaluation of Mp1p antigen screening for talaromycosis in HIV-infected antiretroviral therapy-naïve
population in Guangdong, China .......................................................................................................................... 56
33 - A Field Evaluation of a Dual Treponemal/Non-treponemal Point-Of-Care Test for Syphilis Within an HIV
Pre-exposure Prophylaxis Program in Hanoi, Vietnam......................................................................................... 57
34 - The incidence of active tuberculosis in HIV-infected individuals not receiving universal tuberculosis
preventive treatment: a retrospective cohort study ............................................................................................ 58
35 - Expression and prognostic significance of the PD-1/PD-L1 pathway in AIDS-related non-Hodgkin lymphoma.............................................................................................................................................................................. 59

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36 - Transverse comparison of clinical characteristics and prognostic factors in HIV infected patients with
Cytomegalovirus encephalitis in Guangdong, China ............................................................................................ 60
37 - HIV knowledge, its transmission, prevention and treatment associated with HIV testing among
reproductive women ............................................................................................................................................ 61
38 - Patterns of liver fibrosis evolution in Chinese HIV/HBV coinfected adults after 5-year TDF-containing ART62
39 - Overweight and low anti-HBs antibody titers are associated with earlier loss of anti-HBV seroprotection
after HBV vaccination in Japanese people living with HIV.................................................................................... 63
40 - In silico and in vitro Anti-hepatitis B virus activity of bioassay-guided compound quercetin and Myricetin-3O-rhamnoside from Pistacia lentiscus .................................................................................................................. 64
41 - Efficacy of Bictegravir/Emtricitabine/Tenofovir Alafenamide among Treatment-Naïve Patients with Pretreatment Drug Resistance: A Chinese Real-World Study .................................................................................... 65
42 - Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed Participants with
Historical Pre-existing Drug Resistance ................................................................................................................ 66
43 - Efficacy of antiretroviral therapy in HIV-1 patients harboring drug resistance mutations to non-nucleosidereverse transcriptase inhibitors: Results of a retrospective study in China ......................................................... 67
44 - Neglected Low-Level Viremia on Virological Failure in People Living With HIV: Is Prediction Possible? ...... 68
45 - Acceptance and preference for Long-Acting Antiretrovirals among people living with HIV in China ........... 69
46 - Cost-Effectiveness Analysis of Long-Acting Cabotegravir Plus Rilpivirine Versus Daily Oral Antiretroviral
Therapy for People with HIV-1 Infection Who are Virologically Suppressed on a Stable Antiretroviral Regimen in
Singapore .............................................................................................................................................................. 70
47 - Willingness to switch to long-acting injectable cabotegravir and rilpivirine every 2 months for HIV-infectedpatients in Nanjing, China..................................................................................................................................... 71
48 - Effect of Fluconazole on the Pharmacokinetics of Ainuovirine in Healthy Adult Subjects ............................ 72
49 - Charting the Uncharted: The Anonymous Clinic's Revolutionary March to 95-95-95 Victory in Bangkok.... 73
50 - Enhanced Treatment Outcomes in Chinese Patients with Rapid Initiation of ART: Insights from Central
China ..................................................................................................................................................................... 74
51 - HIV-1 Viral RNA and total DNA Decay Dynamics in Antiretroviral-Naïve Adults Initiating
Dolutegravir/Lamivudine versus Bictegravir/Emtricitabine/Tenofovir Alafenamide Therapy ............................. 75
52 - Efficacy and effect on lipid profile of ainuovirine-based regimen versus efavirenz-based regimen intreatment-naïve, HIV-1–positive adults: week 24 results from a multicenter, real-world, retrospective cohort
study ..................................................................................................................................................................... 76
53 - Efficacy and effect on lipid profiles of switching to ainuovirine-based regimen versus continuing efavirenzbased regimen in HIV-1-Infected patients: week 24 results from a real-world, retrospective multi-center cohort
study ..................................................................................................................................................................... 77
54 - The Efficacy and Safety of Switching to Dolutegravir and Lamivudine-Based Regimen for Virological
Suppression in People Living with Human Immunodeficiency Virus Type 1: A Systematic Review and MetaAnalysis ................................................................................................................................................................. 78

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55 - Pharmacokinetics, efficacy and safety study of switching to albuvirtide every 4 weeks plus dolutegravir for
maintenance of virological suppression in adults living with Human Immunodeficiency Virus 1........................ 79
56 - Dolutegravir/lamivudine as a First-Line Regimen in a Test-and-Treat Setting: Real-World Evaluation ........ 80
57 - Real-world Virologic and Safety Outcomes in People Living With HIV-1 Using Dolutegravir + Lamivudine in
Asia Stratified by Viral Load, Including in Individuals With High Viral Loads ........................................................ 81
58 - CHANGES IN SLEEP QUALITY AFTER TRANSITIONING FROM NEVIRAPINE TO DOLUTEGRAVIR-BASEDREGIMEN IN ADULTS LIVING WITH HIV ................................................................................................................ 82
59 - Anal high-grade squamous intraepithelial lesion screening algorithms for Thai cisgender men andtransgender women who have sex with men: baseline results of a multiphase optimization strategy study .... 83
60 - Differences in cognitive trajectories between sexes among aging virologically suppressed Thai people livingwith HIV ................................................................................................................................................................ 84
61 - Clinical impact of switching to DTG/3TC on the recovery of BMD in PLHIV .................................................. 85
62 - Impact of Depression on Virological Outcomes and Quality of Life among People Living with HIV in
Thailand ................................................................................................................................................................ 86
63 - ASSOCIATION OF STAPHYLOCOCCUS AUREUS NASAL COLONIZATION WITH SKIN AND SOFT TISSUE
INFECTIONS AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN A SPECIALTY HOSPITAL IN
THE PHILIPPINES ................................................................................................................................................... 87
64 - The burden of sleep disturbances among people living with HIV/AIDS in China: A systematic review andmeta-analysis ........................................................................................................................................................ 88
65 - The Ratio of Hemoglobin to Red Cell Distribution Width is the Superior Predictor of Survival in AIDS-related
DLBCL: a Novel Inflammatory Marker .................................................................................................................. 89
66 - The prevalence and risk factors of frailty in Japanese people living with HIV aged over 40 years; A single
centre analysis ...................................................................................................................................................... 90
67 - Screening and Linkage Coverage for Mental Health and Substance Use among People Living with HIV
attending an Outpatient HIV Clinic in Malaysia .................................................................................................... 91
68 - Factors associated with the longitudinal trajectories of depression and their impact on mortality amongpeople living with HIV in Guangdong Province, China.......................................................................................... 92
69 - Expression and prognostic significance of PD-1/PD-L1 pathway in AIDS-related non-Hodgkin lymphoma.. 93
70 - Causes of hospitalization and trends of HIV/AIDS inpatients in a tertiary hospital in Nanjing, China, 20132022 ...................................................................................................................................................................... 94
71 - Non‐communicable disease multimorbidity among adults living with HIV in a tertiary care hospital in
Nanjing, China....................................................................................................................................................... 95
72 - Cognitive performance disparities between sexes among aging people living with and without HIV in
Thailand: A cross-sectional study ......................................................................................................................... 96
73 - CTO in People Living with HIV: Navigating Complexities in Interventional Challenges. ................................ 97
74 - Oral semaglutide demonstrates comparable effectiveness to conventional injectable GLP1 receptor
agonists in Asian HIV-positive patients with type 2 diabetes mellitus. ................................................................ 98

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75 - Safety and Efficacy of Anti-PD-1/Anti-PD-L1 Therapy in Cancer Patients Living With HIV: A Systematic
Review and Meta-Analysis .................................................................................................................................... 99
76 - Incidence and risk factors regarding atherosclerotic cardiovascular disease in middle-aged and elderly
people with HIV treated in Chongqing, China .................................................................................................... 100
77 - Mental Health-seeking Behaviour and Literacy among Women Living with HIV: An Exploratory Qualitative
Study at a Tertiary Teaching Centre ................................................................................................................... 101
78 - Late HIV diagnosis among people with HIV in Thailand in the era of same-day ART initiation................... 102
79 - Growing sustainable HIVST self-test (HIVST) markets: Fostering community leadership and private sector
engagement to facilitate market entry for commercial HIVST kits in Vietnam. ................................................. 103
80 - Comparative analysis of people living with HIV identified by community-based organizations and healthcare facilities in Bishkek and Osh, Kyrgyzstan .................................................................................................... 104
81 - Incidence, predictors and health outcomes associated with cognitive frailty in people ageing with HIV .. 105
82 - Health outcomes among ageing women living with HIV on antiretroviral therapy in Malaysia ................. 106
83 - Coronary Artery Calcium and Abnormal Arteries for Predicting Death and Cardiovascular Outcome in Older
People Living with HIV: A cohort Study .............................................................................................................. 107
84 - Risk factors associated with progression to or persistence of sarcopenia over time in people living with HIV............................................................................................................................................................................ 108
85 - Efficacy, safety and patient reported outcome of Dolutegravir/Lamivudine in Antiretroviral-experienced
Adults in Yunnan, China ...................................................................................................................................... 109
86 - Depression, Anxiety, Stress, Self-Esteem, and HIV-related Stigma in Adolescents and Young Adults Livingwith Perinatal HIV in Northern Thailand. ........................................................................................................... 110
87 - Late HIV diagnosis and the unrealised benefit of regular testing: findings from a study on people with
newly diagnosed HIV infection ........................................................................................................................... 111
88 - Linkage to care and prevention after HIV self-testing: A systematic review and meta-analysis ................. 112
89 - Enhancing Communication but Falling Short on Timely Visits: A Case Study of the Medical Appointment
Notification Assistance (MANA) Application in HIV Patient Care, Bangkok ....................................................... 113
90 - Attrition and viral suppression rates among children with perinatally acquired HIV in the Thai National
AIDS Program ...................................................................................................................................................... 114
91 - Rapid initiation of antiretroviral therapy under the Treat-All policy reduces loss to follow-up and virological
failure in routine HIV care settings in China: A retrospective cohort study (2016-2022)................................... 115
92 - HIV continuum among key populations through the Universal Health Coverage program in Thailand in theera of treat all ..................................................................................................................................................... 116
93 - Longitudinal Health-Related Quality of Life in Hospitalized Patients with Advanced HIV Disease - A MultiCenter Cohort Study in Vietnam ......................................................................................................................... 117
94 - Testing for Neisseria gonorrhoeae infections and performing test-of-cure within a HIV pre-exposure
prophylaxis program in Hanoi, Vietnam ............................................................................................................. 118
95 - Masked by Mildness: Differentiating Mpox from Common STIs in a Bangkok OPD Clinic .......................... 119

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96 - Incidence of Gonorrhea, Chlamydia and Syphilis Infection among Asymptomatic Women in a HIV Clinic in
Hong Kong .......................................................................................................................................................... 120
97 - High Incidence of Chlamydial and Gonorrheal Infection Among Asymptomatic MSM in a HIV Clinic in Hong
Kong .................................................................................................................................................................... 121
98 - Mpox vaccination uptake and inclination to vaccinate among men who have sex with men .................... 122
99 - Doxycycline prophylaxis for sexually transmitted infection prevention in Vietnam: Awareness, attitudes,
and willingness to use among men who have sex with men using HIV PrEP ..................................................... 123
100 - A pilot study of the Internet of Things (IoT) medication-assisted system to improve HIV antiretroviraltherapy adherence and treatment response ..................................................................................................... 124
101 - Behavioral Survey of HIV-Infected Cases with Delayed Diagnosis in Taoyuan District, Taiwan ................ 125
103 - Potential Acceptability, Feasibility, and Effectiveness of Point of Care HIV Syphilis Testing (POCT) by
Community Health Workers (CHW) in Indonesia from Multiple Perspectives: A Formative Research.............. 126
104 - Increasing access to SelfCare: Employing a online-based demand generation strategy to increase uptakeof peer-led unassisted HIV self-testing among key populations in the Philippines ............................................ 127
105 - Implementation of the first quality control program for HIV recent infection testing using dried tube
specimens in Lao People's Democratic Republic, 2022 ...................................................................................... 128
106 - Revolutionizing HIV Viral Load Testing: A Leap Towards Non-Infectious, Stable Quality Control Materials............................................................................................................................................................................ 129
107 - Lessons learned from implementing multilingual HIV and syphilis testing events for internationalmigrants in Japan ................................................................................................................................................ 130
109 - Do young people prefer to use HIVST? Evidence from a choice experiment in northeastern Thailand .. 131
110 - Introducing Social and Sexual Network Testing in the Philippines through Pilot Capacitation of HIV Service
Delivery Sites in Greater Manila: A Novel Step in Expanding HIV Testing in the Philippines ............................. 132
111 - Scaling-up Index Testing Services through Qualitative Evaluation and Capacity Building for a Non-Profit
Organization for PLHIV in Metro Manila, Philippines ......................................................................................... 133
112 - Lessons Learned from Cambodia's Integrated Point-of-Care Testing for Prevention of Mother-to-Child
Transmission (PMTCT) of HIV ............................................................................................................................. 134
113 - Real-world experience of providing HIV pre-exposure prophylaxis for female sex workers in Hong Kong............................................................................................................................................................................ 135
114 - Efficacy and Safety of Switching to Dolutegravir plus Lamivudine in HIV-1 infected adults with virologicalsuppression and evidence of TDF toxicity: interim analysis through week 24 ................................................... 136
115 - Enhancing HIV Care: Rapid Antiretroviral Therapy Initiation in a Community-Based Organization Clinic in
Kuala Lumpur, Malaysia...................................................................................................................................... 137
116 - Roles and experiences of community action workers in a community-based antiretroviral therapy
delivery model for people living with HIV in Cambodia: A mixed-methods cross-sectional study .................... 138
117 - Construction and validation of prognostic scoring models to risk stratify patients with acquired immune
deficiency syndrome‐related diffuse large B cell lymphoma ............................................................................. 139

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118 - How well does a tailored approach work for the implementation of an evidence-based intervention:
qualitative findings from a hybrid type III trial of a systems navigation and psychosocial counseling intervention(SNaP) for people who inject drugs living with HIV in Vietnam ......................................................................... 140
119 - Clinical Characteristics and Outcomes of AIDS-Related Burkitt Lymphoma in China: A Retrospective
Single-Center Study ............................................................................................................................................ 141
120 - Amphotericin B Colloidal Dispersion is efficacious and safe for the management of talaromycosis in HIVinfected patients: Results of a retrospective cohort study in China................................................................... 142
121 - Evidence of peer-led demedicalized delivery of same-day PrEP in various community centers in thePhilippines .......................................................................................................................................................... 143
122 - HIV self-testing as an entry point to HIV status-neutral approach services for transgender women:
Experiences from real-world implementation at the Tangerine Clinic in Thailand ............................................ 144
123 - Improving Treatment Outcomes in Medication for Opioid Use Disorder through Low-Cost Contingency
Management: Insights and Recommendations from a qualitative study in Vietnam ........................................ 145
124 - Strategy for implementation of long acting cabotegravir as Prep in Australia - a perspective from generalpractice ............................................................................................................................................................... 146
125 - The role of private sector engagement in scaling up and sustaining access to pre-exposure prophylaxis(PrEP) in Vietnam. ............................................................................................................................................... 147
126 - Barriers and facilitators to implementing a pharmacy-based HIV pre-exposure prophylaxis (PrEP) service
delivery model among key populations, PrEP prescribers and community pharmacists in the Klang Valley,
Malaysia. ............................................................................................................................................................. 148
127 - Barriers and facilitators of implementation of a pay-it-forward gonorrhoea and chlamydia testing
program among Chinese men ............................................................................................................................ 149
128 - Empowering communities to optimise uptake and use of HIV pre-exposure prophylaxis (PrEP):
Crowdsourcing open calls in Australia, the Philippines, Thailand and China ..................................................... 150
129 - Association between attitudes towards PrEP and its adherence pattern: findings from an implementation
study ................................................................................................................................................................... 151
130 - WILLINGNESSA ND COMFORT TO COUNSEL HIV PRE-EXPOSURE PROPHYLAXIS TO CLIENTS AMONG
PHARMACISTS IN SELANGOR, MALAYSIA ........................................................................................................... 152
131 - Easy way to level up your strength of prevention. One retrospective study at one HIV-care designatedhospital since 2017-2023 .................................................................................................................................... 153
132 - Restarting pre-exposure prophylaxis (PrEP) for HIV: A systematic review and meta-analysis ................. 154
133 - Missed opportunities of HIV Pre-Exposure Prophylaxis (PrEP) discussion among clients attended for STIrelated care at a Community-Based Organization (CBO)- led clinic in Malaysia ................................................ 155
134 - Sexual risk compensation and retention of PrEP: a HIV PrEP Demonstration Study in South Korea ........ 156
135 - Community-led same day antiretroviral therapy initiation successfully closes linkage to treatment gaps at
a sex worker-led clinic in Bangkok, Thailand ...................................................................................................... 157
136 - The Impact of a Multi-Intervention Program on Depression in HIV-Positive Patients Engaging in Chemsex:
A 42-Week Study ................................................................................................................................................ 158

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137 - Impact of Local Civil Society Organizations on Early Diagnosis in the Thailand Test and Treat Contest:
Assessment of Provincial Short-Term and Long-Term Outcomes ...................................................................... 159
138 - Enhancing motivational counseling training for HIV service providers in Vietnam ahead of nationalrollout: Insights into perceived applicability and barriers among trainees ........................................................ 160
139 - Using a rule-based algorithm to automatic classify cause of mortality from free-text on death certificates:
AIDS-related mortality results among PLHIV registered in the National AIDS Program, Thailand, 2008-2022 .. 161
140 - Bridging the gaps: Identification of capacity and financing needs to integrate and sustain community
complementarity to the national HIV response in Vietnam ............................................................................... 162
141 - Perception Towards the Implementation of the Iloilo City Anti-Discrimination Ordinance (IC-ADO) to theAccessibility of HIV Preventive Services (HIV-PS) among Gay, Bisexual, and Men who have Sex with Men (GBMSM) .................................................................................................................................................................. 163
142 - Thailand’s First Comprehensive Integrated Prevention and Treatment for HIV, TB, and STI in Bangkok
Metropolitan Administration’s Primary Health Clinic ........................................................................................ 164
143 - Sustaining high-quality HIV services through the HIV Disease-Specific Care Certification program in
Thailand, 2020-2023 ........................................................................................................................................... 166
144 - Understanding multi-stakeholder perspectives on comprehensive chemsex services for young men who
have sex with men in Thailand: Qualitative findings from the CLYMAX study ................................................... 168
145 - A multidisciplinary team meeting approach for the care of persons ageing with HIV in a resource-limited
setting ................................................................................................................................................................. 169
146 - The facilitators and barriers to the access of mental health services and support for people living with HIV
in China: A qualitative study from the patient's perspective ............................................................................. 170
147 - In-person pick-up versus postal delivery: PrEP service and its association with adherence and retention
among Chinese MSM .......................................................................................................................................... 171
148 - Feasibility of implementing cognitive testing in a transgender health clinic in Thailand: qualitative insightsfrom transgender women living with and at risk for HIV and their healthcare providers ................................. 172
149 - Co-creating an integrated gonorrhea and chlamydia testing program at community-based HIV testing
centers for men who have sex with men in China ............................................................................................. 173
150 - Cognitive Health Matters: Facilitators and Barriers to The Integration of A Multi-Disciplinary Cognitive
Rehabilitation Programme for Persons Living with HIV(PWH) in an HIV Clinic in Malaysia :A PreImplementation, Qualitative Study. ................................................................................................................... 174
151 - A crowdsourcing open call for reducing hepatitis stigma among healthcare providers in China ............. 176
152 - HIV-related stigma among young people growing up with HIV during transition from pediatric to adultcare in Thailand: a mixed-methods study........................................................................................................... 177
153 - Quality of Life determinants among people living with HIV: an Australian HIV Observational Database(AHOD) sub-study ............................................................................................................................................... 178
154 - HIV-related knowledge, stigma attitudes, and intent to discriminate in healthcare settings among medical
and nursing students: A cross-sectional study in Bangkok ................................................................................. 179
155 - Breaking Barriers and Stigmas: Lessons Learned from Malaysia's First Kidney Transplant on a Person
Living with HIV .................................................................................................................................................... 180

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156 - Promoting Inclusivity in HIV Care: The Evolution of the Combating Stigma in HIV and Key Populations
Programme (SHAKE UP!) .................................................................................................................................... 181
157 - Patterns of Internalized HIV-related Stigma among Youth Living with HIV in Thailand: A Cross-Sectional
Study ................................................................................................................................................................... 182
158 - Empowering Youth: PrEP4U campaign as an innovative intervention in HIV prevention and demand
generation for HIV services. ............................................................................................................................... 183
159 - Empowering Choices for Health and Beyond: A Status-Neutral Demand Generation Campaign toProactively Combat HIV Transmission in the Philippines ................................................................................... 184
160 - Empowering HIV prevention: Strategies to more meaningful engage key population (KP) and community
leaders in driving tailored HIV pre-exposure prophylaxis (PrEP) communications in Myanmar........................ 185
161 - HIV-related knowledge, attitude, and practice (KAP) among nurses towards people living with HIV in
Singapore. ........................................................................................................................................................... 186
162 - Harmonizing a global vision with local action: safeguarding clients in HIV programming in Vietnam...... 187
163 - Clinical features-based machine learning models to separate sexually transmitted infections from otherskin diagnoses ..................................................................................................................................................... 188
164 - Can AI Chatbots Assist Clinicians in Managing HIV-Related Opportunistic Infections? A Comparative
Evaluation of Accuracy and Readability of ChatGPT 3.5, Gemini, and Microsoft Copilot .................................. 189
165 - Improving Treatment Management Efficiency and Outcomes of People Living with HIV Using an Online
Reservation Application in Laguna Medical Center, Philippines ........................................................................ 190
166 - Implementation and Evaluation of Electronic Patient Reported Outcomes (ePRO) in Japanese Clinical
Practice ............................................................................................................................................................... 191
167 - Is there demand for long-acting injectable cabotegravir for HIV prevention in Australia? Results from across-sectional survey of men who have sex with men ..................................................................................... 192
168 - HIV-related service use and preferences among key populations (KPs) in Vietnam: Results from a
consumer study to support the private sector with strategies for HIV prevention services.............................. 193
169 - iPARTY2: Increasing Pre-Exposure Prophylaxis (PrEP) Access and Reach through Telehealth for Young
Men Who Have Sex with Men (YMSM) in Singapore 2022-2023 ....................................................................... 194
170 - Barriers and facilitators of pay-it-forward interventions for HIV/STI research: A systematic review andqualitative evidence synthesis ........................................................................................................................... 195
171 - Strengthening Community Systems: A strategic advancement for sustainable HIV Response in India .... 196
172 - The differences in attitude and willingness to recommend PrEP among health personnel in rural andurban areas of Iloilo, Philippines ........................................................................................................................ 197
173 - A global review of national guidelines of post-exposure prophylaxis for the prevention of HIV.............. 198
174 - Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD
patients in China: Interim findings from the PIONEER pragmatic, cluster randomized controlled trial. ........... 199
175 - Preferences and Acceptability of Testing for Sexually Transmitted Infections in an HIV pre-exposure
prophylaxis clinic in Hanoi, Vietnam................................................................................................................... 200

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176 - Withdrawn................................................................................................................................................. 201
177 - Pre-Exposure Prophylaxis (PrEP) option preferences among sex workers (SW) in seven provinces inThailand: a national cross-sectional study.......................................................................................................... 202
178 - Ground-Up Harm Reduction Practices for Chemsex in the Context of Punitive Drug Laws: A Qualitative
Study Among Sexual Minority Men in Singapore ............................................................................................... 203
179 - Factors associated with Pre-Exposure Prophylaxis (PrEP) uptake among female, male and transgenderfemale sex workers in seven provinces in Thailand ........................................................................................... 204
180 - High prevalence of gender-based violence among among female, male and transgender female sex
workers in seven provinces in Thailand – A cross sectional study ..................................................................... 205
181 - Negotiating safer chemsex: A qualitative study among sexual minority men who engage in chemsex in
Singapore ............................................................................................................................................................ 206
182 - Association between Sexual Orientation Disclosure, Community Engagement, and HIV/STI Testing Uptake
among Men who Have Sex with Men in Guangdong Province, China: A Mediation Analysis. ........................... 207
183 - Self-reported HIV testing behaviors among migrants in Okinawa, Japan ................................................. 208
184 - High potential for HIV exposure among sex workers in Thailand: a cross-sectional study of pre-exposure
prophylaxis (PrEP) among Thai sex workers ....................................................................................................... 209
185 - High rates of HIV Serostatus Self-Disclosure Amongst Adolescents and Young Adults Living with HIV in
Thailand .............................................................................................................................................................. 210
186 - Mental health knowledge and attitudes among social workers: Quantitative data from animplementation study assessing integration of mental health screening for PLHIV in the Philippines. ............ 211
187 - Moving beyond condomless sex as an indicator of HIV risk: an analysis of national HIV diagnoses andbehavioural surveillance among men who have sex with men in Australia 2012-2022 .................................... 212
188 - Survival probability and risk factors associated with mortality among people living with HIV in Thailand,
2008-2021 ........................................................................................................................................................... 213
189 - Factors Associated with Global and Domain-Specific Neurocognitive Impairment Among People Livingwith and without HIV in Malaysia....................................................................................................................... 214
190 - Shining a Light on the Unseen: Assessing Mycoplasma genitalium in Bangkok's STI and HIV Screening
Efforts ................................................................................................................................................................. 215
191 - Mortality Rate and Cause of Death in People Living with HIV in Long Term Antiretroviral Therapy at HIVNAT, Bangkok, Thailand. ..................................................................................................................................... 216
192 - HIV mortality trends and spatial distribution among persons living with HIV, Thailand, 2008–2022 ....... 217
193 - Trend and associated factors for late and advanced HIV diagnoses in 2011-2023 in Melbourne, Australia............................................................................................................................................................................ 218
194 - PrEP Re-initiation among Men Who Have Sex with Men in Guangzhou and Wuhan, China: a Multi-center
Cohort Study ....................................................................................................................................................... 219
195 - Epidemiological impacts and cost-effectiveness of daily and on-demand oral Pre-Exposure Prophylaxis
among key HIV populations in China: an economic evaluation ......................................................................... 220

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196 - Impact of peer referral on Pre-Exposure Prophylaxis adherence and persistence among Gay, Bisexual,and Other Men Who Have Sex with Men: A cohort ctudy in China ................................................................... 221
197 - Addressing the mental health needs of HIV program beneficiaries: Outcomes of two distinct screening
approaches in public and private clinics in Vietnam .......................................................................................... 222
198 - Usage patterns, experiences, harms, and sexual agency among Thai young men who have sex with men
who use chemsex: Quantitative findings from the CLYMAX study .................................................................... 223
199 - We Ask the Y (WAY): The impact of capacity-building in improving young people-led initiatives for the HIV
response in Malaysia .......................................................................................................................................... 224
200 - Unitour Campaign: How public-private sector engagement enhanced youth access and uptake of HIV andsexual and reproductive health (SRH) services in Vietnam. ............................................................................... 225
201 - Insights and Strategies: The Evolving Landscape of HIV/AIDS Cases Pre and Post the COVID-19 Pandemicin Hong Kong....................................................................................................................................................... 226
202 - Co-create innovative PrEP service approaches with the community: Experiences from PrEP users in China............................................................................................................................................................................ 227
203 - Analysis of Mpox Knowledge and Associated Risk Factors Among Men Who Have Sex with Men withDifferent HIV Infection Status in Jiangsu Province, China .................................................................................. 228
204 - Promoting PrEP among overseas-born and newly arrived gay, bisexual, and other men who have sex withmen (GBMSM): An Australian perspective ......................................................................................................... 229
205 - Community engaged interventions and advocacy efforts for hepatitis B/C elimination: a global systematic
review and crowdsourcing open call .................................................................................................................. 230
206 - Gaymi as a Bridge: Campaign Evaluation of HIV Self-testing Secondary Distribution among YSMSM ..... 231
207 - Implementation of virological point-of-care testing for HIV-positive mothers and exposed infants toincrease testing and timely clinical action: Cambodia’s experience .................................................................. 232

E-POSTER ABSTRACT PRESENTATIONSPaper # - Paper Title

Page #

208 - Effect of inter-cellµlar HIV-1 Nef transfer on the liver diseases in HIV-1/HCV Co-infected Patients ........ 234
209 - High satisfaction with point-of-care Chlamydia and Gonorrhoea testing in community-led clinics amongclients and key population lay providers in Thailand ......................................................................................... 235
210 - Addressing TB-HIV management gaps in Nepal: collaborative strategies and policy recommendations . 236
211- Treatment Outcomes and Associated Factors among Tuberculosis-Human Immunodeficiency Virus Coinfection Patients at Bicol Medical Center: a Retrospective Cohort Study ........................................................ 237
212 - What lies beneath: Multi-drug resistant disseminated tuberculosis of the bone marrow, GI and lymph
nodes in a 31-year old PLHIV with severe aplastic anemia: A CASE REPORT ..................................................... 238
213 - False-Negative Serum Cryptococcal Antigen Test due to Post-zone Phenomenon in an Advanced HIV
Patient ................................................................................................................................................................ 239

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214 - HIV knowledge and attitudes of women toward PLHIV in Iloilo City, Philippines ..................................... 240
215 - Factors associated with prevalence of cryptococcal capsular antigen among people living with HIV: aretrospective observational cohort study. ......................................................................................................... 241
216 - The willingness for HIV testing among risk women population and reasons for not getting tested ........ 242
217 - Disseminated Non-tuberculous Mycobacterial Infections among People Living with Human
Immunodeficiency Virus: A Systematic Review and Meta-Analysis ................................................................... 243
218 - Epidemiological investigation on the incidence and mortality risk of Kaposi's sarcoma associated with HIV
in Japan ............................................................................................................................................................... 244
219 - Genital Warts in People Living with HIV in Korea: A Retrospective Descriptive Study. ............................ 245
220 - Exploring sexual behavior patterns in women with HIV and cervical dysplasia: A descriptive study on early
age at first intercourse and number of sexual partners ..................................................................................... 246
221 - Erythema Nodosum Leprosum in an HIV patient with Poor CD4 Cell Recovery: A True Co-Infection ...... 247
222 - HIV knowledge of young adults and HIV testing ....................................................................................... 248
223 - FEATURES OF THE EPIDEMIC PROCESS OF HIV INFECTION IN THE CONDITIONS OF PANDEMIC OF
INFECTIOUS DISEASE COVID-19 .......................................................................................................................... 249
224 - Analysis of Prevalence and Risk Factors with Cytomegalovirus Infection in People with Human
Immunodeficiency Virus (HIV) ............................................................................................................................ 250
225 - Addressing the burden of Hepatitis C among High-Risk Groups: Learning from Punjab Experience ........ 251
226 - HIV/TB Co-infection Managed with Dolutegravir and Lamivudine Combined with Rifampin-based Antituberculosis Therapy .......................................................................................................................................... 252
227 - Finding the TB missing case in the areas of low reported TB cases in Cambodia ..................................... 253
228 - Isoniazide and ofloxacin-loaded PLG nanoparticles: a promising new treatment option for tuberculosis............................................................................................................................................................................ 254
229 - Simplified ART with DTG/3TC in an experienced HIV-Infected Patient with 3TC Resistance: A Case Report............................................................................................................................................................................ 255
230 - Detection of KatG Ser315Thr substitution in Mycobacterium tuberculosis infected patients using PCR RFLP method for screening Isoniazid-Resistance ............................................................................................... 256
231 - Effectiveness and safety study of DTG + 3TC duo simplified regimen in HIV / AIDS complicated withtuberculosis infection ......................................................................................................................................... 257
232 - Efficacy and Safety of INI-based Regimens in Treatment-Naïve and Experienced HIV-1 Patients: A RealWorld Retrospective Study ................................................................................................................................. 258
233 - Real-world efficacy, safety and feasibility of different initiation modes of Dolutegravir/Lamivudine in HIV
treatment-naïve patients.................................................................................................................................... 259
234 - Efficacy, Safety, and Patient-Reported Outcomes After Reverting from DTG/3TC to TDF+3TC+EFV Due toFinancial Difficulty .............................................................................................................................................. 260

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235 - Addressing Treatment Interruption among people living with HIV using a systematic monitoring tool
piloted in Bacoor City, Philippines ...................................................................................................................... 261
236 - Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in treatment-naïve (TN) and treatmentexperienced (TE) people with HIV (PWH): 24-month outcomes from the BICSTaR Asia cohort ........................ 262
237 - Factors associated with poor adherence to antiretroviral therapy in people with HIV in Taiwan ............ 263
238 - ICAROS - An Australian observational study of clients and health workers who use long-acting
cabotegravir and rilpivirine injections for HIV treatment - preliminary baseline survey results. ...................... 264
239 - Effect of baseline factors on the efficacy of DTG/3TC in ART-naive PLHIV: a multicenter retrospective
observational study ............................................................................................................................................ 265
240 - DTG/3TC improve early renal dysfunction caused by TDF in Chinese PLWH ............................................ 266
241 - Efficacy and Safety of Switching to DTG/3TC from INI-Based Three-Drug Regimens in Treated HIV Patients............................................................................................................................................................................ 267
242 - Withdrawn ................................................................................................................................................. 268
243 - Efficacy and Safety of Integrase Inhibitor (INSTI)-based ART Regimens B/F/TAF and DTG/3TC in
Treatment-Naive People with AIDS .................................................................................................................... 269
244 - Efficacy and Metabolic Safety of Bictegravir/ Emtricitabine/ Tenofovir Alafenamide（B/F/TAF）in
Treatment-Naive People Infected with Human Immunodeficiency Virus (HIV)：A 48-week Observational
Analysis ............................................................................................................................................................... 270
245 - Safety and Efficacy of Albuvirtide plus Dolutegravir/Lamivudine compared withBictegravir/Emtricitabine/Tenofovir Alafenamide as initial therapy for HIV-1 Infected and ARV-naïve inpatients,
12-week results of a preliminary real-world study ............................................................................................. 271
246 - Real-world implementation of dolutegravir plus lamivudine for rapid initiation-ART of people living withHIV ...................................................................................................................................................................... 272
247 - Effectiveness and safety of Dolutegravir + Lamivudine for late detection of people infected with HIV... 273
248 - Outcomes of bictegravir/emtricitabine/tenofovir alafenamide versus Tenofovir/lamivudine/ efavirenz innorth China: a single center, real-world assessment ......................................................................................... 274
249 - The efficacy and safety of switching to dolutegravir/lamivudine versus continuing on
abacavir/lamivudine/dolutegravir in adults with virologically-suppressed human immunodeficiency virus-1(HIV-1) infection: the first report of a real world experience from Singapore ................................................... 275
250 - Efficacy and Safety of dolutegravir plus lamivudine versus efavirenz plus tenofovir and lamivudine in HIV1 infected and ART-naive patients in West China .............................................................................................. 276
251 - Changes in weight and blood pressure and its association in treatment naive People Living with HIV(PLHIV) who initiated antiretroviral therapy (ART) in a tertiary care hospital in Malaysia ................................ 277
252 - Prevalence and influencing factors of dyslipidemia among HIV/AIDS patients receiving antiretroviraltherapy in Henan region ..................................................................................................................................... 278
253 - Prevalence and risk factors of metabolic syndrome among HIV patients in a medical center of Northern
Taiwan -- a cross sectional study ........................................................................................................................ 279

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254 - FEASIBILITY AND OUTCOMES OF PCI WITH NOVEL TAPERED CORONARY STENT IN PEOPLE LIVING WITH
HIV: A PROSPECTIVE, SINGLE-CENTER STUDY WITH LITERATURE REVIEW ........................................................ 280
255 - Quality of Life and Nutritional Status in HIV-1 Infected Patients on Maintenance Hemodialysis............. 281
256 - Navigating Challenges: PTMC in People Living with HIV with Severe Mitral Stenosis............................... 282
257 - Hospital Outcomes among People Living With HIV with Opportunistic Infections in a Tertiary Government
Hospital ............................................................................................................................................................... 283
258 - A Case Report of Concurrent Infections in a 17-year-old male: Acquired Immunodeficiency Syndrome,
Pulmonary Tuberculosis, Treatment Failure T/C Multiple Drug Resistant Tuberculosis, COVID-19 confirmed
severe; Cerebral Toxoplasmosis, Paradoxical Immune Reconstitution Inflammatory Syndrome ...................... 284
259 - Withdrawn.................................................................................................................................................. 285
260 - Improving coverage of viral load testing through a referral system led by People Living with HIV (PLHIV) in
Greater Metro Manila (GMM), Philippines ........................................................................................................ 286
261 - From bench to bedside: Elucidating the diagnosis of acute HIV in complex DADA2 case with serial 4th
generation HIV serology, HIV RNA viral load, and Line Immunoassay ............................................................... 287
262 - Withdrawn.................................................................................................................................................. 288
263 - Real World Experience on the Use of Two-Drug Antiretroviral Therapy Regimens in Older People with
HIV: Clinical Parameters ..................................................................................................................................... 289
264 - Optimization of treatment outcomes using client segmentation: Differences between clients who missed
and adhered to clinical appointments. ............................................................................................................... 290
265 - Concurrent Testing for COVID-19 and HIV Infection at Udon Thani Hospital, Field Hospital, and Prison
Field Hospital for Ending the HIV Epidemic in Udon Thani Province, Thailand .................................................. 291
266 - Willingness to receive the 4-component meningococcal serogroup B vaccine for gonorrhoea prevention
in a trial setting among men who have sex with men ........................................................................................ 292
267 - High prevalence of gonorrhea among Thai adolescent and young adult men who have anal sex: A crosssectional study .................................................................................................................................................... 293
268 - Identifying individuals at high risk for HIV and sexually transmitted infections with an artificial
intelligence-based risk assessment tool ............................................................................................................. 294
269 - Significant obstacles to Women Commercial Sex Workers' (WCSWs') access to HIV and STD programs
during the COVID-19 pandemic in Rajshahi, Bangladesh ................................................................................... 295
270 - Impact of human papillomavirus vaccination on anal HPV infection and anal dysplasia among HIV-positivemen who have sex with men .............................................................................................................................. 296
271 - Designing a model of HIV Community-Based Services to address the disruption of HIV services during
Covid-19 Pandemic among MSM community in South Sulawesi, Indonesia: An Implementation Study .......... 297
272 - Cracking the Code to Boost HIV Testing Uptake: A Comprehensive Model Integrating E-commerce
Accessibility and Treatment Referral. ................................................................................................................. 298

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17273 - Acceptability, Feasibility, and Effectiveness of HIV Community-Based Services among MSM Community inIndonesia: An Implementation Research ........................................................................................................... 299
274 - Boosting HIV Self-Testing Kit Uptake: Leveraging Mpox Vaccination Opportunities in Taiwan ................ 300
275 - Rapid Development of Neurological Infection in an HIV Patient Following Schistosomiasis .................... 301
276 - Outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experiencefrom a single-center retrospective cohort.......................................................................................................... 302
277 - The clinical prognostic risk stratification system for HIV infected hepatocellular carcinoma ................... 303
278 - Enhancing private sector’s role in providing comprehensive person-centered care and HIV treatment
services to people in need. ................................................................................................................................. 304
279 - Reaching the unreached vulnerable population with HIV prevention and care services: Learning from
National AIDS Control Programme in India ........................................................................................................ 305
280 - Development and delivery of an online HIV pre-exposure prophylaxis (PrEP) training for community
pharmacists for the implementation of pharmacy-based PrEP service in the Klang Valley, Malaysia............... 306
281 - PrEPPY Spaces: Community-led initiation of PrEP using self-testing kits among men who have sex with
men using online social networks in Metro Manila, Philippines ........................................................................ 307
282 - A Comparative Analysis of the Willingness to Access PrEP Among Cisgender and Other Gender-diverse
Individuals of Iloilo Province ............................................................................................................................... 308
283 - Stakeholder insights on implementing pharmacy-based HIV pre-exposure prophylaxis (PrEP) service
delivery model in the Klang Valley, Malaysia ..................................................................................................... 309
284 - Knowledge, perception, and willingness to access PrEP among individuals in Iloilo, Philippines ............. 311
285 - Overcoming Barriers and Harnessing Opportunities: Lessons from Mongolia's PrEP Demonstration Projectfor MSM Populations .......................................................................................................................................... 312
286 - Dysbiosis of Gut Microbia and Changes of Immune Markers in HIV Pre-Exposure Prophylaxis (PrEP) Users............................................................................................................................................................................ 313
287 - Withdrawn................................................................................................................................................ 314
288 - The Hidden Crisis: The Causes and Consequences of Sexualised Drug Use (‘Chemsex’) amongst Key
Populations in Pakistan....................................................................................................................................... 315
289 - Client and Provider Perspectives on Mental Health Screening and Linkage to Care in Key Population HIV
and Sexual Services in Thailand: A Pre-Implementation Qualitative Study........................................................ 316
290 - Young Trans People First: Youth-inclusive gender-affirming services facilitate access to HIV and sexual
health services among young transgender women in Bangkok, Thailand ......................................................... 317
291 - Strengthening integrated HIV/STD testing services among MSM in China: Qualitative findings from cocreation groups ................................................................................................................................................... 318
292 - The fourth 90: Qualitative study on improving quality of life of young PWH men who have sex with men
living in Metro Manila, Philippines ..................................................................................................................... 319

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293 - Navigating facilitators and barriers to establishing chemsex services in Thailand: Qualitative findings fromthe CLYMAX study .............................................................................................................................................. 320
294 - Transcending healthcare: Exploring tailored service packages to boost transgender key-populations’access and return rate to HIV service deliveries................................................................................................. 321
295 - Navigating pathways towards Thailand's Universal Health Coverage on transgender health: theimportance of catalytic funding, concerted community-led efforts, and political advocacy. ............................ 322
296 - The Unassisted HIV Self-Testing Tag-o-war: A review on Philippines' health system response tocommunity-led HIVST implementation among key populations. ....................................................................... 323
297 - Examining participant satisfaction in service-based research: Prevalence and risk factors of cervical
dysplasia and HPV transmission in women living with HIV in Bali, Indonesia .................................................... 324
298 - Low incidence of directly observed stigmatizing behaviors but high prevalence of attitudes that
contribute to stigma, an analysis of nation-wide stigma survey in healthcare settings in Indonesia. ............... 325
299 - Fear of progression among people living with HIV was positively associated with a negative medical
coping strategy: a cross-sectional study ............................................................................................................. 326
300 - Lived Experiences of Young Professionals Living with Human Immunodeficiency Virus (HIV) ................. 327
301 - Lessons learnt: Challenges of setting up a PrEP clinic in a tertiary hospital in Singapore ......................... 328
302 - Three decades growing up together with HIV in Thailand: Lessons learned............................................. 329
303 - Learning from the expansion of HIV-Related Stigma and Discrimination (S+D) Reduction Quality
Improvement (QI) Project in Government Primary Health Clinics Malaysia ...................................................... 330
304 - Perspectives from Thailand’s National Stakeholders on implementation of key population-led hepatitis C
virus test and treat: A qualitative pre-implementation study ............................................................................ 331
305 - Collaborative Surveillance Strategies against Alarming HIV Prevalence among TGs and MSM in Multan,
Pakistan .............................................................................................................................................................. 332
306 - HIV/AIDS prevention initiatives by rural/tribal community based organizations in rural/tribal Asia ....... 333
307 - Using chatbot for creating awareness on Sexual and Reproductive Health and Rights (SRHR) and HIV
among adolescent from marginalized communities – Learnings from a field project in India .......................... 334
308 - Association of digital media use for information about sex with comprehensive HIV knowledge andawareness of anti-retroviral treatment among adolescents and young adults: Evidence from a middle-income
country................................................................................................................................................................ 335
309 - Community-led Research for Enhancing Pre-Exposure Prophylaxis (PrEP) Uptake Among Sex Workers in
Thailand .............................................................................................................................................................. 336
310 - Transcending the Virus: Understanding the Societal Dynamics Shaping the HIV/AIDS Crisis through a Lens
of Social Inequality ............................................................................................................................................. 337
311 - 'KISARA is my second school': A Phenomenological Exploration of Volunteer Motivations, Challenges, andBenefits in KISARA's Sexual and Reproductive Health Advocacy Program in Bali, Indonesia ............................ 338
312 - HIV PrEP initiation leads to reduced HIV and PrEP stigma and depression severity among GBMSM in
Singapore: A prospective cohort study and mixed-methods analysis ................................................................ 339

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19313 - Decoding U=U: A Comparative Study on Knowledge and Perceptions toward
Undetectable=Untransmittable, and Willingness to HIV testing among Heterosexual and Non-Heterosexual
Populations in the Philippines ............................................................................................................................ 340
314 - Internet-based self-sampled testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and HPV
as a tool for expanding testing coverage ............................................................................................................ 341
315 - “Flourishing like the forest and clear like the sky”: a Photovoice exploration of challenges experienced
and resilience resources employed by key populations and people with HIV in Malaysia ................................ 342
316 - The Positive Perspectives Wave 3 study protocol: co-developing a patient experience study with
community to assess unmet needs, engagement in care, and quality of life in people living with HIV ............ 344
317 - Understanding impact of COVID19 on Sex Workers: Findings from a study in Madhya Pradesh, India ... 346
318 - Chemsex as lines of flight? Critical Deleuzean perspectives on chemical intimacies ................................ 347
319 - Primary care providers’ knowledge, attitudes, and practice of recommending HPV vaccination toadolescent males in mainland China: a cross-sectional study ............................................................................ 348
320 - HIV, hepatitis, and syphilis self-testing among adolescents and young people: A systematic review andmeta-analysis ...................................................................................................................................................... 349
321 - A secondary data analysis of HIV testing service database from 2021-2024: Preliminary assessment of risk
profiles among clients in four community-based HIV care facilities in Greater Metro Manila, Philippines ...... 350
322 - The impact of COVID-19 pandemic on the clinical characteristics of new HIV diagnoses- a retrospective
single-centre observational study in Sabah, Malaysia........................................................................................ 351
323 - Correlation between High-Risk HPV and Cervical Abnormalities in Women Living with HIV in Bali,
Indonesia ............................................................................................................................................................ 352
324 - Diversity of HIV-1 CRF01 AE cluster 4 and its impact on immune recovery during combination
antiretroviral therapy ......................................................................................................................................... 353
325 - Clinical characteristics, clinical outcome and mortality among people living with HIV in Siriraj Hospital,
Thailand. ............................................................................................................................................................. 354
326 - Molecular epidemiological characteristics and dynamic molecular network analysis of HIV-1 in Nanjing
from 2016 to 2018 .............................................................................................................................................. 355
327 - Meeting 95-95-95 targets in Vietnam: An analysis of decreasing HIV prevalence in Quang Ninh Province
over the last decade ........................................................................................................................................... 356
328 - Knowledge and awareness on sexually transmitted diseases (STDs) among Women in Kerala ............... 357
329 - The correlation between NAFLD and PNPLA3 rs738409 gene polymorphism in naïve patients with
HIV/AIDS in Nanjing from 2022 to 2023 ............................................................................................................. 358
330 - Quality of Life of patients living with Human Immunodeficiency Virus Infection – Evidence from South
India .................................................................................................................................................................... 359
331 - Strengthening systems for meaningful engagement of communities to address HIV Response in India. 360
332 - Assessing the private health sector’s readiness: Private-Sector Engagement (PSE) benchmarking for HIV
services in Vietnam. ............................................................................................................................................ 361

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333 - Community-led Testing among People Who Inject Drugs: Exploring new cases of HIV and Hepatitis C in
urban Nepal ........................................................................................................................................................ 362
334 - Advancing Private Sector Engagement (PSE) in Vietnam's HIV Response: Driving sustainable change in PSE
through a National PSE Technical Working Group (TWG). ................................................................................. 363
335 - Lesson Learned from HIV Control Program for Dealing with COVID-19 Crisis, 2019-2023, I.R.Iran .......... 364
336 - Increasing PrEP uptake among Transgender Women (TGW): Development Journey of Ruby Clinic, a TGWLed social enterprise in Vietnam. ....................................................................................................................... 365
337 - Influencing factor of HIV positive on anonymous HIV testing in a medical center (2017 to 2023) ........... 366
338 - Project High Five: Effectiveness of Peer-To-Peer Education on HIV Awareness in Iloilo City, Philippines, a
Cross-Sectional Study ......................................................................................................................................... 367
339 - Education providers’ roles in providing sexual and reproductive health education to international
students in Victoria, Australia: A qualitative study............................................................................................. 368
340 - A thematic analysis on the awareness and experiences of Ilonggo GBMSM towards the importance ofAnti-Discrimination Ordinance (ICADO) in improving sexual health and HIV services in Iloilo City, Philippines 369
341 - Driving peer-to-peer learning and strengthening collaborative key population (KP) organizational
networks in Vietnam through Business Innovation Talks and Digital Marketing Forums. ................................. 370
342 - Growth of Glink Academy: First key-population (KP) led peer to-peer capacity building program in
Vietnam for HIV awareness and service uptake. ................................................................................................ 371
343 - Impact of Health Education Intervention on Self-Efficacy among Men who have Sex with Men ............. 372
344 - Aspirations and Sustainability of Youth HIV Civil Society Organizations in the Philippines ...................... 373

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

ORAL ABSTRACTPRESENTATIONS
Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

27 – 29 June 2024
Hong Kong

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Oral Abstract

1

Optimizing real-time data flowfrom community outreach to
public facility HIV confirmatory
testing and treatment for key
population clients in Ho Chi
Minh City, Vietnam
Tran G1, Nguyen V1, Bui D1, Nguyen C1, Tran P1,Luong B2, Nguyen Q3, Nguyen P3, Levitt D1, Nguyen
D2
1FHI360/EpiC, Hanoi, Viet Nam, 2Ho Chi Minh Center for Disease

Control, Ho Chi MInh City, Vietnam, 3USAID Vietnam, Hanoi,
VietnamBackground: Approximately 6,500 key population(KP) clients are referred annually from community
outreach to HIV facilities (HFs) in Ho Chi Minh City
(HCMC), Vietnam. Early data management using
an offline Excel tool lacked seamless flow between
community outreach and facilities, resulting ininaccuracies in client records and suboptimal
tracking. To enhance program management, EpiC
collaborated with the Ho Chi Minh City Center for
Disease Control (HCDC) to introduce an online
platform (KP eLog) in October 2022.
Materials and Methods: The KP eLog web-based
platform enables outreach and facility workers torefer and track KP clients from community testing
to confirmatory testing and treatment at HFs. Lay
workers input client and HIV screening data using
internet-enabled devices. HFs then accessindividual records online to offer clients tailoredservices. Prior to KP eLog, testing record
crosschecks were conducted manually on Excel. KP
eLog employs user interface indicators to notify
whether a testing record has mismatched
information.
We compared data flow by looking for consistency
on select data between community and HF testing
records over a 21-month period prior to KP eLog
implementation (January 2021–September 2022)
and a one-year period after implementation(October 2022–October 2023) in HCMC, Vietnam.
Data points included PrEP registration date, PrEP
customer code, ARV registration date, masterpatient index code, and service providers’ unique

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21

treatment codes. We exported databases before
and after implementation in JSON format andanalyzed the data using Excel and Python.
Results: In the period prior to KP eLog, 48.25% of
unique IDs from community testing records
matched with HF records (89,441 records).
Following KP eLog implementation alignment
increased to 94.1% (234,599 records). Real-timedata flow enabled HFs to validate unique IDs
assigned to community workers and client data
entered during initial contact. Routine data quality
assurance led to improved consistency for above
key information between community and HF
records — from 25% with the same values prior to
implementation, to 80% after.
Conclusions: Seamless, real-time data flow canstrengthen community-facility referrals by helping
HFs track ART/PrEP referrals with treament datafrom the national HIS, enhancing client
management across the cascade. It can also
promote complementarity and coordinated publichealth response. HCDC will expand KP eLog to allcommunity partners and HFs in HCMC and sharelessons with other provinces preparing to roll out
KP eLog.

Oral Abstract2

Hybrid Model of Care: Looking
at Lessons Learned in Blending
In-person and Teleconsultationin an HIV Clinic in thePhilippines through the REAIM Framework
Dungca-Lorilla A1, Cosca K1, Bucal R1
1Research Institute For Tropical Medicine, Muntinlupa City,

Philippines

Background: Teleconsultation has been recognized
for years as a way to increase access to care but
was not widely adopted until the COVID 19
pandemic. In the Philippines, HIV services wereaffected during the pandemic with temporary
closure of HIV clinics. To ensure access to care andtreatment, the HIV clinic at the Research Institutefor Tropical Medicine, which provides care to 6600
people living with HIV (PLHIV) on antiretroviral
medication, started providing teleconsultation to
PLHIV in August 2020. This was maintained withreintroduction of in-person consultation in April
2022 resulting to the adoption of a hybrid caremodel.
Description: We used the RE-AIM framework toevaluate the hybrid care service in the HIV clinic
through observed data on clinic processes,
patients’ and providers’ perspectives and clinic
census.
Reach: From its inception in April 2022, 7 159 inperson consultations and 4 097 teleconsultations
were provided.
Effectiveness: Described as the benefit of
implementing a hybrid care, it has offered more
options in accessing care for PLHIV. Newly
diagnosed PLHIV were primarily consulted inperson. Those on antiretrovirals or had treatment
disruptions, can be retained or re-engaged in care,
respectively through either in-person or
teleconsultation.
Adoption: All five doctors in the HIV clinic
provided both in-person and tele-consultations.
Infrastructure, toolkits and process for

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teleconsultation which started during the
pandemic, were in place which facilitated thewider adoption of hybrid care.
Implementation: The following organizationalchanges were made to implement hybrid care:
integrating the digital consultation platform andsupporting infrastructure into routine services,
restructuring clinic processes, and adaptation ofhealthcare workers to provide both in-person andteleconsultations.
Maintenance: Hybrid care has been integrated asa routine practice at the clinic. Processes forteleconsultation and in-person consultation havebeen institutionalized and incorporated into thecare system. Organizational policies, leadershipcommitment, financial support, personnel
engagement, and communication mechanisms arein place to ensure its maintenance.
Lessons learned: The hybrid care model may help
improve the accessibility of HIV care for PLHIV andis a feasible approach to maintain services acrossthe HIV care continuum in a low-to-middle-income
setting. To expand the adoption of the model into
routine clinical care, several organizational-level
adaptions were made. During the integration
process, institutional commitment through good
leadership, technical support, and allocation of
resources were important contributing factors.
Personnel engagement and the recognition ofpatients’ needs were integral in theimplementation and maintenance of hybrid care.
Conclusions: The hybrid care model helped sustain
HIV care during and after the pandemic bycreating additional options for accessing HIV
services. It can provide a more patient-centeredapproach by taking diverse patient needs into
consideration with the potential to promoteretention in care and reduce loss to follow-up.
However, a more robust evaluation is still needed
to assess its reach and effectiveness in retention
and re-engagement in care, and sustainability.

Oral Abstract23

3

effort received cash prize and a certificate from ahigh-level MOPH officer.

Enhancing Same-Day ART
Policy and Implementation at
a Provincial Level through a
National Contest: Short-Termand Long-Term Results fromthe Thailand Test and Treat
ContestResults: A Provincial Test and Treat Contest kickoff meeting was held across provinces where highlevel officers from Provincial Health and
Administrative Offices, hospitals, and civil society
organizations were brought together to discussprovincial SDART implementation plan. Short-term
analysis across 16 provinces found 4,837
individuals newly diagnosed with HIV and 4,615
started ART. Significant improvements in ART
initiation rapidness were seen in the contest
phase, compared to the pre-contest phase, withpercentages of same-day, 1-7 days, and >7 days
ART initiation being 14.9%, 25.2%, and 59.9% vs.
13.7%, 23.6%, and 62.7%, p=0.033. Long-term datafrom 9 provinces showed 6,730 new HIV
diagnoses, with 6,511 ART initiations. Percentagesof same-day, 1-7 days, and >7 days ART initiation
improved from 7.0%, 27.5%, and 65.5% precontest to 24.1%, 23.9%, and 52.0% during thecontest (p<0.001).

Thammajaruk N1, Thongsuksangcharoen S1,Pengnonyang S1, Suriwong S1, Tasomboon W1,
Benjarattanaporn P2, Sirisinsuk Y3, Lertpiriyasuwat
C4, Noknoy S4, Lumyai S5, Triamvichanon R1,
Phanuphak N1, Phanuphak P1
1Institute of HIV Research and Innovation (IHRI), Bangkok,

Thailand, 2Joint United Nations Programme on HIV/AIDS(UNAIDS), Bangkok, Thailand, 3National Health Security Office(NHSO), Bangkok, Thailand, 4Division of AIDS and STIs,
Department of Disease Control, Ministry of Public Health,
Nonthaburi, Thailand, 5National Institute of Health, Departmentof Medical Sciences, Ministry of Public Health, Nonthaburi,
ThailandBackground: Thailand launched its same-day
antiretroviral therapy (SDART) guidelines in 2021,
with a series of training conducted by the Ministryof Public Health (MOPH). However, the translationof guidelines into practice varied substantially byprovince and by hospital. The Thailand Test andTreat Contest explored how competition andrewarding system could enhance SDART policy
adoption and implementation at a provincial level.
Methods: Of 77 provinces in Thailand, 16 applied
for the contest; 4 participating exclusively in Phase
I (March-September 2022), 3 in Phase II (FebruaryJuly 2023), and 9 engaging in both phases. HIV
diagnosis and ART status were retrieved from the
National AIDS Program database. Outcomes werecategorized into short-term (single-phaseparticipation) and long-term duration(participation in both phases). Data during thecontest phase were compared with those 6months prior. Statistical analyses evaluateddifferences of percentages of ART initiation withinsame-day, 1-7 days, and >7 days after HIV
diagnosis. The province with the largest
improvement in ART initiation rapidness and thebest demonstrated multi-stakeholder coordination

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions: The Thailand Test and Treat Contest
successfully boosted up provincial implementationof SDART policy. Actual improvement in ART
initiation rapidness was demonstrated as results.
The national competition and rewarding system
may be useful in scaling up other evidence-based
health interventions.

Oral Abstract

4

Enhancing treatment
outcomes, mental health, andquality of life for stable people
Living with HIV: a quasiexperimental study of acommunity-based
antiretroviral therapy delivery
model in Cambodia
Tian Z1, Tuot S2,3, Zahari M1, Chhoun P2,
Nagashima-Hayashi M1, Yam L1, Samreth S4,
Ngauv B4, Choub S2, Ouk V4, Yi S1,2,4,5
1Saw Swee Hock School of Public Health, National University ofSingapore and National University Health System, Singapore,
Singapore, 2KHANA Center for Population Health Research, ,Cambodia, 3Department of Community and Global Health,Graduate School of Medicine, The University of Tokyo, Tokyo,
Japan, 4National Center for HIV/AIDS, Dermatology and STD, ,Cambodia, 5Center for Global Health Research, Touro University
California, California, United States

Background: HIV response highlights the crucialrole of community-based service delivery of
antiretroviral therapy (ART), enabling stablepeople living with HIV (PLHIV) to benefit fromfewer clinic visits and enhanced care. This study
evaluated the effectiveness of the Communitybased ART Delivery (CAD) intervention on the care
continuum for stable PLHIV in Cambodia.
Methods: This quasi-experimental study was
conducted in 20 purposefully selected ART clinics
spanning the capital city and nine provinces fromMay 2021 to April 2023. ART adherence (selfreporting + pill identification test), viral loadsuppression, care retention, mental health, andquality of life were compared within and between
two arms, comprising 1626 PLHIV in the CAD
group and 1441 in the group (multi-monthdispensing [MMD]), at baseline and endline.
Descriptive analyses, difference-in-difference
analyses, and multivariable logistic regressions
were performed using STATA and R.
Results: Viral suppression and care retention
consistently exceeded 97% throughout the study.
In comparison, self-reported ART adherence
remained stable in the CAD group (87.0% at

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202424

baseline, 86.8% at endline). In contrast, the MMD
group experienced a significant decline from
90.3% to 84.4% (p<0.001). Pill identification tests
showed minimal change in the CAD group (98.0%
at baseline, 97.0% at endline) but a significant
decrease in the MMD group (98.5% at baseline,
95.1% at endline) (p<0.001). Difference-indifference analyses revealed a higher predictedmargin of ART adherence in the MMD group(89.8%) than the CAD group (85.6%) at baseline,with a steeper decline in the MMD group (81.3%)
compared to the CAD group (84.6%) at endline,
suggesting CAD's potential effectiveness insustaining ART adherence. Predicted margins also
indicated an increase in PLHIV with good mental
health in CAD (76.3% to 77.6%) over time,
contrasting with a decline in MMD (84.2% to82.1%), highlighting a positive impact on mental
well-being in the CAD group.
Conclusions: The study highlights the CAD
intervention's success in sustaining ART
adherence, promoting mental health, andimproving the quality of life for stable PLHIV. It
establishes a solid evidence base, paving the way
for future CAD model implementation, scale-up,
and development of standard operatingprocedures in Cambodia, advancing its impactful
adoption.

Oral Abstract

5

Facilitators and Barriers toMental Health Service
Integration in Outpatient HIV
Care: Insights from Women
Living with HIV in Malaysia
Kukreja A1, Salleh A1, Hasmukharay K1, Ross J2,
Lovero K3, Rajasuriar R1
Universiti Malaya, Kuala Lumpur, Malaysia, 2TREAT Asia, amfAR- The Foundation for AIDS Research, Bangkok, Thailand,
3Columbia University, Department of Psychiatry and New YorkState Psychiatric Institute, New York , USA
1

Background: Women living with HIV(WWH) have ahigher prevalence of mental health(MH) disorders
compared to women without HIV. MH disorders in
WWH are associated with non-adherence toantiretroviral therapy and poor retention in care.
In low-and-middle income settings like Malaysia,
integrating HIV and MH services is uncommon,
despite evidence of improved outcomes in both
domains. This pre-implementation study exploredfacilitators and barriers to integrating MH
screening and linkage to care amongst WWH at a
tertiary care hospital in Malaysia.
Material and Methods: We conducted in-depth
interviews with nineteen WWH receiving HIV careat the Infectious Diseases(ID) Clinic, University
Malaya Medical Centre between December 2022January 2024. WWH were purposively sampled toensure maximum variation by age, race, andprevious engagement with MH services. A semistructured interview guide, developed using theConsolidated Framework for Implementation
Research 2.0, was utilized to explore facilitatorsand barriers to integrating MH screening andlinkage to care into outpatient HIV care. We
conducted thematic analysis using Dedoose.
Results: Nineteen WWH, comprising 17
Malaysians of varying ethnicities-Malay, Chineseand Indian, and 2 Non-Malaysians wereinterviewed by an ID clinician. Their median age
was 49, with a median of 10 years since HIV
diagnosis. Facilitators of integrating MH screening
into the HIV clinic included patients’ awareness of
MH conditions and willingness to disclose their MH
status to their ID clinicians. WWH preferred face-

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202425

to-face screenings and were open to screening bynurses or peer counsellors. Barriers to integrating
MH screening included a reluctance to engage
with digital platforms, and that all WWH were
hesitant to answer MH screening questions as theyevoked negative memories of HIV acquisition.
WWH expressed a preference for screening
conducted by staff possessing non-discriminatory
behaviour and effective communication skills. For
MH linkage to care integration, facilitators include
WWH’s motivation to feel better and openness torecommendations from their ID clinicians, thoughsome preferred exclusive MH consultations with
their ID clinicians. Participants also reported thatco-location, same-day appointments, face-to-faceconsultations, and trust in HIV statusconfidentiality facilitated linkage to care within the
HIV clinic. WWH considered additional costs of up
to USD5 acceptable. Significant barriers to MH
linkage to care included poor MH-seeking
behaviour driven by HIV stigma and limited
knowledge of available MH treatments.
Recommendations for addressing these barriers
included establishing peer support groups andoffering flexible follow-up appointment timing.
Unique themes specific to women emerged,
emphasizing the role of patients, providers andcommunities in influencing MH engagement. At
the patient level, familial responsibility and thedesire for autonomy drive engagement. Providers
prioritizing timely MH support, especially at HIV
diagnosis, while understanding evolving needs,
was important for WLWH. At the community level,family support and religious faith emerge as
powerful motivators to engage in MH care, while
cultural stigma among Indians presents asignificant barrier.
Conclusion: This study emphasizes the imperative
for integrated MH screening and linkage to carefor WWH. WWH prefer integrated services despite
multiple identified barriers. Addressing suchbarriers and obtaining provider perspectives arevital for developing tailored integrated MH
services for WWH.

Oral Abstract

6

Strongly Association of
PNPLA3 rs738409 genotype on
hepatic steatosis among nonobese people living with HIV
Apornpong T1, Chuaypen N2, Lwin H1, Hiransuthikul
A1,3, Gatechompol S1, Ubolyam S1, Kerr S1,4,5,
Tangkijvanich P2, Avihingsanon A1,6, Han W1,5
1HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand, 2Center of Excellence in Hepatitis and Liver Cancer,
Department of Biochemistry, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 3Department ofPreventive and Social Medicine, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 4Biostatistics
Excellence Centre, Faculty of Medicine, Chulalongkorn
University, Bangkok, Thailand, 5The Kirby Institute, University of
New South Wales, Sydney, Australia, 6Center of Excellence inTuberculosis, Bangkok, Thailand

Background: In addition to the well-establishedassociation of obesity, there is a growing
recognition of genetic influences on susceptibility
to liver diseases. We investigated genetic
determinants of steatotic liver disease (SLD)
among Thai people with HIV (PWH).
Methods: A cross-sectional study was conductedat the HIV Netherlands Australia Thailand (HIVNAT), Bangkok, Thailand. PWH aged ≥18 years
without excessive alcohol consumption who
underwent controlled attenuation parameter(CAP) between July 2013 and June 2023 and had
tested with single nucleotide polymorphism (SNPs)
including PNPLA3 rs738409 and HSD178B
rs6834314 were analysed. SLD was defined as CAP≥248 dB/m. Multivariable logistic regression
investigated associations between SNPs and SLD,
and interactions between genotypes and obesity(BMI>25 kg/mm2).
Results: Of 764 PWH (35% female, median age 45(IQR 36-52) years) analysed, SLD was observed in
270 (35.3%) participants and 136 (50%) were notobese. The median duration of ART and medianCD4 count was 11 (5-18) years and 581 (422-753)
cells/mm3, respectively. Seventy-four (35%) wereon integrase integrase strand transfer inhibitors.
Participants with SLD had higher BMI (24.9 [22.828.1] vs 22.1 [IQR 20.3-23.9] kg/m2) and a higher
proportion diabetes mellitus (25% vs. 16%),
hypertension (83% vs. 60%), dyslipidemia (88% vs.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

2676%) and liver fibrosis (LSM≥7.5 kPa, 22% vs. 12%),compared to those without SLD. Overall, PNPLA3
rs738409 CC, CG and GG genotypes were present
in 50%, 39% and 11%, and HSD178B rs6834314 AA,
AG and GG genotypes in 36%, 51% and 13%,respectively. In the multivariable model, the malesex (aOR=1.98, 95% CI 1.23-3.18, p=0.005), higher
BMI (aOR=1.32, 95% CI 1.24-1.41, p<0.001) and
PNPLA3 rs738409 G allele (aOR=1.49, 95% CI
1.003-2.22, p=0.049) were associated with anincreased risk of SLD. There was a significant
interaction between PNPLA3 rs738409 genotype
and BMI (p=0.014). After subgroup analysis using
BMI, PNPLA3 rs738409 G allele was significantly
associated among non-obese individuals(aOR=1.79, 95% CI 1.18-2.72, p=0.006).
Conclusions: Nearly half of the participants with
SLD in our cohort were not obese. PNPLA3
rs738409 genotype was associated with SLD
among non-obese Thai individuals. This
underscores that genetic factors can influence liverdisease susceptibility in PWH, independent of
established risk factors.

Oral Abstract

7

Noninferior efficacy, reduced
weight gain, and improved
lipid metabolism of switch toainuovirine- versus boosted
elvitegravir-based regimen in
virologically suppressedpeople living with humanimmunodeficient virus 1: the48-week results of the SPRINT
trial
Zhang F1, Wu H2, Ma P3, Zhao Q4, Wei H5, Lu H6,
Wang H6, He S7, Chen Z7, Chen Y8, Wang M9, Cai
W10, Qin H11
1Clinical and Research Center for Infectious Diseases, Beijing

Ditan Hospital Affiliated to Capital Medical University, Beijing ,China, 2Clinical and Research Center for Infectious Diseases,
Beijing Youan Hospital Affiliated to Capital Medical University,
Beijing , China, 3Department of Infectious Diseases, Tianjin
Municipal Second People’s Hospital, Tianjin, China, 4Department
of Infectious Diseases, Zhengzhou Municipal Sixth People’s
Hospital and Infectious Disease Hospital of Henan Province,
Zhengzhou, China, 5Department of Infectious Diseases, Nanjing
Municipal Second Hospital and Nanjing Hospital Affiliated to
Nanjing University of Chinese Medicine, Nanjing, China,
6Department of Infectious Diseases, Shenzhen Municipal Third
Hospital, Shenzhen, China, 7Department of Infectious Diseases,
Chengdu Municipal Public Health Clinical Center, Chengdu,
China, 8Department of Infectious Diseases, Chongqing Municipal
Public Health Medical Center, Chongqing, China, 9Department of
Infectious Diseases and Immunology, Changsha Municipal First
Hospital and Changsha Hospital Affiliated to Central South
University Yale School of Medicine, CHangsha, China,
10Department of Infectious Diseases, Guangzhou Municipal
Eighth People’s Hospital Affiliated to Guangzhou Medical
University, Guangzhou, China, 11Jiangsu Aidea PharmaceuticalCo., Ltd, Yangzhou, China

Background: Safety concerns arise from integrase
strand transfer inhibitor (INSTI)-based regimen
due to weight gain and metabolic complications.
An alternative antiretroviral (ARV) switch therapy
may be warranted for in virologically suppressedpeople living with human immunodeficient virus 1(PLWH). We compared the efficacy and safety
profiles of ainuovirine (ANV), a new-generation
non-nucleoside reverse transcriptase inhibitor(NNRTI), with boosted elvitegravir (EVG), both
combined with the nucleoside reverse
transcriptase inhibitor (NRTI) backbone in single-

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

27

tablet regimen (STR), in PLWH who had achievedvirological suppression on previous NNRTI-based
ARV regimen.
Methods: This is a phase 3, multicenter,randomized, double-blind, active-controlled, noninferiority study. Eligible participants must havemaintained virological suppression (plasma HIV-1
ribonucleic acid [RNA] titer below 50 copies permL) confirmed on two successive tests at aninterval of at least one month prior to
randomization. Participants were randomly
assigned (1:1) to receive ANV 150 mg plus
lamivudine (3TC) 300 mg and tenofovir disoproxil
fumarate (TDF) 300 mg or cobicistat (Cobi) 150 mg
boosted EVG plus emtricitabine (FTC) 200 mg andtenofovir alafenamide (TAF) 10 mg. Both arms
received ARV in STR once daily for up to 48
successive weeks, followed by an optional openlabel extension period with 48-week ANV/3TC/TDF
treatment. The primary efficacy endpoint was the
proportion of participants with HIV-1 RNA titer at
50 copies per mL or above at week 48 using the US
Food and Drug Administration snapshot algorithm,
with a non-inferiority margin of 4 percentage
points at a two-side 95% confidence level. A single
efficacy estimand (de jure) was defined using thecomposite variable strategy, in which the protocoldefined intercurrent events were considered as
virological failure. This trial is active, but not
recruiting, and is registered at Chinese Clinical Trial
Registry (ChiCTR), ChiCTR2100051605.
Findings: 762 participants were randomized andhad received at least one dose of ANV/3TC/TDF(n=381) or EVG/Cobi/FTC/TAF (n=381). At week48, 7 (1.8%) participants on ANV/3TC/TDF and 6(1.6%) participants on EVG/Cobi/FTC/TAF had
plasma HIV-1 RNA titer at 50 copies per mL or
above including missing virological data within thetime window (the Cochran-Mantel-Haenszel
method, estimated treatment difference [ETD],
0.3%, 95%CI -1.6 to 2.1), establishing the noninferiority of ANV/3TC/TDF regimen to
EVG/Cobi/FTC/TAF regimen. At week 48, theparticipants on ANV/3TC/TDF showed asignificantly less weight gain from baselinecompared to those on EVG/Cobi/FTC/TAF (leastsquare mean, 1.16 versus 2.05 kg, -0.90 kg, -1.43
to -0.37). At week 48, the ETDs in changes frombaseline were -0.39 mmol per L [-0.47,-0.32] forlow-density lipoprotein cholesterol, -0.69 mmol
per L [-0.77,-0.60] for non-high-density lipoproteincholesterol, -0.84 mmol per L [-0.92,-0.75] for totalcholesterol, and -0.98 mmol per L[-1.18,-0.78] fortriglyceride, respectively. A small proportion ofparticipants discontinued study drug due to AE

Oral Abstract(0.3% versus 0.3%), and serious AEs (SAEs) weresimilar across groups (2.9% versus 2.4%).
Interpretation: In virologically suppressed PLWH,
switch to ANV-based regimen resulted in lessweight gain and improved lipid metabolism while
maintaining virological suppression non-inferior tothat to boosted EVG-based regimen.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

28

Oral Abstract

29

8

participants of Asian descent were evaluated forthis analysis.

Week 96 Asian Sub-Analysis ofa Phase 3 Randomized
Controlled Trial ofBictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF)
vs Dolutegravir +Emtricitabine/Tenofovir
Disoproxil Fumarate (DTG +F/TDF) as Initial Treatment inHIV-1/HBV Coinfected Adults(ALLIANCE)

Results: Data from 212 participants of Asiandescent who were randomized and treated with
B/F/TAF or DTG + F/TDF (106 in each treatmentarm) were analyzed. Baseline characteristics,
including age (< 50 years, 95.3 vs 96.2%), HIV-1
RNA (> 100,000 copies/mL, 30.2 vs 30.2%), CD4
count (median, 243 vs 228 cells/µL; <200 cells/µL,
38.7% vs 45.3%), HBV DNA (≥ 8 log10 IU/mL,
48.1% vs 50.9%), and HBeAg positive status (77.4
vs 79.2%), were similar between the treatmentgroups. Overall, 95.8% of participants were male.
At week 96, 87.7% of participants in both
treatment groups had HIV-1 RNA < 50 copies/mL(snapshot analysis) (p=1.0000). Numerically larger
proportions of participants in the B/F/TAF vs the
DTG + F/TDF group achieved HBV DNA < 29 IU/mL(75.5% vs 68.9%, p=0.3527) and ALT normalizationby the 2018 AASLD criteria (73.6% vs 53.8%,
p=0.0552).

Avihingsanon A, Lu H, Leong C, Hung C,
Kiertiburanakul S, Lee M, Supparatpinyo K, Zhang
F, Hindman J, Wang H, Mo B, Wong T, Li T
1HIV-NAT, Thai Red Cross AIDS Research Centre , 2Shanghai

Public Health Clinical Center , 3Department of Medicine, Kuala
Lumpur General Hospital, 4National Taiwan University Hospital,
5
Ramathibodi Hospital , 6Queen Elizabeth Hospital ,7Chiang Mai
University, 8Beijing Ditan Hospital, 9Gilead Sciences, Inc., Foster
City, 10Gilead Sciences, Inc., Foster City, 11Gilead Sciences Hong
Kong Limited, 12Gilead Sciences Hong Kong Limited, 13Peking
Union Medical College Hospital, Beijing,

Background: The Asia-Pacific region has one of thehighest hepatitis B burdens in the world. HIV1/HBV coinfection is associated with higher liverrelated mortality than HBV monoinfection. Both
B/F/TAF and DTG+ F/TDF have dual efficacy inmanaging HIV-1 and HBV infections anddemonstrated high viral suppression rates in the
ALLIANCE study. In a recent week 48 Asian subanalysis of the study, B/F/TAF demonstrated
superiority over DTG + F/TDF in relation to HBVDNA suppression, as well as significantly higher
rates of HBsAg and HBeAg loss/seroconversion.
Here, we report week 96 results from an Asian
sub-analysis of the ALLIANCE study.
Methods: This was a post-hoc sub-population
analysis of results from a double-blind, activecontrolled trial in which treatment-naive adults
with HIV-1/HBV coinfection were randomized 1:1
to receive B/F/TAF or DTG + F/TDF (each withmatching placebo). Week 96 data from study

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Compared with DTG + F/TDF, participants treatedwith B/F/TAF maintained significantly higher ratesof HBsAg loss (24.5% vs 10.4%, p=0.0058), HBeAg
loss (39.0% vs 14.3%, p=0.0004), and HBeAg
seroconversion (34.1% vs 11.9%, p=0.0008) atweek 96. There was a numerically higher rate of
HBsAg seroconversion for B/F/TAF vs DTG + F/TDF(10.4% vs 4.7%, p=0.119).
Adverse event rates were similar between
treatment groups. For B/F/TAF and DTG + F/TDF,
median changes in body weight from baseline atweek 96 were 4.0 kg (IQR, 0.7, 7.7) and 2.3 kg (0.3, 5.7), respectively.
Conclusions: In an Asian population with HIV1/HBV coinfection, both B/F/TAF and DTG + F/TDF
achieved high rates of HIV-1 RNA and HBV DNA
suppression over 96 weeks, with the B/F/TAF
treatment group attaining significantly higher ratesof HBeAg/HBsAg loss and HBeAg seroconversion
than the DTG + F/TDF group.

Oral Abstract

9

Dolutegravir/lamivudine
versusbictegravir/emtricitabine/teno
fovir alafenamide fumarate:Real-world Assessment ofweight Gain in people livingwith HIV of Asian OrigiN(DRAGON study)
Cheng C1, Lin C2, Yang C2, Chen T3, Hsih W4, Tsai
M5, Cheng S1, Lin Y1, Chen J1, Ma P6, Zhao Q7, Zou
M8, Sheng W9
1Department of Infectious Diseases, Taoyuan General Hospital,

Taoyuan City , Taiwan, 2Department of Laboratory, Taoyuan
General Hospital, Taoyuan City , Taiwan, 3Department of
Infectious Diseases, Taichung Hospital, Taichung City, Taiwan,
4Department of Infectious Diseases, China Medical University
Hospital, Taichung City, Taiwan, 5Department of Internal
Medicine, Far Eastern Memorial Hospital, New Taipei City,
Taiwan, 6Department of Infectious Diseases, Tianjin Second
People’s Hospital, Tianjin City, China, 7Department of Infectious
Diseases, Henan Infectious Diseases Hospital, Zhengzhou City ,China, 8Department of Infectious Diseases, Nantong Third
People’s Hospital, Nantong, China, 9Department of Infectious
Diseases, National Taiwan University Hospital, Taipei, Taiwan

Background: Studies have shown an increase inweight among people living with HIV (PWH) who
have undergone integrase strand-transfer inhibitor(INSTI) containing antiretroviral therapy (ART).
However, limited data are available regarding
analysis of risk factors of weight gain amongindividuals of Asian origin. The aim of our study
was to assess associated factors of weight gain
after initiating or switching to dolutegravir/
lamivudine (DTG/3TC) or
bictegravir/emtricitabine/tenofovir alafenamide
fumarate (BIC/FTC/TAF) among treatment-naïve or
experienced PWH.
Methods: This was a retrospective, multiplecenter, observational cohort study conducted atseven HIV-care-designated hospitals from October
2019 to October 2023. Information on
demographics, body weight, clinicalcharacteristics, laboratory testing, HIV viral loads,
and lipid profiles was collected and analyzed. The
first weight measure after the prescription of
DTG/3TC or BIC/FTC/TAF, both pre- and 30 days

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202430

post-index, was defined as baseline weight. The
last measure at week 48, both pre- and 30 days
post, was defined as post-weight. Weight change
was reported as absolute change and the
proportion of patients with increased weight.
Results: A total of 2,196 patients were included,with 969 in the DTG/3TC group and 1,227 in the
BIC/FTC/TAF group. At baseline, 21.7% were >50
years old, 92.4% were males, and 15.6% weretreatment-naïve patients (mean baseline weight:
DTG/3TC: 71.8 ± 13.3 kg, BIC/FTC/TAF: 68.6 ± 11.3
kg; p < 0.01). Among treatment-naïve individuals,
88.3% (53/60) of patients in the DTG/3TC group
and 92.6% (262/283) in the BIC/FTC/TAF group
achieved HIV RNA <50 copies/mL (p = 0.28);
among virally suppressed and treatmentexperienced individuals, 97.4% (885/909) of
patients in the DTG/3TC group and 98.0%(925/944) in the BIC/FTC/TAF group maintained
HIV RNA <50 copies/mL (p = 0.37) at week 48.
Statistical analysis revealed no differences frombaseline to week 48 between both groups
regarding total cholesterol (2.7 vs 6.5 mg/dL, p =0.05), HDL (0.6 vs 0.9 mg/dL, p = 0.54), andtriglycerides (-8.9 vs -7.5 mg/dL, p = 0.82).
However, significant differences were observed inbody weight (1.3 vs 2.6 kg, p < 0.01) and LDL (0.5
vs 5.7 mg/dL, p < 0.01) between the DTG/3TC and
BIC/FTC/TAF groups. Additionally, 192 patients(7.7%) exhibited ≥10% weight gain. Logistic
regression analysis identified risk factors for ≥10%
weight gain, including ART-naïve PWH (AOR 2.53,
95% CI 1.81–4.10), previous ART containing TDF
with a switch to BIC/FTC/TAF (AOR 2.05, 95% CI
1.40–2.98), previous ART containing TAF with aswitch to BIC/FTC/TAF (AOR 2.18, 95% CI 1.33–
3.57), previous ART containing efavirenz (EFV)(AOR 1.93, 95% CI 1.23–3.01), and previous ART
containing boosted protease inhibitors (PIs) (AOR
3.24, 95% CI 1.64–6.39).
Conclusions: In a real-world setting, BIC/FTC/TAF
is associated with greater weight gain compared to
DTG/3TC. Furthermore, previous antiretroviraltherapy containing EFV or boosted PIs may
increase the likelihood of experiencing greater
weight gain. The study results provide valuable
insights to healthcare providers when discussing
treatment choices with PWH.

Oral Abstract

10

Same-day treatment ofsexually transmitted infections
among people living with HIV:an opportunity to apply
lessons learned from
community-led clinics in
Bangkok, Thailand
Wongsa A1, Janamnuaysook R1, Sinchai K1,
Boonruang J1, Thitipatarakorn S1, Teeratakulpisarn
N1, Janyam S3, Saiwaew S2, Mills S4, Phanuphak N1,
Ramautarsing R1
1Institute of HIV Research and Innovation, Bangkok, Thailand,
2Rainbow Sky Association of Thailand, Bangkok, Thailand,

3Service Workers in Group Foundation, Bangkok, Thailand, 4FHI

360, Bangkok, Thailand

Background: Community-led clinics are successful
in providing same-day antiretroviral treatment(SDART). However, a gap in management of othersexually transmitted infections (STIs) among key
populations with HIV remains unaddressed,
including treatment of chlamydia trachomatis (CT),
Neisseria gonorrhoeae (NG), syphilis, hepatitis B
virus (HBV), and confirmatory testing andtreatment for hepatitis C virus (HCV).
Methods: We implemented SDART at two
community-led clinics in Bangkok, Thailand. Thainationals who tested HIV positive, were at least 13
years old, and had never received ART were
eligible for SDART. During the baseline visit, STI,HBV, and HCV testing were conducted. Descriptive
analyses were performed.
Results: From October 2021-September 2023, 609
people tested HIV-positive, and 595 (97.7%)
initiated SDART. Of those, 542/595 (91.1%),
44/595 (7.4%), and 9/595 (1.5%) were men who
have sex with men, transgender women, andcisgender women, respectively.
Among people initiating SDART, 120/595 (20.2%),
60/595 (10.1%), and 182/595 (30.5%) tested
positive for CT, NG, and syphilis, respectively,
51/595 (8.6%) had CT-NG co-infection. HBV andanti-HCV positivity were 31/595 (5.2%) and 38/595(6.4%), respectively. HCV-RNA confirmatory testing
rate was 22/38 (57.9%), with 15/595 (2.5%) testing

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

31

positive. All clients with positive STI or HCV werereferred for treatment, of those 114/171 (66.7%)
initiated treatment for CT, 85/111 (76.6%) for NG,
154/182 (84.6%) for syphilis, and 8/15 (53.3%) for
HCV. All clients initiated a tenofovir-based SDART
regimen, including those with HBV.
The median (min-max) times to treatment after
diagnosis were 1 day (0-90) for CT, 3 days (0-118)
for NG, 3 days (0-124) for syphilis, and 0 days (0286) for HCV. The median (min-max) time toconfirmation after screening for HCV was 5 days
(0-112). Overall, for 33.15% of clients with STI or
HCV, treatment was initiated after more than 5
days.
Conclusions: Key populations with HIV initiating
SDART at community-led clinics have high STI
prevalence. While community-led clinics are
successful in providing HIV treatment services,
linkage to timely STI management remains achallenge. Using lessons from SDART
implementation, same-day STI test and treat
should be integrated at community-led clinics, as
another promising strategy in order to eliminate
HIV and STI co-infections.

Oral Abstract

32

11

dosing strategies, and retention in care (i.e.
whether the loss to follow-up).

The Effectiveness of CoCreated Digital Intervention to
Improve PrEP Adherence
Among Chinese Men Who
Have Sex with Men: A
Stepped-wedge Randomized
Trial in China

Results: From July 2021 to December 2023, 910
MSM (mean age=28.4, IQR=24.1-31.6) who
completed at least one follow-up survey (i.e. at 3
months) were included. About 24.2% of theparticipants were college students, and 64.1% had
2 or more sex partners in the past 3 months. SWT
cluster sizes at baseline were 251, 272, 280, and282, respectively. About 25% (n=277) of theparticipants were lost to follow-up before the 12thmonth, with no significant difference across SWT
clusters. Throughout the trial, approximately 60%of the participants reported almost 100%
adherence to PrEP, with an insignificant seculartrend of declining adherence over time. The cocreated PrEP messages intervention marginally
improved adherence levels (aOR=1.07, 95%C.I.:
0.82-1.40), but not statistically significant. Ondemand PrEP users [(55%) versus daily PrEP users(45%) were less likely to report optimal adherence(aOR=90.2, 95%C.I.: 54.59-148.99). MSM ofyounger age or with higher income are more likely
to report optimal adherence.

Li C1,2, Yin Z1, Li Q3, Li L3, Wu S4, Liang K4, Marley
G1, Fan C1, Dai Y1, Huang H5, Hazra A6, Lio J6,
Tucker J1,7,8, Tang W1,7, Sherer R6
1UNC Project China, Guangzhou, China, 2Tokyo College, theUniversity of Tokyo, Tokyo, Japan, 3Guangzhou Eighth People’s
Hospital, Guangzhou, China, 4Zhongnan Hospital of Wuhan
University, Wuhan, China, 5Wuhan Tongxing LGBT Center,
Wuhan, China, 6Department of Medicine,University of Chicago, ,USA, 7Institute for Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill, , USA, 8ClinicalResearch Department, Faculty of Infectious and Tropical
Diseases, London School of Hygiene and Tropical Medicine,
London, UK

Background: Co-creation – an iterative process
where researchers and participants work together
in health intervention- is a promising strategy forencouraging behavior change. We conducted a
stepped-wedge trial (SWT) to evaluate the efficacy
of co-created digital PrEP adherence messages tofacilitate adherence among Chinese MSM PrEP
users.
Methods: This trial is nested in a PrEP
demonstration trial in Guangzhou and Wuhan,
China (NCT04754139). Participants were provided
TDF/FTC for 12 months and followed up quarterly.
MSM were randomly allocated to four sequential
groups receiving weekly WeChat-based (a popular
Chinese chat media) PrEP adherence messages in aquarterly staggered order. Intervention messages
were co-created through open calls and three cocreation rounds with 19 PrEP users in the trial,
including short videos, images, and infographics.
Generalized linear mixed-effects models wereused to assess primary outcomes, including selfreported optimal PrEP adherence (daily users: 6-7
pills/week, on-demand users: full compliance withthe 2-1-1 dosing scheme per sex event), selfinitiated switching between daily and on-demand

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions: Co-creating PrEP adherence
intervention messages with Chinese MSM has thepotential to improve self-reported adherence. Ourfindings of varied adherence performance amongindividuals highlight the need for future research
into differentiated PrEP interventions.

Oral Abstract

12
Abstract number 12 has been withdrawn.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

33

Oral Abstract

13

Preferences for accessing preexposure prophylaxis among
men who have sex in Australia
Tieosapjaroen W1, Chan C2, Bavinton B2, Schmidt
H3,4, Phanuphak N5, Fraser D2, Wright E6,7,8,
Murphy D2,9, Cornelisse V1,2,10, Zhang L1,11, Ong J1
1Central Clinical School, Medicine, Nursing and Health

Sciences,Monash University, Melbourne, Australia, 2Kirby
Institute, University of New South Wales, Sydney, Australia,
3
UNAIDS, Geneva, Switzerland, 4WHO , Geneva, Switzerland,
5Institute of HIV Research and Innovation, Bangkok, Thailand,
6Alfred Hospital, Central Clinical School, Monash University,
Melbourne, Australia, 7The Burnet Institute, Monash University,
Melbourne, Australia, 8The Peter Doherty Institute for Infection
and Immunity, Melbourne, Australia, 9Australian ResearchCentre in Sex, Health and Society, La Trobe University,
Melbourne, Australia, 10New South Wales Health, North Coast
Sexual Health Services, Lismore, Australia, 11Clinical Medical
Research Center, Children’s Hospital of Nanjing Medical
University, Jiangsu, China

Background: The introduction of HIV pre-exposure
prophylaxis (PrEP) has contributed significantly to
reducing annual HIV notifications among men who
have sex with men (MSM). However, PrEP usage
remains below the national 75% coverage target.
This study examined PrEP choice drivers,
predictors of uptake for different program models,and identified subgroups with similar preferencesamong MSM in Australia.
Method: MSM aged ≥18 years with no prior HIV
diagnosis and residing in Australia completed an
online discrete choice experiment (DCE) between
May and November 2022. They were recruited
through dating apps and local MSM community
organisations. We used random parameters logit(RPL) models to estimate each attribute’s relative
importance and predict PrEP uptake for varied
program configurations. A latent class model(LCM) was used to explore sub-groups with similar
preferences for PrEP programs.
Result: Overall, 1,892 MSM participated, with amean age of 40 (±12.7) years. Cost was the mostimportant driver of PrEP program choice, followedby the type of PrEP, side effects, extra sexuallytransmitted infection (STI) testing, location andvisit frequency. The least preferred PrEP program,which resulted in 48% predicted uptake, consistedof a cost of AU$100, a removable PrEP implant

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202434

with potential rare kidney problems, and access to
PrEP via hospital every two months without STI
testing. Our model predicted that the uptake could
increase up to 100% with the most preferred PrEP
program, which included free long-acting oral PrEP
with no side effects, accessing PrEP via a pharmacy
annually, and including STI testing. The LCM
identified four groups of MSM: “Long-acting oral
or injectable PrEP from STI clinics” (22%), “Daily
oral PrEP from pharmacy” (5%), “Long-acting oral
PrEP from pharmacy” (52%), and “injectable PrEP
from the hospital” (22%).
Conclusion: There is a growing demand foralternatives to oral daily PrEP, with the majority of
MSM in Australia prefer long-acting oral or
injectable PrEP. Decentralising access to PrEP
through pharmacies was also preferred by the
majority. Re-designing PrEP programs to cater forchanging preferences could optimize the uptake of
PrEP and accelerate the achievement ofeliminating HIV transmission in Australia.

Oral Abstract

14

Impact of changing PrEP
regimens on retention among
men who have sex with men in
Hanoi, Vietnam (2020-2023)
Setrakian N1, Bui H3, Adamson P2, Gorbach P1,
Hoang T4, Giang L3
1UCLA Fielding School of Public Health, Los Angeles, UnitedStates, 2Division of Infectious Diseases, David Geffen School of
Medicine at UCLA, Los Angeles, United States , 3Hanoi Medical
University, Hanoi, Vietnam, 4Division of Global HIV & TB
(DGHT), Centers for Disease Control and Prevention, Hanoi,
VietnamBackground: Understanding retention patterns
among people who use HIV pre-exposure
prophylaxis (PrEP) is necessary to achieve its
protective benefits. We examined the associationof PrEP retention with use of daily, event-driven(ED), or regimen switching reported at last visit
among men who have sex with men (MSM) in
Hanoi, Vietnam.
Methods: Between April 2020 and February 2023,
we collected data from PrEP clients at Hanoi
Medical University. We restricted analysis to those
who were male at birth, identified as male,reported sex with men, and returned for followup. The routine follow-up schedule was: 30 days
after the initial visit, 60 days after the first revisit,and every 90 days thereafter. Clients wereprescribed either ED or daily PrEP at the initial
visit; at subsequent visits, clients reported theregimen used since the prior visit. For analyses, wedefined three categories of PrEP use: ED-PrEP
exclusively, daily PrEP exclusively, and switching
between the two. The outcome was time to first
discontinuation in the study period, defined as
missing a scheduled visit by >30 days. We
performed survival analysis using Kaplan-Meiercurves.
Results: In total, 2,115 people were included;
61.1% (n=1,292) reported using daily PrEP
exclusively, 10.5% (n=221) using ED-PrEP
exclusively, and 20.7% (n=602) switched PrEP
regimens. Among those who switched, 425(70.6%) switched once and 177 (29.4%) switched
multiple times. Median time to first
discontinuation was 105 days [IQR: 80-204] among

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

35

those reporting ED-PrEP at last visit, 104 days [IQR:
119-411] among those reporting daily PrEP, and136 days [IQR: 123-386] among those who
switched (multi-switchers: 231 days; one-timeswitchers: 133 days) (Figure 1).
Conclusion: We provide real-world data from
MSM in Vietnam that switching between PrEP
regimens is common. Those who switched had
longer periods of retention during the study
period. This supports offering PrEP clients in global
settings an option to switch regimens.

Oral Abstract

15

Assessing HIV prevention
coverage among men who
have sex with men (MSM)
across 15 countries in Asia:
Results from the PrEP APPEAL
Study
Bavinton B1, Ong J2,3,4, Phanuphak N5, Fraser D1,
Tieosapjaroen W2,3, Schmidt H6,7, Chan C1
1The Kirby Institute, Sydney, Australia, 2Melbourne Sexual
Health Centre, Melbourne, Australia, 3Central Clinical School,
Alfred Health, Melbourne, Australia, 4Faculty of Infectious andTropical Diseases, London School of Hygiene and Tropical
Medicine, London, United Kingdom, 5Institute of HIV Researchand Innovation, Bangkok, Thailand, 6UNAIDS, Geneva,
Switzerland, 7Global HIV, Hepatitis and STIs Programme, World
Health Organization, Geneva, Switzerland

Background: Asia has some of the fastest growing
epidemics among men who have sex with men(MSM) globally. Measuring behaviours associatedwith HIV risk is critical to determine areas for
improvement and monitoring.
Methods: We used data from an online crosssectional survey conducted in 15 Asian countries
and territories among MSM from May to
November 2022 (Cambodia, China, Hong Kong,
India, Indonesia, Japan, Lao People’s Democratic
Republic [PDR], Nepal, Malaysia, Myanmar,
Philippines, Singapore, Taiwan, Thailand,
Vietnam). Among those who were sexually active,
we assessed behavioural HIV risk from questions
on sexual behaviour, condom use, and PrEP use in
the last 6 months. Risk categories were: 1) No
anal/vaginal intercourse, 2) Consistent condom
use with all casual partners, 3) Condomless
intercourse with casual partners (CLIC) with PrEP,
and 4) CLIC without PrEP; the final category wasconsidered the highest-risk for HIV. Factors
associated with CLIC without PrEP were identified
with multivariable logistic regression.
Results: Among 13,437 MSM, within the last 6months, 1,520 (11.3%) had no anal/vaginal sex,
4,016 (29.9%) consistently used condoms, 1,984(14.8%) had CLIC with PrEP, and 5,917 (44.0%) had
CLIC without PrEP. This varied significantly bycountry. For example, CLIC without PrEP ranged

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

36

from 76% in Lao PDR to 28% in Vietnam; CLIC with
PrEP ranged from 38% in Nepal to 2% in India; andconsistent condom use ranged from 41% in China
to 16% in Lao PDR and Nepal. Compared to those
not at highest-risk, participants reporting CLIC
without PrEP were more likely to: live in a highincome country (28.4% vs 33.9%, aOR=1.40,
95%CI=1.29-1.51), have been paid for sex (10.3%
vs 12.8%, aOR=1.37, 95%CI=1.21-1.54), or haveengaged in chemsex (18.3% vs 21.2%, aOR=1.23,
95%CI=1.12-1.35). They were less likely to: beolder (31.4 vs 30.9, aOR=0.99, 95%CI=0.99-0.99),
be in a relationship (44.5% vs 41.9%, aOR=0.93,
95%CI=0.86-1.00), or have engaged in injecting
drug use (7.4% vs 6.1%, aOR=0.71, 95%CI=0.610.83). They were more likely to prefer eventdriven PrEP (23.9% vs 26.0%, aOR=1.29,
95%CI=1.15-1.44) or a monthly oral pill (23.9% vs26.1%, aOR=1.32, 95%CI=1.18-1.48) compared todaily PrEP.
Conclusions: Significant proportions of MSM
throughout Asia reported sexual behaviour with arisk of HIV transmission: overall, this was nearly
half of participants at 44%, with more than 50% of
MSM in four of the countries being in this category(i.e. Lao PDR, Indonesia, Taiwan and Japan).
Greater PrEP access, including to new PrEP
modalities, and supporting condom use, should
remain priorities in this region.

Oral Abstract

16

Fully Integrated Mental HealthManagement within Routine
HIV Adolescent and Young
Adult Services using a
Collaborative Care Model in
Thailand: Lessons Learned
Songtaweesin W1,2,3, Saisaengjan C2, Thipakorn Y4,
Wongharn P2, Puthanakit T2,3, Thisayakorn P4
1School of Global Health, Faculty of Medicine, Chulalongkorn

University, Bangkok, Thailand, 2Center of Excellence for
Pediatric Infectious Diseases and Vaccines, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 3Department ofPediatrics, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand, 4Department of Psychiatry, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand

Background: Approximately 20% of Thaiadolescents and young adults living with HIV(ALHIV) have mental health disorders (MHDs).
Thailand has only 8 mental health professionals
per 100,000 population compared to the global
average of 13 and 45 in Europe. We aimed toprovide a fully integrated collaborative care model(CCM) for mental healthcare in routine ALHIV clinic
services to improve access.
Description: This program was conducted in a
hospital-based clinic for ALHIV aged 15-24 years in
Bangkok.
Phase 1 (2018-2019): PHQ-9 screening wasroutinely conducted at clinic visits. If ALHIV had
moderate depressive symptoms (PHQ-9 score > 9),scored > 0 to question 9 of the PHQ-9 on
suicidality, or pediatricians diagnosed major
depressive disorder (MDD) using DSM-5, they
were referred to the psychiatrist.
Phase 2 (2020-2023): The CCM utilizes
collaboration and task shifting between a mental
health specialist and primary care team to deliver
shared care plans that incorporate patient goals.
CCM was integrated into the clinic for mental
health care. Initial capacity building of HIV careproviders (physicians, nurses, counsellors) on basic
mental health care (counselling, psychiatric
medication) and monthly meetings (casemanagement guidance) by a supervising

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202437

psychiatrist and protocol-driven care(management plans based on PHQ-9 follow-up
scores at set intervals offering a combination ofcontinued counselling, pharmacotherapy and/or
monitoring) was conducted. All initial mental
health care assessment and management,
including emergencies, was done by clinic staff.
Case managers accompanied ALHIV referred to
psychiatric clinic and coordinated care delivery formoderate to severe conditions.
Lessons Learned: Between 2018-2023, 312 ALHIV
were served, 57% of whom had acquired HIV
during adolescence while 43% had perinatallyacquired HIV. Median age was 18 years. Eighty(25.6%) were diagnosed with MHDs, mostcommonly MDD (83.8%) and to a lesser extent
bipolar disorder (7.5%). Of these, 19/80 (23.8%)attempted suicide, often in the context of HIV
diagnosis, major life events or crystal
methamphetamine intoxication. Psychiatristdelivered care reduced from 100% in phase 1 to
37% in phase 2. Mental health outcomes were notsystematically measured in phase 1, but in phase2, 52.5% achieved remission of their MHD, 38.8%
receive ongoing care and 8.7% refused care but
remain in follow-up.
Conclusions: ALHIV access to mental healthservices was improved through existing provider
trust, reduced stigma in accessing psychiatricservices and reduced clinic visits. Monthly
meetings empowered providers. The integrated
CCM for mental health care supports WHO’s
fourth 90 on optimizing quality of life for people
living with HIV.
Integrated mental health care using CCM enabled
increased ALHIV mental health care accessibility
and sustainable mental health care provision by
HIV staff. This model can be adapted to otheryouth-focused services in middle-income
countries. Cost-utility analyses looking at caredelivery expenses relative to patient benefits areunderway to explore the cost-effectiveness of thismodel of care.

Oral Abstract

17

Enhancing access to HIV,sexual and reproductive
health, and gender-based
violence services for female
entertainment workers in
Cambodia: a cluster
randomized controlled trial ofa mobile health intervention
Yi S1,2,3, Chhoun P2, Tuot S2, Fehrenbacher A4,
Moran A4, Swendeman D4, Brody C31National University of Singapore, Singapore, Singapore,

2KHANA Center for Population Health Research, Phnom Penh,

Cambodia, 3Touro University California, VALLEJO, United States,
University of California Los Angeles, Los Angeles, United States

4

Background: The challenges of reaching andlinking female entertainment workers (FEWs) toessential health services are compounded by theirelusive nature and the associated stigma. This
implementation research developed,
implemented, and evaluated the Mobile Link. This
mobile health intervention actively engaged andconnected FEWs with available HIV, sexual andreproductive health, and gender-based violence(GBV) services through a network of peer outreachworkers in Cambodia.
Methods: In a randomized controlled trial
spanning 2018 to 2022, 600 participants aged 18
to 30 were randomly selected from a pool of 4,000
female entertainment workers (FEWs) in
Cambodia's capital city and three provinces.
Utilizing a random number generator, 300 wereassigned to the intervention arm, receiving
automated health messages and direct links topeer outreach workers. The remaining 300 formed
the control group receiving standard services.
Outcome measures encompassed self-reported
HIV/syphilis testing, contraceptive use, contact
with peer outreach workers, escorted referral
service utilization, forced drinking experiences,and gender-based violence incidents. Data
analyses involved repeated measures andmultilevel mixed-effects logistic regression.

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38

Results: We included 218 FEWs in the intervention
and 170 in the control arms in per-protocol
analyses. Positive intervention effects wereobserved in specific areas. FEWs in theintervention group were significantly more likely
to contact an outreach worker (at 30 weeks: AOR
3.29, 95% CI 1.28–8.47) and receive an escorted
referral (at 30 weeks: AOR 2.86, 95% CI 1.09–7.52;
at 60 weeks: AOR 8.15, 95% CI 1.65–40.25).
Additionally, the intervention group showed asignificant reduction in instances of forced drinking
at work compared to the control group (at 60
weeks: AOR 3.95, 95% CI 1.62–9.60). However, nosignificant differences were noted in fully adjusted
models for primary outcomes.
Conclusions: The Mobile Link intervention
effectively connected FEWs with outreach workers
and facilitated escorted referrals, indicatingpromise in addressing specific issues such as
forced drinking. While the impact on primary
outcomes was not significant, the potential for
longer-term messaging to enhance service accessand influence the health outcomes of FEWs isevident, highlighting avenues for future
improvements in this mobile health intervention.

Oral Abstract

18

Developing and evaluating an
HIV self-testing service with
online real-time counsellingprovided by an artificial
intelligence Chatbot (HIVSTChatbot)
Wang Z1, Chen S1, Zhang Q2, Fang Y3, Yu F1, Yau J4,
Ng N4, Choi K4
1JC School of Public Health and Primary Care, The Chinese

University of Hong Kong, Hong Kong, Hong Kong, 2Musketeers
Foundation Institute of Data Science, The University of Hong
Kong, Hong Kong, Hong Kong, 3Department of Health andPhysical Education, The Education University of Hong Kong,
Hong Kong, Hong Kong, 4AIDS Concern, Hong Kong, Hong Kong

Background: Proactively providing counselingsupport for all HIV self-testing (HIVST) users could
increase the linkage to care. HIVST-OIC, theprovision of online real-time instruction andcounseling for HIVST, was an evidence-based
HIVST intervention developed by our team.
Although the HIVST-OIC is effective in increasing
HIVST uptake and the proportion of HIVST users
receiving counselling along with testing, it requires
intensive manpower to implement and is lesssustainable. In this study, we developed an
artificial intelligence Chatbot to provide real-time
instruction and counseling for HIVST users (HIVSTChatbot).
Objectives: The primary objectives are to compare
the efficacies of HIVST-Chatbot and HIVST-OIC inincreasing HIVST uptake and proportion of HIVST
users receiving counselling along with testing.
Methods: A partially-blinded (outcome assessors
and data analysts), parallel-group, and noninferiority RCT was conducted. Participants wereHong Kong Chinese-speaking sexually-active MSM
aged ≥18 years. Those who have been diagnosed
as HIV-positive were excluded. A total of 531
participants were recruited through multiple
sources and randomized evenly to either the
HIVST-Chatbot (n=266) or the HIVST-OIC group(n=265).
In the HIVST-OIC group, participants watched an
online video promoting HIV testing in general and

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

39

HIVST-OIC, selected their preferable HIVST kits(oral fluid-based or blood based), chose a service
model (comprehensive version: both real-time
pre-test and post-test counseling, or simplified
version: real-time post-test counseling only). Upon
appointment, an experienced HIV testing
administrator implemented HIVST-OIC throughlive-chat applications. Users who received apositive result were given immediate psychologicalsupport and linked to care.
In the HIVST-Chatbot group, participants watched
an online video promoting HIV testing in generaland HIVST-Chatbot, and selected their preferable
HIVST kits. Participants could get the Chatbot to
implement their preferable service model(comprehensive or simplified) without a previous
appointment. Chatbot would provide standard-ofcare pre-test and/or post-test counseling. Users
were asked to report their results by answering a
multiple-choice question, and to upload a photo of
their testing result to a secure webpage forverification. For users receiving a positive result,
the Chatbot would automatically and immediately
notify designated supporting staff, who would
follow up with the user as soon as possible.
Intention-to-treat (ITT) analysis was performed.
Results: Majority of the participants were under
35 years old (56.9%), received tertiary education(84.0%), and identified themselves as gay (90%). At
Month 6, 194 participants (72.9%) in the HIVSTChatbot group and 196 participants (74.0%) used
any type of HIVST during the follow-up period. The
between-group difference in the HIVST uptake wasstatistically non-significant (p=.79). The proportionof HIVST users received counseling support wassignificantly higher in the HIVST-Chatbot groupthan that in the HIVST-OIC group (93.3% vs. 61.2%,
p<.001). Regarding the types of counseling, more
HIVST users in the HIVST-Chatbot group received
comprehensive version than that in the HIVST-OIC
group (35.6% vs. 5.1%, p<.001).
Conclusion: The HIVST-Chatbot is feasible andacceptable to deliver real-time counseling support
for MSM HIVST users in Hong Kong. The RCT
proved that the HIVST-Chatbot was non-inferior to
HIVST-OIC in improving HIVST uptake among
MSM. More HIVST users in the HIVST-Chatbot
group received counseling along with HIVST.

Oral Abstract

19

Integrating strengths fromvarious sources through adigital health platform: an
online-to-offline service modelfor HIV pre-exposure
prophylaxis (PrEP)
Gu Y1, Luo Y, Lu Y, Meng G, Sun L, Cai Y, Han Z
1Guangzhou Center for Disease Control and Prevention,

Guangzhou, China

Background: Over the past decade, PrEP has
globally proven highly effective, reducing the riskof acquiring HIV by at least 90% among men who
have sex with men (MSM). In 2020, China
approved TDF/FTC for PrEP. However, PrEP
services, primarily provided by hospitals
specializing in HIV antiretroviral treatment (ART),
face low utilization due to factors such as intricate
clinic procedures and inadequate friendlinesstowards the LGBT community. In Guangzhou, aprominent city in China, the proportion of MSM
seeking PrEP services in 2022 was merely 4.9%
compared to post-exposure prophylaxis cases inthese HIV ART hospitals, emphasizing the need formore convenient, LGBT-friendly, andcomplementary service models.
Description: The HIV digital health platform,
named "Chabei," established by our team,functions as a central hub connecting
organizations specializing in specific services toform an online-offline PrEP service model. Initially,
LGBT community-based organizations (CBOs) offer
online/offline MSM-friendly consultation andassessments for PrEP. Guangzhou center for
disease control and prevention, in collaboration
with third-party testing facilities, conduct offline
testing for HIV, HBV, HCV, STIs, and creatinine.
Physicians familiar with ART medicines review test
results and prescribe PrEP medications throughonline medical platforms. The medications arethen delivered to MSM by the online medical
platform. Subsequent follow-up, including testing
and medication renewal, is managed by CBOs. The
HIV digital health platform acts as a unified portal
for all online/offline services, integrating service
processes and data from different organizations to

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40

enhance efficiency, user experience, and data
flow. In this model, consultation, assessment,
testing, and follow-up services are all provided
free of charge, with MSM only responsible for
medication costs.
Lessons learned: This model was designed in 2019and launched in Guangzhou in December 2021. As
of June 2023, we have provided PrEP consultations
for a total of 920 MSM, with 223 participating in
pre-medication testing. Among, 4 individuals withpositive HIV antibodies were deemed unsuitablefor PrEP, while 6 with positive HBV antigen werereferred to HIV ART hospitals for further
assessment. Additionally, 27 exhibited abnormal
creatinine levels, but the severity did not preclude
PrEP use. Ultimately, 207 MSM initiated PrEP
through our model, representing 3.6 times theservice volume of all HIV ART hospitals in
Guangzhou during the same period. In our model,
99.5% of PrEP users opted for event-driven PrEP,
with 50.7% participating in the follow-up. No
instances of HIV antibody seroconversion
observed up to the present.
Conclusions/next steps: By integrating strengths
from various sources through the HIV digital
health platform, this model blends theconvenience of online healthcare withstandardized, safe, and MSM-friendly PrEP service
procedures. Our model represents a distinctive
complement to the PrEP services offered by HIV
ART hospitals, improving the applicability andpromotion of PrEP. It has considerable potential
for adaptation and expansion to other Chinese
cities. In the next phase, we aim to investigate
simplified processes and flexible follow-up
methods in accordance with the WHO PrEP
guidelines.

Oral Abstract

41

20

Integrating hepatitis C virus
self-testing into HIV and harm
reduction services as an
approach towards HCV microelimination among key
populations and people livingwith HIV in Vietnam.
Ngoc B , Green K , Hung M , Mai H , Tuan K ,Huong L1, Khanh A1, Thu G2, Pham C2
1

1

2

1

1

PATH, Hanoi, Viet Nam, 2Center for Creative Initiatives in
Health and Population (CCIHP) , Hanoi, Viet Nam

1

Background: Hepatitis C virus self-testing (HCVST)
is an innovative approach to accelerate progress
towards HCV elimination goals. We conducted across-sectional observational study to assess theacceptability and effectiveness of HCVST
compared to routine HCV testing among key
populations (KP) and people living with HIV (PLHIV)in Hanoi and Ho Chi Minh City, Vietnam.
Methods: From September 2023 to January 2024,
we engaged eight community-based organizations(CBOs), six anti-retroviral therapy and methadone
maintenance treatment (MMT) public clinics, andfour KP-led private clinics in implementing
community-based, facility-based, online, andsecondary distribution. Clients were offered the
choice of an oral fluid-based HCVST, or rapid HCV
testing provided by CBOs and clinic staff (PLHCVT). Individuals with a positive HCV test werereferred or linked to designated public and private
clinics for HCV confirmatory testing and treatment
initiation. Acceptability of HCVST was defined as
the proportion of first-time HCV testers utilizing
the service, and effectiveness was measured by
HCV positivity and treatment initiation rates.
Results: Of 2,882 individuals recruited, 1,858
opted for HCVST and 1,024 opted for PL-HCVT. The
proportion of first-time HCV testers was
significantly higher among HCVST clientscompared to PL-HCVT clients (67.6% vs. 59,1%),and particularly high in secondary distribution andcommunity-based HCVST compared to online andfacility-based HCVST (91.4% and 83.8% vs. 48.9%
and 36.8%, respectively). Overall, HCV positivity

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

rate was lower in HCVST than in PL-HCVT (11.1%
vs. 17.9%), however, it was higher in communitybased and facility-based HCVST compared tosecondary distribution and online HCVST (17.7%
and 16.8% vs. 3.6% and 1.5%, respectively). HCV
positivity rate was highest among PLHIV (27.5%),
followed by MMT clients (25,5%), people who
inject drugs (17.2%), KP partners (3.9%), female
sex workers (2.8%), and men who have sex withmen (0.3%). Of 392 HCV positive individuals
detected, 208 were from HCVST, of which 94.1%
received confirmatory testing, and 93.2% of theminitiated HCV treatment.
Conclusions: HCVST is an additional effective
approach to increase uptake of HCV testing andtreatment among KPs and PLHIV. HCVST is mosteffective in reaching unreached high-risk
populations through community-based model,
followed by facility-based, secondary distribution
and online distribution.

Oral Abstract

21

Outcomes from a communityclinic hybrid PrEP approach aspart of a clinical trial in China,
2021-2023
Yin Z1, Dai Y1, Fan C1, Li C2, Wu S3, Li Q4, Huang H5,
Liang K3, Li L4, Hazra A6, Lio J6, Tucker J1,7,8, Sherer
R6, Tang W1,8
1UNC Project China, Guangzhou, China, 2Tokyo College, theUniversity of Tokyo, Tokyo, Japan, 3Zhongnan Hospital of
Wuhan University, Wuhan, China, 4Guangzhou Eighth People's
Hospital, Guangzhou, China, 5Wuhan Tongxing LGBT Center,
Wuhan, China, 6University of Chicago, Chicago, USA, 7London
School of Hygiene and Tropical Medicine, London, UK,
8University of North Carolina at Chapel Hill, Chapel Hill, USA

Introduction:Data on PrEP uptake, persistence,
discontinuation, adverse events, and HIV incidence
among Chinese at-risk PrEP users is limited. This
study addresses the research gap by summarizing
the results of a PrEP phase 4 clinical trial in China.
Methods: We conducted a 12-month PrEP
demonstration project in Wuhan and Guangzhou,
China, using a community-clinic hybrid model for
recruitment, participant engagement, and PrEP
delivery. The healthcare providers implemented
oral PrEP prescribing, medical consultation, andmedicine dispensed through clinic visits or maildelivered PrEP by community-based organizations.
PrEP refill was monthly for the first quarter andtrimonthly thereafter. PrEP persistence (defined as
finishing the follow-up as required) and adherence(defined as self-reported taking more than 4 pillsin 7 days for daily and over 75% strict adherence
to 2+1+1 for event-driven dosing) information was
surveyed quarterly. Enrollment, PrEP persistence,
adherence, discontinuation, and adverse eventswere descriptively summarized.
Results: From September 2021 to December 2023,
we screened 3649 PrEP-eligible participants. Of
those, 1138 participants started oral PrEP, with a
median age of 29.1(SD=5.9). Most participants
identified as gay or bisexual(1066/1138) and cisgender men(1134/1138). After initiation, PrEP
persistence at 3, 6, 9, and 12 months were
83.7%(947/1131),76.9%(795/1034),68.2%(589/864), and 60.6%(439/724) respectively. At 3-monthfollow-up, 43.8%(415/947) and 56.2% (532/947)

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42

chose the daily and on-demand regimen. In theend, 39.4%(173/439) of participants reported
increasing dosing strategies switching, 35.3%(61/173), 40.5%(70/173), 57.8%(100/173),
64.7%(112/173) at each time follow up. Amongthem 88.4%(153/173) participants had transferredfrom daily to the on-demand regimen. The selfreported adherence was
75.0%(774/1032),67.8%(637/940),58.6%(469/800), and 50.7%(340/670) at each time point.
285 participants (25.0%,285/1138) discontinued
PrEP during the study. 47.6% and 55.4% ofsubjects reported alcohol use and nitrates atbaseline and 12 months. Six participants were
seroconverted, resulting in an HIV incidence rateof 0.53 per 100 person-years. ( The absence of
PrEP in this population is 5.10 per 100 personyears)
Conclusion: The hybrid CBO and clinic-basedmodel proved feasible for reaching and dispensing
PrEP among Chinese at-risk populations. Ondemand use and mail-order drugs were popular
alternatives and one-half of participants engaged
in sex using alcohol and nitrates. Long-term PrEP
persistence and optimal adherence continuously
decreased among Chinese users during the 12months.

Oral Abstract

102

Machine Learning Algorithms
for Predicting HIV Infection
among Young Men Who Have
Sex with Men in Thailand.
Soha K1, Phuthomdee S2,3, Srichai T4, Han W5,
Teeraananchai S1,2
1Master of Biomedical Data Science program, Faculty of

Science, Kasetsart University, Bangkok, Thailand, 2Departmentof Statistics, Faculty of Science, Kasetsart University, Bangkok,
Thailand, 3Panyananthaphikkhu Chonprathan Medical Center,
Srinakharinwirot University, Nonthaburi, Thailand, 4National
Health Security Office, Bangkok, Thailand, 5Kirby Institute,
University of New South Wales, Sydney, Australia

Background: Scaling up of HIV testing among key
populations in Thailand has indicated an increasing
trend in the number of new HIV infection among
young men who have sex with men (MSM). The
study aimed to develop machine learning (ML)models to predict HIV infection and assessed theassociated factors at diagnosis among young MSM
through the Universal Health Coverage program(UHC) in Thailand.
Methods: Young MSM aged 15 to 24 years at HIV
testing through the UHC program from 2015 to2022 were included. HIV infection was diagnosed
HIV positive in the database according to the UHC
program. Risk factors included age, year at HIV
test, HIV routine testing, region, nonoccupational
post-exposure prophylaxis, number of HIV testing,prisoner status and having a sexual partner with
HIV. We divided data for the model development
into two groups: training data (70%) and testingdata (30%) by applying Synthetic Minority
Oversampling Technique to address the imbalancein the dataset. ML models, including K-nearest
neighbor (KNN), Random Forest (RF) and Extreme
Gradient Boosting (XGB), were established to
predict HIV infection. Model performance was
evaluated using accuracy, precision, sensitivity,
specificity, and the Area Under the Curve (AUC).
Feature selection was based on the featureimportance (FI) score derived from the bestperforming ML model. Multivariable logistic
regression was used to investigate factors
associated with HIV infection based on the top
ranked of FI score.

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43

Result: A total of 146,813 young MSM were
included, 11% were diagnosed with HIV. The
median age at HIV test was 20 years and 74%
underwent routine HIV testing (defined as a rateof tests per year ≥1.5 tests/year). Most young
MSM were from Northeastern region (26%) andfollowed by Northern region (21%) and Bangkok(15%). After developing ML with feature selection,
the XGB model exhibited the highest performanceof predicting HIV infection, with 72% accuracy,
88% precision, 73% sensitivity, 72% specificity and
72% AUC, respectively. The XGB algorithm ranked
the top three important predictors based on FIscores, which were routine testing (27.8%), year at
HIV test (26.3%) and age at HIV testing (18.4%). In
the multivariable model, MSM with age 20-24
years (aOR 2.63, 95%CI 2.53-2.74) had a higher riskof testing positive for HIV compared to those aged
15-20 years. Young MSM who underwent routine
testing (aOR 3.23, 95%CI 2.99-3.49) were more
likely to test positive for HIV than those who did
not have routine testing. Additionally, young MSM
who were tested for HIV between 2015-2017 (aOR
6.31, 95%CI 6.01-6.63) and 2018-2020 (aOR 2.51,
95%CI 2.41-2.62) had higher odds of HIV infection
compared to those tested during 2021-2022.
Young MSM with a sexual partner with HIV (aOR
6.10, 95%CI 4.23-8.80) were at a higher risk of HIV
infection.
Conclusion: XGB machine learning algorithm
effectively identified significant predictors for HIV
infection among Thai young MSM. Limitations
include the absence of PrEP data or sexual
behavior, which could influence HIV diagnosis.
These findings support the scale-up of HIV testing
to monitor community HIV risk potential throughUHC program in Thailand.

Oral Abstract

108

A mobile health approach forfacilitating regular HIV testing
among men who have sex withmen
Kwan T1,2,3, Chan D2,3, Lee S2,3
Jockey Club School of Public Health and Primary Care, The
Chinese University of Hong Kong, Shatin, Hong Kong, 2S.H. Ho
Research Centre for Infectious Diseases, The Chinese Universityof Hong Kong, Shatin, Hong Kong, 3Stanley Ho Centre for
Emerging Infectious Diseases, The Chinese University of Hong
Kong, Shatin, Hong Kong

1

Introduction: HIV testing plays a crucial role inidentifying undiagnosed people living with HIV andpromoting early access to treatment. Innovativemeans is warranted to boost the suboptimal
regular testing rate among men who have sex withmen (MSM). To this end, this study aimed toassess the effectiveness of a mobile health(mHealth) approach in promoting regular HIV
testing.
Methods: A stepped wedge trial was designed tocompare the effectiveness of two approaches,
namely an mHealth approach with text messagebased reminders and an HIV self-test (HIVST)
subscription model. The 1-year observation period
was divided into 3-month intervals. All participants
started with the mHealth approach then crossed
over to the HIVST arm at Month 3, 6, or 9,
depending on the 1:1:1 randomization at baseline.
Participants in either arm received a text message(reminder for the reminder arm, and HIVST
delivery information for the HIVST arm). Fourteendays after receiving the message, a follow-up
survey was sent to enquire if they had undergone
testing. In the current analysis, the focus was on
the first interval when all participants were in thereminder arm. Proportion of and factors
associated with adherence to the protocol as wellas performance of HIV test were evaluated using
bivariate analysis.
Results: Between 15 January and 15 March 2024, a
reminder message and consequent follow-up
survey were delivered to 135 recruited MSM.
Totally 55 (41%) responded to the follow-up
questionnaire and 28 (51%) self-reported an HIV
test had been done after receiving the message.

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44

Among them, 15 (54%) self-tested, 11 (39%) tested
at a community-based organisation, and 2 tested
elsewhere. The most commonly cited reason for
not testing was not having time (37%), followed by
not knowing where to get tested (22%) and low
perceived risk (22%). Participants adhering to theprotocol by completing the follow-up survey weremore educated (p=0.02) and more concerned
about the opening hours of testing services(p=0.006). They were also more experienced inusing an HIV self-test (p=0.02) and did not have apreference for the type of HIV self-tests (p=0.02).
MSM who did not get tested after receiving thereminder message were less likely to have aregular testing habit for at least twice yearly(p=0.01), and more likely to avoid discussing about
sexual behaviours during testing sessions (p=0.05)
and give a lower score for recommending theirpeers to join a text message-based reminder
programme (p=0.03).
Conclusion: HIV self-testing has become morecommon in the MSM community, which could be
preferred by people who did not want to share
their sexual history for risk assessment whenattending a testing service. The mHealth approach
was useful to reinforce regular testing habit andcould be promoted through peer influencers.

POSTER ABSTRACTPRESENTATIONS
Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

27 – 29 June 2024
Hong Kong

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Poster Abstract

22

Integrated analysis of
microbiome and hosttranscriptome unveils
correlations between lungmicrobiota and host immunein bronchoalveolar lavage fluidof pneumocystis pneumonia
patients with HIV/AIDS
Zhang L1, Zhang Y1
1Beijing Youan Hospital, Beijing, China

Objective: Studies have indicated that the lungmicrobiota of patients with pulmonary diseases is
disrupted and impacts the immunity.
Pneumocystis pneumonia (PCP), a severe
opportunistic pulmonary infection in HIV/AIDS, ispredominately attributed to host immune status.
Little is known about the microbiological andimmune landscape of the lungs in these patients.
We aimed to explore the interaction between thelung microbiota and host immunity in PCP throughmulti-omics analysis.
Methods: We selected pulmonary infection
patients with HIV/AIDS admitted to Beijing You An
Hospital, Capital Medical University, from January
1, 2022 to August 31, 2022 and underwent
bronchoscopy. Participants were divided into PCP
and non-PCP group. We investigated the lungmicrobiota (via 16S rRNA gene sequencing) andhost immune (via RNA-sequencing) on
bronchoalveolar lavage fluid samples. The datasets
were analyzed individually using bioinformatics
approaches. Then we constructed a diagnostic
model using differential genes with LASSO
regression. The immune infiltration analysis was
performed to explore the landscape of lungimmune in patients with PCP. Additionally, we
performed spearman correlation analysis to assess
the correlation between the OUT abundance ofdifferential species and the expression levels of
the differentially expressed genes (DEGs) related
to the MAPK signaling pathway.
Results: The study enrolled 58 patients, including
19 with PCP and 39 without. The microbiota data

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46

showed a low alpha diversity of lung microbiota in
PCP patients. At the level of phylum, patients with
PCP displayed the microbiota signature in the lungcharacterized by the declined abundance ofActinobacteriota, Bacteroidota, Fusobacteriota
and Campilobacterota, and the elevatedabundance of Firmicutes and Patescibacteria
compared to non-PCP samples. The predictedfunction of these differentially abundantmicrobiota primarily influenced immunity andmetabolism. Transcriptome data analysis showedthat compared with non-PCP patients, the PCPgroup had 3433 DEGs, of which 1103 genes wereupregulated. These genes were mainly associatedwith immunity, inflammatory response as well ascell growth and death. Moreover, the Gene Set
Enrichment Analysis (GSEA) revealed a downregulation of the MAPK signaling pathway. The
transcriptomic marker MAPK10, TGFB1, andEFNA3 indicated a potential to predict the onset of
PCP (AUC = 0.86, 0.73-0.99). The lung immune
landscape of patients with PCP showed the lower
levels of naïve CD4 T cells and activated dendritic
cells compared to non-PCP individuals. The
correlation analysis of the MAPK signaling
pathway-related DEGs and the OTU abundance ofthe differential microorganisms at the level ofphylum showed that the Firmicutes was negatively
correlated with these DEGs.
Conclusion: In addition to characterizing lungmicrobiota and host immunity, our study indicatedthat the Firmicutes may negatively regulate the
MAPK signaling pathway. This knowledge may
pave the way for novel therapeutic strategies
targeting the lung microbiota to enhance hostimmune defenses and improve outcomes in PCP
patients with HIV/AIDS.

Poster Abstract

23
Abstract number 23 has been withdrawn.

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47

Poster Abstract

24

Enhanced immune
reconstitution with Albuvirtidein HIV-infected immunological
non-responders
Ma P1, Fan L1, Hu Y1, Li R1, Ding J1, Yu A1, Su R2,
Zhao Q3, Li Y4
1Tianjin Second People’s Hospital, Nankai University, Tianjin,

China, 2Tianjin Institute of Hepatology, Tianjin Second People’s
Hospital, Tianjin, China, 3Department of Infectious Diseases,
Henan Infectious Diseases Hospital,, Zhengzhou, China,
4Department of Pathology, Tianjin Second People's Hospital,
China

Background: Incomplete immune recovery inpeople living with HIV/AIDS (PLWHA) remains animportant clinical challenge with the lack of aneffective strategy currently available to restore
their T-cell immune response. This study aimed toevaluate the effect of Albuvirtide (ABT) on immune
recovery in immunological non-responders (INRs)
and attempted to explore potential mechanisms of
ABT on the functionality of immune cells.
Methods: In this prospective, open-label,
controlled clinical study, participants withincomplete immune reconstitution (continuous
ART over 5 years and CD4+ T lymphocyte absolutecount of <500 cells/µl or ART for 2-5 years andCD4+ count of <200 cells/µl with undetectableviral load) were received intensive treatment with
ABT or maintained on the original ART regimen at
a ratio of 1:1. Immune response and safety were
examined within 24 weeks. In the cytologicalstudy, T subsets, cell apoptosis, and cell autophagy
were analyzed using immunofluorescence staining
and flow cytometry from 25 blood specimens（6healthy donors (HDs); 5 immunological responders(IRs); 8 satisfactory immune response (sIRs); 6
unsatisfactory immune response (UIRs)).
Satisfactory immune response was defined asincomplete immune reconstitution with CD4+ cellcounts >200 cells/µL, and unsatisfactory immune
response was defined as incomplete immune
reconstitution with CD4+ cell counts <200 cells/µL.
Results: Both groups (n=25 each) in the clinicalstudy were comparable in age, gender, and ART
duration. At week 12, CD4+ cell count increased
significantly in the intensive ABT group compared

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202448

with the control group (the change from baselinein CD4+ count: 45 vs. -5 cells/µL, p<0.001). After
ABT discontinuation, CD4+ cell counts remained
significantly higher in the intensive ABT group at
week 24 (55 vs. -5 cells/µL, p=0.012). Participants
over 45 years or ART treatment history over 5
years benefit most from ABT. All participants were
well tolerated with ABT treatment. In laboratory
analysis, naïve CD4+ T cell amounts were lowest
among participants with UIR to ABT (p=0.001).
Compared with HDs and PLWHA with sIR, adecreased proportion of CD45RA+CD31+CD4+ T
cells (thymocyte output) was found in PLWHA with
UIR (26.5%, 31.5%, 19.3% vs 7.4%，p=0.001). The
proportion of caspase 3+CD45RA+CD31+CD4+ T
cells (cell apoptosis) was significantly lower inparticipants with sIR to ABT (p<0.05).
Conclusion: Significant CD4+ cell count increasesuggests ABT enhances immune function in INRs
which may be attributed to its antiviral properties
as well as its ability to increase thymic cell output
and decrease cell apoptosis.

Poster Abstract

25

Altered KEGG pathways areassociated with different
immunologic responses toantiretroviral therapy in HIVinfected men who have sex
with men
Zhao H1,2,3, Luo D3, Feng A3, Zhou X3, Lin Y3, Chen
Y3, Yuan J4, Liu C1,2, Li L1,2, Zou H5,6,7
1Guangzhou Medical Research Institute of Infectious Diseases,

Guangzhou Eighth People’s Hospital, Guangzhou Medical
University, Guangzhou, China, 2Infectious Disease Center,
Guangzhou Eighth People’s Hospital, Guangzhou Medical
University, Guangzhou, Guangzhou, China, 3School of Public
Health (Shenzhen), Sun Yat-sen University, Shenzhen, China, 4Big
Data Center, The Seventh Affiliated Hospital, Sun Yat-sen
University, Shenzhen, China, 5School of Public Health, Fudan
University, Shanghai, China, 6School of Public Health, Southwest
Medical University, Luzhou, China, 7Kirby Institute, University of
New South Wales, Sydney, Australia

Background: The association between Kyoto
Encyclopedia of Genes and Genomes (KEGG)
metabolic pathways and immunologic nonresponse among people living with HIV (PLHIV) on
antiretroviral therapy (ART) is not well
documented. This study aimed to characterize
KEGG metabolic pathways among HIV-infected
men who have sex with men (MSM) with different
immunologic responses.
Methods: We recruited HIV-uninfected MSM(healthy controls, HC) and HIV-infected MSM on
ART >24 months in Guangzhou, June-October
2021. HIV-infected MSM were grouped into poor
immunological responders (PIR) (CD4+ T cell count< 350 cells/μL) and good immunologicalresponders (GIR) (CD4+ T cell count ≥ 350
cells/μL). Stool samples were collected. Bacterial
16S ribosomal DNA sequencing was performed onstool samples, and KEGG metabolic pathways ofgut microbiota were imputed from 16S rDNA
sequences.
Results: A total of 51 HC, 41 PIR, and 56 GIR wereenrolled. The median time since HIV diagnosis for
PIR and GIR was 4.6 and 4.2 years. KEGG metabolic
pathways were significantly different among HC,
PIR, and GIR groups. Retrograde endocannabinoid
signaling, pantothenate and CoA biosynthesis, bile

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49

secretion, non-homologous end-joining, andgastric cancer were the top five important KEGG
metabolic pathways associated with the
immunologic responses. Specifically, retrograde
endocannabinoid signaling performed best in
discriminating PIR and GIR.
Conclusions: This study presented acomprehensive landscape of KEGG metabolic
pathways in PLHIV with different treatment
outcomes. These results suggest the potential of
KEGG metabolic pathways as novel diseaseprogression markers and therapeutic targets.

Poster Abstract

26

Polymorphonuclear MyeloidDerived Suppressor Cells
regulates immune
reconstitution during HIV
infection through PD-L1 andTGF-β signaling
Xia H1, Ma P1
1Tianjin Second People's Hospital, Tianjin, China

Background: Although myeloid-derived suppressor
cells (MDSCs) are widely recognized for theirimmunoinhibitory effect in a variety ofpathological conditions, their function during
human immunodeficiency virus (HIV) infection andthe onset of inadequate immune reconstitution
remains elusive.
Methods: We conducted a cross-sectional study
in which 30 healthy controls and 62 HIV-1-infectedsubjects [31 immunological non-responders (INRs)
and 31 immunological responders (IRs)] wereselected. The proportion of MDSCs was measured
and their relationship with HIV disease progression
was studied. Specifically, using flow cytometry andreal-time PCR, immune regulatory molecules(including programmed death-ligand 1 [PD-L1],
arginase 1, inducible nitric oxide synthase,interleukin 10, transforming growth factor beta
[TGF-β], and indoleamine 2,3-dioxygenase) thatare relevant for MDSCs activity were quantified.
Furthermore, we investigated the impact of theblockade of PD-L1 and/or TGF-β signaling on
MDSCs and their effects on CD4+ T cells using invitro functional experiments.
Results: We found that polymorphonuclear MDSCs(PMN-MDSCs) are more abundant and negatively
correlated with CD4+ T-cell counts in HIV-infectedindividuals. PMN-MDSCs suppress CD4+ T-cellproliferation and interferon-γ (IFN-γ) production in
INRs. Furthermore, correlations were foundbetween PD-L1 expression on PMN-MDSCs andPD-1+ CD4+ T-cells. TGF-β expression on PMNMDSCs was likewise enhanced in INRs.
Importantly, inhibiting both PD-L1 and TGF-βsignaling had a synergistic impact on restoring
CD4+ T-cell activity in vitro.

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50

Conclusions: PMN-MDSCs expansion inhibits CD4+
T-cell responses. We suggest that targeting PD-L1
and TGF-β pathways together may significantly
improve immune reconstitution in INRs.

Poster Abstract

27

The potential role of P-selectin
glycoprotein ligand-1 in theonset of incomplete immune
recovery in HIV infection
Zaongo S1, Chen Y1
Chongqing Public Health Medical Center, Chongqing , China

1

P-selectin glycoprotein ligand-1 (PSGL-1) is an HIV1 restriction factor; however, cumulative evidence
indicates that expression and signaling of PSGL-1
may not be entirely beneficial to the human host.
Indeed, considered to be an immunologicalcheckpoint protein, PSGL-1 is also responsible for
T-cell (i) exhaustion and (ii) loss of function.
Contemporarily, the expression of PSGL-1 during
HIV-1 infection, and the precise role that PSGL-1
may play in the pathophysiology of HIV infection,
particularly during highly active antiretroviraltherapy (HAART), remains elusive.
In this observational study, blood samples fromHIV-1 positive patients under HAART [bothimmunological responders (IRs) andimmunological nonresponders (INRs)] werecollected and analyzed. Flow cytometry and qRTPCR were used to determine the levels of PSGL-1
on/in CD4+ T-cells. Levels of CD4+ T-cell-platelet
aggregates in IRs and INRs were determined using
anti-CD42a antibodies. Similarly, anti-caspase 3
was used to determine the levels of caspase 3 in
CD4+ T-cells and CD4+ T-cell-platelet aggregates.
Also, enzyme-linked immunosorbent assay (ELISA)
kits were used to determine levels of plasma
markers of inflammation and/or translocation, i.e.,
sCD163, sCD14, sCD40, lipopolysaccharides, and βglucans. Spearman’s correlation test was used todetermine the correlation between PSGL-1
expression and plasma markers of inflammation
and/or translocation.
qRT-PCR results indicated that compared to INRs,
intracellular expression of PSGL-1 in IRs was
significantly lower (p=0.010). Flow cytometry
analysis confirmed the preceding observation,
indicating that PSGL-1 is overexpressed in INRs
(p<0.001). Interestingly, when compared to IRs,
INRs display higher levels of CD4+ T-cell-platelet
aggregates (p<0.001). When considering individual

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51

CD4+ T-cells, INRs display a higher proportion of
caspase 3, and thus, have higher levels of
apoptosis compared to IRs (p<0.001). In thecontext of CD4+ T-cell-platelet aggregates, thesepreliminary results suggest that PSGL-1 signaling
promotes increased cellular death via apoptosis inboth IRs (from 2.9% in individual CD4+ T-cells to
30.8% in CD4+ T-cell-platelet aggregates) and INRs
(from 58.1% in individual CD4+ T-cells to 87.5% in
CD4+ T-cell-platelet aggregates). In analysing
plasma markers of inflammation and/ortranslocation, both IRs and INRs display significant(p<0.05) and strong correlations between PSGL-1
and the considered plasma markers (r=0.86, 0.79,
0.79, 0.74, and 0.86, for PSGL-1-sCD163, PSGL-1LPS, PSGL-1-β-glucan, PSGL-1-sCD14, and PSGL-1sCD40, respectively).
It is likely that elevated levels of inflammation andmicrobial translocation may drive PSGL-1
upregulation in INRs. Consequently, theupregulated levels of PSGL-1 may engage Pselectin on a higher number of platelets, whichconsequently form elevated numbers of CD4+ Tcell-platelet aggregates. Thus, these trapped CD4+
T-cells are likely to ultimately initiate cellular death
via apoptosis. Further investigations are required
to validate the preceding observations.

Poster Abstract

28

An atlas of immune celltranscriptomes in humanimmunodeficiency virusinfected immunological nonresponders identified marker
genes that control viral
replications
Han X1, Chen Y1, Ao W1, Lin J1, Li Z1, Wu S2, Ye H1, Li
D3, Lin T1
Mengchao Hepatobiliary Hospital Of Fujian Medical University,
Fuzhou, China, 2Fujian Provincial Center for Disease Control andPrevention, Fuzhou, China, 3900th Hospital of Joint Logistics
Support Forces of the Chinese PLA, Fuzhou, China

1

Background: Previous studies have examined thebulk transcriptome of peripheral
blood immune cells inacquired immunodeficiency syndrome patients
experiencing immunological non-responsiveness.
This study aimed to investigate the characteristics
of specific immune cell subtypes inacquired immunodeficiency syndrome patients
who exhibit immunological non-responsiveness.
Methods: A single-cell transcriptome sequencingof peripheral blood mononuclear cells obtained
from both immunological responders (IRs) (CD4 +T-cell count >500) and immunological nonresponders (INRs) (CD4 + T-cell count <300) was
conducted. The transcriptomic profiles were used
to identify distinct cell subpopulations, marker gen
es, and differentially expressed genes aiming to
uncover potential genetic factors associatedwith immunological non-responsiveness.
Results: Among the cellular subpopulations
analyzed, the ratios of monocytes, CD16 +monocytes, and exhausted B cells demonstrated
the most substantial differences between INRs andIRs, with fold changes of 39.79, 11.08, and 2.71,
respectively. In contrast, the CD4 + T cell ratio wassignificantly decreased (0.39-fold change) in INRs
compared with that in IRs. Similarly, the ratios ofnatural killer cells and terminal effector CD8 +T cells were also lower (0.37-fold and 0.27-fold,respectively) in the INRs group. In addition toseveral well-characterized immune cell-

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52

specific markers, we identified a set of
181 marker genes that were enriched in biologicalpathways associatedwith human immunodeficiency virus (HIV) replicati
on. Notably, ISG15 , IFITM3 , PLSCR1 , HLA-DQB1 ,CCL3L1 , and DDX5 , which have been
demonstrated to influence HIV replication throughtheir interaction with viral proteins, emerged as
significant monocyte marker genes. Furthermore,
the differentially expressed genes in naturalkiller cells were also enriched in biologicalpathways associated with HIV replication.
Conclusions: We generated
an atlas of immune cell transcriptomes in HIVinfected IRs and INRs. Host genes associated withHIV replication were identified as markers of, andwere found to be differentially expressed in,different types of immune cells.

Poster Abstract

29

Diagnostic and prognostic
utility of Xpert Ultra in bloodand Myco/F Lytic blood culture
for TB in hospitalized patientswith advanced HIV disease in
Vietnam
Trinh L1, Nguyen Quang Dieu1, Do Dang Anh Thu1,
Vo Trieu Ly2,3, Nguyen Thanh Dung3, Pham Ngoc
Thach4, Nguyen Le Quang1, Dang Hoang Khanh1, Le
Van Duyet4, Dinh Van Trang4, Do Duy Cuong5, PhamHong Nhung5,6, Nguyen Phu Huong Lan3, Vu Tien
Viet Dung1, Vu Quoc Dat1,6, Thomas Kesteman1,7,Nguyen Thuy Thuong Thuong1,7, HR van Doorn1,7,Thuy Le 8,91Wellcome Africa Asia Programme, The Oxford University ClinicalResearch Unit (OUCRU), Dong Da, Viet Nam, 2University of
Medicine and Pharmacy , Ward 5, Vietnam, 3Hospital for
Tropical Diseases, Ward 1, Vietnam, 4National Hospital for
Tropical Diseases, Dong Da, Vietnam, 5Bach Mai Hospital, Dong
Da, Vietnam, 6Hanoi Medical University, Dong Da, Vietnam,
7Nuffield Department of Medicine, University of Oxford, Oxford,
United Kingdom, 8Tropical Medicine Research Center for
Talaromycosis in Vietnam at Pham Ngoc Thach University of
Medicine, Ward 10, Vietnam, 9Division of Infectious Diseases andInternational Health, Duke University School of Medicine,
Durham, United States

Background: People with advanced HIV disease(AHD) are at risk for disseminated TB that isdifficult to diagnose and has high mortality. We
aim to determine (1) the added value of Xpert
Ultra directly in blood and Myco/F Lytic blood
culture in TB diagnosis, (2) the prognostic value ofcycle threshold (Ct) in blood Xpert Ultra and time
to positivity (TTP) from Myco/F Lytic blood culture.
Material and Methods: We prospectively
recruited hospitalized adults with AHD (CD4 count≤ 100 cells/µL or WHO stage 3 or 4 disease) atthree referral hospitals in Vietnam. In addition toconventional microscopy, GeneXpert, and MGIT
culture of sputum and/or other clinical specimens
as clinically indicated, we performed Xpert Ultra inblood and Myco/F Lytic blood culture for all
enrolled participants - regardless of symptoms.
Whole blood was treated with 5% acetic acid prior
to Xpert procedure to remove red cells. Positive
blood cultures for acid-fast bacilli were subcultured further for molecular identification of TB.

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53

Participants were treated according to standard ofcare and were followed monthly over 24 weeks.
Cox proportional hazard models were used toassess the association between 24-week mortality
and (1) Ct value of IS6110-1081 gene (CtIS) in the
Xpert Ultra test, and (2) TTP of Myco/F Lytic blood
culture.
Results: Among 901 participants recruited
between February 2021 and July 2023, 82.9% weremen; median age 36 years (IQR: 29-44); medianCD4 count 19 (IQR: 9-45). 253/901 participants(28.1%) had microbiologically-confirmed TB. TB
was diagnosed less often by conventional
approach (150/253, 60%) than the intensified
approach (168/253, 66.4 %), p=0.3, McNemar. The
intensified approach identified 89 (35.2%)
additional TB cases; 45 (50.6%) by Xpert only, 28(31.5%) by Myco/F Lytic blood culture only, and 16(18.0%) by both. Among the total 119 cases withpositive Xpert, the CtIS value was significantly
lower in cases where Myco/F Lytic culture was also
positive (21.1 vs. 23.9, P<0.001, Wilcoxon ranksum test). The 253 confirmed TB cases weredivided in four Ct clusters: CtIS ≤21, CtIS 21-25,
CtIS >25, and negative Xpert Ultra. Kaplan-Meiercurve and a multivariable Cox regression model,
adjusted for sex, age, and CD4 count, showed that
CtIS ≤ 21 was associated with significantly higher
mortality compared to the other 3 groups (46% vs.
24%, HR: 2.5, 95% CI: 1.3 - 4.7, p=0.003). In a Cox
regression model adjusted for age and CD4 count,
TTP (in days) was significantly associated withmortality (HR: 0.95, 95% CI: 0.91 - 0.99, p=0.02).
Conclusion: Screening for TB in blood using Xpert
Ultra and Myco/F lytic culture detected a 35.2%
additional TB cases in hospitalized patients with
AHD; half of these were detected by Xpert Ultra
which enables rapid TB therapy. CtIS value ≤ 21
was significantly associated with high mortality.
This study reveals an important role of blood Xpert
Ultra in making an early diagnosis of disseminated
TB in patients with AHD, enabling early therapy aswell as prognosis of patient outcome.

Poster Abstract

30

Mortality Risk Prediction
Model in AIDS Patients with
Pneumocystis Pneumonia in
China
Wang X1, Wang W1, Zhang Y1, Chen H2, Gao Y1,
Wang Z1, Huang Y2, Sun L1,3, Li A1
1Center for Infectious Diseases, Beijing Youan Hospital, Capital

Medical University, Beijing, China, 2School of Biomedical
Engineering, Capital Medical University, Beijing, China, 3Chinese
Association of STD and AIDS Prevention and Control, Care andTreatment Committee, Beijing, China

Introduction:We aimed to develop a risk model forthe near-term prognosis of acquired
immunodeficiency syndrome (AIDS) people withpneumocystis pneumonia (PCP) and verify its
effectiveness.
Methods: This single-center, retrospective
observational study was conducted at Beijing
Youan Hospital, Capital Medical University fromJanuary 2012 to October 2022. Totally, 972 eligible
AIDS patients with PCP were recruited. The
patients were divided into death group andsurvival group according to clinical outcome duringhospitalization. Data of the two groups werecollected including general information andlaboratory tests. We adopted two methods(Multivariate logistic regression and Lasso
regression) to screen prediction variables. Then,
we used Receiver Operating Characteristic (ROC)
curve to identify the discrimination of training andtesting data sets. Finally, we used Sharpley
Additive exPlanations (SHAP) values to explain thefeature weights.
Results: The overall mortality rate amonghospitalized patients was 17.8%. We found thatthe best prediction effect can be obtained whenalbumin (ALB), arterial oxygen partial pressure(PaO₂), Total bilirubin (TBIL), lactate
dehydrogenase (LDH), CD4 counts wereincorporated into the PCP risk prediction model.
The model had a perfect discrimination with area
under curve (AUC) of 0.994 and 0.947 in training
and testing cohorts. Other model performance
evaluation indicators: accuracy, precision, recall,and F1 scores of 0.816, 0.507, 0.926, and 0.656 in
the training dataset; 0.902, 0.579, 0.917, andAbstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

54

0.710 in the testing dataset, respectively. The
calibration curve showed good consistency
between the training dataset and the testingdataset. Hosmer Lemeshow goodness of fit test p> 0.05. The importance of variables was measured
by the mean SHAP value. Based on the linear
transformation of the measured values and SHAP
values of each variable, a prognostic model scoring
system was ultimately established. The prognosis
risk grade was divided into three grades: low-risk
group (0-25 points, mortality rate 5.9%),
moderate-risk group (25-50 points, mortality rate
45.1%) and high-risk group (greater than 50 points,
mortality rate 80%). There was a statisticallysignificant difference in mortality among the threegrades (p < 0.001).
Conclusion:
We developed and validated a model of the
prognostic risk of AIDS patients with PCP using theresults of blood tests reviewed by patients atroutine visits. The model is more convenient touse, allowing clinicians to obtain a determinedprobability value of PCP mortality with simple
calculations.

Poster Abstract31

HCV, HBV and Syphilis
Infections Incidence Among
People living with HIV in a Thai
CohortLwin H1, Nochaiwong T1, Apornpong T1, Han W2,
Gatechompol S1,3, J. Kerr S1,2,3, Avihingsanon A1,3
1HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok,
Thailand, Bangkok , Thailand, 2The Kirby Institute, University of
New South Wales, Sydney, Australia, 3Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 4Biostatistics
Excellence Centre, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand

Background: Sexually transmitted infections (STIs)
are major public health issues worldwide.
Emerging evidence suggests a rising prevalence ofhepatitis C virus (HCV), hepatitis B virus (HBV)
infections and other STIs among young men who
has sex with man (MSM) living with HIV. Our study
investigated the incidence rates of HBV, HCV and
Syphilis infections over time in our cohort.
Methods: We conducted a longitudinal cohort
study of people living with HIV aged ≥18 years who
underwent regular STI screening at The HIV
Netherland- Australia-Thailand Research
Collaboration from 2010-2023. HCV (HCV antibody
and/or HCV RNA), HBV (HBs Ag and/or HBc
antibody/antigen) and Syphilis (Treponema
pallidumantibody and/or VDRL test) were
performed as screening tests in our clinic annually.
A positive test result was defined as an incident
infection. We excluded those with positive tests atbaseline and who did not have follow-up testings.
We assessed incidence rates of HBV, HCV andsyphilis infections. Cox-regression was performed
for each STI.
Results: Of three thousand and fifty-eightparticipants (3058) in our cohort, 70.3% weremale, and 38.2% were men who have sex withmen (MSM). Median age was 32 (interquartile
range (IQR) 26-39) years and only 3.3% (N=102)
self-reported substance use. The overall incidence
rate of HCV, HBV or syphilis was 2.92 (95%
confidence interval 2.65-3.21) per 100 persons
year follow-up (PYFU). In MSM, the incidence rate
7.26 (95%CI 6.42-8.20) per 100 PYFU. For
multivariable analysis, Incidence rates of each

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55

individual infection were higher in MSM comparedto heterosexual men and women, adjusted hazard
ratio (aHR) for HCV, HBV and syphilis of 3.09
(95%CI 2.00-4.78; p<0.001), 1.83 (95%CI 1.22-2.74,
p=0.003) and 2.88 (95%CI 1.63-5.10); p<0.001)
respectively.
Conclusions: STIs incidence was significantly
higher in MSM than heterosexual clients in ourcohort. Regular screening and treatment for STIs
should be implemented in prevention packages foryoung PLWH and high-risk population.

Poster Abstract32

An evaluation of Mp1p antigen
screening for talaromycosis in
HIV-infected antiretroviraltherapy-naïve population in
Guangdong, China
Gong D1, Lin W1, Zhang H1, Ou X1, Li L2, Guo P1, He
Y1, Liu C1, Cai W1, Tang X2, Li L1
Infectious Diseases Center, Guangzhou Eighth People's
Hospital,Guangzhou Medical University, Guangzhou, China,
2Research Institute, Guangzhou Eighth People's
Hospital,Guangzhou Medical University, Guangzhou, China
1

Objective: Southern China is one of the major
endemic regions of T. marneffei, thus theprevention and control of talaromycosis areurgently needed. Unfortunately, the lack ofscreening remains a major obstacle to improve thetreatment of T. marneffei-infected patients. To
address the knowledge gaps, we performed thisstudy to evaluate the prevalence of talaromycosis
based on the Mp1p antigen detection, a T.
marneffei-specific protein which locatedthroughout the cell wall of T. marneffei yeast andwas abundantly secreted, and to assess the utilityof Mp1p antigen screening among HIV-infected
ART-naïve population in Guangdong, China.
Methods: We performed a cross-sectional study of
HIV-infected antiretroviral therapy (ART)-naïve
adult patients in 2018 at Guangzhou Eighth
People’s Hospital, Guangzhou Medical University.
Serum samples collected from all the 784 enrolled
patients were tested for Mp1p antigen using
double-antibody sandwich enzyme-linked
immunosorbent assay. Receiver operating
characteristic (ROC) curve analysis and Youden’s
index (J) were used to determine the optimal cutoff of CD4 count for classifying the presence of
Mp1p antigen. A culture of pathogen was
conducted in 350 clinically suspected patients toconfirm talaromycosis, and to evalute thescreening efficacy of Mp1p antigen by comparing
this result with that of the Mp1p antigen test.
Results: The overall prevalence of talaromycosis
based on the Mp1p antigen detection was 11.4%(89/784) and peaked at 32.2% (75/233) in patientswith CD4+ ≤50 Nr/μl. Logistic regression analysis

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56

found Mp1p antigen positive rate decreased with
the increase in CD4+ counts (OR 0.982, 95% CI
0.977-0.987, P<0.01). Compared to the Mp1p
negative group, the positive group presented withmore advanced HIV disease, characterized bysignificantly lower CD4+ counts (12 Nr/μl [IQR, 638 Nr/μl] vs. 179 Nr/μl [IQR, 61-315 Nr/μl],P<0.001), lower CD4+/CD8+ ratio (0.05 [IQR, 0.030.10] vs. 0.22 [IQR, 0.10-0.38], P<0.001), higher
proportion of HIV/AIDS stage IV (78.7% vs. 11. 2%,
P<0.001), higher proportion of other known OIs(86.5% vs. 34.2%, P<0.001) and higher risk of
hospitalization (83.2% vs. 40.3%, P<0.001). ROC
curve analysis revealed the ability of CD4+ countto discriminate between patients who were Mp1p
antigen positive or negative with the area under
ROC curve [AUC] = 0.870 (95% CI, 0.835–0.906,
P<0.001). The optimal cut-off point of the CD4+
count was 50 Nr/μl or less, yielding a sensitivity of
84.3% and specificity of 77.7%. Among the 350
patients received both fungal culture and Mp1p
antigen detection, 95/350 (27.1%) patients were
culture-positive for a Talaromyces marneffei,
75/350 (21.4%) patients were Mp1p antigen
positive. The Mp1p antigen assay showed a good
agreement to the culture of pathogen, and thesensitivity, specificity, positive predictive value,
negative predictive value and kappa value was
71.6% (68/95), 97.3% (248/255), 90.7% (68/75),
90.2% (248/275), and 0.737, respectively. The
screening accuracy of the Mp1p antigen assay inpatients with CD4+ counts of ≤50 Nr/μl wassuperior to that in those with higher CD4+ counts.
Conclusions: Mp1p antigen screening can be aneffective tool for more efficient diagnosis of
Talaromycosis, especially in HIV/AIDS patients with
low CD4+ counts. Future validation studies areneeded.

Poster Abstract

33

A Field Evaluation of a Dual
Treponemal/Non-treponemal
Point-Of-Care Test for Syphilis
Within an HIV Pre-exposure
Prophylaxis Program in Hanoi,
Vietnam
Biba U1, Nguyen L2, Bui T2, Nguyen T2, Dau N2, Bui
H2, Le G2, Adamson P1
1David Geffen School of Medicine, University of California Los

Angeles, Los Angeles, United States, 2Center for Training andResearch on Substance Abuse-HIV, Hanoi Medical University,
Hanoi, Vietnam

Background: Syphilis infections are high among
men who have sex with men (MSM) on HIV preexposure prophylaxis (PrEP). Point-of-care tests(POCTs) that incorporate non-treponemal testing
can improve diagnosis and treatment, particularly
in a high-prevalence population. We performed afield evaluation of a dual treponemal/nontreponemal POCT within an HIV PrEP program in
Hanoi, Vietnam.
Methods: From December 2023 to March 2024,
MSM aged ≥18 years who received care at the HIV
PrEP clinic at Hanoi Medical University andreported sexual intercourse in the last year wereenrolled into a study to evaluate the Chembio DPPSyphilis Screen and Confirm (Medford, NY).
Demographic, behavioral, and clinical data werecollected. Participants underwent fingerstick for
DPP testing and venous blood draw fortreponemal (Abbott Bioline or Determine; Abbott
Park, IL) and non-treponemal (Rapid Plasma
Reagin [RPR]) testing. Clinical staff performed andinterpreted the DPP tests in clinic, and DPP results
were not used for clinical management. Positive
percent agreement (PPA), negative percent
agreement (NPA), Cohen’s kappa, and 95%
confidence intervals (CI) were calculated for the
DPP versus treponemal/non-treponemal tests.
Results: There were 120 participants enrolled(median age 26.7 years; IQR: 22.5–29.9), and93.3% (112/120) identified as men. Among
participants who reported sex partners in the last
week, 9.3% (10/108) reported two or more.
Among those who reported anal sex with a male

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57

partner in the last month, 15.2% (12/79) reported
never using condoms. In the last six months, 13.3%(16/120) of participants reported group sex, 48.3%(58/120) reported sexualized drug use, and 67.5%(81/120) reported meeting sexual partners
through mobile apps. STI diagnosis in the last
three months was reported by 5.4% (5/93) ofparticipants asked, and syphilis was the mostcommon diagnosis among the six reported (50%,3/6). In the prior month, 22.9% (24/105) ofreported STI symptoms were rectal symptoms.
Diarrhea was reported most often (37.5%; 9/24).
The overall prevalence of treponemal reactivity
was 35.0% (41/117). The PPA for the DPP
treponemal test was 75.6% (95% CI: 59.7%–87.6%)
and the NPA was 93.4% (95% CI: 85.3%–97.8%),
with Cohen’s kappa of 0.71 (95% CI: 0.55–0.82).
The prevalence of RPR reactivity was 17.6%(21/119). The PPA for the DPP non-treponemal
test was 42.9% (95% CI: 21.8%–66.0%) and the
NPA was 99.0% (95%CI: 94.4%–100.0%), with
Cohen’s kappa of 0.53 (95% CI: 0.28–0.71). For RPR
titers ≥1:8, the PPA of the DPP was 100.0% (95%
CI: 59.0%–100.0%) and the NPA was 97.3% (95%
CI: 92.4%–99.4%), with Cohen’s kappa of 0.81
(95% CI: 0.52–0.93).
Conclusion: Among MSM with a high prevalenceof syphilis in an HIV PrEP program in Vietnam, theDPP performed well as a POCT compared toroutine treponemal tests. While the nontreponemal DPP performance was lower,
performance was very high for RPR titers ≥1:8. This
field evaluation of the DPP test shows that it holds
promise for identifying high-priority, active syphilis
infections within this population. Continued study
with RPR titers ≥1:8 is needed to further
characterize the clinical applicability of DPP testingin a population with a high prevalence of syphilis.

Poster Abstract

34

The incidence of active
tuberculosis in HIV-infectedindividuals not receiving
universal tuberculosis
preventive treatment: a
retrospective cohort study
Chen L1, Zhang L1, Song X1, Li Y1, Li X1, Lv W1, Tang
J1, Zhang L1, Zheng L1, Han Y1, Li T1, Cao W1
1Department Of Infectious Diseases, Peking Union Medical

College Hospital, Chinese Academy Of Medical Sciences, Beijing,
China

Background: Tuberculosis (TB) preventive
treatment (TPT) is recommended for people livingwith HIV (PLWH) due to increased risks ofdeveloping active TB. However, implementation of
TPT varies with regions; and necessity of universal
TPT remains debated. We retrospectively
investigated the incidence of developing active TB
following ART initiation among PLWH without
universal prophylaxis, for a more targeted strategy
in TB management.
Methods: Treatment-naïve patients of HIV-1
infection who started ART between January 2000
and May 2023 were retrospectively enrolled in
Peking Union Medical College Hospital (PUMCH),
Beijing, China. Incidence of active TB was
estimated in the first five years of ART. KaplanMeier analysis was used to plot survival curves,and Log-rank test was used to evaluate
differences. Cox proportional hazards model wasused to determine the risk factors associated withactive TB development.
Results: We screened and enrolled 940 treatmentnaïve HIV-1-infected patients. Among them, 23
developed active TB during the five-year followup. Kaplan-Meier analysis showed that the
cumulative incidence of active TB was around
2.4%. The incidence density was about 7 per 1,000
person-years (95% confidence interval (CI): 4-10).
Most episodes of active TB occurred within thefirst three months of ART. 65% (15/23) of those
who developed TB had a baseline CD4+ T cellcount <200/μl. Specifically, the cumulative
incidence of active TB in patients with a baseline

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58

CD4+ T cell count <200/μl was significantly higher
than that in patients with CD4+ count ≥200/μl(P=0.006). Active TB seldomly took place when the
average CD4+ count exceeded 470/μl. All the 23
patients were successfully treated for TB, with only
one experiencing apparent drug-related side
effects. Multivariate regression analysis revealed
that baseline CD4+T cell counts <200/μl (odds ratio(OR):2.541, 95%CI: 1.036-6.640) and baseline HIV1 RNA≥5log10 copies/mL (OR:2.832, 95%CI: 1.1747.025) were independent risk factors for active TB
development in HIV patients not receiving TPT.
Conclusions: In HIV/AIDS patients not receiving
universal TPT, risk of active TB development in thefirst 5 years of ART was largely dependent onpatient baseline immune status, more prominent
in those with advanced HIV status. Stratified
strategy for TB prophylaxis may be necessary in
different disease statuses.

Poster Abstract

35

Expression and prognostic
significance of the PD-1/PD-L1
pathway in AIDS-related nonHodgkin lymphoma
Han Z1,2, Cai S1, xiao y2, xia m1, chen h1, Xie Z3, tang
X2, He H2, Peng J1, Chen J1
1Department of Infectious Diseases, Nanfang Hospital, Southern

Medical University, Guangzhou, China, Guangzhou, china,
Infectious Diseases Center, Guangzhou Eighth People's Hospital,
Guangzhou Medical University, Guangzhou, China, Guangzhou,
china, 3Guangxi AIDS Clinical Treatment Center, the Fourth
People's Hospital of Nanning, Nanning, China, Guangxi,China

2

Objective: Immune tolerance and evasion play a
critical role in virus-driven malignancies. However,the phenotype and clinical significance ofprogrammed cell death 1 (PD-1) and its ligands,
PD-L1 and PD-L2, in aggressive acquired
immunodeficiency syndrome (AIDS)-related nonHodgkin lymphoma (AR-NHL) remain poorly
understood, particularly in the Epstein–Barr virus(EBV)-positive subset.
Methods: We used in situ hybridization with EBVencoded RNA (EBER) to assess the EBV status. We
performed immunohistochemistry and flow
cytometry analysis to evaluate components of thePD-1/PD-L1/L2 pathway in a multi-institutional
cohort of 58 patients with AR-NHL and compared
EBV-positive and EBV-negative cases.
Results: The prevalence of EBV+ in AR-NHL was
56.9% and was associated with a marked increasein the expression of PD-1/PD-L1/PD-L2 inmalignant cells. Patients with AR-NHLs who tested
positive for both EBER and PD-1 exhibited lower
survival rates compared to those negative forthese markers (47.4% vs. 93.8%, P = 0.004).
Similarly, patients positive for both EBER and PDL1 also demonstrated poorer survival (56.5% vs.
93.8%, P = 0.043). Importantly, PD-1 tissueexpression demonstrated independent prognostic
significance for overall survival in multivariate
analysis and was correlated to elevated levels of
LDH (r = 0.313, P = 0.031), increased PD-1+ Tregs(P = 0.006), and robust expression of EBER (r =0.541, P < 0.001) and PD-L1 (r = 0.354, P = 0.014)
expression.

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59

Conclusions: These data emphasize theimportance of PD-1-mediated immune evasion in
the complex landscape of immune oncology in ARNHL co-infected with EBV, and contribute to thediagnostic classification and possible definition of
immunotherapeutic strategies for this uniquesubgroup.

Poster Abstract

36

Transverse comparison ofclinical characteristics andprognostic factors in HIV
infected patients with
Cytomegalovirus encephalitis
in Guangdong, China
Meng Y1
1Guangzhou Eighth People's Hospital, Guangzhou, China

Background: Cytomegalovirus encephalitis (CME)
is one of the serious opportunistic complications inhuman immunodeficiency virus (HIV) infectedpatients, characterized by a rapid onset, poor
prognosis and high mortality. Until now, there
have been limited comprehensive research on
the clinical and prognostic characteristics of
HIV/CME patients reported in China.
Methods: We conducted a retrospectiveenrollment of 43 patients diagnosed with CME
among individuals infected with HIV from 2015 to2023 in Guangzhou eighth people’s hospital.
Among them, 27 patients experienced favorable
prognosis and 16 patients experienced
unfavorable prognosis (which includes death,ineffectiveness of treatment, or aggravatedcondition) as determined by clinical diagnosis.
Statistics of clinical symptoms and laboratory
examinations between two groups were analyzed.
Multivariate analysis and nomogram weredeveloped using statistical variables.
Results: HIV/CME patients with unfavorable
prognosis represented more consciousness
disorder and nuchal rigidity than those withfavorable prognosis. There were no identifiable
differences between the two groups in terms ofclinical characteristics such as hemiparalysis,
meningeal irritation, cerebrospinal fluid (CSF)
pressure, and other relevant factors. In the CSF,
the level of chloride (Cl) was obviously higher in
HIV/CME patients with favorable prognosis, while
the Cytomegalovirus (CMV)- DNA showed the
opposite trend. A multivariate analysis of fever,
nuchal rigidity, consciousness disorder, and CSF
CMV-DNA can be used to predict prognosis in
HIV/CME patients, with C-index of 0.83 (95% CI:

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60

0.64-1.00). The log CSF CMV-DNA copies/mL
emerged as an independent risk factor for
prognosis. High CSF CMV-DNA (≥ 300,000
copies/mL) indicated unfavorable prognosis.
Conclusion: HIV/CME patients with unfavorable
prognosis usually showed obvious signs andsymptoms of central nervous system infection,
lower CSF Cl level, and higher CSF CMV-DNA
compared to favorable prognosis patients.
Recognizing these indicators early andadministering timely antivirus therapy before thedisease progresses to CME are of great value in
improving the survival rate of patients.

Poster Abstract

37

HIV knowledge, its
transmission, prevention andtreatment associated with HIV
testing among reproductive
women
Macalalag A1, Yap M3, Cataluna E1, Tinguban K2, De
Guzman J1
1
Iloilo Doctors' College- Biological Department, Iloilo City,
Philippines, 2Department of Health, Iloilo City, Philippines, 3Iloilo
Doctors' College- College of Medicine, Iloilo City, Philippines

Background: From 2021 Country Snapshots for
Asia and the Pacific reported data of HIV/AIDS
cases, Philippines has approximated 7100 cases ofwomen and 431 cases of pregnant living with HIV(PMTCT). The low level of awareness andinsufficient knowledge of HIV and AIDS had
identified by some researches as hindrances inpreventing the spread of infections.
Methods: A validated questionnaire was used tocollect the data that covered in February, 2024.
The knowledge questionnaire comprised of 20
items: 6 items about HIV, 6 items HIV mode oftransmission, 4 items HIV prevention and 4 items
HIV treatment. A total of 454 women participatedin the study Almost half of the respondents (48%)
had ages of < 23 years old and more than half(52%) had ages of > 24 years old. Majority of the
respondents were residents of Molo District inIloilo City. There were several pregnant women(12%) participated in the study. More than half of
the women were willing to be tested for HIV (55%)
and almost half were not willing (45%). To assess
the association between the knowledge in HIV, itsmode of transmission, prevention, and treatment
and willingness to be tested for HIV among
women, Chi square test was executed.
Results: Majority of the respondents had highknowledge about HIV (70%) and its mode oftransmission (62%). More than half of them had
high knowledge on HIV prevention (68%) but only
one- third of the respondents had high knowledge
on HIV treatment (37%). Chi square test results
indicated an association between HIV knowledge(p=.002) , its prevention (p=.001) and treatment(p=.002) and willingness to be tested for HIV. For

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61

knowledge in HIV, age group (p=.004),
employment (p=.000), marital status ( p=.005),
family income ( p=.000), level of education(p=.000) and being pregnant or not (p=.000) weresignificantly associated. Furthermore, theknowledge level about HIV mode of transmission,
displayed significantly associated withrespondents’ employment status (p=.000), marital
status (p=.005) family income (p=.000), level of
education (p=.000 and being pregnant or not(p=.003). For level of knowledge on mode oftransmission, it was significant associated with
employment status, For level of knowledge in HIV
prevention, it only associated with the level of
education (p=.001) of the respondents. Lastly, thelevel of knowledge in HIV treatment wassignificantly associated with respondents’ level of
education (p=.001) and being pregnant or not(p=.001). The mentioned associations had their p <.05 alpha at 95% confidence interval. The results
were generated through the use of SPSS software,version 25.
Conclusions: Women with high level of knowledge
about HIV, its mode of transmission, prevention
and treatment are more likely have highwillingness to be tested for HIV. In the four areasof HIV knowledge being assessed, only few areknowledgeable to HIV treatment. Woman musthave wide understanding and awareness on HIV
prevention and treatment. They must be
informed about HIV
Undetectable=Untransmittable, or U=U, concept.
They have to care and protect themselves for
reducing vulnerability to HIV infection.

Poster Abstract

38

Patterns of liver fibrosis
evolution in Chinese HIV/HBV
coinfected adults after 5-year
TDF-containing ART
Zhang Q1, Chen H1, Jiang T2
1
Sun Yat-sen University, Shenzhen, China, 2Beijing Youan
Hospital, Beijing, China

Background: The patterns of liver fibrosis change
during long-term combined antiretroviral therapy(ART) in adults with HIV and chronic hepatitis B
virus remain (HBV) unclear. We investigated the
trajectories of liver fibrosis and the association of
baseline variables with different patterns of liver
fibrosis evolution.
Material and Methods: 507 HIV/HBV coinfectedindividuals treated with long-term ART wereenrolled in this study. Demographic, clinical, andbiochemical data was collected at entry andannual visits. The trajectory patterns of liver
fibrosis were detected by group-based trajectorymodels (GBTMs) by using the longitudinal data of
FIB-4 and APRI scores. Baseline predictors of liver
fibrosis evolution were identified by logistic
regression analysis.
Results: The median age of all participants was 33
years. Of these, 86.1% were initially treated with
TDF-containing ART. Two patterns of liver fibrosis
evolution were detected by GBTMs either using
APRI or Fib-4 scores: more than three-quarters ofindividuals showed stable none or low fibrosis withno progression (78.5% for APRI scores and 75.3%
for Fib-4 scores; pattern A), and the remaining
presented liver fibrosis regression from high levels(21.5% for APRI scores and 24.7% for Fib-4 scores;
pattern B). Participants in pattern A were younger,of higher CD4 cell count and white blood cellcount, of lower platelet count and higher
hemoglobin than in pattern B.
Conclusions:Long-term ART containing TDF has
demonstrated efficacy in reducing liver fibrosis in
Chinese individuals co-infected with HIV and HBV.

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62

Poster Abstract

39

Overweight and low anti-HBs
antibody titers are associatedwith earlier loss of anti-HBVseroprotection after HBVvaccination in Japanese people
living with HIV
Muramatsu T1, Miyashita R1, Kamikubo Y1,
Yamaguchi T1, Ichiki A1, Chikasawa Y1, Bingo M1,
Sekiya R1, Yotsumoto M1, Hagiwara T1, Amano K1,
Kinai E1
1Tokyo Medical University Hospital, Shinjuku, Japan

Background: Hepatitis B virus (HBV) co-infection is
one of the most common co-infections amongpeople living with HIV (PLWH). Althoughvaccination against HBV is recommended for all
PLWH without immunity to HBV infection, HBV
vaccination response and duration ofseroprotection are suboptimal in PLWH. The
earlier loss of anti-HBs antibody has been reported
but the associated factors are unknown.
Methods: We performed a retrospective analysisof the hepatitis B virus vaccination program among
PLWH in our hospital (n=277). Three doses ofhepatitis B vaccine (Biimugen®, containing 10μg ofhepatitis B surface antigen) were administeredsubcutaneously (at 0, 1, and 6 months). Among
primary responders (n=164, 59%), we analyzed the
durability of anti-HBV seroprotection by assessing
antibody titers at least twice after the vaccination.
Participants with decreasing anti-HBs titers <10
mIU/mL were defined as earlier loss of anti-HBVseroprotection. Cox proportional hazards analysis
was performed to identify predictors of earlier lossof HBV seroprotection.
Results: 152 participants were included in theanalysis. The median age was 39 (IQR: 35-46) years
and 144 (95%) were men. The median body massindex (BMI) was 22.9 (20.7-26.1) and 55 (36%)
were overweight (BMI>25). The median CD4 cellcount was 479 (352-651) /μL, and 98 (64%) werereceiving antiretroviral therapy at the entry of thisprogram. During 616.3 participant-years of followup, 113 (74%) showed a loss of anti-HBVseroprotection. The median time to loss of anti-

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63

HBV seroprotection was 3.5 and 10.2 years forparticipants with an anti-HBs titer of 10-100, and>100 mIU/mL at first vaccination, respectively.
Cox-proportional hazards analysis showed
overweight (BMI>25) and low anti-HBs antibody
titer (anti-HBs titer < 100 mIU/mL) after
vaccination were independently associated withearly loss of anti-HBs seroprotection, adjusting forage, CD4 and HIV viral suppression [adjusted
hazard ratio (aHR) 1.882, 95% confidence interval(CI) 1.261-2.810; p = 0.002, aHR 3.979, 95%CI
2.517-6.290; p < 0.001, respectively].
Conclusions: The response to HBV vaccination in
Japanese PLWH was weak, both in terms of initial
response and long-term durability ofseroprotection. Further research is warranted to
implement better HBV vaccination strategies for
PLWH.

Poster Abstract64

40

affinity for Pol/RT than NTCP and Core wasrevealed by molecular docking.

In silico and in vitro Antihepatitis B virus activity ofbioassay-guided compound
quercetin and Myricetin-3-Orhamnoside from Pistacia
lentiscus

Conclusions: By binding to viral Pol/RT and Core aswell as host NTCP proteins, their potential route ofanti-HBV activity is indicated. And shown that bothchemical compounds isolated from Pistacia
lentiscus were found to be effective and suggested
potential virus inactivation mechanisms

Singh M1, Singh D2
1HMFA Memorial Institute of Engineering & Technology,

Allahabad, India, 2SHUATS, Allahabad, India

Background: In silico and in vitro Anti-hepatitis B
virus activity of bioassay-guided compound
quercetin and Myricetin-3-O-rhamnoside from
Pistacia lentiscus Aims Acute and chronic hepatitis
B are disorders of the liver brought on by thehepatitis B virus (HBV). The current study
describes the column-guided isolation andstructural characterization of two anti-HBVcompounds from Pistacia lentiscus utilizing an
HBV-reporter cell culture paradigm, as well as themolecular docking elucidation of the mode ofaction.
Methods: Pistacia lentiscus leaves recently
demonstrated in vitro anti-hepatitis B virus (HBV)
action, and quercetin and other flavonoids wereidentified by HPTLC. Here, we describe thebioassay-directed fractionation of Pistacia
lentiscus leaves using column chromatography andthe isolation of two flavonoinds from the nbutanol fraction, as well as the determination of
their structures (1H, 13C, and 2D-NMR) andevaluation of their antiviral activities (HBsAg and
HBeAg assay) in HBV-reporter HepG2.2.2.15 cells.
Results: The HBV polymerase (Pol/RT) and capsid(Core) proteins, as well as the host-receptor
sodium taurocholate co-transporting polypeptide(NTCP), were subjected to further moleculardocking. Myricetin-3-O-rhamnoside and quercetin
were recognized as the two isolated bioactive
substances that are to be isolated from Pistacia
lentiscus. In comparison to myricetin-3-Orhamnoside, quercetin considerably decreased thesynthesis of HBsAg and HBeAg by 43% and 36%,
respectively, and by roughly 58% and 64%,
respectively. The two anti-HBV flavonoids' greater

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Poster Abstract

41

Efficacy ofBictegravir/Emtricitabine/Tenofovir Alafenamide among
Treatment-Naïve Patients with
Pre-treatment Drug
Resistance: A Chinese RealWorld Study
Cao X1, Wang M2, Peng Y1, Wang Y1, Cao J2, Qi H2
1Graduate Collaborative Training Base of the First Hospital of

Changsha, Hengyang Medical School, University of South China,
Changsha City, China, 2The Institute of HIV/AIDS, The First
Hospital of Changsha, Changsha City, China

Background: The trend of increasing Pretreatment drug resistance (PDR) cannot be
overlooked. BIC/FTC/TAF has been endorsed bymajor international guidelines as the preferredregimen for treatment-naïve patients.
Consequently, there is an urgent need toinvestigate the impact of pre-treatment resistanceon the efficacy of BIC/FTC/TAF. In this study, we
address this issue within the context of central
China.
Material and Methods: We retrospectively
selected patients newly diagnosed with HIV-1
infection at The First Hospital of Changsha fromJanuary 2021 to December 2023, who had
available HIV-1 RNA genotype results.
Subsequently, we conducted a descriptive analysisof the HIV-1 virology results in all patients.
Results: A total of 829 HIV-1 naïve patients
underwent PDR testing, with 202 patients tested
PDR, of which 53 were treated for BIC/FTC/TAF.
Among these patients, 46 were male, with a
median age of 31.0 years. The most common HIV-1
subtype observed was CRF01_AE (22/53, 41.5%),
with a median follow-up duration of 9 months.
Baseline measurements indicated a median CD4
count of 255 cells/mm3 and a median HIV-1 RNA
count of 133,840 copies/ml. 6 patients exhibited
resistance to Nucleoside reverse transcriptase
inhibitors (NRTIs), with resistance mutation sites
including M184I (n=1), M184V (n=3), D67G (n=1),
and A62V+K65R+Y115F+M184V (n=1), all with viralloads below 50 copies/ml. Among the 45 patients

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202465

with Non-nucleoside reverse transcriptase
inhibitors (NNRTIs) resistance mutation, including
V179D (n=11), V179E (n=13), K238N (n=12),
E138G+V179E (n=2), K103N (n=2), A98G(n=1),
K103N+M230I(n=1), V106M+V179D(n=1),
K238N+V179D(n=1), and Y181V(n=1), 91.1% (41 /45) of these individuals exhibited viral loads below
50 copies/ml, while all of them had viral loads
below 200 copies/ml. Resistance mutation to
Integrase strand transfer inhibitors (INSTIs)
were observed in E157Q (n=5) and T97A (n=1), allachieving virological suppression. Additionally,four patients demonstrated PDR to proteaseinhibitors (PIs), with resistance mutation sites
including V82L+Q58E, Q58E, L33F, and M46L, ofwhich 75% (3/4) had viral loads below 50
copies/ml, and all were below 200 copies/ml.
Conclusion: In real clinical scenarios, BIC/FTC/TAF,
as a first-line ART, demonstrates a favorable
antiviral effect in treatment-naïve patients
infected with HIV-1 who exhibit PDR.

Poster Abstract

42

Switching toBictegravir/Emtricitabine/Tenofovir Alafenamide in
Virologically Suppressed
Participants with Historical
Pre-existing Drug Resistance
Chang Z1, Zhu H1, Zhang Y1, Li J1, Chen Y1, Chi Y1,Cheng C1, Wei H1, Chen G3, Qian F2, Zou M4, Hu Z1
1Department of infectious disease, the Second Hospital Of

Nanjing，Affiliated Hospital to Nanjing University of Chinese
Medicine, Nanjing, China, 2Department of infectious disease, theFifth People's Hospital Of Suzhou, Suzhou, China, 3Department of
infectious disease, the Third People's Hospital Of Changzhou,
Changzhou, China, 4Department of infectious disease, the Third
People's Hospital Of Nantong, Nantong, China

Background: Pre-existing drug resistance can limit
the efficacy of human immunodeficiency virus(HIV) antiretroviral therapy (ART). Data on theefficacy of the single-tablet regimen
Bictegravir/Emtricitabine/Tenofovir Alafenamide(B/F/TAF) in people with HIV (PWH) who fail to
respond to the initial therapy has been relatively
scarce, particularly for those who have developed
resistance to K65N/R mutations.
Methods: This was a prospective, multicenter,single-arm, observational study conducted at 4
clinical centers in Jiangsu, China, from August 2022
to December 2023, to evaluate the efficacy andsafety of switching to a B/F/TAF single-tablet
regimen in virologically suppressed (plasma HIV
RNA load (PVL) <200 copies/ml) PWH aged ≥18
years with pre-existing resistance to reverse
transcriptase inhibitors or protease inhibitors (PIs).
The primary endpoint was the proportion ofparticipants with PVL<50 copies/mL at week 24.
The secondary outcomes included the rate of
medication adherence and the proportion ofparticipants maintaining PVL <200 copies/mL atweek 24.
Results: Of 73 PWH enrolled, 80.8% (59/73)
completed the 24-week efficacy follow-up period,
61.6% (45/73) completed the 48-week follow-up
period. The participants were predominantly male
(97.3%), median duration of PVL<200 copies/mL
before switching to B/F/TAF was 4 years (2-6),

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66

median (IQR) baseline CD4 count was 442
cells/mm3 (294-618), and had median (IQR) age of
36 years (33-36). 78.1% (57/73) participants
switched from lopinavir/ritonavir (LPV/r ) based
regimen. An analysis of resistance substitutions
revealed that 68.5% (50/73) participants hadarchived M184V/I, 32.9% (24/73) participants hadarchived K65N/R, and 15.1% (11/73) cases
exhibiting a combination of M184V/I and K65N/R.
The proportion of participants with PVL<50
copies/mL and PVL<200 copies/mL was both
97.8%（58/59）at week 24 and100%（45/45）at week 48. Only one individual
discontinued at week 36 due to financial reasons.
No serious adverse events (SAEs) were observed.
Conclusion: B/F/TAF can maintain its efficacy
regardless of the presence of M184V/I and/or
K65N/R mutations and is well tolerated. No
participant discontinued B/F/TAF due to efficacy orsafety issues.

Poster Abstract

43

Efficacy of antiretroviraltherapy in HIV-1 patients
harboring drug resistancemutations to non-nucleosidereverse transcriptase
inhibitors: Results of a
retrospective study in China
Liu M1, Yang H
1Chongqing Public Health Medical Center, Chongqing, China

Objectives: The prevalence of mutations
associated with pretreatment drug resistance(PDR) is up to 20.3% in the class of non-nucleosidereverse transcriptase inhibitors (NNRTIs) in people
living with HIV-1 (PLWH) in our region, and PLWH
harboring NNRTIs drug resistance mutations(DRMs) receive different regimens for initial
antiretroviral therapy (ART). This study aimed toanalyze the efficacy of different ART regimens for
PLWH with DRMs to NNRTIs.
Methods: We retrospectively enrolled the ARTnaïve patients with NNRTIs PDR in Chongqing
Public Health Medical Center from June 1, 2018 toJune 1, 2022, The choice of ART regimens wasstudied and the efficacy was analyzed. Low-level,intermediate-level, or high-level resistance wasdesignated as truly resistant (TR), and thepotential low-level resistance was designated as
PR.
Results: A total of 165 patients with varied NNRTIs
DRMs were enrolled in this study and all ofthem received 3-drug ART regimens. At baseline,
the median HIV-1 viral load (VL) (log10) was 5.7(IQR: 5.1, 6.1) copies/mL, and the median CD4+ Tcell count was 73.0 (IQR: 28.0, 179.0) cells/µL. A
total of 133 of the 165 patients (80.6%) received
protease inhibitors (PIs)- or integrase inhibitors(INSTIs) -based regimens throughout thetreatment. Among those 133 patients, 85.0%(113/133) achieved successful virologicalsuppression (VS) at week 24 and 94.0% (125/133)
achieved successful VS at week 48. Twenty-two of
the 165 patients (13.3%) initially selected EFV PR
as the 3rd drug. Among those 22 patients, 17

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67

patients (77.3%) achieved VS at week 24 and 19
patients (86.4%) achieved VS at week 48. Two of
the 165 patients (1.2%) initially selected EFV with
low-level TR as the 3rd drug, 1 patient achieved VS
at week 24 and week 48, while the other one
experienced VF. In addition, 8 of the 165 patients(4.8%) were initially initiated PIs/INSTIs-based
regimens, which were later switched to EFV- based
regimens with PR later for different reasons after
successful VS was achieved. All of the 8 patients
successfully achieved complete VS at week 48.
Conclusions: Our results demonstrated thatpatients with NNRTIs DRMs should avoid EFVbased regimens as initial ART regimens for a lower
VS rate. However, for patients with EFV-PR, it
seemed still feasible to be switch to EFV- based
regimens after successful VS has been achieved
with more potent ART regimens.

Poster Abstract

44

Neglected Low-Level Viremia
on Virological Failure in People
Living With HIV: Is Prediction
Possible?
Zhao S1
Center for Infectious Diseases, Beijing Youan Hospital, Capital
Medical University, Beijing, China, Beijing, China

1

Background: Low-level viremia (LLV) followed byanti-retroviral therapy (ART) for people living withHIV (PLWH), has not received enough attention. To
ascertain the prevalence and risk factors for LLV, asystematic review was conducted to identify theevidence-based intervention for PLWH.
Furthermore, LLV was examined for association
with an increased risk of mortality and virological
failure (VF).
Methods: In this meta-analysis, PubMed,
Cochrane Library, Embase, and Web of Science
were searched for clinical trials, and prospective or
retrospective cohort studies reporting LLV in
PLWH from inception to February 23, 2024.
Studies that investigated PLWH over the age of 15
years and presented data that allowed theestablishment of the prevalence of LLV or the
association between LLV and VF were included.
According to the 2021 WHO Guidelines, allparticipants were categorized by their longitudinalviremia profiles 6 months or more after starting
ART using the following definitions: (1) LLV,
defined as the occurrence of at least one viral load
measurement of 51–999 copies/mL; (2) VF,
defined as one or more HIV VLs of ≥1000
copies/mL; and (3) virological suppression, definedas VL <50 copies/mL. This study was registeredwith PROSPERO (CRD42023410779).
Results: Acquired data from 15 cohorts thatreported the LLV of 698,478 patients. In all,
1,345,692 PLWH had a pooled prevalence of LLV of
14.51% (95% CI 12.56%-16.46%), blip of 15.32%(6.57%-24.07%, 21,552/121,129), and persistent
LLV (pLLV) of 4.85% (3.25%-6.45%, 2,883/101,226).
A relative risk (RR) and 95% Confidence Intervals(CI) for LLV in PLWH with viral load (VL) ≥10⁵
copies/mL at baseline (1.79, 1.11-2.88), AIDSdefined illness (1.22, 1.08-1.38) at baseline, andAbstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

68

protease inhibitors-based regimen (1.45, 1.371.53) at antiretroviral therapy (ART) initiation can
increase the risk of LLV. Conversely, the nonnucleoside reverse transcriptase inhibitors(NNRTIs)-based regimen (0.91, 0.86-0.96) and theintegrase strand transfer inhibitors (INSTIs)-based
regimen (0.56, 0.51-0.61) can reduce the risk of
LLV. Furthermore, there was increased aHR for VF
in PLWH with LLV (2.77, 2.03-3.76). In the blip
subgroup, PLWH with a VL of 500-999 copies/mL
had a greater risk of VF (2.46, 1.35-4.48). In thesubgroup of persistent LLV, the aHR of developing
VF was higher than those with virologicalsuppression, and this risk increased with anincreasing range of LLV, from 51-199 copies/mL(2.41, 1.91-3.05) to 200-499 copies/mL (5.11, 1.6415.88) to 500-999 copies/mL (9.44, 3.85-23.15).
Conclusions: The prevalence of LLV in PLWH
should not be overlooked. Screening for LLV risk
factors, including PLWH with high baseline VL and
AIDS-defined diseases. Regimens based on INSTIs
are advised. Strict management of LLV patients,
particularly pLLV and blip patients with high VLlevels, could reduce the incidence of VF and allcause mortality.

Poster Abstract

45

Acceptance and preference forLong-Acting Antiretrovirals
among people living with HIV
in China
Ding H1
1NHC Key Laboratory of AIDS Prevention (china Medical

University), National Clinical Research Center For Laboratory
Medic, Shenyang, China

Background: Long-acting Antiretroviral (LAARV)
was found as effective as standard daily oral ART
for maintaining HIV-1 suppression. A novel Longacting Antiretroviral regimen of cabotegravir andrilpivirine (CAB+RPV LA) was approved for use as acomplete alternative regimen for PLHIV. As
CAB+RPV LA may be available in China in the near
future, the acceptance and preference among
PLHIV in China are left unknown.
Material and Methods:
We conducted a cross-sectional survey by online
questionnaire among PHIV in China between June
1 and November 30, 2020 on acceptance andpreference of LAARV.The acceptance based on a
five-point scale was dichotomized to more likely touse (i.e., very likely, likely) and less likely to use(i.e., very unlikely, unlikely, uncertain). We usedlogistic regression to assess acceptance andpreference for LAARV and correlates.
Results: A total of 2570 PLHIV responded to thequestionnaire, among which 67% were interested
in switching to LAARV. For univariate logistic
regression, people who were interested in using
LAARV was significantly higher among heavy
drinkers (OR 1.74, 95% CI 1.04 to 2.94 p=0.037) .
Multivariable logistic regression, adjusted for age,
race, marital status, income, and alcohol use,
discovered that the odds of being interested intrying LAARV were 1.68 times higher among thoseusing a single pill versus those not using a single
pill (OR 1.68 95% CI 1.32 to 2.15 p<0.01), andpatients taking medicine for twice a day weremore desired to choose LAARV compared withthose who take medicine only once a day (OR 1.37
95% CI 1.10 to 1.69 p<0.01 p=0.004). Besides that,
suboptimal adherence (self-reported
adherence<90%) was also independently
associated with interest in trying LAARV with

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69

significant statistical differences (OR 1.54, 95% CI
1.17 to 2.00 p=0.001), especially for those withadherence less than 80% (OR 1.63, 95% CI 1.30 to2.05 p<0.01) . The preference for LAARV types
from high to low among PLHIV in China wasintramuscular injection (35.1%, every 1-2 months),
implants (24.4%, every 6-12 months), andintravenous infusion (7.5%, once every 1-2
weeks).The most common reason why
respondents would try LAARV was "They don't
need to remember to take HIV drugs every day"
(36.4%), followed by "concerns about carrying
medicines with them at all times "(30.7%) and "noone will see themselves taking HIV drugs" (26.4%).
The most concerned problem about LAARV was
the possible side effects (82.4%) and worries about
the possible interaction with alcohol or otherdrugs (79.1%).
Conclusion: This study firstly revealed a nearly
70% acceptance of LAARV among PLHIV in China.
We identified the PLHIV currently using the STR as
the most potential users for LAARV in China.
Subjective assessment of less adherence to ART
was correlated with more interest in LAARV. The
long-acting intramuscular injection ART is the most
preferred type of LAARV in China, followed by
implants. With the largest national sample, thisstudy closed the knowledge gap that exists in theimplementation of LAARV in China, having added
value to future LAARV implementation strategies
worldwide.

Poster Abstract

46

Cost-Effectiveness Analysis ofLong-Acting Cabotegravir Plus
Rilpivirine Versus Daily Oral
Antiretroviral Therapy for
People with HIV-1 Infection
Who are Virologically
Suppressed on a Stable
Antiretroviral Regimen in
Singapore
Jacob I1, Poh C2, Ewe R2, Choy C3, Leong H4
ViiV Healthcare, Brentford, United Kingdom, 2GlaxoSmithKline, ,Singapore, 3National Centre for Infectious Diseases and Tan Tock
Seng Hospital, , Singapore, 4Mount Elizabeth Novena Hospital, ,Singapore1

Background: Cabotegravir plus rilpivirine is a twodrug long-acting regimen (CAB+RPV LA) comprising
an integrase strand transfer inhibitor (INSTI) and a
non-nucleoside reverse transcriptase inhibitor(NNRTI), respectively. CAB+RPV LA is indicated forthe treatment of HIV-1 infection in adult people
who are virologically suppressed (HIV-1 ribonucleic
acid [RNA] <50 copies/mL) on a stable
antiretroviral regimen, without present or pastevidence of viral resistance to, and no priorvirological failure with NNRTIs or INSTIs. This longacting regimen is administered intramuscularly
every two months.
Compared with standard of care oral antiretroviraltherapies (ARTs), two-monthly CAB+RPV LA is noninferior to daily oral ARTs in achieving virologic
suppression, and resulted in a comparable change
in CD4+ count, from baseline to week 48, based on
an indirect treatment comparison of the ATLAS,
ATLAS-2M and FLAIR trials. This long-acting
regimen is expected to reduce adherence burden
compared with daily oral ARTs, which in turnimproves viral suppression and improves healthrelated quality of life.
This analysis evaluates the cost-effectiveness of
CAB+RPV LA against a basket of clinically relevant
oral ARTs in people with HIV-1 who arevirologically suppressed on a stable antiretroviralregimen in Singapore.

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70

Materials and Methods: A deterministic hybrid
cost-effectiveness model comprising a Markov
model and a decision tree process was developed
to compare CAB+RPV LA versus oral ARTs, from a
Singapore healthcare payer perspective. The
model accounted for disease transmission tocapture the decreased likelihood of sub-optimal
viral suppression, and therefore reduced onwards
disease transmission, from improved adherence
associated with long-acting treatment. The model
included health states defined by treatment line,
virologic response and CD4+ cell count, and deathis an absorbing state. A lifetime time horizon of 36
years was adopted.
HIV transmission probabilities, adherence rates,and efficacy of CAB+RPV LA and oral ARTs were
informed by the ATLAS-2M trial, publishedliterature, and local clinicians’ input. Health stateutilities were informed by ATLAS and FLAIR trials,
published literature and local clinicians’ input.
Costs and healthcare resource use were informedby the Singapore Healthcare Resource Sheet andlocal clinicians’ input. A 3.0% discount rate wasapplied to costs and outcomes. Sensitivity analyses
were conducted to assess the robustness of themodel.
Results: CAB+RPV LA was associated with anincrease of 0.334 quality-adjusted life years(QALYs) and 0.167 life years, at an incremental
cost of SGD37,642.90 versus oral ARTs. The
incremental cost-effectiveness ratio (ICER) was
SGD112,573.69/QALY. The ICER was most sensitive
to variations in the adherence to first-line ART in
both the CAB+RPV LA and oral ARTs arms,
switching adherence modelling off in the model,
and time horizon.
Conclusion: At a willingness-to-pay threshold of
SGD113,779/QALY gained, which represents the2023 gross domestic product per capita in
Singapore, two-monthly CAB+RPV LA is costeffective versus daily oral ARTs for people with
HIV-1 who are virologically suppressed on a stable
antiretroviral regimen in Singapore.

Poster Abstract

47

Willingness to switch to longacting injectable cabotegravir
and rilpivirine every 2 monthsfor HIV-infected patients in
Nanjing, China
Li M1, Guan H1, Zhong M1, Di X2, Yu N2, Chen C2, Cai
R2, Wei H1
The Second Hospital of Nanjing, Nanjing Medical University,
Nanjing, China, 2The Second Hospital of Nanjing, Nanjing, China

1

Background: Daily oral medication is currently themost common antiretroviral therapy (ART) for
patients infected with human immunodeficiency
virus (HIV). As the first complete long-acting (LA)ART regimen, cabotegravir (CAB) and rilpivirine(RPV), are considered as novel treatment approachwith less frequent administration, via bimonthly
infusion. Due to the upcoming availability of thisregimen in China, the present study aimed toanalyze the willingness and reasons of people
living with HIV (PLWH) to switch to CAB+RPV
therapy.
Methods: A questionnaire survey among PLWH
receiving oral ART was carried out between March
25 and April 8, 2023, in the Second Hospital of
Nanjing, China. The participants were asked about
their willingness to switch to CAB+RPV LA regimen
and provided reasons for their decision.
Subsequently, we analyzed the reasons forswitching to CAB+RPV LA therapy, and the factors
affecting their willingness were analyzed bymultinomial logistic regression.
Results: A total of 712 participants completed thequestionnaire, with 693 cases being valid. Amongthe 693 participants, 56.7% expressed willingness
to switch to the CAB+RPV regimen, 32.6% wereuncertain, while 10.7% were unwilling to change
therapy. The most common reasons for switching
to CAB+RPV therapy included not being concerned
about daily adherence to ART (22.6%), not having
to carry antiretroviral (ARV) drugs (21.7%) and not
being concerned about others seeing their ARV
drugs (14.1%). Uncertainty about switching to
CAB+RPV therapy was mainly associated withpatients' concern in terms of price (31.6%) andsafety (31.1%) of the novel drugs. Unwillingness

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71

was mainly due to patients' satisfaction with theircurrent treatment regimen (20.3%) and theirconcern about the cost of the novel drugs (13.7%).
In multivariate analysis, Higher education level[odds ratio (OR): 2.990; 95% confidence interval(CI): 1.171-7.636] was positively associated withthe willing of patients to switch to CAB+RPV
therapy, while age of ≥60 (OR: 0.142; 95% CI:
0.036-0.554) was negatively associated.
Conclusions: Our survey demonstrated that the
majority of PLWH were willing to switch from oral
ART to the CAB+RPV LA regimen. The enhanced
convenience and reduced risk of disease exposurein patients treated with LA regimens were the key
factors that made CAB+RPV therapy particularly
appealing. However, their concerns regarding
price, efficacy, safety and the requirement toadhere to the bimonthly injection could be the key
challenges for the clinical implementation of the
CAB+RPV LA regimen in the future.
Keywords: HIV, Cabotegravir, Rilpivirine, Longacting injectable

Poster Abstract48

Effect of Fluconazole on the
Pharmacokinetics of
Ainuovirine in Healthy Adult
Subjects
Huang J1,2, Lei Y3, Zhao Y3, Lin W3, Meng Y1,2, He
Y1,2, Cai W1,2, Huang K3, Li L1,2
1Guangzhou Medical Research Institute of Infectious Diseases,

Guangzhou Eighth People’s Hospital, Guangzhou Medical
University, Guangzhou, China, 2Infectious Disease Center,
Guangzhou Eighth People’s Hospital, Guangzhou Medical
University, Guangzhou, China, 3Phase I Clinical Trial Center,
Guangzhou Eighth People's Hospital, Guangzhou Medical
University, Guangzhou, China

Background: Ainuovirine (ACC007), is a newly
developed next-generation non-nucleosidereverse transcriptase inhibitor (NNRTI) for used in
combination therapy for treatment-naïve humanimmunodeficiency virus type 1 (HIV-1) positive
adults in China. The aim of this phase 1 study wasto assess the drug-drug interactions and safety of
ainuovirine when coadministered withfluconazole, a strong CYP2C19 inhibitor andmoderate CYP2C9 and CYP3A inhibitor, in healthy
adult subjects.
Methods: This was a single-center, open-label,parallel-group, sequential design, two-period
study in healthy subjects (aged 20–45 years). 18
healthy subjects were randomly allocated into twogroups. In group A, 18 healthy subjects received
oral ainuovirine (150 mg single dose) once daily in
Period 1 (Days 1–7), followed by coadministration
with oral fluconazole (200 mg single dose) once
daily in Period 2 (Days 8–16). In group B, 18
healthy subjects received oral fluconazole (200 mg
single dose) once daily in Period 1 (Days 1–7),
followed by coadministration with oral ainuovirine(150 mg single dose) once daily in Period 2 (Days
8–16). Blood samples were collected before andafter dosing.
Results: All subjects (N = 36) completed the study.
In group A, when coadministered with fluconazole,geometric means of ainuovirine pharmacokinetics
parameters Cmax,ss, AUC0-24,ss increased by
233.0% and 349.6% respectively, versus
ainuovirine alone, whereas the median Tmax,ss
was unaffected. In group B, there were no

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72

apparent effects of ainuovirine on Cmax,ss, AUC024,ss and Tmax,ss for fluconazole. Possible
treatment-related adverse events (AEs) assessedby investigators were fewer in Group A (83.3%)
versus Group B (94.4%), no death or grade ≥3
serious AE was reported.
Conclusion: Coadministration of ainuovirine withfluconazole significantly increased ainuovirine
systemic exposure, whereas ainuovirine did notappear to affect the exposure of fluconazole.
Therefore, it is recommended that the ainuovirine
dose be halved (i.e., 75 mg) when ainuovirine iscoadministered with fluconazole.

Poster Abstract

49

Charting the Uncharted: The
Anonymous Clinic's
Revolutionary March to 95-9595 Victory in Bangkok
Pankam T1, Pipattaweepon T1, Chanasriphum N1,
Pattanachaiwit S1, Manmon E1, Barisri S1, Jomja P1,
Pichitchok Y1, Putcharoen O1,2,3, Chumpa N2,3
1The Thai Red Cross Aids Research Centre, Bangkok, Thailand,

Thai Red Cross Emerging Infectious Diseases Clinical Center,
King Chulalongkorn Memorial Hospital, Bangkok, Thailand,
3Division of Infectious Diseases, Department of Medicine, Facultyof Medicine, Chulalongkorn University, Bangkok, Thailand
2

Background: The Anonymous Clinic at the Thai
Red Cross AIDS Research Centre in Bangkok
navigates the complexities of delivering HIV/AIDS
care in an urban setting. This study evaluates theefficacy of the clinic's urban-centric approachagainst the ambitious UNAIDS 95-95-95 targets,
hypothesizing that specialized strategies in a
metropolitan context significantly improve ART
initiation and viral suppression, especially among
diverse populations including Thai nationals andforeigners.
Methods: This retrospective analysis (October
2020-September 2023) examined medical recordsof HIV-positive individuals at Thai Red Cross
Anonymous Clinic, Thai Red Cross AIDS ResearchCentre (ACTRCARC), focusing on an
urban demographic. The study evaluated ART
initiation and viral suppression, considering thechallenges unique to a metropolitan area. Key
strategies included same-day ART services, free
initial ART supported by various funding sources,
and comprehensive counseling. Data wereanalyzed using SPSS version 27, with a focus on theurban context and demographic differences.
Results: Among 94,297 individuals tested, 3,800
were HIV-positive, primarily male (86.0%), with a
median age of 30, and a large proportion being
MSM(67.5%). The clinic's urban-adapted approachled to 94.1% of diagnosed individuals initiating
ART. 79.2% of PLWH on ART underwent viraltesting, with 77.1% achieving undetectable viralloads for over six months. Notably, the clinic's
strategies resulted in higher viral testing andsuppression rates among Thai nationals compared

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 202473

to foreigners(80.6% vs. 78.5% in viral testing;
78.5% vs. 62.4% in viral suppression), reflecting
the effectiveness of tailored care for diverse urban
populations. ACTRCARC also outperformed other
healthcare providers in both viral testing(84.2%vs.70.6%) and suppression (88.3%vs.66.4%).
Conclusions: The study demonstrates the successof the Anonymous Clinic's urban-centric model in adiverse metropolitan environment like Bangkok.
By focusing on immediate ART initiation andcontinuous support, the clinic has made significant
strides in meeting the 95-95-95 targets. Thismodel, effective for both Thai nationals andforeign visitors, offers a scalable and impactful
approach for urban healthcare systems globally incombating HIV/AIDS.

Poster Abstract

50

Enhanced Treatment
Outcomes in Chinese Patientswith Rapid Initiation of ART:
Insights from Central China
Wang S1, Wu D1, Wan Y1, Xu C1, Li H2, Zhang S2,Tong Y1, Li Y1, Chi N3
1Center for Disease Control and Prevention, Xiaonan District,

Xiaogan City, Xiao Gan, China, 2Xiaogan first People's Hospital,
Xiao Gan, China, 3Dougang Township Health Center, Xiaonan
District, Xiaogan City, Xiao Gan, China

Background: Rapid initiation of Antiretroviral
Therapy(ART) is a global consensus in thetherapeutic field. The concept of Rapid ART
Initiation is nascent in China, with limited
research and real-world data available, it isimperative to explore the benefits of rapid
treatment initiation for individuals infected with
HIV-1.
Material and Methods: A retrospective study was
conducted to analyze the effects of ART on 745
patients confirmed to be infected with HIV-1 in
Xiaonan District, Xiaogan City, Hubei Province,from 2002 to 2015, from 2016 to 2018, and from2019 to 2023. The study comprised three phases:
the initial routine diagnosis and treatment phase(2002-2015), the optimization of the diagnostic
process phase (2016-2018), and the rapid initiation
phase (2019-2023). During the routine phase,
which spanned from 2002 to 2015, procedures
included initial screening, confirmation,
epidemiological investigation, and treatment
initiation, with an average duration of 28 days. The
second phase, from 2016 to 2018, focused on
optimizing the diagnostic process, reducing thetime from initial screening to confirmation to 7
days, and initiating ART after controlling
opportunistic infections. In the third phase,starting from 2019 to 2023, ART initiation occurred
within 7 days or on the same day as the diagnosis
of HIV-1 infection. Data collected included gender,
age, education, infection route, diagnosis and ART
initiation time, opportunistic infections, CD4+ T
cell count, viral load, follow-up status.
Results: Through the optimization of theconfirmation process and the rapid initiation of
ART and other interventions, the average time for

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74

HIV confirmation was shortened from the initial 28
days to 7 days, the treatment coverage rate wasincreased by 30% (from 63.73% to 98.61%), andthe maintenance treatment rate of ART for 12months was increased by 40% (from 50% to98.61%). Immune function was restored to acertain extent (the proportion of CD4+T cell count≥500 cells /mm3 increased from 34.63% to81.74%, an increase of 47%), and viral load was
effectively suppressed (the proportion of viral load
negative after 6 months of antiviral treatment
increased from 60.77% to 90.45%, an increase of30%). The case fatality rate of HIV-1 decreased by
24.1% (from 25.49% to 1.39%), the loss of followup rate decreased by 35% (from 36.27% to 0.55%),
and the risk of transmission decreased.
Conclusion: Optimization of HIV-1 confirmation
process and rapid initiation of ART can improvetreatment coverage and 12-month maintenancetreatment rate, inhibit HIV-1 effectively, reduce
virus damage to the immune system, improve
immunity, and reduce the loss of follow-up rate.

Poster Abstract

51

HIV-1 Viral RNA and total DNA
Decay Dynamics inAntiretroviral-Naïve Adults
Initiating
Dolutegravir/Lamivudine
versusBictegravir/Emtricitabine/Tenofovir Alafenamide Therapy
Wang R1, Liu Y2, Sun L1, Li A1, Hua W1, Wang X1,Feng Y1, Gao Y1, Wang Z1, Li H2, Jia L2, Han J2, Kang
Q2, Wang R1, Li L2
1Beijing Youan Hospital, Capital Medical University, Beijing,

China, 2Department of Virology, State Key Laboratory of
Pathogen and Biosecurity, Beijing Institute of Microbiology andEpidemiology, AMMS,, Beijing, China

Background: In recent years, research on
treatment for antiretroviral-naïve HIV-infectedpatients has shown that the two-drug regimen(2DR) of dolutegravir/lamivudine (DTG/3TC) has
exhibited similar virological efficacy compared tothree-drug regimens (3DR) based on dolutegravir(DTG) or bictegravir (BIC).Although the DTG/3TC
regimen has also been recommended by multiple
international guidelines, the discussion on its
efficacy is still ongoing, particularly regarding thepotential issue of residual viremia (including viralreservoirs). This potential issue may suggest that
this 2DR have shortcomings in treatment
outcomes. This study aims to evaluate the impactof the DTG/3TC versus thebictegravir/emtricitabine/tenofovir alafenamide(BIC/FTC/TAF) on viral decay dynamics in in
antiretroviral-naïve HIV patients.
Materials and methods: This prospective openlabel study was conducted at the Center for
Infectious Diseases Clinic of Beijing Youan Hospital.
This study enrolled 101 antiretroviral-naive maleto-male (MSM)HIV patients aged 18 years or older.
Based on patient preference, they were assigned
to receive either the BIC/FTC/TAF (n=57) or the
DTG/3TC (n=44), taken orally once daily. Blood
samples were collected at baseline, week 4, week
12, week 24, and week 48. Plasma was separated
by centrifugation and used for quantification of

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75

HIV RNA (Abbott Diagnostics Inc, USA). DNA wasextracted from peripheral blood mononuclear
cells(PBMCs）( Qiagen, Valencia, CA, USA) for
quantification of HIV-1 total DNA (SUPBIO,
Guangzhou, China). Generalized estimating
equations were used to assess the overall trendsof changes in HIV-1 RNA and HIV-1 total DNA overthe entire study period, testing for differences
between the two treatment regimens, andanalyzing the interaction between treatment
regimen and time to compare the trajectories ofthe outcome variables.
Results: Among the 101 patients in this study, 97
reached the primary endpoint at week 48(BIC/FTC/TAF group,n=56; DTG/3TC group，n=41),
with similar proportions of lost to follow-up in thetwo groups. At week 48, the BIC/FTC/TAF groupand the DTG/3TC group had reductions in HIV RNA
levels of 2.99 (2.49 to 3.60) and 3.07 (2.44 to 3.46)
log₁₀ copies/mL, respectively. The levels of HIV-1
total DNA decreased by 0.75 (0.47 to 1.06) and
0.84 (0.62 to 1.31) log₁₀ copies/10⁶ PBMCs,
respectively.
Conclusions: No significant differences were foundin the decay of HIV-1 RNA levels and HIV-1total
DNA between the two regimens. These findings
suggest that the two-drug regimen (DTG/3TC) may
be as effective as the three-drug regimen(BIC/FTC/TAF) in suppressing viral RNA andreducing HIV-1 total DNA, which has important
implications for ART strategies.

Poster Abstract

52

Efficacy and effect on lipid
profile of ainuovirine-based
regimen versus efavirenzbased regimen in treatmentnaïve, HIV-1–positive adults:
week 24 results from amulticenter, real-world,
retrospective cohort study
Long H1, He Q2, Bi Y3, Ke Y4, Xie X1, Zhao X3, Tan S5,
Luo Y6, Chen Z5, Yu X6, Gan L, Li L4
1Department of Infectious Disease, GuiYang Public Health

Clinical Center, Guiyang, China, 2Department of Outpatient,Yunnan Provincial Infectious Disease Hospital, Kunming, China,
3
Department of Dermatology, Shandong Public Health ClinicalCenter, Shandong University, Jinan, China, 4Infectious Disease
Center, Guangzhou Eighth People's Hospital, Guangzhou
Medical University, Guangzhou, China, 5Department of Infection
and Immunology, The First Hospital of Changsha City, Xiangya
School of Medicine of Central South University, Changsha,,
China, 6Department of Infection and Immunology with Chinese
Integrative Medicine, Wuhan Jinyintan Hospital, Tongji Medical
College of Huazhong University of Science and Technology,
Hubei Clinical Research Center for Infectious Diseases, Wuhan
Research Center for Communicable Disease Diagnosis andTreatment, Chinese Academy of Medical Sciences, Joint
Laboratory of Infectious Diseases and Health, Wuhan Instituteof Virology and Wuhan Jinyintan Hospital, Chinese Academy of
Sciences, Wuhan, China

Objective: This study aimed to compare theefficacy and safety of Ainuovirine (ANV) andefavirenz (EFV) in treatment-naïve, HIV-1–infected
adults after 24 weeks treatment.
Patients and methods: A multicenter, real-world,
retrospective cohort study was conducted in 6
cities in China. Data of participants receiving either
ANV-based regimens (ANV group) or EFV-based
regimens (EFV 400 mg group and EFV 600mggroup) were collected. Data of visit 0 (baseline),
visit 1 (12 w) and visit 2 (24 w), including
demographic, clinical features and laboratory
results were compared. The primary endpoints
included the difference in the log10-transformed
HIV RNA level between ANV and EFV groups atweek 24, and the difference in lipid profilechanges, including total cholesterol (TC),triglycerides (TG), high-density lipoproteincholesterol (HDL-C), and low-density lipoprotein-

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76

cholesterol (LDL-C) between groups at week 24.
The secondary endpoints included the differencesin immune function changes (CD4+ cell countchanges and CD4+/CD8+ ratio changes) at week 12
and week 24, the difference of TC/HDL-C, TG/HDLC changes between groups at week 12 and week
24, the difference of lipid profiles between groups
at week 12. Safety endpoints were the incidenceof adverse events over 24 weeks.
Results: We retrospectively identified 274 eligible
patients’ data being treated with ANV+3TC+TDF or
ANV/3TC/TDF fixed-dose compound tablet and
541 patients being treated with EFV+3TC+TDF. The
baseline demographics and clinical characteristics
of participants were generally balanced between
groups. At week 24, 89.18% patients in the ANVgroup and 76.04% in the EFV group had HIV-1 RNA
level below LOQ (P = 0.002). Compared with the
EFV group, the mean change of log10 HIV-1 RNA atweek 24 from baseline decreased greater (-4.34 vs.
-4.18, P < 0.001), the median changes frombaseline in CD4+ T cell count increased more
(106.00 cells/μL vs. 92.00 cells/μL, P = 0.007) in
ANV group, while the CD4+/CD8+ ratio (0.15 vs.
0.20, P = 0.167) was similar between the ANV andEFV group at week 24 from baseline. The meanchanges from baseline in TC (-0.02 vs. 0.25
mmol/L, P < 0.001), TG (-0.14 vs. 0.11 mmol/L, P =0.024), and LDL-C (-0.07 vs. 0.15 mmol/L, P <0.001) at week 24 was significantly different
between the two groups. The incidence of any
adverse events in ANV group was significantly
lower than that in EFV group at week 12 (6.2% vs.
30.7%, P < 0.001) and was comparable at week 24(3.6% vs. 5.5%, P = 0.28).
Conclusion: The ANV-based regimen was welltolerated in treatment-naïve HIV-1 infectedpatients with effective HIV-RNA suppressing effect,
more CD4+ cell count improvement, less lipid
abnormality, good safety profile, less AEs at week24.

Poster Abstract

53

Efficacy and effect on lipid
profiles of switching toainuovirine-based regimen
versus continuing efavirenzbased regimen in HIV-1Infected patients: week 24
results from a real-world,
retrospective multi-center
cohort study
Wang C1, Yu X2, Ke Y3, Fu Y4, Luo Y2, Li Y5, Bi Y1,
Chen X6, Li L3, Zhao X1, Chen Z5
1Department of Dermatology, Shandong Public Health ClinicalCenter, Shandong University, Jinan, China, 2Department of
Infection and Immunology with Chinese Integrative Medicine,
Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong
University of Science and Technology, Hubei Clinical ResearchCenter for Infectious Diseases, Wuhan Research Center forCommunicable Disease Diagnosis and Treatment, Chinese
Academy of Medical Sciences, Joint Laboratory of Infectious
Diseases and Health, Wuhan Institute of Virology and Wuhan
Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China,
3Infectious Disease Center, Guangzhou Eighth People's Hospital,
Guangzhou Medical University, Guangzhou, China, 4Department
of Infectious Disease, GuiYang Public Health Clinical Center,
Guiyang, China, 5Department of Infection and Immunology, The
First Hospital of Changsha City, Xiangya School of Medicine ofCentral South University, Changsha,, China, 6Department of
Outpatient, Yunnan Provincial Infectious Disease Hospital,
Kunming, China

Background: Ainuovirine (ANV) is a novel nonnucleoside reverse-transcriptase inhibitor (NNRTI).
In a randomized phase 3 trial, ANV demonstrated
noninferior efficacy relative to efavirenz (EFV) and
was associated with lower rates of hepatotoxicity,dyslipidemia, and neuropsychiatric symptoms.
Methods: We conducted a multi-center,retrospective, controlled cohort study to compare
the lipid profile modifications in experienced HIV1-infected patients switching to the ANV-based
regimen from EFV.
Results: We retrospectively identified 318 patients
eligible for the ANV group and 460 patients for theEFV group. At week 24, 96.65% of patients in the
ANV group and 93.25% in the EFV group had HIV-1
RNA level below limit of quantification (LOQ).
Median changes from baseline in CD4+ T-cell

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77

counts (37.0 vs 36.0 cells/μL, p=0.886) andCD4+/CD8+ ratio (0.03 vs 0.10, p=0.360) weresimilar between the ANV and EFV group. The ANVgroup was superior to the EFV group for meanchanges from baseline in total cholesterol (TC,−0.06 vs 0.26 mmol/L, p=0.006), triglycerides (TG,−0.6 vs 0.14 mmol/L, p<0.001), high-density
lipoprotein-C (HDL-C, 0.09 vs 0.08 mmol/L,
p=0.006), and low-density lipoprotein-C (LDL-C,−0.18 vs 0.29 mmol/L, p<0.001) at week 24. We
also observed a higher proportion of patients in
the ANV group had their TC (13.55% vs 4.45%,
P=0.015) or LDL-C (12.93% vs 6.89%, P=0.017) level
improved at week 24 than those in the EFV group.
Conclusions: We demonstrated good efficacy,favorable changes in lipid profile of switching to
ANV from EFV in treatment-experienced HIV-1infected patients in real-world, providing apromising switching option for patients who may
have risk factors for metabolic syndrome or
cardiovascular disease.

Poster Abstract

54

The Efficacy and Safety of
Switching to Dolutegravir andLamivudine-Based Regimen for
Virological Suppression in
People Living with Human
Immunodeficiency Virus Type
1: A Systematic Review andMeta-Analysis
Ong L1, Chee N1, Loh A1
1Faculty Of Medicine, University Of Malaya, Kuala Lumpur,

Malaysia

Introduction:Combination antiretroviral therapy(ART) effectively reduces the risks of opportunistic
infections, decreases mortality, and improves life
expectancies in people living with humanimmunodeficiency virus (PLHIV). Major guidelines
currently recommend dolutegravir and lamivudine(DTG/3TC) as the initial treatment for PLHIV who
are naïve to ART. The DTG/3TC-based regimen
exhibits favourable tolerability, a high genetic
barrier to resistance, and reduced potential for
drug-drug interactions. Therefore, this study aims
to determine the efficacy and safety of switching
to a DTG/3TC-based regimen for virologicalsuppression in PLHIV.
Methods: A systematic literature search was
conducted in PubMed, ScienceDirect and Ovid SPfrom inception up until 31st January 2024 to
identify relevant studies. The pooled effect of
dichotomous data variables were expressed using
risk ratio (RR) with 95% confidence intervals (CI)and the pooled effect of continuous data variables
were expressed using mean difference (SMD) with
95% CI. The DerSimonian and Laird random-effects
model was used to compute the pooled estimates.
Statistical analysis was conducted in R
programming.
Results: A total of 5 randomised controlled trials
with 1065 patients switched to a DTG/3TC-based
regimen and 1076 patients remained on theircurrent ART were included in this meta-analysis.
There were no statistically significant differencesin virological suppression in the intention-to-treat

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78

population (RR:1.00, 95% CI:0.98–1.03) and the
per-protocol population (RR:1.01, 95% CI:0.98–
1.03) for both treatment groups. In addition, there
was no statistically significant change in CD4+ cellcounts (MD:20.37, 95% CI:-2.16–42.90) in both
treatment groups. The adjusted treatment
difference for virological failure was –0.38 (95%
CI:-0.96–0.20). The upper limit of CI was well
below the most conservative published noninferiority margin of 4%, demonstrating noninferiority. Furthermore, the adjusted treatment
difference for virological suppression was –0.02(95% CI:-5.36–5.32). The lower limit of CI was well
above the most conservative published noninferiority margin of -8%, demonstrating noninferiority. For the safety profile, there was no
statistically difference in the rate of adverse
events for both treatment groups (RR:1.11, 95%
CI:0.98–1.38). However, patients who switched toa DTG/3TC-based regimen had a higher rate ofneuropsychiatric adverse events (RR:2.28, 95%
CI:1.36–3.80) compared to patients who remainedon their current ART. Additionally, the patients
who switched to DTG/3TC-based regimen had ahigher rate of withdrawal due to adverse events(RR: 6.41, 95% CI:2.18–18.89).
Conclusions: Our study demonstrated thatswitching to DTG/3TC-based regimen was noninferior compared to continuing current ART for
patients with stable virological suppression.
However, patients who were on DTG/3TC-based
regimen had a higher rate of neuropsychiatricadverse events.

Poster Abstract

55

Pharmacokinetics, efficacy andsafety study of switching to
albuvirtide every 4 weeks plus
dolutegravir for maintenanceof virological suppression in
adults living with Human
Immunodeficiency Virus 1
Xie X1, Long H1, Fu Y1, Song C1, Sun F1, Song Y1,
Zeng W1, Li Y1, Jiang J1, Tu W1, Song C1
Guiyang Public Health Clinical Center, Guiyang, China

1

Objective: Currently there are very few options oflong-acting antiretroviral drugs. Albuvirtide (ABT)
is the first long-acting fusion inhibitor with potent
anti-HIV activity and good safety. We evaluatedthe pharmacokinetic profile, safety, and efficacy of
ABT 640mg administered every 4 weeks in adults
living with HIV who were virologically suppressed.
Methods: This was an open-label, prospective,
single arm study enrolling ART-experienced adults
with plasma HIV-1 level of less than 50 copies/mL.
The subjects switched to ABT plus dolutegravir(DTG) for 24 weeks. ABT was intravenously
administrated at the dose of 640mg every 4
weeks, and DTG was orally taken once daily. The
safety, pharmacokinetics profile of ABT in bloodplasma, HIV-1 viral-load, CD4+ T cell counts wereassessed during treatment.
Results: Of 10 participants enrolled, the medianage was 48.50 (37.00 ,50.00) years and 70% weremale. The first dose and steady state troughconcentrations(Ctrough) of albuvirtide were2.43±0.67μg/mL and 2.61±1.07μg /mL,
respectively, which were 32.4- and 34.8- foldgreater than the protein-adjusted concentration
required for 90% viral inhibition (PA-IC90) of
0.075μg/mL. At the time of analysis, week 24 data
were available for 9 participants. Virologicalsuppression was maintained in all participants. We
used the trend effect of mixed-effect model test
time to analyze the changes in CD4+T-cell counts
before and after treatment. Compared to thebaseline, CD4+T-cell counts were significantly
increased after 24-weeks treatment

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79

(F=7.38,P=0.0092). None of 10 participants
experienced injection site reactions(a series ofsymptoms that occur around the injection site
after the injection , such as erythema, pain,
swelling, or itching) , and all of participants wereable to complete the study without serious ARTrelated adverse events during treatment.
Conclusion: For 24 weeks, ABT 640mg every 4
weeks in combination with DTG maintained
virological suppression and increased CD4+ T cellcounts even when the viral load was below limit ofdetection. The efficacy, safety, lack of injection site
reaction suggest ABT potential in future longacting ART regimen.

Poster Abstract

56

Dolutegravir/lamivudine as aFirst-Line Regimen in a Testand-Treat Setting: Real-World
Evaluation
Ming W1, Xv X1, Ma C1, Liu Z1, Bo C1, Wei H1, Feng
W2, Hu Z1
1The Second Hospital Of Nanjing, Nanjing, China, 2Huai' an No.4

People' s Hospital, Huai' an, China

Introduction:Dolutegravir/lamivudine (DTG/3TC) is
indicated for treatment-naive and experienced
people with HIV; however, questions remain about
its utility in a test-and treat setting because of
potential transmitted resistance, baseline hepatitis
B virus (HBV) co-infection and high baseline HIV-1
viral loads. In real world clinical practice, results ofhepatitis B virus (HBV) co-infection can beobtained on the same clinical day, and many datasuggest that initiating DTG/3TC in individuals withhigh baseline HIV-1 viral loads is effective.
Therefore, the primary concern of test-and-treat is
potential transmitted resistance.
Methods: This retrospective study included
treatment-naive HIV-1-infected individuals
initiating the DTG/3TC between June 2021 andJanuary 2023. Observed the maintenance rate andeffectiveness of initiating DTG/3TC in real-world
settings before HIV drug resistance reports areavailable. ART modifications were made if baseline
testing revealed DTG or 3TC resistance. Primary
endpoints were the maintenance rate of DTG/3TC
treatment and the proportion of HIV-1 RNA <50
copies/mL at 48 weeks and the drug resistance.
Results: Of 266 participants enrolled, 248 (93.2%)
were male, 56 (21.1%) were aged ≥50 years, and
209 (78.6%) were infected through homosexual
activity. 231 (86.8%) initiated ART within 7 days
(including 7 days) after the initial hospital visit, themedian time was 4 days (IQR 0-7). While themedian time from diagnosis of HIV-1 infection at
the CDC to initiation of ART was 16 days (IQR 1130). 65 (24.6%) participants had HIV-1 RNA≥100,000 copies/mL, and 6 (2.27%) had HIV-1 RNA≥500,000 copies/mL. 65 (24.6%) having a CD4+ T
cell count < 200 cells/μL. Subsequent resistancetesting results showed that 231 (86.8%) individuals

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had resistance results, among which 29 (12.55%)
were NNRTI-related resistance, 4 (1.73%) were PIrelated resistance, and 1/231 (0.43%) was NRTIrelated resistance, with no of 3TC-related
resistance. There were no INSTI-related resistancecases. None of the patients who started ART
within 7 days of their first clinical visit had drug
resistance reports available.
At week 48, 256 (96.2%) still on DTG/3TC
treatment. 10(3.8%) participants modified
regimens for various reasons, including 5 due toadverse reactions, 3 due to economic reasons, and2 due to other reasons. The proportions ofparticipants with HIV-1 RNA <50 copies/ml atweeks 48 were 93.3%, among the participants who
initiated the DTG/3TC regimen within 7 days of theinitial hospital visit, the proportions with HIV-1
RNA <50 copies/ml at weeks 48 were 95.0%,
respectively. By the end of week 48, the medianCD4+ T cell count increased from 324 cells/μL (IQR
201-449) to 483.50 cells/μL (IQR 356.00-696.25), P< 0.001.
Conclusion: This study demonstrates that rapid
initiation of the DTG/3TC regimen prior toresistance testing results lead to high maintenanceand virological suppression rates, with nointerruptions in DTG/3TC due to transmitted
resistance or treatment failure. So there is no needto exclude DTG/3TC from the recommendation of
rapid initiation regimen. The main barrier to testand-treat may be the extended duration between
diagnosis at the CDC and referral to a clinicalcenter. Further discussion is needed on how tosimplify this process.

Poster Abstract

57

Real-world Virologic and
Safety Outcomes in People
Living With HIV-1 Using
Dolutegravir + Lamivudine in
Asia Stratified by Viral Load,
Including in Individuals With
High Viral Loads
Doblado-Maldonado A1, Yit Reen Ooi A2, Chen J3,
Letang E4
1
ViiV Healthcare, Wavre, Belgium, 2ViiV Healthcare, Singapore,
Singapore, 3Shanghai Public Health Clinical Center, Fudan
University, Shanghai, China, 4ViiV Healthcare, Madrid, Spain

Background: Viral load (VL) is an importantconsideration when initiating antiretroviraltherapy (ART). Dolutegravir (DTG) + lamivudine(3TC) was effective for achieving virologic
suppression (VS) among ART-naive adults livingwith HIV-1 with VL ≥100,000 copies/mL in the
GEMINI-1/-2 and STAT trials. Althoughinternational guidelines recommend DTG + 3TC as
first-line therapy for ART-naive people with VL<500,000 copies/mL, individuals in real-world
settings have initiated this regimen with higher
VLs. To complement trial data and support
treatment decisions, we summarize real-world
evidence for DTG + 3TC effectiveness in ART-naive
individuals with high VL in Asia.
Material and Methods: Embase®, PubMed, andCochrane library databases and congress materials
were searched (January 2013-March 2023) to
identify non-interventional observational studies
reporting DTG + 3TC use in N ≥10 individuals. Post
hoc targeted searches were performed to add
more recent (to December 2023) and non–Englishlanguage literature. Publications were screened
for studies reporting effectiveness and/or safety in
ART-naive individuals in Asia, stratified by baseline
VL, at any time point. Results were summarizedusing lead study data for each cohort (ie, study
with highest N) to avoid overlap. High VL wasdefined as ≥ or >100,000 copies/mL and very highVL as ≥ or >500,000 or 1,000,000 copies/mL.
Results: From 235 publications identified, 21 were
included, representing ART-naive individuals using

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DTG + 3TC from China (n=551, 6 cohorts) andTurkey (n=56, 1 cohort). Median ages ranged from37 to 66.5 years, and 59% to 93% of cohorts weremale. No baseline resistance-associated mutations
were reported. The most common reasons for
initiating were polypharmacy/drug-druginteractions and renal comorbidities. When leadstudy n/N were pooled according to VL category,
149/262 (57%) individuals had high VL and147/353 (42%) had very high VL (≥500,000
copies/mL, 113/353; ≥1,000,000 copies/mL,
40/152) at baseline. VS (primarily defined as VL<50 copies/mL) rates among lead studies in people
with VL ≥100,000 vs <100,000 copies/mL were
52% vs 64% at Week 4 and 60% vs 93% at Week
12; corresponding rates in those with VL ≥500,000
vs <500,000 copies/mL were 5% vs 20% and 50%
vs 75%. Week 48 VS rate was 92% for high VL (1study; entire cohort had VL >100,000 copies/mL)
and ranged from 64% to 96% for very high VL (vs90%-92% with VL <500,000 copies/mL; 3 studies).
In one study, 2 individuals with high VL had
virologic rebound at Week 48 and re-suppressedat Week 72. CD4+ cell counts increased across all
VL categories. Outcomes were generally consistent
between lead and non-lead, within-cohort studies.
One virologic failure was reported in an individualwith very high VL, attributed to non-adherence(non-lead study). Studies reported no
discontinuations (n=1 study) or no
discontinuations due to adverse events (AEs; n=7
studies), drug-related AEs (n=1 study), or drugrelated serious AEs (n=1 study). Few serious AEs
were reported.
Conclusions: Similar to randomized clinical trials,
real-world evidence from ART-naive individuals
initiating DTG + 3TC in Asia demonstrated high VS
rates and favorable safety outcomes, even when
VL was high or very high at treatment initiation.

Poster Abstract

58

CHANGES IN SLEEP QUALITY
AFTER TRANSITIONING FROMNEVIRAPINE TO
DOLUTEGRAVIR-BASEDREGIMEN IN ADULTS LIVINGWITH HIV
Pane M1, Putranto R1, Widhani A1,2, Yunihastuti E1,2
1Internal Medicine Department Faculty Of Medicine Universitas

Indonesia, Jakarta, Indonesia, 2HIV Integrated Clinic Cipto
Mangunkusumo Hospital, Jakarta, Jakarta, Indonesia

Background: Indonesia recently running an ART
transition program from nevirapine (NVP) to
dolutegravir (DTG). Previous study showed thatDTG associated with sleep problems. The aim of
this study were to evaluate sleep quality change in
6 months after transitioning to DTG-based
regimen and its predicting factors.
Methods: We conducted a cohort observational
study on 145 adults living with HIV who underwent
transitioning from AZT/3TC/NVP to TDF/3TC/DTG(TLD) from April to June 2023. Participants wereasked to fill the Indonesian version of Pittsburg
Sleep Quality Index (PSQI) before and 6 months
after changing the regimen. Worsening sleep
quality was defined as an increase of PSQI score atleast 1 point. Baseline factors evaluated were sex,age, BMI, duration on previous ART, marriage
status, HIV risk of transmission and baseline PSQI
score.
Results: A total 145 participants were included inthis study. The median age was 43 (min-max 1867) years and 57.2% participants were male.
Median duration of AZT/3TC/NVP was 14 (minmax 2-29) years before transition to TLD. At
baseline 43.45% participant had poor sleep
quality. After 6 months transition, 45.5%
participants experienced worsening of sleep
quality index. There were no significant difference
in worsening sleep quality between sex (RR 0.98:
95% CI 0.68 – 1.41, p=0.94), age (RR 1.1: 95% CI
0.7 – 1.9, p=0.48), BMI (overweight versus nonoverweight, RR 0.76: 95% CI 0.53 – 1.04, p=0.15),
duration on previous ART (<10 versus minimal 10
years, RR 1.04: 95% CI 0.7-1.5, p=0.83), marriage

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status (RR 1.26: 95% CI 0.8 – 1.8, p=0,19) androute of transmission (RR 1.2: 95% CI 0.7 – 2.2,
p=0,42). The only predicting factor of worsening
sleep quality index was baseline PSQI score < 5(normal sleep quality) before transitioning.
Conclusions: Almost half of participant developed
worsening sleep quality after transitioning todolutegravir-based regimen. We recommend
clinicians should actively discuss this issue tominimize the effect.

Poster Abstract

59

Anal high-grade squamous
intraepithelial lesion screening
algorithms for Thai cisgender
men and transgender women
who have sex with men:baseline results of amultiphase optimization
strategy study
Thitipatarakorn S1, Suriwong S1, Chaya-ananchot
T1, Sripitathanasakul T1, Tongmuang S1,
Hongchookiat P1, Nonenoy S1, Teeratakulpisarn N1,
Ramautarsing R1, Phanuphak N1,2
1Institute of HIV Research and Innovation, Bangkok, Thailand,
2Center of Excellence in Transgender Health, Chulalongkorn

University, Bangkok, Thailand

Background: Men who have sex with men,
especially with HIV, face heightened risk of analcancer. Treating its precursor, anal high-grade
squamous intraepithelial lesion (HSIL), can reduce
this risk. The current standard screening practice,anal cytology, has low sensitivity (19%). We aimed
to identify an optimal anal HSIL screening
algorithm using a Multiphase Optimization
Strategy Trial (MOST).
Methods: The optimization phase enrolled
participants aged ≥30 years old with HIV and ≥40years old without HIV in Bangkok, Thailand, andfollowed them every six months for one year.
Participants chose between self-sampling andphysician sampling. Self-sampled participants wererandomized into groups receiving combinations ofanal cytology and high-risk human papillomavirus(HPV) DNA testing. Physician-sampled participants
were randomized into groups receiving
combinations of digital anorectal examination,
anal cytology, high-risk HPV DNA testing, and highresolution anoscopy (HRA). In groups without HRA,
positive digital rectal examination, cytology, or
high-risk HPV results were followed up with HRA.
Results: Between October 2022 and April 2023,
157 cisgender men and 23 transgender women
were enrolled and conducted baseline visits. Of
these, 132 (73.3%) had HIV. Median age was 43

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years in those with HIV, and 46 years in those
without HIV. Four (2.22%) chose self-sampling,
while 176 (97.8%) chose physician sampling. No
HSIL diagnoses originated from self-sampled
groups, while 20 were from physician-sampled
groups (11.1% of 180, 95%CI 6.9%–16.6%). Of all
HSIL diagnoses, 16/20 (80.0%) originated fromgroups with HRA as standard screening method,while 4/20 (20.0%) were from a positive high-risk
HPV DNA followed up with HRA.
Conclusions: Most participants favored physiciansampled HSIL screening over self-sampling. HRA,
with or without adjunctive testing, detected themost HSIL. While anal cytology did not contributeto HSIL diagnosis, using HRA as a follow-up test
after a positive high-risk HPV result demonstrated
potential as a screening approach.

Poster Abstract

60

Differences in cognitive
trajectories between sexes
among aging virologicallysuppressed Thai people livingwith HIV
Hiransuthikul A1,2, Kerr S1,3,4, Apornpong T1, Han
W1,3, Lwin H1, Gatechompol S1,5, Ubolyam S1,5,
Avihingsanon A1,5
1HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand, 2Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 3Kirby Institute, UNSW Sydney, Sydney, Australia,
4Biostatistics Excellence Centre, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 5Center of
Excellence in Tuberculosis, Department of Medicine, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand

Background: Due to the disparities inbiopsychosocial factors experienced by men andwomen, the impact of HIV on cognitive
performance may differ between sexes. We aimed
to determine the differences in cognitive
trajectories between men and women in an aging
people living with HIV (PWH) cohort in Thailand.
Material and Methods: Virologically suppressed
Thai PWH aged ≥50 years in the HIV-NAT 006
cohort were enrolled during 2015–2017 toevaluate cognitive performance using the Thaivalidated Montreal Cognitive Assessment (MoCA),
with the second assessments conducted since2021. A multivariate linear mixed-effects model,
with an interaction term between sex and age,
was utilized to estimate for sex differences incognitive trajectories with aging.
Results: Among 224 PWH included, median (IQR)
age was 54.5 (51.9–59.7) years, 39.3% were
women, 73.2% had >6 years of education, median
duration of HIV infection was 17.9 (14.2–20.8)
years, and median MoCA score was 24 (21–26),
with 57.1% having cognitive impairment atbaseline. Women were less likely to have >6 yearsof education (52.3% vs. 86.8%, p<0.001) and had
lower MoCA score (23 [18–25] vs. 25 [22.5–26],
p<0.001) than men. After adjusting for baseline
MoCA, body mass index, education, smoking,alcohol consumption, diabetes, hypertension, anddepression, men showed a greater decline in

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84

cognitive performance with increasing age
compared to women: from 23.7 (95%CI 23.0–24.5)
to 21.4 (95%CI 20.5–22.3) in men and from 22.6
(95%CI 21.5–23.6) to 21.9 (95%CI 20.7–23.0) in
women between the ages of 50 to 70 years. The
greater decline in cognitive performance observedin men persisted after adding HIV-related factors
to the model: from 23.8 (95%CI 23.0–24.7) to 21.1
(95%CI 20.0–22.2) in men and from 23.0 (95%CI
21.9–24.2) to 21.5 (95%CI 20.2–22.9) in women
between the ages of 50 and 70 years.
Conclusions: Despite higher cognitive performanceat the earlier stage, men living with HIV
demonstrated a greater cognitive decline
compared to their women counterparts. Thesefindings underscore the importance of further
investigation in sex differences for cognitive
decline in aging individuals living with HIV.

Poster Abstract

61

Clinical impact of switching to
DTG/3TC on the recovery of
BMD in PLHIV
Liu B1, Zhang C2
1Anshan Infectious Disease Hospital, An Shan, China, 2China
Medical University, Shen Yang, China

Background: The incidence of decreased BMD ishigh in PLHIV and has been demonstrated to be
associated with Tenofovir (TFV). Proactive
switching to TFV-free antiviral regimens should be
beneficial for bone mineral density (BMD)
recovery, but relevant clinical real world data are
still very limited.
Material and Methods: A single-center
retrospective observational study was conducted
to analysis the impact of switching to DTG/3TC vsmaintaining 3DR (TDF) on the recovery of BMD at
48 weeks. In addition, we analyzed T-values inpatients ≥ 50 years and Z-values in patients < 50years and We also analyzed the effect of switching
to DTG/3TC on BMD recovery when -1< T > -2.5
and T < -2.5 and Z > -2 and < -2. Chi-square test
and logistic regression were used to analyze thedifferences between the two groups.
Results: A total of 240 PLHIV with a decline in BMD
or osteoporosis and with virus suppressed for >3months were enrolled in this study: 120 switching
to DTG/3TC between January 2021 and January2023, 120 maintaining 3DR (TDF), 212 (88.3%)
males, 137 (57.0%) homosexuals, 97 (40.4%) aged
≥ 50 years. The mean duration of continuous TDF
use was 52.5 months. At week 48, the changes of
BMD in the DTG/3TC group [0.10（0.06,0.18）]
was significantly better than that in the 3DR(TDF)
group [-0.20（-0.06,0.10), P＜0.001 ]. In patients ≥50 years, the changes of BMD and T in the
DTG/3TC group [BMD, 0.10（0.06,0.19）; T,
0.79（0.55,0.98)] were better than those in the
3DR(TDF) group [BMD, -0.01 (-0.04,0.01) ,P＜0.001 ; T, -0.02（-0.20,0.13）, P＜0.001 ];Compared with T<-2.5 [BMD, 0.09（0.05,0.14）;
T, 0.70（0.52,1.11）] , there was no difference in
BMD and T changes at 48 weeks when switching to
DTG/3TC at -1<T>-2.5 [BMD, 0.10（0.06,0.21） ,P=0.4 ; T, 0.81（0.56,0.95）, P=0.5 ]. In patients <Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

85

50 years, the changes of BMD and Z in the
DTG/3TC group [BMD, 0.10（0.06,0.17）; Z,
0.62（0.44,0.95）] were better than those in the
3DR(TDF) group [BMD, -0.03（-0.09,0.00） ,P＜0.001 ; Z, -0.20（-0.40,0.13）, P＜0.001]；Compared with Z<-2 [BMD, -0.03（0.09,0.00） ; Z, -0.20（-0.40,0.13））], the BMD
and Z changes were better at 48 weeks whenswitching to DTG/3TC at Z>-2 [BMD,
0.10（0.06,0.17）, P＜0.001; Z,
0.62（0.44,0.95）, P＜0.001 ].
Conclusion: This study demonstrates thatswitching from 3DR(TDF) to DTG/3TC (TFV-free)
has a positive effect on BMD (T in patients ≥ 50
years and Z in patients < 50 years) recovery in
PLHIV with decreased BMD or osteoporosis.
Although there was no statistically significant
change in BMD and T when switching to DTG/3TC
at -1<T>-2.5 and T<-2.5, there were still
differences in numerical values, which we believe
may be related to shorter observation time (48weeks) and slower BMD recovery in patients over
50 years old. So we believe that choosing toactively switch from 3DR (TFV) to DTG/3TC as earlyas possible is more beneficial for the recovery of
BMD (T and Z) than choosing to switch passively.

Poster Abstract

62

Impact of Depression on
Virological Outcomes andQuality of Life among People
Living with HIV in Thailand
Nochaiwong T1, Han W1,5, Sophonphan J1,Apornpong T1, Lwin H1, Thammapiwan S1,Tongyonk C3, Gatechompol S1, Kerr S1,2,5,
Avihingsanon A1,4
1
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand, 2Biostatistics Excellence Centre, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 3Department of
Psychiatry, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand, 4Excellence center in Tuberculosis, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand, 5Kirby
Institute, UNSW Sydney, Sydney, Australia

Introduction:Depressive symptoms impact thewell-being and quality of life (QoL) in people livingwith HIV (PLWH), and is often associated withpoorer virological control. Understanding
depressive symptoms and their association withvirological outcomes and QoL are crucial indevising comprehensive healthcare strategies
tailored to the specific needs of PLWH. This study
investigated the relationship between depression,
virological outcomes, and QoL among PLWH.
Methods: A cross-sectional study was conductedamong PLWH at HIV-NAT, Thai Red Cross AIDS
Research Centre, Thailand, from December 2020
to June 2023. A Patient Health Questionnaire(PHQ)-9 score≥10 was considered to represent
moderate-to-severe depression. QoL wasmeasured using the World Health Organization’s
Quality of Life-HIV (WHOQOL-HIV BREF) which is avalidated 31-item in six domains, each rated on a
5-point scale, with 1 indicating low, negative
perception and 5 indicating high, positive
perception. Mean scores for each domain werecomputed. The scores ranged between 4 and 20.
Higher scores indicated better QoL. Virologicalsuppression was defined as having HIV RNA<50copies/mL. Multivariable logistic regression wasused to evaluate the factors associated withmoderate-to-severe depression.
Results: Among 508 participants, 17.5% werefemale, and the median age was 33.3 years, with
90.4% had HIV RNA<50 copies/mL. Fifty individuals

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86

(9.8%) experienced moderate-to-severe
depressive symptoms. In a multivariable model,
females (aOR: 4.18, 95%CI: 1.04-16.72) and HIV
RNA≥50 copies/mL (aOR: 3.07, 95%CI: 1.28-7.35)
had higher risk to develop moderate-to-severe
depression. Of all participants, 72.1% reported
good or very good overall QoL and 71.1%
expressed satisfaction and very good satisfaction
with their general health perception. PLWH withminimal or mild depression had higher mean
overall QoL (4.0±0.7 vs. 3.2±0.7, P<0.001), general
health perception (3.9±0.8 vs. 3.2±0.9, P<0.001),
and HIV RNA<50 copies/mL (91.7% vs 78%,p<0.002) compared to those with moderate-tosevere depression. In the QoL six domains,participants with minimal or mild depression alsoscored higher in physical health (16.7±2.3 vs.
13.0±3.1, P<0.001), psychological health (16.0±2.3
vs. 12.6±2.5, P<0.001), level of independence(16.6±2.4 vs. 14.3±2.4, P<0.001), social
relationships (15.4±2.4 vs. 12.6±2.2, P<0.001),
environmental health (15.6±2.3 vs. 13.3±2.4,
P<0.001), and spirituality/self-beliefs (15.7±3.1 vs.
12.7±3.0, P<0.001) compared to those withmoderate-to-severe depression. Among PLWH
with minimal or mild depression, there was no
significant difference in the six domains between
those with virological suppression and those
without suppression. PLWH with moderate-tosevere depression and virological non-suppression
had the lowest overall QoL score as well as in each
QoL domain.
Conclusion: PLWH with elevated rates ofdepression had lower QoL scores and were higher
rates of virological non-suppression. Prioritizing
mental health care is essential to improve healthoutcomes and quality of life in PLWH.

Poster Abstract

63

ASSOCIATION OF
STAPHYLOCOCCUS AUREUS
NASAL COLONIZATION WITH
SKIN AND SOFT TISSUE
INFECTIONS AMONG PEOPLE
LIVING WITH HUMANIMMUNODEFICIENCY VIRUS IN
A SPECIALTY HOSPITAL IN THE
PHILIPPINES
Cruz T1, Gianan-Gascon A1, Sia S1, Nazareno P1,
Boehme K1, Gayetta J1, Lagrada M1, Olorosa A1,
Macaranas P1
Research Institute for Tropical Medicine, Parañaque City,
Philippines

1

Background: Skin and soft tissue infections (SSTI)
encompass a wide spectrum of common infectious
diseases caused by Staphylococcus aureus anddisproportionately impact people living withhuman immunodeficiency virus (PLHIV). Nasal
carriage of S. aureus has been linked tosubsequent infections, not just SSTIs, in a variety
of clinical settings and populations.
Objective. In this study, we sought to determine
the incidence of nasal S. aureus carriage anddetermine its association with SSTIs; describe theclinical factors associated with risk of having SSTIs
among PLHIV; and determine the genetic
determinants of antimicrobial resistance among
methicillin-resistant S. aureus (MRSA)
Methods: The study was conducted from
November 2022 to July 2023 at the ResearchInstitute for Tropical Medicine (RITM). A total of
379 nasal swabs from PLHIV seen in the out- andin-patient clinics were screened for growth of S.
aureus. MRSA was determined using cefoxitin disk
test and further analyzed using phenotypic
antibiotic susceptibility testing and whole genome
sequencing (WGS). All subjects were followed up
from the time of collection until 3 months.
Patients who were laboratory confirmed to have
MRSA carriage underwent decolonization after the
3-month follow-up.

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Result: Nasal carriage of S. aureus was at 84.16%(n= 319/379), of which 2.82% (n=9/319) was
identified as MRSA. None of the isolates weredetected with vancomycin resistance. The mostdiagnosed SSTI was folliculitis, followed bycarbuncles. There was no significant difference inthe rate of current SSTI among patients colonizedwith MRSA/MSSA compared to those who werenon-colonizers. However, there was an increased
odds ratio of 2.05 (95% CI: 1.67-2.46, p = 0.05) ofdeveloping SSTI among subjects with nasal
MSSA/MRSA colonization. The major risk factor fornasal S. aureus carriage was CD4< 350 cells/mm3.
Conclusion: A CD4+ T-cell count of <350 cells/mm3
is a risk factor for nasal carriage of MSSA/MRSA.
The high prevalence of nasal MSSA carriage but
low MRSA rate in this population may be indicativeof high rate of community transmission ofsusceptible isolates; thus empiric treatment in thispopulation need not cover for MRSA. The risk ofdeveloping SSTI is higher in those colonized witheither MSSA/MRSA and prompt decolonization
should be recommended in recurrent cases.

Poster Abstract

64

The burden of sleep
disturbances among people
living with HIV/AIDS in China:
A systematic review and metaanalysis
Li J1, Liu L, Li L, Yan C, Zhong H, Liu C
1Department Of Infectious diseases, Guangzhou Eighth People’s

Hospital, Guangzhou Medical University, Guangdong, China

Objective: People living with HIV/AIDS (PLWH)
commonly face a range of health issues, among
which sleep disturbances are common and are
related to adverse health outcomes. This review
aims to assess the pooled prevalence of sleep
disturbances among PLWH in China through acomprehensive and quantitative meta-analysis.
Methods: We conducted comprehensive searchesof Chinese databases (Wan Fang, SinoMed, theChina National Knowledge Internet, and VIP data)and international databases (Web of Science,
PubMed, Embase, and Cochrane Library) fromtheir inception through December 23, 2023. The
random effects model was used to calculate thepooled prevalence estimates with 95%confidence
interval.
Results: This meta-analysis included 20 studies
involving 10,902 Chinese PLWH, of which 5,086
PLWH experienced sleep disturbances. The pooledprevalence was 46% (95% CI: 42-51%). Subgroup
analysis revealed that the prevalence of sleep
disturbances was influenced by the mental status
of depression (Q=4.21, P<0.01) and anxiety(Q=4.76, P<0.01), receiving support from family
and friends (Q=6.63, P<0.01), treatment with
Efavirenz (EFV) (Q=37.53, P=0.007), studies using
different instruments (Q=42.69, P<0.01) and thecutoff value of PSQI (Q=48.29, P<0.01).
Conclusions: Chinese PLWH experience asignificant burden of sleep disturbances, which is
generally higher than the general population. Early
screening and comprehensive interventions
targeting sleep disturbances in this population
should be prioritized.

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88

Poster Abstract

65

The Ratio of Hemoglobin to
Red Cell Distribution Width is
the Superior Predictor of
Survival in AIDS-related DLBCL:a Novel Inflammatory Marker
Chen J1, Peng J
1Department Of Infectious Diseases, Nanfang Hospital,

Southern Medical University, Guangzhou, China

Background: AIDS-related diffuse large B-cell
lymphoma (AR-DLBCL) remains a leading cancer inpeople living with HIV after the introduction of
combined antiretroviral therapy, partly withinferior outcome. Identification of independent
prognostic markers may help to stratify risk moreaccurately.
Material and Methods: We conducted aretrospective multicenter cohort study spanning
nine years from 2011 to 2019, involving 153
eligible AR-DLBCL patients. We assessed factors
related to overall survival (OS) through Kaplan–
Meier analyses, univariate and multivariate Cox
proportional hazards models. Risk score
discrimination was evaluated using the area under
the receiver operating characteristic curve.
Results: The median age was 47 years (IQR 39–58),
83.7% were men, the median follow-up was 12.0
months (95% CI, 8.5–15.5), and the OS rate stoodat 35.9%. Of the novel inflammatory markers, only
the ratio of hemoglobin to red cell distribution
width (Hb/RDW) was independent prognostic
parameter of OS both in the training (HR = 2.645,
95% CI = 1.267–5.522, P = 0.010) and thevalidation (HR = 2.645, 95% CI = 1.267–5.522, P =0.010) cohorts. An inferior Hb/RDW ratio wasstrongly associated with adverse clinical factors,
including advanced Ann Arbor stage, increased
extranodal sites, reduced CD4 count, elevatedlactate dehydrogenase levels, poorer ECOG PS,
and higher International Prognostic Index (IPI)
score. When Hb/RDW ratio was added to IPI, thecomposite score Hb/RDW-IPI showed impressively
prognostic discrimination.
Conclusions: The Hb/RDW ratio, an inexpensive
and easily accessible inflammatory biomarker,

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independently predicts outcomes in AR-DLBCL
patients. Incorporating the Hb/RDW ratio into the
IPI partially enhances prognostic accuracy.

Poster Abstract

66

The prevalence and risk factors
of frailty in Japanese people
living with HIV aged over 40
years; A single centre analysis
Nakamura H1, Ikemiyagi N1, Arakaki W1,
Yamamoto K1
1First Department of Internal Medicine, Division of Infectious,

Respiratory, and Digestive Medicine, University of the Ryukyus
Graduate School of Medicine , Nishihara, Japan

Background: Despite a rapid increase in the
proportion of senior people living with HIV (PLWH)
in Japan, few studies have addressed frailty in thispopulation. The aim of this study was to assess theprevalence of frailty and factors that cannegatively interplay.
Method: This was a cross-sectional analysis ofmale Japanese PLWH (aged ≥40 years at
enrollment) on ART for at least 12 months,
attending a tertiary hospital in Okinawa, Japan.
Sociodemographic data were extracted frommedical records, while frailty was assessed by theFried frailty assessment. The following information
was collected to evaluate the frailty profile: Short
Performance Physical Battery (SPPB), Generalized
Anxiety Disorder-7 (GAD-7), Patient Health
Questionnaire-9 (PHQ-9), and the Japaneseversion of the Montreal Cognitive Assessment(MOCA-J).
Results: Among 133 participants (median age, 51),
11 (8.3%) and 93 (70.5%) were frail or prefrail,
respectively. 126 (94.7%) participants had an
undetectable viral load (<20 copies/mL) with a
median CD4 cell 553 cells/μL. Unintentional weightloss (42.4%) and low activity (31.8%) were themain frailty markers. In univariate models, noemployment status, diabetes, hypertension,
cerebrovascular disease, hemophilia, low skeletal
muscle index, and PHQ-9 ≥ 10 were significantly
associated with frail and pre-frail phenotype.
Conclusions: The prevalence of frailty in Japanese
PLWH seems to be consistent with previous
reports from other countries. However, due to thesmall number of participants precluded
multivariate analysis. Further studies are

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warranted to understand the impact of frailty inJapanese PLWH.

Poster Abstract

67

Screening and Linkage
Coverage for Mental Healthand Substance Use among
People Living with HIV
attending an Outpatient HIV
Clinic in Malaysia
Tan X1, Ng N2, Loh J2, Rajasuriar R1,2, Ross J3, Chong
M1,2, Petersen B3, Stockton M4, Weinberg M5
1Centre of Excellence for Research in AIDS, Kuala Lumpur,

Malaysia, 2Department of Medicine, Faculty of Medicine,
Universiti Malaya, , Malaysia, 3TREAT Asia/amfAR – The
Foundation for AIDS Research, , Thailand, 4Department of
Epidemiology, Gillings School of Global Public Health, Universityof North Carolina, Chapel Hill, United States, 5Columbia
University College of Physicians and Surgeons and New YorkState Psychiatric Institute, Columbia, United States

Background: Mental health (MH) and substanceuse (SU) issues are prevalent among adult people
living with HIV (PWH), often resulting in negative
health outcomes such as poor ART adherence anddisengagement from care. The integration of
MH/SU screening into HIV care has been shown to
improve MH and SU as well as HIV outcomes. The
aim of this study is to ascertain the prevalence ofscreening and linkage coverage for MH and SU
issues among adult PWH undergoing routine HIV
care at a tertiary outpatient clinic in Malaysia.
Material and methods: We reviewed the medical
records of all adult PWH attending the Infectious
Diseases (ID) clinic, University Malaya Medical
Centre (UMMC) for HIV care from 1/1/202331/12/2023. Screening for MH/SU were defined as
any documented formal screening or discussionsof MH/SU during healthcare provider consultation
and a positive screen defined as the
documentation of any signs or symptoms
associated with MH/SU by the healthcare
provider. We describe the cascade of MH/SU careas follows; number of PWH screened for MH/SU(excluding screening conducted for research), thenumber screened positive for MH/SU, the number
referred to MH specialists (counsellors or
psychiatrists) for further assessments and thenumber attending MH/SU care.

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Results: 1448 PWH received outpatient HIV care at
the ID clinic, UMMC in 2023. 1282 (89%) weremale and the distribution of age (years) were <3039 (34%), 40-49 (31%), 50-59 (23%), 60-69 (9%),
70-79 (2%) and >80 (1%). The total number of
PWH screened for MH was 60 (4%) and 28/60(47%) screened positive. Of those screened
positive, 16/28 (57%) were already engaged in MH
care and 12/28 (43%) were new cases. Among newcases, 3/12 (25%) were referred and attended by
MH specialists, 7/12 (58%) declined further
assessments, 2/12 (17%) did not receive referrals.
The total number of PWH screened for SU was 51(4%) and 13/51 (26%) screened positive. Of thosescreened positive, 5/13 (38%) were already underactive care and 8/13 (62%) were new cases.
Among new cases, 3/8 (38%) declined to bereferred and 5/8(62%) did not receive referrals.
Most clinic attendees were screened for MH or SU
in isolation and only a small number received
screening for both MH and SU, 18 (1%). Of these,
7/18 (39%) screened positive for both MH and SU
and 3/18 (17%) screened positive for MH only. Of
those screened positive for MH and SU, 3/7 (43%)
were already engaged in care and 4/7 (57%) did
not receive referrals. Of those screened positive
for MH only (n=3), 1/3 (33%) was referred andattended by MH specialists and 2/3 (67%) werealready under MH care.
Conclusions: MH/SU screening is not routine in
HIV care in UMMC and when performed, is often
assessed in isolation. There was poor follow
through in referrals following positive screens but
the majority of PWH who received referrals weresuccessfully linked to MH/SU care. Further studies
are needed to better understand the barriers to
MH/SU screening uptake and successful referrals
within the ID clinic.

Poster Abstract

68

Factors associated with thelongitudinal trajectories ofdepression and their impact onmortality among people livingwith HIV in Guangdong
Province, China
Xie Y1, Liu J2, Lin K1, Fu X2, Yan Y1, Xie Y2, Tan Z1, Liu
Q3, Li J3, Wang L4, Zhou Y5, Ye C6, Cen M7, Xu L8,
Yan Y9, Yang F2, Yang Y1, Li Y2, Jiang H1
1Guangdong Pharmaceutical University, Guangzhou, China,
2Guangdong Provincial Center for Disease Control andPrevention, Guangzhou, China, 3Guangzhou Eighth People's
Hospital, Guangzhou, China, 4Jiangmen Center for Disease
Control and Prevention, Jiangmen, China, 5Zhuhai Center for
Disease Control and Prevention, Zhuhai, China, 6Yangjiang
Center for Disease Control and Prevention, Yangjiang, China,
7
Yunfu Center for Disease Control and Prevention, Yunfu, China,
8Shantou Center for Disease Control and Prevention, Shantou,
China, 9Huizhou Center for Disease Control and Prevention,
Huizhou, China

Introduction:Depression may change over timeand have different effects on mortality. This study
aimed to explore factors associated withlongitudinal trajectories of depression among
newly reported people living with HIV (PLHIV) in
Guangdong Province, and to explore the impact ofdepression trajectories on mortality.
Methods:
A prospective cohort study was conducted torecruit newly reported PLHIV in six cities in
Guangdong Province from May 2018 to June 2019.
Data on depression were collected at baseline andone-year follow-up. Participants were followed up
until June 2023. Generalized estimating equations
were used to explore factors associated withdepression trajectories. Cox proportional hazards
regression models were used to explore theimpact of depression trajectories on mortality
after propensity score matching (PSM) weighting.
Results:
Of the 1071 PLHIV enrolled at baseline, 792(73.9%) completed the one-year follow-up survey
and were included in this analysis. Depression
trajectories showed that 30.9% of participants had
a pattern of remission at one-year follow-up, 6.3%
had persistent depression at both baseline andone-year follow-up, and 5.9% had new-onset
depression at one-year follow-up. 44 (5.6%)

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participants died during the study period.
Generalized estimating equations showed thatparticipants with high levels of education (highschool: β=0.45, 95%CI: 0.05 to 0.85, college orabove: β=0.79, 95%CI: 0.35 to 1.23), with HIVrelated symptoms (β=0.35, 95%CI: 0.11 to 0.59)
and with high levels of HIV-related stigma (β=0.46,
95%CI: 0.22 to 0.70) were more likely to havedepression. Individuals with high social cohesion
were less likely to have depression (β=-0.48,
95%CI: -0.73 to -0.23). After PSM weighting, Cox
regression models showed that the group with
new-onset (OR=7.65, 95%CI: 2.70 to 21.70) andpersistent (OR=5.98, 95%CI: 1.71 to 20.91)
depression had a higher risk of mortality than the
non-depressed group.
Conclusion:
Different trajectories of depression were foundamong PLHIV. Individuals with persistent or newonset depression have a higher risk of mortality
than those without depression. More attention
should be paid to individuals with high levels of
education and those with HIV-related symptoms.
Reducing HIV-related stigma and improving social
cohesion may also help to reduce depression
among PLHIV.

Poster Abstract

69

Expression and prognostic
significance of PD-1/PD-L1
pathway in AIDS-related nonHodgkin lymphoma
Chen J1, Zhao H1, Peng J1
Department Of Infectious Diseases, Nanfang Hospital,
Southern Medical University, Guangzhou, China

1

Background: Immune tolerance and evasion play a
critical role in virus-driven malignancies. However,the phenotype and clinical significance ofprogrammed cell death 1 (PD-1) and its ligands,
PD-L1 and PD-L2, in aggressive acquired
immunodeficiency syndrome (AIDS)-related nonHodgkin lymphomas (AR-NHLs) remain poorly
understood, particularly in the Epstein–Barr virus(EBV)-positive subset.
Material and Methods: We employed EBVencoded RNA (EBER) in situ hybridization to assess
the EBV status. We performed
immunohistochemistry and flow cytometry
analysis of the PD-1/PD-L1/L2 pathway in a multiinstitutional cohort of 58 AR-NHLs and compared
EBV-positive and EBV-negative cases.
Results: The prevalence of EBV+ in AR-NHLs was
56.9%, associated with impressively increased PD1/PD-L1/L2 expression in malignant cells. Patientswith AR-NHLs who were positive for both EBER
and PD-1 (47.4% vs. 93.8%, P = 0.004) or PD-L1(56.5% vs. 93.8%, P = 0.043) showed poorer
survival. Importantly, PD-1 tissue-expression
demonstrated independent prognostic significancefor overall survival in multivariate analysis,correlated to a high plasma HIV-1 viral load (r =0.347, P = 0.018), elevated LDH (r = 0.313, P =0.031), increased PD-1+ Tregs (P = 0.006), androbust EBER (r = 0.541, P < 0.001) and PD-L1 (r =0.354, P = 0.014) expression.
Conclusions: These data emphasize theimportance of PD-1-mediated immune evasion in
the complex landscape of immune-oncology in
EBV co-infected AR-NHLs, contributed to thediagnostic classification and potential
immunotherapeutic strategies for this uniquesubgroup.

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Poster Abstract

70

Causes of hospitalization andtrends of HIV/AIDS inpatientsin a tertiary hospital in
Nanjing, China, 2013-2022
Li M1, Guan H1, Zhong M1, Yu N2, Di X2, Chen C2, Cai
R2, Wei H1
1The Second Hospital of Nanjing, Nanjing Medical University,

Nanjing, China, 2The Second Hospital of Nanjing, Nanjing, China

Background: The introduction of Antiretroviraltherapy (ART) has led to an increase in life
expectancy for People living with HIV (PLWH),
which has been accompanied by an increase in theprevalence of PLWH comorbidities. Monitoring thecause of hospitalization for PLWH is important toassess PLWH comorbidities and improve
management strategies. Therefore, this study
describes the reasons for the hospitalization of
PLWH in the Second Hospital of Nanjing in China
over the past ten years and its changing trend overtime.
Methods: This study was a retrospective analysisof adult inpatient PLWH between January 1, 2013,and December 31, 2022, in Nanjing Second
Hospital. Discharge principal diagnoses werecategorized according to the International
Statistical Classification of Diseases and Related
Health Problems, Tenth Revision (ICD-10). We
described the distribution of causes of
hospitalization for hospitalized PLWH from 20132022. Trends in the causes of PLWH hospitalization
over time were analyzed using the Joinpoint
regression model.
Results: This study included 11706 hospitalizedcases, among them, 87.4% were male (87.4%), andthe median age was 43 (32-53). During the study
period, AIDS-defining illnesses (ADI) was the mostcommon reason for hospitalization (40.5%) whichshowed a decreasing trend (AAPC=-8.0%; 95% CI: 8.9, -7.1), tuberculosis (9.2%) and Pneumocystis
pneumonia (8.9%) were the most common AIDSdefining events. The proportion of admissions for
non-AIDS-defining diseases (NADs) increased, withthe largest increases in admissions for
genitourinary diseases (AAPC=31.1%; 95% CI: 23.9,
84.9), non-HIV-related tumors (AAPC=17.5%; 95%

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94

CI: 13.6, 25.5), and circulatory diseases(AAPC=11.5%; 95% CI: 4.9, 25.9). Disease trends
were similar when stratified by age.
Conclusions: During the study period, PLWH had
an increased risk of hospitalization for NADs suchas non-HIV-related tumors and circulatory
disorders, while the risk of hospitalization for ADI
decreased. Early diagnosis, treatment, andcontinuous monitoring may be effective strategies
to improve hospitalization rates and quality of life
in PLWH.

Poster Abstract71

Non‐communicable diseasemultimorbidity among adults
living with HIV in a tertiarycare hospital in Nanjing, China
Li M1, Guan H1, Yu N2, Di X2, Peng J2, Xia Z2, Chen
C2, Cai R2, Wei H1
1The Second Hospital of Nanjing, Nanjing Medical University,

Nanjing, China, 2The Second Hospital of Nanjing, Nanjing, China

Background: As the life expectancy of people livingwith HIV (PLWH) increases, age-related noncommunicable diseases (NCDs) are becoming
more common among PLWH, and PLWH often
suffer from 2 or more NCDs, that is
multimorbidity. There are relatively few studies on
multimorbidity in PLWH in China. Therefore, thestudy described the prevalence of NCDs andmultimorbidity among PLWH in the Second
Hospital of Nanjing in China from 2017 to 2022
and analyzed the factors affecting them.
Methods: This is a retrospective study of adult
PLWH hospitalized in the Second Hospital of
Nanjing between January 1, 2017, and December
31, 2022. We described the prevalence of NCDs
and multimorbidity in patients. NCDs included
non‐AIDS‐defining cancers (NADC), cardiovasculardisease (CVD), hypertension, diabetes, chronic
kidney disease (CKD), and cirrhosis. Chronic andmultimorbidity were described again after
stratifying patients by age (<40, 40-49, 50-59, ≥60
years). The Cochran-Armitage test was used toanalyze trends in NCDs and multimorbidity overtime and age. Logistic regression was used toanalyze factors influencing NCDs andmultimorbidity.
Results: Between January 2017 and December
2022, 5480 PLWH were included. The median age
was 42(31-54) years, and 86.4% were men. The
percentage of PLWH with NCDs showed a trend ofincreasing with age during the study period (all P
trend < 0.001). The percentage of PLWH
multimorbidity was 7.8%, and its percentage
increased with the age of the patients (P trend <0.001). Higher age (all P<0.001), other routes ofinfection (OR=1.72, 95% CI:1.12-2.62), duration of
HIV infection >5 years (OR=1.50, 95% CI:1.09-

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

952.06), and last CD4+ T lymphocyte count ≥200
cells/mL (OR=1.48, 95% CI:1.11 to 1.97) wereassociated with multimorbidity.
Age was positively associated with the prevalenceof all NCDs (all P<0.05). The occurrence of NADC
was associated with VL ≥ 50 copies/mL(OR:0.47,95% CI: 0.25 to 0.84). The occurrence of
CVD was associated with being married(OR:0.52,95% CI: 0.32 to 0.86), duration of HIV
infection ≥10 years (OR:2.06,95% CI:1.35 to 3.11),
and CD4+ T lymphocyte count of 200-349/mL(OR:1.38,95% CI:1.01 to 1.88). The occurrence ofhypertension was associated with being married(OR:1.82,95% CI:1.13 to 3.04), transmission route
other (OR:1.69,95% CI: 1.13 to 2.49), duration of
HIV infection for ≥10 years (OR:1.59,95% CI:1.08 to2.34), and CD4+ T-lymphocyte count of 200349/mL (OR:2.01,95% CI:1.52 to 2.66) and≥500/mL (OR:1.82,95% CI:1.25 to 2.64). The
occurrence of CKD was associated with a durationof HIV infection of 6-9 years (OR:1.95,95% CI:1.16
to 3.25) and CD4+ T lymphocyte counts of 200349/mL (OR:2.11,95% CI:1.25 to 3.56) and VL ≥50
copies/mL (OR. 0.44,95% CI:0.23 to 0.81). The
occurrence of cirrhosis was associated with theinfection route of heterogeneous (OR:3.09,95%CI:1.11 to 9.93) and other (OR:22.96,95%CI: 9.08 to 70.55), CD4+/CD8+ T
lymphocyte ratio ≥0.8.
Conclusions: NCDs and multimorbidity prevalence
has increased among PLWH, which suggests thatthe screening and treatment of common NCDs
should be integrated into routine HIV care, and themonitoring of comorbidities should be
strengthened, and the management ofcomorbidities should be optimized.

Poster Abstract

96

72

impairment compared to male counterparts(70.9% vs. 54.3%, p=0.002).

Cognitive performancedisparities between sexes
among aging people living withand without HIV in Thailand: A
cross-sectional study

Among PWoH, males showed a higher prevalenceof cognitive impairment than females in the 50-54(men, 76.9%; female, 62.5%) and 55-59 (men,55.9%; female, 42.1%) age groups, while females
had a higher prevalence of cognitive impairment
than males in the 60-64 (men, 64.3%; female,
75.0%) and ≥65 (men, 76.5%; female, 100%) age
groups. In contrast, females consistently exhibiteda higher proportion of cognitive impairment thanmales across all age groups among PWH.

Hiransuthikul A1,2, Apornpong T1, Kerr S1,3,4, Han
W1,3, Lwin H1, Gatechompol S1,5, Ubolyam S1,5,
Avihingsanon A1,5
1HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok,
Thailand, 2Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 3Kirby Institute, UNSW Sydney, Sydney, Australia,
4Biostatistics Excellence Centre, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 5Center of
Excellence in Tuberculosis, Department of Medicine, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand

Background: Given potential variations in
cognitive reserve influenced by diverse
biopsychosocial factors among men and women,
the impact of HIV on cognitive performance may
differ between sexes. We aimed to determine thedisparities in cognitive performance between
sexes among aging people living with (PWH) andwithout HIV (PWoH).
Material and Methods: Thai PWH and agematched PWoH aged ≥50 years were enrolledfrom 2015 to 2017 to assess cognitive
performance using the Thai-validated Montreal
Cognitive Assessment (MoCA) in the HIV-NAT 207
cross-sectional study. Age was categorized into
four groups for descriptive analysis: 50-54, 55-59,
60-64, ≥65 years. Generalized linear models (GLM)
and multivariable logistic regression models were
utilized to predict adjusted MoCA scores and theprobability of cognitive impairment, respectively.
Results: Among 357 PWH (mean [SD] age 56.2
[5.5] years, 134 [37.5%] female, and 262 [73.4%]
with >6 years of education) and 148 PWoH (mean[SD] age 58.8 [6.0] years, 57 [38.5%] female, and74 [50.0%] with >6 years of education) enrolled,
216 (60.5%) and 97 (65.5%) had cognitive
impairment, respectively. There were no
significant differences in the proportion of
cognitive impairment between sexes among
PWoH. However, female living with HIV had asignificantly higher proportion of cognitive

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

These findings align with the constant decline ofadjusted predicted MoCA scores from the GLM(from 24.1 [95%CI 23.3–24.8] to 21.9 [95%CI 20.6–
23.2] in men living with HIV and from 22.6 [95%CI
21.6–23.6] to 19.9 [95%CI 18.1–21.8] in women
living with HIV between the ages of 50 to 70 years)
and a constant increase in the probability ofcognitive impairment from the multivariablelogistic regression model in PWH for both sexes(from 0.50 [95%CI 0.40–0.60] to 0.76 [95%CI 0.62–
0.90] in men living with HIV and from 0.61 [95%CI
0.48–0.75] to 0.86 [95%CI 0.69–1.00] in women
living with HIV between the ages of 50 to 70
years).
Conclusions: Our study revealed consistent sex
differences in cognitive performance across age
groups among PWH. These findings underscoreemphasize the necessity of further investigation indiverse populations and exploration of sex-specifictimelines for cognitive decline in aging PWH.

Poster Abstract73

CTO in People Living with HIV:
Navigating Complexities inInterventional Challenges.
Natraj Setty H1, Sridhar L1, Rahul P1, Chethan K1,
Srinivas K1, Ravindranath K1
1Sri Jayadeva Institute Of Cardiovascular Sciences And Research
Bangalore, Bangalore, India

Background: Coronary chronic total occlusions(CTOs) present a unique challenge in coronary
artery disease, particularly among People livingwith HIV (PLWH). Successful percutaneous
coronary intervention (PCI) for CTOs is essential
for improving angina and left ventricular function.
People living with HIV face an increased risk ofadverse cardiovascular events due to complex
interactions between traditional risk factors andthe ongoing endothelial dysfunction, immune
activation, inflammation, and heightened
thrombosis risk associated with HIV infection.
Objective: This prospective observational study
aimed to evaluate the procedural success andcomplications of PCI for CTOs in People living withHIV.
Methods: From August 2015, we enrolled 25
consecutive People living with HIV with CTOs in acomprehensive study. Each patient underwent
coronary angiography, and clinical presentations
were meticulously evaluated. All participants
underwent PCI, with clinical follow-up for 5 years.
Results: The study demonstrated a 100%
procedural success rate with an uneventful inhospital course. The mean age was 48 years, andHIV duration was 4.1 years. CTO distribution
included 15 patients with 100% LAD occlusion, 5with 100% RCA occlusion, 1 with 100% LMCA and
LAD occlusion, and 4 with 100% LCX occlusion.
Various vessels were targeted during PCI, with anaverage stent size of 3x30mm and the fluoroscopy
time averaged 2-3 hours. Three deaths occurred
during the 5-year follow-up, unrelated to PCI. No
major adverse cardiovascular events werereported, and patients experienced significant
symptom relief post-PCI.

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Conclusion: People living with HIV face anincreased risk of coronary CTO lesions at a younger
age, predominantly during the initial HIV infection
phase. PCI emerges as an effective and safe
coronary revascularization strategy, providing
sustained symptomatic and prognostic benefits.
HIV status and highly active antiretroviral therapy
did not hinder procedural success or impact
clinical outcomes.

Poster Abstract74

Oral semaglutide
demonstrates comparable
effectiveness to conventional
injectable GLP1 receptor
agonists in Asian HIV-positive
patients with type 2 diabetes
mellitus.
Sekiya R1,2, Jung S2, Fukushima K2, Tanaka M2,
Kobayashi T2, Muramatsu T1, Yajima K2,
Yotsumoto M1, Hagiwara T1, Amano K1, Imamura
A2, Kinai E1
1Tokyo Medical University, Shinjuku-ku , Japan, 2Tokyo
Metropolitan Cancer and Infectious Diseases Center Komagome
Hospital, Bunkyo-ku, Japan

Background: Weight gain in HIV-positive
participants is of significant concern worldwide.
The impact of GLP1 receptor agonists on HbA1c
and weight control in HIV-positive diabetic
participants is a drug of interest.
In general, the weight loss effect of GLP1 receptor
agonists depends on the characteristics of eachdrug. Oral semaglutide offers a better weight loss
approach than other GLP1 receptor agonists.
However, data for HIV-positive participants arelimited. This study aimed to determine whether
oral semaglutide is more valuable thanconventional GLP1 receptor agonists in HIVpositive participants with diabetes mellitus.
Material and Methods: A retrospective study
investigated HIV-positive participants withdiabetes mellitus at two hospitals in Japan.
Inclusion criteria are no change in ART for one year
before initiating GLP1 receptor agonists.
Initially, the study enrolled 40 HIV-positive
participants undergoing treatment with GLP1
receptor agonists. However, 10 participants were
subsequently excluded due to various reasons,
including type 1 diabetes (n=1), undergoing
dialysis (n=2), interrupted clinic visits (n=3), andchanges (n=2) or discontinuation (n=2) of GLP1
receptor agonists. The study comprised 16
participants in the oral semaglutide group and 14
in other GLP1 receptor agonist groups (dulaglutide
and liraglutide).

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Results: All HIV-positive participants were Asianmales. Age was 57.0 (±10.4) years in the oralsemaglutide group and 63.5 (±10.4) years in theother GLP1 receptor agonist group. The mean
body weight of the oral semaglutide group was 82
kg (±16.8 kg), and that of the other GLP1 receptor
agonist group was 76.2 kg (±14 kg).
In the oral Semaglutide group, three participants
were treated with 3 mg/day, eight with 7 mg/day,and five with 14 mg/day. Sixteen participants inthe oral Semaglutide group were treated with RAL
in three patients, eight with DTG, and five with
BIC. Ten patients were treated with TAF.
In the other GLP1 receptor agonist groups, RAL
was in 7 cases, DTG in 3 cases, EVG in 1 case, BIC in
4 cases, and TAF in 6 cases.
HbA1c at the start of GLP1 receptor agonist
treatment was 7.8% (±1.21) and 8.15% (±0.99) inthe oral Semaglutide group.
At six months, the mean HbA1c decreased by -0.35(±0.727)% in the oral semaglutide group and by 1% (±1.24) in the other GLP1 receptor agonist
groups, with no significant difference (P=0.10).
Weight change averaged -1.8 kg (±3.14) in the oralsemaglutide group and -1.7 kg (±2.69) in the other
GLP1 receptor agonist group, not significantly
different (P=0.759).
Conclusions: In Asian HIV-positive participants,
oral semaglutide use was non-inferior toconventional injectable GLP1 receptor agonists interms of HbA1c and weight loss. These real-world
results in Asians make oral semaglutide a helpful
option in the management of type 2 diabetes in
HIV care.

Poster Abstract75

Safety and Efficacy of Anti-PD1/Anti-PD-L1 Therapy inCancer Patients Living With
HIV: A Systematic Review andMeta-Analysis
Wang W1, Yuan Y2, Zhao S1, Li S1, Huang X1
1Capital Medical University, Beijing, China, 2The AffiliatedHospital of Qingdao University, Qingdao, China

Background: Many studies have confirmed thegood efficacy of anti-programmed death receptor
or ligand 1 (anti-PD-(L)1)) therapy. However,
because people living with HIV (PLWH) have
impaired autoimmunity and may cause more
adverse events after receiving the therapy, they
are often excluded from studies. To systematicallyconduct the safety and efficacy of anti-PD-(L)1)
therapy for PLWH.
Methods: PubMed, Web of Science, and CochraneLibrary were systematically searched frominception to May 7, 2023 for studies reported thedata, including the objective response rate (ORR)
and the incidence of immune-related adverse
events (irAEs). Either the fixed-effect model or the
random-effect model was selected based on theheterogeneity. StataMP 14.0 was utilized tocompute the 95% confidence intervals (CIs) for theeffect sizes.
Results: There were 7 prospective clinical trials
and 11 retrospective case series involving 254
PLWH with cancer. Anti-PD-(L)1 therapy had an
ORR of 0.25 ([95% CI 0.19, 0.31); I²=0%). PLWH≤50
years old [0.58 (95% CI 0.38, 0.78)] responded
better than elderly PLWH [0.20 (95% CI 0.09,0.30)]. AIDS-defining cancers (ADCs), such as NHL[0.63 (95% CI 0.40, 0.86); I²=36.7%] and KS [0.46(95% CI 0.27, 0.65); I²=64.4%], demonstrated a
relatively high level of efficacy when treated with
anti-PD-(L)1 therapy. PLWH with cancer seemed torespond better to pembrolizumab [0.25 (95% CI
0.13, 0.36); I²=34.6%] in monotherapy.
Pembrolizumab+pomalidomide andnivolumab+ipilimumab have also demonstrated
positive outcomes. The incidence of irAEs was 0.37
(95% CI 0.28, 0.47; I²=0%) and grade 3 or higher

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irAEs was 0.11 (95% CI 0.03, 0.19; I²=0%) in PLWH
similar to general patients. No immune
reactivation of the inflammatory syndrome wasseen during anti-PD-(L)1 therapy. Baseline CD4+T
cell counts and CD4/CD8 ratios did not affect theefficacy or safety. The majority of treated patients
exhibited stable CD4+T cell counts.
Conclusions: Anti-PD-(L)1 therapy can be a safeand effective treatment for PLWH with cancer,
regardless of CD4+T cell counts and CD4/CD8
ratios. Pembrolizumab may be a promisingtreatment for PLWH with cancer. ADCs show
better response to anti-PD-(L)1 therapy. Moresuitable immunosuppressive treatment strategies
are needed for the elderly PLWH to enhance theirefficacy.

Poster Abstract

76

Incidence and risk factors
regarding atherosclerotic
cardiovascular disease in
middle-aged and elderly
people with HIV treated in
Chongqing, China
Liu M1, Yang H
1Chongqing Public Health Medical Center, Chongqing, China

Background: Antiretroviral therapy (ART) has
tremendously improved the survival of people
living with HIV (PLHIV) and provided a nearlynormal lifespan. However, this improvement inlongevity has resulted in an increase in the numberof PLHIV living in middle-aged and older age
groups. There is a shift in the prevalence of HIVassociated disorders from opportunistic infection
manifestations to other complex comorbid
disorders, such as atherosclerotic cardiovasculardisease (ASCVD). ASCVD is a common cause ofmorbidity and mortality among PLHIV, andcompared with the general population, PLHIV are
twice as likely to develop ASCVD. In Chongqing,
approximately half of the PLHIV were middle-aged
or elderly, and their diets were mainly high in salt,
spices and oil; however, there is still a lack of
relevant research on the risk factors and whether
the disease burden of ASCVD is greater in theseareas. This study was to investigate the risk of
ASCVD in middle-aged and elderly PLHIV receiving
ART and analyze the factors influencing high risk.
Methods: A retrospective study was conducted at
Chongqing Public Health Medical Center.
Questionnaire surveys, physical examinations andlaboratory examinations were used to collectinformation from PLHIV aged ≥ 45 years. Pooled
cohort equations (PCEs) were used to calculate the10-year ASCVD risk and analyze the influencing
factors. The 10-year ASCVD risk score was used todefine patients in the low-risk subgroup (<7.5%)
and high-risk subgroup (≥7.5%), and the risk
factors were compared between the two groups.
Results: In total, 463 PLHIV (median age 55.0
years, male 68.5%) were included, and the median
duration of ART was 45.0 (15.0, 70.3) months. Of

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the 463 PLHIV, 13 (2.8%) had a known history of
ASCVD. In the present study, 153 PLHIV (33.0%)
were classified into the high-risk group, and 310
PLHIV (67.0%) were classified into the low-risk
group. Compared with the low-risk group, thehigh-risk group was more likely to be female, older
age, live in urban areas, be unemployed, havepoor sleep quality, have higher low-density
lipoprotein cholesterol (LDL-c), have higher totalcholesterol (TC), and have diabetes andhypertension; however, coffee consumption was
associated with a low risk of ASCVD. In addition,
there were no differences in HIV viral load, CD4+
T-cell count, or duration on ART, or ART regimes
between the two groups. According to multiple
logistic regression, older age [odds ratio (OR)=62.469, 95% CI=27.456, 142.134], female sex [OR=9.635, 95% CI =4.384, 21.179], higher LDL-c levels[OR =1.018, 95% CI =1.000, 1.036], accompanied
hypertension [OR =8.642, 95% CI =3.373, 22.143]
and diabetes [OR =10.806, 95% CI =3.787, 30.834]
were found to be independent risk factors for the
10-year risk of ASCVD.
Conclusions: The overall 10-year ASCVD risk isgreater for middle-aged and elderly PLHIV in
Chongqing, China. The risk factors for the 10-yearrisk of ASCVD were older age, female sex, elevated
LDL-c level, and coexisting hypertension anddiabetes.

Poster Abstract

77

Mental Health-seeking
Behaviour and Literacy among
Women Living with HIV: An
Exploratory Qualitative Studyat a Tertiary Teaching Centre
Salleh A1, Kukreja A2, Rajasuriar R2, Hasmukharay
K2, Ross J3, Lovero K4
Centre of Excellence for Research in AIDS (CERiA), Universiti
Malaya, Kuala Lumpur, Malaysia, 2Department of Medicine,
Universiti Malaya, Kuala Lumpur, Malaysia, 3TREAT Asia/amfAR- The Foundation for AIDS Research, , Thailand, 4Department of
Psychiatry and New York State Psychiatric Institute, Columbia
University, , USA
1

Background: Mental health (MH) disorders are
more prevalent amongst women living with HIV(WWH) compared to women without HIV.
Addressing MH issues is imperative for improving
WWH’s overall wellbeing and HIV-related
outcomes. People with HIV tend to have poorer
health-seeking behaviour, especially for MH care,often due to stigma. This study aimed to explore
MH literacy and MH care-seeking behaviour
among WWH receiving HIV care at a tertiary care
hospital in Malaysia.
Material and Methods: We conducted in-depth
interviews with twenty WWH at the Infectious
Diseases (ID) Clinic, University Malaya Medical
Centre (UMMC) between December 2022 andFebruary 2024. Purposive sampling ensured
diversity in age, race, and levels of previous
engagement with MH services. Interviews wereconducted in local languages, Malay, English andMandarin by trained study staff. Content analysis
was used to analyse qualitative data. Mental
health literacy was explored through sequential
open-ended questions. Initially, participants wereasked if they had heard of MH. Those who
acknowledged awareness were further asked
about their understanding of various MH
conditions, available MH treatment options, theirpersonal mental state and what MH means tothem. MH care-seeking behaviour was thenassessed by asking participants about their actions
taken when affected by a disturbed personalmental state.
Results: Interviews were conducted with 20 WWH,
including 18 Malaysians of Malay, Chinese, or

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Indian descent, and one Indonesian and one
British citizen. Median age was 50 years, andmedian years after HIV diagnosis was 11 years. All
were on antiretroviral therapy with 18/20 (90%)
having suppressed viral loads. Study participants
demonstrated a fundamental understanding ofMH, linking it to stress, anxiety, and depression,
and were aware of non-pharmacological methodsof MH treatment, including talk therapy anddeveloping coping strategies. Participant
knowledge on pharmacological treatment for MH
conditions was limited. All participants had
experienced a disturbed personal mental state,especially during HIV diagnosis, and recognizedwhen they felt “more stressed or had a troubled
heart”. Financial struggles and social prejudice due
to HIV status were among factors indicated ashaving a detrimental impact on their mental
health. Regarding MH care-seeking behaviour,most women preferred discussing their emotions
with loved ones over interacting with healthcare
personnel. Instead of seeking assistance, many
WWH chose to manage MH challenges by being“self-reliant”, “avoiding the problem”, and“completely isolating from society”. Women
expressed a willingness to discuss their MH with
their ID doctors rather than seeking assistancefrom a mental healthcare professional, citing
concerns regarding HIV status confidentiality, HIVstigma, and a desire to avoid discussions
pertaining to the acquisition of HIV or their HIV
status. However, some women were open to
consulting a mental healthcare professional if
recommended by their ID doctors.
Conclusions: While WWH in our sample did
indicate MH literacy, MH literacy alone was notreflected in MH care-seeking behaviour among
WWH in our setting. While WWH preferred MH
self-management or seeking support from family,
they did describe being open to discussing MH
with ID doctors, suggesting they may play a pivotal
role in linking WWH to mental healthcare.
Addressing these barriers are critical to ensuringthat WWH receive the treatment required.

Poster Abstract

78

Late HIV diagnosis amongpeople with HIV in Thailand in
the era of same-day ART
initiation
Phuthomdee S1,2, Sinsomboonthong J1,3,
Wongouthong C1, Srichai T4, Teeraananchai S1,3
1Department of Statistics, Faculty of Science, Kasetsart

University, Bangkok, Thailand, 2Panyananthaphikkhu
Chonprathan Medical Center, Srinakharinwirot University,
Nonthaburi, Thailand, 3Master of Biomedical Data Science
program, Faculty of Science, Kasetsart University, Bangkok,
Thailand, 4National Health Security Office, Bangkok, Thailand

Background: The scaling-up of HIV testing has
continually increased for detecting early HIV
diagnosis along with the recommendation ofsame-day antiretroviral therapy (ART) for people
newly diagnosed with HIV infection (PLHIV) in
Thailand since 2021. This study aimed to assess
the rate of late HIV diagnosis among PLHIV andtheir associated factors under the Universal Health
Coverage (UHC) system in the era of starting ART
on the same day of HIV diagnosis.
Methods: The HIV testing database from the UHC
program was retrieved for individuals aged ≥15
years who were diagnosed HIV positive with CD4
result at positive test between 2021-2022. The
baseline was defined as the date of the first HIVpositive test. CD4 count at HIV diagnosis was
defined as the closest result within a window 3
months before, or up to 1 month after the date of
HIV testing. Late HIV diagnosis was defined as CD4
count at HIV diagnosis < 200 cells/mm3. The rateof late HIV diagnosis was calculated as apercentage with a 95% confidence interval (CI).
Logistic regression was used to identify factors
associated with late HIV diagnosis.
Results: Of a total of 40,921 individuals, 72% weremale with the median age at HIV diagnosis of 33(interquartile range (IQR) 25-44). Most PLHIV(26%) were from the Northern region and 17%
from Bangkok. Overall, 43% had a late HIV
diagnosis. PLHIV at age ≥ 50 years (55%, 95%CI 5159%) were the highest rate of late HIV diagnosis
followed by 53% (95%CI 50-55%) in PLHIV at age
35-49 years, 41% (95%CI 39-43) at age 25-34 years
and 23% (95%CI 21-25) in PLHIV at age 15-24

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years. Overall, the median CD4 count at HIV
diagnosis was 250 (IQR 85-446) cells/mm3, andthe median CD4 was lower than 200 cells/mm3
among PLHIV at age ≥ 50 years [172 (IQR 55-355)
cells/mm3] and age 35-49 years [183 (IQR 56-375)
cells/mm3]. In multivariate logistic regression
analyses assessing late HIV diagnosis, males had
21% (aOR 0.79, 95% CI 0.76 to 0.83) higher odds oflate HIV diagnosis than females. PLHIV aged ≥ 50
years at HIV positive (aOR 4.34, 95% CI 4.04 to4.67) had the highest risk of late HIV diagnosis
than those aged 15 to 24 years at HIV positive. The
odds of having a late diagnosis increased by 40%(aOR 1.40, 95% CI 1.34 to 1.46) in PLHIV who werediagnosed in year 2022 versus those diagnosed
with HIV in year 2021. PLHIV living in the Bangkok
Metropolitan area had lower odds of having late
HIV diagnosis than in other country regions.
Conclusions: Late diagnosis are important todescribe the effects of HIV testing and treatment
programs. The median CD4 cell count at diagnosis
is low among older aging PLHIV indicating a higher
proportion of late diagnosis in the era of same-day
ART treatment. New interventions to promote
early HIV diagnosis in Thailand should include a
focus on the older age population.

Poster Abstract

79

Growing sustainable HIVST
self-test (HIVST) markets:
Fostering community
leadership and private sector
engagement to facilitate
market entry for commercial
HIVST kits in Vietnam.
Tran T1, Green K1, Vu Y1, Nguyen H1, Phan T1, Vu P1,
Tran T1, Ngo T2, Nguyen D2, Doan A2
PATH, Hanoi, Viet Nam, 2United States Agency forInternational Development (USAID), Hanoi, Viet Nam

1

Background: HIVST has been included in Vietnam’s
health guidelines since 2018. However, kitsavailable in the market for purchase have been
limited. Increasing supply by registering new
products while enhancing client demand throughawareness-raising and greater choice of test kits is
critical for improving HIVST uptake. The
USAID/PATH Support for Technical Excellence andPrivate-Sector Sustainability in Vietnam (STEPS)
project engaged private sector and community
leadership to facilitate market entry and led the“Self-test easily with CheckNOW™ HIVST”
campaign to grow a viable commercial market for
Abbott’s CheckNOW™ HIVST in Vietnam.
Description: STEPS provided technical assistanceto Abbott Laboratories Vietnam to guide
CheckNOW™ HIVST through product registrationand market entry, with regulatory clearance
received in March 2023 and CheckNOW™ available
in the market in April 2023. STEPS and Glink
Academy, a key population (KP)-led social
enterprise (SE) collaborated with men who havesex with men (MSM) and transgender alliances
and KP influencers to co-create and launch the“Self-test easily with CheckNOW™ HIVST”
campaign, aimed at encouraging the use of HIVST.
The campaign was launched in December 2023
across six provinces, and comprised offline events
accompanied by social media posts with sales
livestreams led by 20 community
influencers/leaders.
Lessons learned: From December 2023-January2024, campaign posts had more than 224,000

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103

views and more than 400 individuals participatedin seven offline events, resulting in the commercial
sale of 1,586 CheckNOW™ kits at KP-led SEs andclinics. Fostering collaboration between Abbott
Laboratories Vietnam and Glink Academy toimplement the campaign was critical for asustainable private sector partnerships inVietnam’s HIV response. Community leadership indesigning and driving the campaign coupled withthe active participation of influencers in events
was key to developing compelling campaign
materials that resonated with key population
communities and encouraged uptake and sales ofcommercial HIVST services.
Conclusions/Next steps: Strong engagement
between the private sector and community
stakeholders and community leadership in driving
awareness-raising efforts led to the successful
market entry of CheckNOW™ HIVST. Continued
efforts to grow private sector and community
partnerships are needed to advance a sustainable
HIVST market in support of Vietnam’s efforts to
end AIDS by 2030.

Poster Abstract

80

Comparative analysis ofpeople living with HIV
identified by community-basedorganizations and health carefacilities in Bishkek and Osh,
Kyrgyzstan
Kubatova A1, Stankevitz K2, Gottlieb A3, Mambetov
T1, Samoilova O1, Saliev D1
1FHI360, Bishkek, Kyrgyzstan, 2FHI360, Durham, United States,
3FHI360, Washington, United States

Background: Community-based organizations(CBOs) have been essential to the HIV response,
but as countries near epidemic control, CBO
support is diminishing. Launched in 2019 andfunded by the U.S. President's Emergency Plan for
AIDS Relief, EpiC Kyrgyzstan aims to maintainepidemic control by focusing on innovative testing
approaches. The study examined thecharacteristics of people living with HIV (PLHIV)
receiving care from health care facilities (HCFs)
and CBOs in Bishkek and Osh cities, Kyrgyzstan.
The analysis aimed to uncover the contribution of
CBOs to HIV case identification, explore
differences in age distribution, identification ofhigh-risk populations, and demographic factors
between CBOs and HCFs.
Methods: Using the electronic databases of EpiC
and the Republican AIDS Center (RAC), we
generated a dataset with sociodemographic andrisk characteristics of all clients diagnosed
between October 1, 2020, and September 31,
2023, in Bishkek and Osh. We divided the sample
into two groups: those identified by HCFs and by
CBOs. Using descriptive statistics and logistic
regression, we explored client characteristics andorganizational settings.
Results: CBOs contributed to the identification of
18.8% of PLHIV in Bishkek and Osh. The averageage of PLHIV identified in CBOs was significantly
lower than in HCFs (34.5 vs. 37.9, p <0.001). CBOs
also reached a higher proportion of men (76% vs60%, p<0.001), homeless people (6.7% vs 2.7%,
p=0.001), single individuals (71.8% vs 54.6%,
p<0.001), and drug users (9.0% vs 4.3%, p=0.002).

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CBOs covered more people with previous HIV tests(51.4% vs 42.8%, p=0.02), and those identified in
CBOs were more likely to be initiated on ART
within 30 days (97.0 vs 95.1, p=0.06).
In the multivariate model, CBOs showed a specificidentification profile with significantly more
homeless people (OR=2.9, CI=1.3-6.4), individuals
from key populations (OR=4.3, CI=3.0-6.0), and
PLHIV in earlier stages of infection (OR=0.5, CI=0.30.8).
Conclusions: This analysis highlights the significant
contribution of CBOs in identifying PLHIV fromhigh-risk groups, especially homeless people, andkey populations. The findings underscore the needfor collaborative strategies between CBOs and
HCFs that emphasize an individualized approach toaddressing risk factors among PLHIV and expand
coverage of testing and treatment services among
women.

Poster Abstract

81

Incidence, predictors andhealth outcomes associatedwith cognitive frailty in people
ageing with HIV
Hisham S1, Aravindhan K1, Hasmukharay K1,
Neelamegam M2, Tan X1, Syed Omar S1, Anjanna
K1, Ong H1, Abdul Aziz S3, Kamaruzzaman S1, Meng
Li C1, Pui Li W1, Rajasuriar R1
1
University of Malaya, Kuala Lumpur, Malaysia, 2The Universityof North Texas, Fortworth, United States, 3National Universityof Malaysia, Bangi, Malaysia

Background: Cognitive frailty (CF) is associatedwith an increased risk of dementia, disability andmortality but little is known about this construct
among people with HIV (PWH). We explored theincidence, predictors and health outcomes
associated with CF in ageing PWH.
Methods: 180 PWH under routine HIV care in
University Malaya Medical Centre, Malaysia and81 controls (all ≥ 25 years) were prospectively
assessed for frailty, cognitive function and healthoutcomes at two time-points; 2014-2016(baseline) and 2020-2023 (follow-up). All PWH
received ART for at least 12 months. Incident CF
was defined as the new onset of frailty (≥2 Fried’s
criteria) and impaired Montreal cognitive
assessment (MoCA) scores (global deficit score≥0.5) at follow-up in participants without clinicaldementia at baseline. Stepwise logistic regression
was performed to assess baseline factors
predicting the simultaneous worsening of MoCA
and frailty scores during follow-up. Logistic
regression adjusted for age, sex and ethnicity was
performed to assess the association between CFwith outcomes of quality of life (CASP-19),
mortality risk scores (VACS 1.0) and disability(WHODAS 2.0).
Results: All 261 participants were followed-up andthe median (interquartile range, IQR) duration
between visits was 7 (6-7) years. Median age atbaseline among PWH and controls were 43(36-50)
and 45(31-53) years, respectively. 83% of PWH
and 56% of controls were males. CF incidence washigher in PWH vs controls (4.53 vs 2.22 per 100
person-years). Male sex (OR 8.18, 95%CI 1.4147.54, p=0.019), lower stress scores (OR 0.86,

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105

95%CI 0.75-0.99, p=0.030), lower HDL (OR 0.16,
95%CI 0.03-0.89, p=0.036), lower grip strength (OR0.92, 95%CI 0.85-0.99, p=0.022) and lower
haemoglobin levels (OR 0.94, 95%CI 0.90-0.98,
p=0.002) independently predicted declines in both
physical and cognitive health in PWH at follow-up.
CF in PWH was associated with greater disability(OR 1.03, 95%CI 1.01-1.06, p=0.017) but notpoorer QoL (OR 0.97, 95%CI 0.93-1.01, p=0.140)
and increased mortality risks (OR 1.03, 95%CI 1.001.06, p=0.065).
Conclusion: Ageing PWH on stable ART experience
an increased risk of CF which negatively impacts
their functional ability. Modifiable factors,
potentially amenable to lifestyle interventions,predicted declines in physical and cognitive healthamong PWH. The unexpected protective role ofstress against CF needs further investigation.

Poster Abstract

82

Health outcomes among
ageing women living with HIV
on antiretroviral therapy in
Malaysia
Hisham S1, Kukreja A1,2, Lim J1, Ho W1, Chong M1,2,
Cheong J1, Salleh A1, Wong P1,2, Neelamegam M3,
Rajasuriar R1,2
1Centre of Excellence for Research in AIDS, Faculty of Medicine,

Universiti Malaya, Kuala Lumpur,, Malaysia, 2Department ofMedicine, Faculty of Medicine, Universiti Malaya, Kuala
Lumpur,, Malaysia, 3Department of Population & Community
Health, School of Public Health, The University of North Texas,
Denton,, United States

Background: Despite increase in life expectancy inpeople with HIV (PWH), they have poorer healthoutcomes compared to individuals without HIV. To
date, few studies in Asia-Pacific region have
explored this issue specifically among women withHIV (WWH+) who may experience ageing
differently from women without HIV (WWOH-)
and men with HIV (MWH+). We aimed to explore
various health-related outcomes in WWH+ incomparison to WWOH- and MWH+ to identify
unique phenotypes of ageing among WWH+ in
Malaysia.
Materials and Methods: This was a secondary
analysis from the Malaysia HIV and Aging cohort
2021-2023 (MHIVA, PWH=200, HIV-=101).
Participants included PWH on antiretroviraltherapy, ≥35 years old and attending routine HIV
care in Universiti Malaya Medical Centre, Malaysia
and community controls. All 46 WWH+ recruitedin the cohort were matched for age (± 1 year) andethnicity with WWOH-(n=46) and MWH+ (n=46).
All participants underwent performance basedassessments, standard questionnaires andprovided blood samples for biochemical analysis.
In addition to socio-demographics and lifestylefactors, the health outcomes measured included
psychosocial, physical health, and quality of life.
Pearson Chi-square and Mann Whitney U tests
were performed to compare differences incharacteristics and health outcomes across
WWH+, WWOH- and MWH+.
Results: The median age in all groups was 50
years. Duration of living with HIV was comparable

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106

in WWH+ and MWH+ (15 vs 14 years, respectively)
as was the proportion with CD4 counts ≥500
cells/ul (76% vs 63%, respectively) andundetectable viral load, HIV RNA <50 copies/ml(93% vs 85, respectively). WWH+ had significantly
lower household income and education levels
compared to WWOH- but comparable to MWH+.
While the median number of chronic
comorbidities were comparable in all groups, theproportion with metabolic syndrome (WHO 1998
criteria) was significantly higher in WWH+ (20%)
compared to WWOH- (4%) but similar to MWH+(17%). WWH+ had significantly higher mortality
risk scores (VACS 2.0) and systemic inflammation(hsCRP) compared to both WWOH- (VACS,
p=0.005; hsCRP, p=0.029) and MWH+ (VACS,
p=0.009; hsCRP, p=0.004). WWH+ were also frailer(Frailty Phenotype) compared to MWH+ (13% vs
4%, p=0.012) but similar to WWOH- (13% vs 7%,
p=0.253). In terms of quality of life, WWH+
performed worse compared to WWOH- in
domains of control (p=0.044), autonomy (p=0.003)
and pleasure (p=0.042) (CASP-19) as well as
psychological (p=0.034) and environmental(p=0.013) aspects (WHOQOL). WWH+ were also atgreater risk of social isolation (Lubben scale,
p=0.002) and loneliness (De Jong Loneliness Scale,
p=0.04) compared to WWOH- but comparable to
MWH+. Higher prevalence of polypharmacy(p<0.001) and neurocognitive but not different
compared to MWH+. No significant difference wasobserved in depression, anxiety and stress (DASS21) among WWH+, WWOH- and MWH+ in our
sample.
Conclusions: Despite well controlled HIV, ageing
WWH+ experienced worse physical and cognitive
health, social connectedness and poorer quality oflife compared to age- and ethnic matched WWOH. WWH+ also had higher mortality risk scorescompared to MWH+ despite few differences intheir ageing phenotype. Follow-up studies inlarger cohorts are needed to identify factors
associated with these poor health outcomes
observed among WWH+.

Poster Abstract

83

Coronary Artery Calcium andAbnormal Arteries for
Predicting Death andCardiovascular Outcome inOlder People Living with HIV: A
cohort Study
Amornritvanich P1, Lwin H2, Apornpong T2,
Avihingsanon A2
1Police General Hospital, Bangkok, Thailand, 2HIV-NAT Research

Collaboration center, TRCS, Bangkok, Thailand

Background: Older PLWH bear a higher CVD
burden due to traditional and HIV-specific factors.
This study explored the use of non-invasive tools
like ABI, CAVI, and CAC to improve CVD prediction
and mortality assessment in this population.
Methods: A prospective cohort study of 358 PLWH
aged 50+ from the HIV-NAT aging study was
conducted. Participants underwent ABI/CAVI and
CAC scoring (0 = no risk, 1-99 = low risk, etc.). CVD
events (myocardial infarction, stroke,revascularization) and deaths were recorded
during follow-up (2015-2023). Survival outcomes
were analyzed using Kaplan-Meier curves andFine-Gray models, accounting for competing risks.
Results: For bassline characteristics statisticallysignificant differences in age, gender andunderlying disease like diabetes or hypertension
were observed between CAC categories. Overall,
16 CVD events and 26 deaths occurred duringfollow-up. Fine-Gray analysis identified smoking(SHR 8.78, 95%CI [.7-45.41], p < 0.05) as significant
risk factors for both CVD and mortality. While formortality laboratory testing like triglyceride and IL6 were associated (SHR 4.36, 95%CI [1.59-11.95],
p<0.05). While positive ABI and CAVI did not
significantly influence CVD survival, PAD patients
exhibited a higher death risk. Interestingly,
participants with a CAC score of 0 had the lowest
event rates, suggesting potential low-risk
identification.
Conclusions: Traditional risk factors, particularly
smoking, remain crucial for PLWH. While ABI/CAVI
may not be optimal for standalone CVD risk

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107

stratification, CAVI shows promise for mortality
prediction. The relationship between higher CAC
scores and events requires further investigation
with larger samples. Exploring inflammatory
markers like IL-6 as alternative predictors is
warranted.

Poster Abstract

84

Risk factors associated with
progression to or persistenceof sarcopenia over time inpeople living with HIV
Lui G1, Cheung C, Yuen R, Au-Yeung C, Li T, Ho T,
Kwok T
1The Chinese University of Hong Kong, Hong Kong, Hong Kong

Background: Sarcopenia is more prevalent amongpeople living with HIV (PLWH), and is associatedwith disability. This study aimed to determine theproportion and risk factors of PLWH progressing toor persistently having sarcopenia over time.
Methods: We performed a prospective
longitudinal study evaluating clinical parameters of
aging among PLWH from 2017 to 2023. PLWH
aged ≥18 and with two Dual-energy X-ray
absorptiometry (DXA) done ≥1 year apart were
included in this study. Socio-demographic andclinical information were collected. Physicalfunction was assessed. DXA was performed forappendicular skeletal muscle mass. Sarcopenia
was defined by Asian Working Group Sarcopenia
2019 consensus. Study endpoint was progression
to sarcopenia during follow-up visit in participants
without sarcopenia at baseline, or persistentsarcopenia at both visits. Baseline parameters thatwere associated with study endpoint wereidentified using multivariate binary logistic
regression model.
Results: 280 PLWH were included, and followed
for a median of 114 (interquartile range, IQR 76193) weeks. The median (IQR) age was 54.3 (43.962.0) years, and 33 (11.8%) were female. 218(77.9%) had no sarcopenia at baseline, and 57(20.4%) reached study endpoint.
Those with study endpoint were older (61.8 years,
IQR 55.0 – 68.2 vs. 53.3 years, IQR 43.2 – 60.3,
p<0.001), had lower education level (secondary
education or above: 67.3% vs. 86.8%, p=0.001),
longer duration of HIV diagnosis (12.3 years, IQR
1.6 – 19.7, vs. 7.4 years, IQR 1.2 – 14.3, p=0.018),
higher Charlson comorbidity index (CCI) (3, IQR 1-4
vs, 1 IQR 0-2, p<0.001), lower body mass index(BMI) (21.5kg/m2, IQR 19.4 – 22.6 vs. 24.7kg/m2,

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IQR 22.3 – 28.3, p<0.001), worse nutrition (Mininutritional assessment: 12, IQR 11-13 vs. 13, IQR
12-14, p=0.001), lower level of physical activity(International physical activity questionnaire: 1323
MET minutes per week, IQR 580 – 2068, vs. 1506
IQR, 693-2994, p=0.034), and poorer social
support (Lubben social network scale: 9.0 IQR, 5.0– 14.0 vs. 11.0 IQR 6.5 – 15.0, p=0.043).
Study endpoint was independently associated withhigher CCI (adjusted odds ratio, aOR 2.189, 95%
confidence interval, CI, 1.593-3.007, p<0.001),
lower BMI (aOR 0.555, 95% CI 0.448-0.686,
p<0.001), and poorer social support (Lubben social
network scale: aOR 0.923, 95% CI 0.854-0.997,
p=0.042).
Conclusions: Progression or persistence ofsarcopenia over time among PLWH was associatedwith multimorbidity, lower BMI and poorer social
support. These results enable identification of atrisk PLWH and future studies should be performed
to evaluate interventions, including sociobehavioural, in improving sarcopenia.

Poster Abstract85

Efficacy, safety and patientreported outcome of
Dolutegravir/Lamivudine in
Antiretroviral-experienced
Adults in Yunnan, China
Xu Y1
1doctor, Kunming, China

Background: Two-drug regimens decrease lifetime
cumulative drug exposure and long-term toxicities
associated with the use of multiple antiretrovirals.
Dolutegravir/lamivudine (DTG/3TC) Phase III
studies have demonstrated non-inferiority of DTG+ 3TC to 3/4-drug regimens in virologicallysuppressed individuals. However, real-world
observational studies are lacking.
We aimed to assess the real-world use of DTG/3TC
in virologically suppressed Chinese patients with
HIV. This was a retrospective study. Patients were
included based on the following criteria: age ≥18
years, using DTG/3TC for any reason. The primaryobjective was the rate of virological suppression.
Changes in laboratory parameters were evaluated.
Participant fear of disclosure of their HIV status,
adherence anxiety, and daily reminder of HIV
status was evaluated at baseline by means of thePatient Emotional Well-being and Adherence
Considerations questionnaire. Treatment
satisfaction was measured in HIV Treatment
Satisfaction Questionnaire status version(HIVTSQs).
One hundred thirty-one patients were eligible foranalysis. Their mean age was 47.5 (19.5–78.9)
years, and 88 (67.2%) patients were male. At 48
weeks,Of these 131 patients switched to DTG/3TC
with informed consent due to drug intolerance(42.9%), drug interactions (35.7%), or chronic renal
impairment (21.4%). At 48 weeks after switching,
98.47% of patients maintained virologicalsuppression and their CD4+/CD8+ ratios increased,
whereas triglyceride and total and high/lowdensity lipoprotein cholesterol levels were notsignificantly altered. The DTG + 3TC regimen
resulted in a 1.09kg gain in weight.14 patients
receiving DTG + 3TC with historical M184V/I, theproportion of participants with VL < 50 copies/ mL

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was 90.2%(13/14). 85 PLHIV completed
questionnaires and Treatment satisfaction score
was high among participants in DTG/3TC cohort(median55,30-60.) However, 38 (44.7%) of 85
participants reported (“always” or “often”) having
a fear of disclosure, adherence anxiety, or a daily
reminder of HIV status.
Conclusions: In conclusion, dual DTG/3TC therapy
effectively induced viral suppression in
virologically suppressed patients with HIV. Longterm follow-up is required to monitor changes inlipids and renal indicators. The virologicalinhibition rate of this treatment was high even inpatients with pre-existing M184V resistance afterswitching; therefore, it is useful as an optimal
regimen for the treatment of HIV infection.Despite
switching DTG/3TC with high treatment
satisfaction scores (approximately 55 of a possible
maximum of 60)，however 44.7% of participants
reported psychological challenges with their daily
therapy at 48weeks. We clinicians need pay
attention to more about with good health-related
quality of life beyond viral load suppression.

Poster Abstract86

Depression, Anxiety, Stress,
Self-Esteem, and HIV-related
Stigma in Adolescents andYoung Adults Living with
Perinatal HIV in Northern
Thailand.
Khamrong C1
1School of Health Sciences Research, Research Institute For

Health Sciences, Chiang Mai University, Muang, Thailand

Background: One of the health determinants ofadolescents with perinatal HIV (APHIV) in Thailand
is mental health problems. It can be challenging
for health care providers to detect adolescents
who develop these signs and symptoms. This study
investigates the incidence of HIV-related stigma,
anxiety, stress, depression, and low self-esteem in
APHIV receiving antiretroviral medication (ART) in
Northern Thailand.
Methods: This cross-sectional study was
conducted at the Research Institute of Health
Sciences, Chiang Mai University from July 2023, to
March 2024. Inclusion criteria were 1) age
between 15-24 years, 2) documented perinatal
HIV infection, 3) receiving ART and willing to join
the study. Participants were recruited from HIV
clinics in Chiang Mai, Lamphun, and Lampang
provinces. The Depression Anxiety Stress Scale(DASS-21), Rosenberg Self-Esteem Scale (RSES),
and Thai Internalized HIV-related Stigma Scale(Thai-IHSS) questionnaires were used to assess
depression, anxiety, and stress, self-esteem, andHIV-related Stigma, respectively.
Results: Of the 57 APHIV enrolled, 18 (31.6%) weremale, 9 (15.8%) were university-graduated, 24(42.1%) was studying, and 24 (42.1%) were
working. Their mean age was 20.96 years(SD=2.34). Virologic suppression (HIV RNA level <50 copies/mL) was documented in 24 participants(42.11%). We found that 21.05%, 31.58% and7.02% of participants had mild to severe
depressive symptoms, anxiety, and stress,
respectively. Low self-esteem was evidenced in 42(73.68%), while a high level of HIV-related Stigma
was seen in 36 APHIV (63.16%). APHIV with HIV

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RNA level > 50 copies/mL had a significantly higher
mean HIV-related stigma score than those withvirologic suppression (6.63 vs. 34.82, p<0.001),
while no difference in the demographic
characteristics, depression, anxiety, stress, andself-esteem scores were observed.
Conclusions: In this study, we found that aroundone-fifth had depressive symptoms, more than aquarter had anxiety, and more than two-third of
APHIV had low self-esteem. Integrating mental
health screening in routine HIV services andcollaborative care would be beneficial to promote
their quality of life of APHIV. The high rate of HIVrelated stigma, particularly among those without
virologic suppression, indicates the need for more
research to identify contributing causes andassociated factors. Designing internalized stigma
reduction intervention for those APHIV would
enable them to improve treatment adherence andachieve virologic suppression.

Poster Abstract

87

Late HIV diagnosis and theunrealised benefit of regulartesting: findings from a study
on people with newly
diagnosed HIV infection
Chan C1, Kwan T1,2,3, Wong N1,2,3, Wong B4, Lui
G2,3,5, Tsang O6, Lee M7, Chan D2,3, Lee S2,3
JC School of Public Health and Primary Care, The Chinese
University of Hong Kong, Hong Kong, China, 2Stanley Ho Centre
for Emerging Infectious Diseases, The Chinese University ofHong Kong, Hong Kong, China, 3S.H. Ho Research Centre for
Infectious Diseases, The Chinese University of Hong Kong, Hong
Kong, China, 4Special Preventive Programme, Centre for HealthProtection, Department of Health, Hong Kong Special
Administrative Region Government, Hong Kong, China,
5Department of Medicine and Therapeutics, The Chinese
University of Hong Kong, Hong Kong, China, 6Department ofMedicine and Geriatrics, Princess Margaret Hospital, Hong
Kong, China, 7Department of Medicine, Queen Elizabeth
Hospital, Hong Kong, China
1

Background: Late HIV diagnosis leads to poor
prognoses and incurs additional healthcare costs.
With detectable viral load, an untreated person
could also generate onward transmissions in thecommunity. With late diagnosis continuing to bereported worldwide, this study evaluates the risk
factors and assesses the role of regular testing forminimising late diagnosis in Hong Kong, where theHIV epidemic is concentrated among men who
have sex with men (MSM).
Methods and Materials: Since 2016, individuals
diagnosed with HIV in one of the major specialist
services in Hong Kong were invited to participate
in a cross-sectional survey, enquiring about theirpre-diagnosis HIV testing practices, sexual
behaviours, and reasons for the most recent
testing. With consent, participants’ baseline CD4count and AIDS-defining illness (ADI) wereretrieved from clinical database. In this study, a
CD4 count <350 at baseline or ADI presentation
within 3 months of diagnosis was classified as “latediagnosis”. The proportion of late diagnosis was
examined in participants reporting different HIV
testing patterns, while the associated factors were
determined using logistic regression. The
population attributable risk for late diagnosis
associated with non-regular testing was measured.

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111

Results: Between 2016 and 2023, totally 766
individuals diagnosed with HIV participated in thisstudy. With 89%, 8% and 3% being MSM,
heterosexual male and female respectively, only
4% reported a history of drug injection. With a
median age of 31 years at HIV diagnosis(interquartile range 26-40 years), 61% wereclassified as “late diagnosis”. Such proportion
differed from 71% in participants who had nevertested for HIV, 59% in irregular testers, to 53% in
regular testers. The main reason(s) for taking themost recent test were: “experience of high-risksexual contact” (30%) and “signs of illness” (30%),
followed by “regular testing” (23%) and“management of other sexually transmitted
infection (STI)” (10%). An older age at diagnosis(odds ratio [OR] 1.04), heterosexual femalecompared to MSM (OR 6.41) and primaryeducation level (OR 7.95) were significant risk
factors for late diagnosis. Conversely, participants
who reported an STI history (OR 0.56),
engagement in chemsex (OR 0.73) and group sex(OR 0.67) in the year prior to infection resulted in asignificantly lower odds of late diagnosis. Adjusted
for significant factors and variations by clinic sites
in a backward stepwise model, regular testing(adjusted OR 0.60) was associated with a lower
risk of late diagnosis compared to never-tested.
Among regular testers, the likelihood of latediagnosis was also found to be significantly linearly
associated with the HIV testing frequency (OR1.56). Noting 67% participants having not
performed HIV tests regularly, it was estimatedthat 23% of the late diagnosis was attributed tothis suboptimal testing practice.
Conclusions: Regular HIV testing reduces the riskof late diagnosis. Public health interventions
should be designed with an aim to scale up testingfor minimising late diagnosis in non-key
populations, while innovations in testing strategies
are needed to enable otherwise silent infections to
be detected without delay.

Poster Abstract

88

Linkage to care and prevention
after HIV self-testing: A
systematic review and metaanalysis
Zhang Y1,2, Goh S3, Tapa J1,2, Johnson C4, Chow
E1,2,5, Zhang L1,2, Phillips T1,2, Fairley C1,2, Ong J1,2,6
1Central Clinical School, Monash University, Melbourne,

Australia, 2Melbourne Sexual Health Centre, The Alfred
Hospital, Melbourne, Australia, 3Chelsea and Westminster
Trust, London, United Kingdom, 4Global HIV, Hepatitis and STI
Programmes, World Health Organization, , Switzerland, 5Centre
for Epidemiology and Biostatistics, Melbourne School of
Population and Global Health, The University of Melbourne,
Melbourne, Australia, 6Clinical Research Department, London
School of Hygiene and Tropical Medicine, , United Kingdom

Background: Effective linkage to prevention andcare is a crucial step following HIV testing services.
This systematic review aimed to determine theproportion of individuals who are linked toprevention and care after HIV self-testing (HIVST)
and describe factors associated with linkage.
Methods: An initial search was conducted acrosseight databases, including conference abstracts,
up to October 2023. Linkage to care after HIVST
was defined as getting a confirmatory test or
antiretroviral therapy (ART) if the self-test wasreactive, and/or pre-exposure prophylaxis (PrEP) if
the self-test was non-reactive. A random-effects
meta-analysis was performed to summarise thelinkage to prevention and care.
Results: Overall, 10,071 studies were screened, of
which, 174 were included in this meta-analysis.
Most studies examining linkage to confirmatory
testing or ART initiation were conducted in the
African region among key populations who usedoral fluid-based HIVST kits without assistance.
Overall, 92% (95% confidence interval (CI): 89–96)
of those whose HIVST was reactive were linked toconfirmatory testing, and 89% (95% CI: 84–93) of
those newly diagnosed with HIV initiated ART.
Eighty-four percent (95% CI: 74–93) of self-testers
were linked to care. Of the individuals whose
HIVST was non-reactive, 9% (95% CI: 2–19) werelinked to PrEP services. Studies utilising assisted
HIVST demonstrated a higher linkage toconfirmatory testing, and ART initiation compared
to unassisted HIVST. Our meta-regression analysis

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112

found that the type of delivery model for the
HIVST kits influenced linkage and that individuals
who obtained their HIVST kits through a social
network–based approach (SNA) were more likely
to be linked to confirmatory testing (adjusted odds
ratio (aOR)=1·28 (95% CI: 1·10–1·50), p= 0·001)
compared to non-SNA service delivery model.
Conclusions: In the context of expanding HIVST
services globally, we found that linkage toconfirmatory testing and ART initiation after HIVST
is generally high, particularly with assisted HIVST
and when SNA was used to obtain the HIVST kits.

Poster Abstract

89

Enhancing Communication but
Falling Short on Timely Visits:
A Case Study of the Medical
Appointment Notification
Assistance (MANA) Application
in HIV Patient Care, Bangkok
Nookhai S1, Tharee P2, Soontarawirat P2, Jangkhum
S3, Mookleemas P3, Ungkatreerat T2, Kanphukiew
A1, Pattarapayoon N3, Northbrook S1
1Division of Global HIV and Tuberculosis, U.S. Centers for

Disease Control and Prevention, Nonthaburi, Thailand, 2Lerdsin
Hospital, Department of Medical Service, Ministry of Public
Health , Bangkok, Thailand, 3Division of AIDS and STI,
Department of Disease Control, Ministry of Public Health ,Nonthaburi, Thailand

Background: In 2020, the Medical Appointment
Notification Assistance (MANA) application wasdeveloped to improve on-time patient visits bysending appointment reminders. We analyzed thefrequency of on-time and late clinic visits among
persons living with HIV who enrolled in MANA at alarge tertiary hospital in Bangkok from May 2020
through October 2023.
Methods: MANA was offered to every client
visiting the clinic for ARV or viral load services,with electronic consent obtained through theapplication at time of registration. Reminders weresent three times before drug refill and viral load
test appointments (7, 3, and 1 day before), andtwo times after missed appointments (5 and 7days). Demographic and visit data were stored
using the hospital information system. Median andchi-square tests were performed to assess
statistical significance using STATA.
Results: Of 4,537 patients, 1,653 (36.4%) accepted
MANA reminders (73.7% male, 89.2% Thainationality) while 2,884 (63.6%) did not (69.6%
male, 87.4% Thai nationality). No significant
difference in median age found between the twogroups. MANA users accounted for 6,901 (40.7%)
of visits while non-MANA users accounted for
10,055 (59.3%) of visits (p<0.001). Both groups had
a median visit count of 5. For visit timeliness,
38.0% of visits by non-MANA users were early oron time compared to 32.0% for MANA users, with

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113

a significant difference (p<0.001). Late visits (1-7days) were 11.8% for non-MANA users and 8.7%
for MANA users. Late visits by 8-28 days
constituted 18.3% for non-MANA users and 20.3%
for MANA users, while late visits by more than 28
days were 32.0% for non-MANA users compared
to 38.9% for MANA users, indicating a higher
proportion of late visits among MANA users.
Conclusion: While MANA successfully enhances
communication between ARV staff and clients, it
falls short of improving on-time clinic visits asinitially proposed. The findings highlight thelimitation of relying solely on message alerts andsuggest the need for additional interventions. Bidirectional messages between ARV staff andclients may prove to be a more efficient strategy
for encouraging timely clinic visits. Our results
emphasize the importance of ongoing learning andadaptation in the development andimplementation of healthcare management tools,
particularly in the context of HIV client care.

Poster Abstract

90

Attrition and viral suppression
rates among children withperinatally acquired HIV in theThai National AIDS Program
Nantanee R1,2, Lolekha R3, Lertpiriyasuwat C4,
Puangtaptim W5, Jupimai T2, Moonwong J2,
Sophonphan J2,6, Puthanakit T1,2
1Department of Pediatrics, Faculty of Medicine, Chulalongkorn

University, Bangkok, Thailand, 2Center of Excellence in Pediatric
Infectious Diseases and Vaccines, Chulalongkorn University,
Bangkok, Thailand, 3Division of Global HIV and TB, U.S. Centers
for Disease Control and Prevention, Nonthaburi, Thailand,
4Division of AIDS and STIs, Department of Disease Control,
Ministry of Public Health, Nonthaburi, Thailand, 5Department ofMedical Sciences, Ministry of Public Health, Nonthaburi,
Thailand, 6The HIV Netherlands Australia Thailand Research
Collaboration, Thai Red Cross AIDS Research Center, Bangkok,
ThailandBackground: Early initiation of antiretroviraltherapy (ART) can reduce HIV-related morbidity
and mortality. We have implemented a nationwide
Active Case Management Network since August
2014 to identify HIV-positive infants andaccelerate ART initiation. Data on HIV early infant
diagnosis (EID) and ART initiation are monitored
using the Thai National AIDS Program (NAP). We
describe treatment initiation and long-term
treatment outcomes of infants living with HIV
diagnosed during 2014-2018 in the Thai NAP
database.
Material and Methods: A retrospective review ofa national cohort of infants diagnosed throughThailand’s EID program between August 2014 andJuly 2018 was performed using NAP data with acensor date of 31 December 2023. HIV infection
was diagnosed using HIV DNA polymerase chain
reaction at birth, 1-2, and 4 months of age,following national guidelines. The recommended
regimen at ART initiation was
zidovudine/lamivudine and lopinavir/ritonavir
twice daily before pediatric dolutegravir (pDTG)
was made available in April 2023. Current national
HIV treatment and care guidelines recommend
pDTG as the first-line regimen for all children livingwith HIV weighing <20 kg. HIV treatment
monitoring included plasma HIV RNA annually andCD4 cell count every 6 months. Outcomes included
mortality rate, attrition rate, and proportion of

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114

favorable treatment outcomes, defined as
virological suppression (plasma HIV RNA <200
copies/ml) after >6 months of ART.
Results: Between August 2014 and July 2018, 267
infants were diagnosed with HIV infection at a
median age of 60 days. Of these, 230 infants(86.1%) were registered for ART initiation andlinked to care in NAP and 209 (78.3%) were on ART>6 months. Median Interquartile Range (IQR) age
at ART initiation was 3.3 (2.2-6) months. Initial ART
regimens were lopinavir/ritonavir-based (87.0%)
or nevirapine-based regimens (12.6%) among
others (0.4%).
As of December 2023, 20/230 (8.7%) infants linked
to care had died at a median (IQR) age of 12.6 (7.335.8) months. Loss to follow-up (LTFU) was 19.1%(44/230) (95% CI 14.3-24.8). Median (IQR) age at
LTFU was 43.4 (23.8-66.9) months.
Among 166 children retained on ART, the median(IQR) age at the last visit was 7.0 (5.6-8.6) years. Of
these, 108 (65.1%) children received DTG-based,
37 (22.3%) lopinavir/ritonavir-based, 14 (8.4%)
efavirenz-based, and 8 (4.8%) other regimens atlast visit. A total of 144/166 (86.7%) children
achieved virological suppression at the last visit, 87(52.4%) maintained virological suppression
throughout the data analysis period, and 57(34.3%) experienced virological rebound (VL >200
copies/mL). Median (IQR) last CD4 cell count was
912 (704-1166) cells/mm3.
Among the 108 children who switched to DTGbased regimens, 71 (66.4%) did so while
virologically suppressed, 20 (18.7%) children
achieved virological suppression after switching,and 17 (15.9%) failed to achieve virologicalsuppression.
Conclusions: With a network promoting early ART
initiation, the majority of HIV-infected infants
were able to promptly initiate ART and achieve
virologic suppression. However, nearly one-thirdof the cohort died or were lost to follow-up. Caselinkage to ART initiation and retention in the HIV
cascade of care are critical in ensuring favorable
outcomes in pediatric HIV prevention programs.

Poster Abstract

91

Rapid initiation of
antiretroviral therapy under
the Treat-All policy reduces
loss to follow-up andvirological failure in routine
HIV care settings in China: A
retrospective cohort study(2016-2022)
Xia H1, Ma P1
1Tianjin Second People's Hospital, Tianjin, China

Background: Following the World HealthOrganization's guidelines for rapid antiretroviraltherapy (ART) initiation [≤ 7 days after humanimmunodeficiency virus (HIV) diagnosis], China
implemented Treat-All in 2016 and has madesignificant efforts to provide timely ART since2017. The purpose of this study was to evaluate
the effects of rapid ART on loss to follow-up (LTFU)
and virological failure compared to those ofdelayed ART.
Methods: This research included newly diagnosed
HIV-infected adults from Tianjin, China between
June 2016 and December 2022. Our primary
outcome was LTFU (more than 90 days after theprior drug pick-up or clinical visit) at 12 months
following enrollment. The secondary outcome was
12-month virological failure after treatment
initiation. Furthermore, Kaplan-Meier estimators
were utilized to examine the LTFU time for rapidand delayed ART initiation. Moreover, thecorrelation between rapid ART initiation and LTFU
was evaluated using univariate and multivariable
Cox regression, whereas the relationship between
rapid ART and 12-month virological failure wasinvestigated via logistic regression.
Results: A total of 896 (19.1%) of 4688 participantsreceived ART ≤ 7 days post-HIV diagnosis. The rateof rapid ART initiation has increased from 7.5% in2016 to 33.3% by 2022. Rapid ART was lesscommon in persons with baseline CD4 counts of
350 - 499 and ≥ 500 compared to those < 200.
Furthermore, it was also less prevalent inindividuals who were diagnosed with tuberculosis

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115

or had an unknown route of HIV infection, while
was more common in people who used
Medicare/self-paid medications. The rapid ART
group had an LTFU rate of 3.3%, as opposed to
5.0% in the delayed initiation group. Moreover,
the rapid ART group had a much reduced
virological failure rate (0.6% vs. 1.8%). Rapid ART
individuals had a reduced likelihood of LTFU
(adjusted hazard ratio: 0.65, 95% CI: 0.44 - 0.96)
and virological failure (adjusted odd ratio: 0.35,
95% CI: 0.12 - 0.80).
Conclusions: Under China's Treat-All policy, rapid
ART initiation reduced the risk of LTFU andvirological failure. The real-world data indicatedthat rapid ART initiation is practicable andbeneficial for Chinese people with HIV, providing
evidence and guide for its widespread
implementation and scaling up.

Poster Abstract

92

HIV continuum among key
populations through the
Universal Health Coverage
program in Thailand in the eraof treat all
Teeraananchai S1,2, Phuthomdee S1, Phanuphak N3,
Boettiger D4
Department of Statistics, Faculty of Science, Kasetsart
University, Bangkok, Thailand, 2Biomedical Data Science
program, Faculty of Science, Kasetsart University, Bangkok,
Thailand, 3Institute of HIV Research and Innovation, , Thailand,
4
Kirby Institute, University of New South Wales, Sydney,
Australia
1

Background: HIV testing among key populations inThailand has increased since 2015 corresponding
to the establishment of the “key population-led
health services” (KPLHS). We assessed the cascadeof HIV care among key populations and identified
predictors of accessing ART and viral suppression(VS) using national database which records HIV
test results, antiretroviral therapy (ART) status,
and viral load (VL) of all citizens documented
under Thailand Universal Health Coverage (UHC)
system.
Methods: We included individuals diagnosed withHIV at age ≥15 years who were enrolled to startART between 2015-2022. Individuals wererecorded HIV risk group as men who have sex withmen (MSM), people who inject drugs (PWID),
female sex workers or transgender women. ART
initiation at any CD4 count and VL testing within 6
to 12 months were offered to all per nationalguidelines. Estimates were calculated as
proportion of participants i) linked to care/starting
ART, ii) with VL testing, and iii) with VS (VL <200
copies/mL). We used logistic regression toinvestigate characteristics associated withaccessing ART and VS.
Results: A total of 6,110 individuals werediagnosed with HIV and enrolled in care,comprising 5,587 (91%) MSM, 203 (3%) PWID, 193(3%) female sex workers and 127 (2%) transgenderwomen. Of those, 5,601 (92%) started ART. Among
participants who started treatment, 4,420 (79%)
had a VL test within 6 to 12 months of starting
ART, with 3,985 (90%) of those tested (71% of the

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116

original cohort after starting ART) achieving VS.
MSM (adjusted odds ratio (aOR) 1.88 (95%
confidence interval (CI) 1.18-3.01; versus PWID),
age 15-24 years (aOR 1.71, 95%CI 1.27-2.33;
versus age 34-49 years) and CD4≥500 cells/mm3(OR=5.34, 95%CI 3.77-7.57; versus CD4 < 200cells/mm3) were associated with higher odds ofstarting ART after HIV diagnosis. MSM with highpre-ART CD4 and no HIV symptoms at diagnosis
were more likely to achieve VS within one year of
ART initiation.
Conclusion: HIV care cascades varied by key
populations in Thailand. Interventions need to be
tailored by population and sub-population
contexts. Earlier diagnosis at higher CD4 countcould benefit both ART initiation and VS among
key populations.

Poster Abstract

117

93

logistic regression were used to identify associatedvariables.

Longitudinal Health-Related
Quality of Life in Hospitalized
Patients with Advanced HIV
Disease - A Multi-Center
Cohort Study in Vietnam

Results: Among 901 patients 747 (83%) were male.
Median age was 36 years (IQR 30,44). The patientswith microbiologically confirmed TB/NTM
infections was 28%, 21% had either talaromycosis,
cryptococcosis, or histoplasmosis, 3.3% had
mycobacterial and fungal co-infections, and 48%
had other OIs. The median EQ-5D-5L utility and
EQ-VAS scores at baseline were 0.49 (IQR: 0.120.70) and 50 (IQR: 40-60), respectively. At 24
weeks, the median HrQoL EQ-5D-5L utility score
was 1.00 (IQR 0.92-1.00), and the median EQ-VAS
score remained at 85 (IQR: 80-90). Participants
with TB / NTM had lower EQ-5D-5L utility
compared to those with fungal infections andother OIs at week 24. In the multivariate linear
regression models, lower education level, CD4 <50
cells/µL, TB/NTM infections, and TB/NTM andfungal co-infections were significantly associatedwith lower EQ-5D-5L utility at baseline (coef. = 0.09, 95% CI: -0.15, -0.02, -0.07, 95% CI: -0.14, 0.01, -0.06, 95% CI: -0.12, 0.00, and -0.13, 95% CI: 0.28, 0.01, respectively). Patients with fungal
infections, TB/NTM, and TB/NTM and fungal
coinfections were significantly associated withlower EQ-VAS scores (coef. = -5.9, 95% CI: -9.3, 2.6, -6.3, 95% CI: -9.3, -3.2, and -11, 95% CI: -18, 3.5, respectively). However, only lower educationlevel and TB/NTM infections predicted lower EQ5D-5L utility at week 24 (coef. = -0.05, 95% CI: 0.09, -0.01, coef. = -0.09, 95% CI: -0.13, -0.06,
respectively). In the logistic regression analyses,
participants with fungal infections were 1.75 times
more likely to experience pain/discomfort thanthose with other OIs (OR = 1.75, 95% CI: 1.18,
2.63). Male participants tended to have less painand discomfort (OR = 0.66, 95% Cl: 0.43, 0.99) andanxiety and depression (OR = 0.45, 95% Cl: 0.30,0.67).

Trinh T1, Nguyen Hong K1, Phan Thi Hong D1,
Nguyen Quang D1, Ha Xuan N1, Nguyen Thi H1, Vo
Trieu L2,3, Nguyen Thanh D2, Pham Ngoc T4, Do
Duy C5, Nguyen Si Anh H1, Vu Quoc D6, van Doorn
H1,7, Le T8,9
Wellcome Africa Asia Programme, Oxford University ClinicalResearch Unit, Ho Chi Minh City/Hanoi, Viet Nam, Hanoi,
Vietnam, 2Hospital for Tropical Diseases, Ho Chi Minh City, Viet
Nam, Ho Chi Minh city, Vietnam, 3University of Medicine andPharmacy at Ho Chi Minh City, Viet Nam , Ho Chi Minh city,
Vietnam, 4National Hospital for Tropical Diseases, Ha Noi, Viet
Nam, Hanoi, Vietnam, 5Bach Mai Hospital, Ha Noi, Viet Nam,
Hanoi, Vietnam, 6Hanoi Medical University, Ha Noi, Viet Nam,
Hanoi, Vietnam, 7Nuffield Department of Medicine, Universityof Oxford, Oxford, United Kingdom, London, United Kingdom,
8Division of Infectious Diseases and International Health, Duke
University School of Medicine, Durham, NC, USA, Durham, USA,
9Tropical Medicine Research Center for Talaromycosis in
Vietnam at Pham Ngoc Thach University of Medicine, Ho Chi
Minh City, Vietnam, Ho Chi Minh city, Vietnam
1

Background: Tuberculosis (TB), non-tuberculous
mycobacteria (NTM), and invasive mycoses
account for 50% of opportunistic infections (OIs)
and are a leading cause of death in patients withadvanced HIV disease (AHD). Morbidity ishistorically expressed from a (one-sided)
healthcare perspective. Here we investigate
morbidity focusing on patients’ perception ofhealth-related quality of life (HrQoL) andinvestigate determinants of poor HrQoL.
Methods: A prospective longitudinal study was
conducted among 901 patients with AHD
hospitalized at three hospitals in Vietnam. Patients≥18 years with a CD4 count ≤ 100 cells/µL or WHO
stage III / IV disease; not ART or ≤3 months on ART
were eligible for enrolment. Participants were
followed in hospital and monthly as outpatientsfor 6 months. HrQoL was assessed at baseline,
week 12, and 24 using the validated EQ-5D-5L (fivedomains: mobility, self-care, usual activities,
pain/discomfort, and anxiety/depression, range: 0.5115 to 1) Visual Analogue Scale (EQ-VAS, range:
0 to 100). Multivariate linear regression and

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusion: Our study HrQoL perception of
hospitalized patients with ADH. HrQoL improves
over time, but remains sub-optimal for patientswith lower educational levels and with TB or NTM
infection. We present a patient-oriented
perspective of health outcomes beyond traditional
doctor-oriented perspective. This highlights theneed to incorporate HrQoL assessment inmorbidity estimates and health outcome
assessment in HIV care.

Poster Abstract

118

94

susceptibility. TOC for NG was performed byculture and NAAT 10-21 days following treatment.

Testing for Neisseria
gonorrhoeae infections andperforming test-of-cure withina HIV pre-exposure
prophylaxis program in Hanoi,
VietnamResults: In total, 529 participants were enrolled,
the median age was 25.1 years (interquartile range[IQR]: 21.7-29.5). All were male and reported
having sex with men in the prior 12 months. The
median number of sex partners in the prior monthwas 1 (IQR: 1 – 2). In the prior week, 16.3%(86/529) reported rectal symptoms, 13.2%(70/529) reported urethral symptoms, and 23.8%(126/529) reported pharyngeal symptoms. The
prevalence of N. gonorrhoeae by NAAT was 14.3%(76/529); there were 57 (10.7%) with pharyngeal,
37 (7.0%) with rectal, and 23 (4.3%) with urethral
infections; 36 (6.8%) had infections at multiple
anatomic sites. There were 12 participants with
culture-positive N. gonorrhoeae infections, 4 fromurethral, 6 from rectal, and 3 from oral sites.
Among those with N. gonorrhoeae infections, 73(96.1%) received treatment and 61 (80.3%)
returned for TOC with a median of 15 (IQR: 12-19)
days after treatment. At the TOC visit, 31.7%(19/60) were positive by NAAT and among those,
19 were positive at pharyngeal site and 1 was also
positive at the rectal site. All TOC cultures were
negative. There was no difference in NAAT
positivity comparing those presenting for TOC <14days and ≥14 days (p=0.25).

Adamson P1, Pham L2, Bui H2, Le H3,4, Gorbach P5,
Klausner J6, Le G2
1David Geffen School of Medicine at UCLA, Los Angeles, UnitedStates, 2Center for Training and Research on Substance AbuseHIV, Hanoi Medical University, Hanoi, Vietnam, 3Department ofMicrobiology, Hanoi Medical University, Hanoi, Vietnam,
4National Hospital of Dermatology and Venereology, Hanoi,
Vietnam, 5UCLA Fielding School of Public Health, Los Angeles,
USA, 6Department of Population and Public Health Sciences,
Keck School of Medicine at USC, Los Angeles, USA

Background: Patients on HIV pre-exposure
prophylaxis (PrEP) have high rates of bacterial
sexually transmitted infections (STIs), like
Chlamydia trachomatis and Neisseria
gonorrhoeae, thus routine testing is
recommended. Antimicrobial resistance (AMR) in
N. gonorrhoeae is an urgent issue, particularly in
the Asia-Pacific region. Performing test-of-cure(TOC) for N. gonorrhoeae infections is
recommended by some guidelines to monitor fortreatment failures. In this study, we assessed theprevalence of N. gonorrhoeae at multiple
anatomic sites and performed TOC following
treatment of N. gonorrhoeae infections among
participants in a HIV PrEP program in Hanoi,
Vietnam.
Methods: From January through December 2022,
participants in the PrEP program at the Sexual
Health Promotion Clinic in Hanoi, Vietnam wererecruited into the study. Participants completed asurvey collecting demographic, behavioral, andclinical data. Participants self-collected urine,
rectal, and pharyngeal specimens for nucleic-acid
amplification testing (NAAT) using either cobas
CT/NG 4800 (Roche Molecular Diagnostics, USA) or
Alinity m STI (Abbott Molecular, USA) assays.
Participants with symptoms, or found to have N.
gonorrhoeae infections, had an additional
specimen collected for culture and antibiotic

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions: The prevalence of N. gonorrhoeae
was significant within this population of MSM in a
PrEP program in Hanoi, Vietnam and a highproportion were positive by NAAT at the TOC visit.
Interestingly, among those positive at TOC, allwere detected by NAAT only and were positive inpharyngeal specimens. While pharyngeal
infections tend to be more difficult to eradicate,increasing risk for treatment failures due to AMR,
in our study, all TOC cultures were negative,
suggesting detection of remnant nucleic acids
following treatment is a more likely explanation.
The development of an assay to determine
bacterial viability at TOC would help distinguishremnant nucleic acids from true infections and isneeded.

Poster Abstract

95

Masked by Mildness:
Differentiating Mpox from
Common STIs in a Bangkok
OPD Clinic
Pipattaweepon T1, Boonkrapue P1, Pankam T1,
Srila-or I1, Pattanachaiwit S1, Jomja P1, Pichitchok
Y1, Putcharoen O1,2,3, Chumpa N2
1Thai Red Cross Anonymous Clinic, Thai Red Cross AIDS

Research Centre (TRCARC), Bangkok, Thailand, 2Thai Red Cross
Emerging Infectious Diseases Clinical Center, King
Chulalongkorn Memorial Hospital, Bangkok, Thailand, 3Divisionof Infectious Diseases, Department of Medicine, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand

Background: The global Mpox outbreak presents
diagnostic challenges in STD clinics, particularly
when manifesting in mild forms mimicking other
STIs. This study at the Thai Red Cross Anonymous
Clinic, Bangkok, focuses on identifying Mpox
presentations and distinguishing them from other
STIs, providing crucial clinical data on the
manifestation of Mpox in Asia.
Material and Methods: An observational study
was conducted, collecting data from 77 individuals
with suspected Mpox symptoms between January
and December 2023. Evaluations included physicalexaminations, Mpox PCR testing from skin lesions,and STD screenings (NAT PCR for Gonorrhea andChlamydia, blood testing for anti-HIV, NAT-HIV,and Treponema or RPR). Sociodemographic data,skin manifestations, systemic signs, and lesion
sites were observed. Confirmed cases werecompared between PLWH and non-PLWH groups.
Prevalence of between-group differences wasmeasured with 95% confidence intervals, anddescriptive statistics were used for analysis.
Results: Among the 77 suspects, 72 (93.5%) wereconfirmed for Mpox via PCR. Of the confirmed
cases, 22 (30.5%) were PLWH with an average CD4count of 537 cells/mm³. The majority of individuals
were MSM (97.2%) and Thai nationals (87.5%).
Skin manifestations in PLWH and non-PLWH
included umbilicated papules/pustules (27.3% vs.
44.0%; p=0.202), ulcers (40.9% vs. 28.0%;
p=0.289), vesicles (4.5% vs. 8.0%; p=1.000),
pustules (18.2% vs. 36.0%; p=0.170), multistage
lesions (36.4% vs. 14.0%; p=0.056), and rash

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

119(13.6% vs. 20.0%; p=0.742). Lesions were found on
the genitalia (45.5% vs. 76.0%; p=0.016), anus
(36.4% vs. 16.0%; p=0.070), trunk (50.0% vs.
42.0%; p=0.208), limbs (50.0% vs. 40.0%; p=0.451),
and face (9.1% vs. 26.0%; p=0.127). Concomitant
STIs included N. gonorrhoeae (16.7% vs. 6.3%;
p=0.333), C.trachomatis (16.7% vs. 8.3%; p=0.380),
and syphilis (9.5% vs. 17.0%; p=0.712).
Conclusions: This study emphasizes theimportance of careful evaluation in STD clinics
during the Mpox epidemic. The early mild skinmanifestations of Mpox, often mimicking other
STIs, particularly umbilicated papules and ulcers in
the anogenital area, underscore the need for
meticulous differential diagnosis to prevent
misdiagnosis and transmission. Screening for other
STIs in suspected Mpox cases is helpful for
diagnosis and appropriate treatment, including codiagnosis with Mpox. A significant statisticaldifference was found in the lesion site at genitalia
between PLWH and non-PLWH groups. Whileindividuals with higher CD4 counts show mild
symptoms, the potential for severe manifestationsin immunocompromised individuals calls for avigilant approach to diagnosis and management.
The predominant Mpox clade identified was IIb
B.1.3.1.

Poster Abstract

96

Incidence of Gonorrhea,
Chlamydia and Syphilis
Infection among
Asymptomatic Women in a
HIV Clinic in Hong Kong
Chan S1, Chan S1, Chan K1, Au S1, Chan K1, Yiu Y1,
Ng S1, Fong C1, Yeung K1, Kwong T1,2, Wu T1,2, Lee
M1
1HIV Clinical Service, Department of Medicine, Queen Elizabeth

Hospital, , Hong Kong SAR, 2Division of Infectious Diseases,
Department of Medicine, Queen Elizabeth Hospital, , Hong Kong
SAR

Background: Sexually transmitted infection (STI) in
women causes health problem as well as
debilitating effect on the reproductive tract. It isprudent to prevent, diagnose and treat any STI in
women, in particular women of child-bearing age.
However, there is a lack of data locally in Hong
Kong on the epidemiology of STI among women
living with HIV who, with the use of antiretroviraltreatment, have near normal life expectancy while
enjoying good health.
Method: STI screening has been enhanced among
HIV-infected male-having-sex-with male (MSM)
who were asymptomatic for STI, at the clinic of
HIV Clinical Service, Queen Elizabeth Hospital Hong
Kong since October 2022. In year 2023,
asymptomatic STI screening has been extended tofemale patients who were scheduled to haveregular cervical smear surveillance. Depending on
the sexual behavior, endocervical / oral / rectal
swabs are taken for nucleic acid amplification test
(NAAT) for Neisseria gonorrhea (NG) andChlamydia trachomatis (CT), and blood test is
taken for Syphilis serology. Patients were also
surveyed for any risk factor for STI. Here we
present the outcomes of the screening program
performed from 1 June 2023 to 29 Feb 2024
among HIV-infected women of the clinic.
Results: A total of 327 women were being
followed up at the clinic, and 104 women who
were asymptomatic for STI were screened during
the period. Women who received STI screening
had a median age of 50 years, and 44% (46/104)
were sexually active (last sex within one year).

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120

96.2% (100/104) of women were on antiretroviraltreatment for HIV, with median CD4 cell count 519
cells/uL, and four were newly diagnosed of HIV
infection. All women were screened for cervical
infection, while 13% were screened for additionalsites according to sexual behavior. Endocervicalswab positivity were 2.9% (3/104) for CT and
0.96% (1/104) for NG. Eight women werescreened for oral infection, while five werescreened for rectal infection, all of which were
negative for NG and CT. Two other women (1.9%)
were diagnosed syphilis on serology screening.
Among women who were sexually active, 6.5%
(3/46) had casual / multiple sex partners, 80.4%(37/46) used barrier method for prevention of STI
but only 60.9% (28/46) reported to haveconsistent use. None of the women in this cohort
was substance user. Among the six women who
were screened positive for STI, five were sexuallyactive with four reporting inconsistent use of
barrier method for STI prevention, and the last
woman was sexually inactive reportedly.
Conclusion: In this cohort of HIV-infected women
mostly receiving antiretroviral treatment,
detection of chlamydia, gonorrhea and syphilis
infection were infrequent and mostly in women
who were sexually active having risk factors for
STI. Regular STI screening and sexual healtheducation should be offered to sexually active
women despite being asymptomatic for STI.

Poster Abstract

97

High Incidence of Chlamydial
and Gonorrheal Infection
Among Asymptomatic MSM ina HIV Clinic in Hong Kong
Fong C1, Chan S1, Chan S1, Chan K1, Au S1, Chan K1,
Yiu Y1, Ng S1, Yeung K1, Tang H1,2, Kwong T1,2, Wu
T1,2, Lee M1
1HIV Clinical Service, Department of Medicine, Queen Elizabeth

Hospital, , Hong Kong, 2Division of Infectious Diseases,
Department of Medicine, Queen Elizabeth Hospital, , Hong Kong

Background: Sexually transmitted infections (STIs)
result in substantial health problems and major
challenges globally in men who have sex with men(MSM) with or without HIV infection. Locally inHong Kong, the epidemiology of STIs among HIVinfected MSM remains unclear, which may hinder
the formulation of measures to battle against thisimportant public health problem.
Method: Yearly asymptomatic screening of STIs,
including Neisseria gonorrhea (NG) and Chlamydia
trachomatis (CT), has been offered to HIV-infected
MSM under the care of HIV Clinical Service, Queen
Elizabeth Hospital Hong Kong since October 2022.
Rectal, urethral and oral swabs are taken to
perform nucleic acid amplification test (NAAT) forNG and CT. Risk factors for STIs are also surveyed,
including inconsistent use of condom, multiple
sexual partners (> 1) and substance abuse. Here
we present the outcomes of the asymptomatic STI
screening program performed from 1/1/2023 to
31/12/2023, together with relevant demographics,
among HIV-infected MSM of the clinic. Chi-square
test was used to compare the STI risk factors
between those positive versus those negative onscreening.
Results: A total of 553 STI screening tests weredone among 515 asymptomatic MSM whose
median age was 42 years (range 22 to 80). Test
positivity rate for either NG or CT was 23.9%(132/553), and the rate of co-infection of both NG
and CT was 5.1% (28/553). Positive results for NG
and CT at any of the three anatomical sites were10% (55/553) and 19% (105/553) respectively. CT
infection was most common in rectum (17.9%) ascompared with throat (2.4%) and urethra (1.1%).
NG infection was most common in rectum (6.2%)

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121

as compared with throat (5.4%) and urethra(1.3%). Among those positive for either NG or CT,
31.8% (42/132) was also found to have syphilis coinfection on serology test.
Concerning risk factors of acquiring STI, whencomparing to those negative at all sites, those who
were positive at any site have higher rates of STI
risk factors, including inconsistent use of condom(70.9% vs 60.1%, p=0.037), multiple sex partners(82% vs 59.8%, p<0.001) and use of substance(23.6% vs 15.5%, p=0.051).
Conclusion: The high rate of STI, in particular
rectal CT, highlights the importance of annual STI
screening test in HIV-infected MSM despite being
asymptomatic. Risk factors for STI including
multiple sexual partners, inconsistent use of
condoms and substance use were prevalent
among HIV-infected MSM, more so in thosepositive on STI screening. Sexual health counselingand STI preventive interventions should be
strengthened in this population.

Poster Abstract98

Mpox vaccination uptake andinclination to vaccinate among
men who have sex with men
Kwan T1,2,3, Chan D2,3, Lee S2,3
1Jockey Club School of Public Health and Primary Care, The

Chinese University of Hong Kong, Shatin, Hong Kong, 2S.H. Ho
Research Centre for Infectious Diseases, The Chinese Universityof Hong Kong, Shatin, Hong Kong, 3Stanley Ho Centre for
Emerging Infectious Diseases, The Chinese University of Hong
Kong, Shatin, Hong Kong

Background: In Hong Kong, a free mpox
vaccination programme has been launched since
October 2022, targeting people at higher risk ofinfection including men who have sex with men(MSM). This study aimed to identify the gap invaccination uptake among MSM.
Methods: A cross-sectional self-administered
online questionnaire study was conducted. Survey
items included sociodemographics, sexual
behaviours in the past six months, travel history
and plan in the past and future six months
respectively, sexually transmitted infections (STI)risk perceptions, mpox vaccination history andinclination, and beliefs about mpox and thevaccine. Eligible participants were locally residing
adults who self-identified as male and had had sex
with another male in the past six months. Bivariate
analysis was conducted to assess factors
associated with vaccination and inclination tovaccinate among those unvaccinated using chisquared and Mann-Whitney U test.
Results: Between 15 February and 20 March 2024,
a total of 148 complete responses from eligible
participants were collected. Some 88 (59%)
received at least one dose of mpox vaccine, ofwhom 78 (89%) completed the vaccination series
according to the recommendations regarding age.
MSM receiving mpox vaccines were older(p<0.001), had a higher perceived risk of mpox
(p<0.001) and other STI (p<0.001), and higher odds
of outbound travel in the past (p=0.002) andcoming (p=0.02) six months. They were also more
likely to have sought male sex partners locally(p=0.07) and during travel (p=0.002), and engaged
in chemsex (p=0.01). Among those unvaccinated,less than half (45%) were inclined to receive thevaccine in the coming year. They gave a higher

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122

agreement score for encouraging their peers to
get vaccinated as well (p=0.004), and a lower one
for being worried about coming out after
vaccination (p=0.003). Inclination to receive
vaccination was not associated with concerns
about its safety (p=0.14), effectiveness (p=0.28), orside effects (p=0.33), nor time and location of thevaccination sites (p=0.15).
Conclusion: MSM with a higher perceived andactual risk of mpox acquisition were more likely tohave been vaccinated. Those unvaccinated andunwilling to be vaccinated were concerned aboutsocial stigma rather than the vaccine’s safety
profile. While structural barriers played a minimalrole, peer influence could be a driver to boost
vaccination uptake for those having a higher mpoxrisk.

Poster Abstract

123

99

Doxycycline prophylaxis forsexually transmitted infection
prevention in Vietnam:
Awareness, attitudes, andwillingness to use among men
who have sex with men using
HIV PrEP
Bui H , Adamson P , Klausner J , Le G , Gorbach P
1

2

3

1

4

1Center for Training and Research on Substance Abuse-HIV,

Hanoi Medical University, Hanoi, Viet Nam, 2Division of
Infectious Diseases, School of Medicine, University of California,
Los Angeles, Los Angeles, USA, 3Department of Population andPublic Health Sciences, Keck School of Medicine, University ofSouthern California, Los Angeles, USA, 4Department of
Epidemiology, Fielding School of Public Health, University ofCalifornia, Los Angeles, Los Angeles, USA

Background: Doxycycline prophylaxis is apromising tool for the prevention of sexuallytransmitted infections (STIs) among groups atincreased risk for infection. Research on the use of
doxycycline as prophylaxis mostly has been
conducted in high-income countries. We assessedawareness of and willingness to use doxycycline
pre-exposure and post-exposure prophylaxis(PrEP/PEP) for STI prevention among men who
have sex with men (MSM) using HIV PrEP in
Vietnam.
Methods: From January 29- February 4, 2024,
males, aged ≥18 years, reporting sex with men in
the prior 12 months were recruited from 11 PrEP
clinics in Hanoi and Ho Chi Minh Cities.
Demographic and behavioral data were collectedusing self-administered surveys. STI perceived risk
was scored between 0 and 10. Multivariablelogistic regression models were constructed toassess factors associated with willingness to use
doxycycline PrEP/PEP for STI prevention.
Results: Among 350 participants (45.7% Hanoi,
54.3% Ho Chi Minh), median age was 25 years(interquartile range [IQR]: 21-30), 75.4% (n=264)
achieved high school or higher degree. In theprevious 6 months, median number of sex
partners was 2 (IQR: 1–4), 53.1% reported
condomless anal sex with male partners. A highpercent of participants reported lifetime alcohol

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

(85.7%) and popper (69.1%) use; 28.3% (n=99)
reported popper use during sex in the previous 6months. In the previous 12 months, 8.3% (n=29)
were diagnosed with syphilis, 2.6% (n=9) Neisseria
gonorrhea, 0.6% (n=2) Chlamydia trachomatis by
self-report. Median score (range 0-10) ofparticipants’ self-perceived risk of STIs was 6 (IQR:
3–9). There were 6.9% (n=24) of participants whoreported Doxycycline use previously for acne
control (n=16), treatment of chlamydia (n=5) andsyphilis (n=2), and one reported Doxycycline for
STI prevention. There were 20.2% (n=65) who
heard of doxycycline PrEP/PEP before the survey.
In total, 75.4% (n=264) reported they would use
doxycycline if it were recommended, among
those, 63.6% (n=168) would prefer PrEP. A concern
about cost of the medicine was reported by 34.9%
of participants and 60.9% reported mostly/very
concerned about the medicine side effect,
including tolerance and the risk of antimicrobial
resistance. The logistic model adjusted for age,education, city of survey, and STI history indicatedthat participants who reported lifetime alcohol use(adjusted odds ratio [aOR]= 3.0; 95% confidence
interval [95%CI]: 1.5–5.7), recent popper use
during sex (aOR, 2.0; 95% CI, 1.0–4.0) andincreased score of perceived STI risk (aOR, 1.1;
95% CI: 1.0–1.2) were more willing to use
doxycycline PrEP/PEP.
Conclusions: We found low prior knowledge of
doxycycline PrEP/PEP among MSM on HIV PrEP in
Vietnam. While the majority reported willingness
to use, almost twice as many preferred PrEP to
PEP. Our findings suggest directions for
doxycycline PrEP/PEP implementation in Vietnam,
including wider dissemination of doxycycline
prophylaxis for STI prevention in target
populations, providing both PrEP/PEP options, andscreening associated factors for enrollment of
MSM willing to initiate doxycycline PrEP/PEP toensure high uptake.

Poster Abstract

100

A pilot study of the Internet ofThings (IoT) medicationassisted system to improve
HIV antiretroviral therapy
adherence and treatment
response
Suh J1,2, Yang K3, Kim J1,2, Yoon Y1,2, Sohn J1,2
1Division of Infectious Diseases, Department of Internal

Medicine, Korea University College Of Medicine, Seoul, South
Korea, 2Institute of Emerging Infectious Diseases, Korea
University, Seoul, South Korea, 3Department of Biostatistics,
Korea University College of Medicine, Seoul, South Korea

Introduction: Encouraging the utilization of andadherence to Antiretroviral therapy (ART) is widely
regarded as the most important intervention for
HIV-positive patients. This pilot study aims toassess the effectiveness of the Internet of Things(IoT) medication-assisted system in enhancing ART
adherence and treatment response.
Method: Between June 2022 and October 2023,
we conducted a study involving adult HIV patients(≥19 years) who prescribed
Bictegravir/Emtricitabine/Tenofovir Alafenamide(Biktarvy, Gilead Science Inc., Canada) and agreed
to use the InPHRPILL system (Softnet Inc., Seoul,
South Korea), IoT medication-assisted devices, andrelated application (Coledy Inc., Seoul, South
Korea). This study assessed viral suppression andCD4 cell counts both before and after the
implementation of the device. Additionally, itevaluated ART adherence based the timing ofdevice usage within 12 months. Monthly ART
adherence was measured through self-reported
compliance and the InPHRPILL system, along with
device error rates.
Results: A total of 12 patients were enrolled. All ofthem were male, with a median age of 30 years,
and the median duration of device usage was 10.5
months. The median self-reported compliance rate
was 99%, while the median device compliance rate
was 87.4%, showing a difference between patientreported adherence and device-measured
adherence. The median device error rate was
4.4%. Patients who used the device within 1 yearof HIV diagnosis (n=5) were statistically

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124

significantly younger (P=0.038). Additionally,
although not statistically significant, the group thatused the device within 1 year of HIV diagnosis had
a higher device-based compliance rate comparedto the group that did not [n=5 (90.6%) vs. n=7(85%), P=0.801]. Furthermore, device utilization
was associated with significant viral suppression(P=0.009) and increases in CD4 cell counts(P<0.001). In Poisson regression model withrandom intercepts, the coefficients associatedwith error rates for each month were statisticallysignificant (β=-0.06493, P=0.003). Notably, weobserved a negative effect during specific months,
suggesting that error rates had a more
pronounced impact on the outcome during those
periods.
Conclusion: In conclusion, our findings suggest theuse of an IoT-based medication-assisted system,
which demonstrates a reduction in error rates, asa strategy to enhance ART adherence among
patients initiating HIV treatment.

Poster Abstract

101

Behavioral Survey of HIVInfected Cases with Delayed
Diagnosis in Taoyuan District,TaiwanSun N1
Taoyuan General Hospital, Tao Yuan City, Taiwan

1

Background: In Taiwan, the number of newly
diagnosed HIV cases has been declining since
2018, but about 30% of cases are delayed
diagnosis. This study aims to explore thebehavioral causes of delayed diagnosis of HIV
infections in Taiwan and understand their specificneeds in order to improve prevention measures.
Methods: This study adopts a mixed methods
approach, combining qualitative and quantitative
research methodologies. The study conducted aquantitative survey with 31 individuals who werediagnosed late with HIV at the Taoyuan Hospital of
the Ministry of Health and Welfare. Additionally,
qualitative interviews recruited 5 interviewees ofthese participants."
Results: The majority of respondents were men
who have sex with men (MSM), age from 25 to 34
years old. Among the respondents, 48.39% had
never been screened for HIV before testing
positive; over 60% were unclear about theavailable resources for HIV screening, and 33.33%
believed that they were not at risk of HIV
infection.
In terms of HIV awareness, 51.61% of respondents
thought HIV infection and AIDS were the same,
80.65% had engaged in unsafe sexual behavior,
and 61.29% had a history of sexually transmitted
infections (STIs). Among STIs, syphilis had thehighest infection rate.
Regarding the use of medicines, 77.42% of the
respondents stated that they had not used preexposure prophylaxis (PrEP) before being
diagnosed with HIV, and 74.19% had not used
post-exposure prophylaxis (PEP) prior to their HIV
diagnosis.

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125

Reasons for delayed diagnosis include
misconceptions about HIV screening, lack ofawareness, and underestimating the importanceof screening and follow-up care. The study
recommends enhancing public awareness of
screening and providing patients with time for
personal reflection.
Conclusion: This study, through qualitativeinterviews and quantitative surveys, found that
only 51.61% of individuals had undergone HIV
screening prior to their diagnosis, indicating a low
rate of screening before infection. Many of those
infected patients had not received HIV screening
before being infected. This study offers fivespecific recommendations for medical and healthpolicy: early education and HIV advocacy, review
of various educational training materials for
accuracy, improvement of notification procedures
and elimination of discrimination, optimization ofhealth education content with an emphasis onconsequences of delay diagnosis, and increasingawareness and convenience of screening to bettersupport HIV patients, thereby reducing the impact
of HIV on society.
Keywords: Delayed Diagnosis, HIV testing, HIVtreatment

Poster Abstract

103

Potential Acceptability,
Feasibility, and Effectivenessof Point of Care HIV Syphilis
Testing (POCT) by Community
Health Workers (CHW) in
Indonesia from Multiple
Perspectives: A Formative
Research
Sudirman S1, Ruxrungtham K1, Phanuphak N2,
Nadia Tarmizi S3
1Chulalongkorn University, Bangkok, Thailand, 2Institute of HIV

Research and Innovation, Bangkok, Thailand, 3Ministry of
Health Indonesia, Jakarta, Indonesia

Background: Indonesia has one of the most rapidly
growing HIV epidemics in Asia. Even though
Indonesia has various services and programs, thelatest national HIV / AIDS report shows thatIndonesia failed to achieve the UNAIDS targets.
Since 2015, the World Health Organization (WHO)has recommended expanding HIV testing outside
the clinical setting. Community-based HIV service(CBS) with point-of-care HIV Syphilis testing (POCT)
by community health workers (CHWs) is one
approach of the recommendation. Recently,
Indonesia has not adopted this modality as its
national program. More research is needed todetermine this approach's acceptability, feasibility,and effectiveness among key populations.
Methods: This qualitative formative research was
conducted from December 2022 to January 2023.
Eight focus group discussions (FGDs) and 22
interviews were conducted with the HIV service
beneficiaries, HIV CHWs, community-basedorganizations, HIV health providers, Ministry of
Health stakeholders, and academicians. We
collected the data on the informant’s perspectives
regarding the acceptability, feasibility, andeffectiveness of POCT of HIV Syphilis by CHWs
among the key population in South Sulawesi,
Indonesia, by implementing HIV CBS. FGDs andinterviews were audio-recorded with permission
from the informants, transcribed verbatim, andanalyzed deductively following the thematic
framework approach.

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Results: Sixty-three informants (49 men and 14
women) aged 21-57 participated in the FGDs andinterviews. POCT HIV Syphilis was potentiallyacceptable and feasible to implement across thegroups of informants. The service beneficiaries
expressed their willingness to be tested by trained
CHWs using POCT HIV Syphilis. The CHWs felt thatthey could conduct capillary-based rapid HIV andsyphilis testing. Health workers mentioned that
rapid tests are not a problem for the community ifthey have been trained because they are simple toperform. Stakeholders stated that it is feasible for
non-health professionals to implement thisapproach. The academicians mentioned thatcapillary blood tests are easy to implement, evenby community members. Regarding theeffectiveness of this method, all the informants
expressed that it could overcome the HIV service
constraints in health facilities and support theIndonesia national HIV program.
Conclusion: The point-of-care testing (POCT) of
HIV Syphilis is potentially acceptable and feasible
to perform by community health workers byimplementing community-based services andeffectively supporting the HIV program inIndonesia.

Poster Abstract

104

Increasing access to SelfCare:
Employing a online-based
demand generation strategy toincrease uptake of peer-led
unassisted HIV self-testing
among key populations in thePhilippines
Brines R1, Rosadino J1, Domingo R1, Cruz D1, Brines
M1, Pagtakhan R1, Dinglasan J, Pe-Benito J1, Gray
C1, Pagtakhan A1, Junio P
1Loveyourself Inc., Mandaluyong, Philippines

Background: Ease of access is one factor in getting
tested for HIV. The imposed limited mobility due
to COVID-19 limited this access even further. Since
its introduction in 2020, unassisted HIV self-testinghas been established as a choice for key
populations to access HIV testing in thePhilippines. Aiming to bring HIV testing awarenessto key populations, a program designed togenerate demand is introduced in SelfCare(LoveYourself's unassisted HIV self-testing
program).
Description: Guided by the AIDA model (Figure 1),
this program aimed to create awareness anddemand generation by creating a massive numberof leads of potential clients accessing SelfCare. A
communications plan was designed by membersof key populations to determine the campaign
architecture, keeping in mind the target market:
gay, bisexual, and other men who have sex withmen (GBMSM) and transgender people. The key
messages focused on testing information, access,and its impact on the lifestyle of clients. The visual
theme and the messages developed include a
motivational tone of espousing selfempowerment. These campaigns are promoted on
various social media platforms.
Lessons Learned: The communications plan was
implemented starting in October 2020. The
continuous posting of content has increased
uptake by 1,012% compared to data from JulySeptember 2020. During the campaign, a total of
513,024 clients were reached (as of Dec 2022).

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These campaigns have generated 20,043 clients
accessing SelfCare, with a reactivity rate of 6%
among those who reported results. 39.13% of theclients tested for HIV for the first time. Among
those reactive, 75.33% of clients have beenenrolled in treatment.
Conclusions: It was seen that demand generation
campaigns powered by the community are
effective in bringing awareness of HIV self-testing.
Community consultations are essential in creatingthese programs for key communities. This
momentum will be maintained with offline
community engagement activities and campaigns
promoted on other online platforms.

Poster Abstract

128

105

performance. EQA results were submitted to Thai
NIH electronically 15 days after receiving panel.

Implementation of the firstquality control program for
HIV recent infection testing
using dried tube specimens in
Lao People's Democratic
Republic, 2022

Result: Almost all laboratories demonstrated
satisfactory results during all three rounds of QC:
11/12 (92%) in June, 10/12 (83%) in July, and11/12 (91%) in August. The two rounds of EQA
performed in June and August 2022 were satisfied
by 8/11 (72%) and 5/10 (50%) laboratories,
respectively. The most common cause of error was
not following HIV-1 RTRI testing instructions andnot allowing the DTS sample panel to completely
dissolve prior to testing.

Suparak S1, Ngueanchanthong K1, Unpol P1, Pimpa
Chisholm S1, Jomjunyoung S1, Thanyacharern W1,
Smanthong N1, Pinrod P1, Yingyong T2, Xayadeth
S3, Somoulay V3, Tasaneeyapan T4, Nookhai S4,Rojanawiwat A1, Northbrook S4Conclusion: The DTS QC/EQA sample panel wasconveniently transported at room temperatureand did not require infectious substances
regulation for shipping, an importantconsideration for EQA programs in rural andremote areas. The QC/EQA program for HIV-1 RTRI
identified further areas to strengthen the qualityof HIV recency testing. Ongoing review oflaboratory performance will ensure that identified
problems are addressed to prevent consistentproblems from recurring.

1Department of Medical Sciences, Ministry of Public Health,

Nonthaburi, Thailand, 2Department of Disease Control, Ministryof Public Health, Nonthaburi, Thailand, 3National Center for
Laboratory and Epidemiology (NCLE), Ministry of Health,
Vientiane, Lao People's Democratic Republic (Lao PDR), 4U.S.
Centers for Disease Control and Prevention, Division of Global
HIV/ TB, Thailand and Laos, Nonthaburi, Thailand

Background: Quality assurance programs are
critical to ensure consistency and reliability of test
results. We established the first implementation ofquality control (QC) and external quality
assessment (EQA) for the national rollout of HIV
recent infection surveillance using Asante HIV-1
Rapid Test for Recent Infection (HIV-1 RTRI) in the
Lao People’s Democratic Republic in 2022.
Method: We developed an ambient temperature
shipment using plasma specimens from the Thai
Red Cross Society to prepare dried tube specimens(DTS) for quality control of HIV-1 RTRI testing.
Twenty microliters of the HIV negative, recent, andlong-term samples were aliquoted into individualtubes and dried at room temperature in abiosafety cabinet overnight. DTS QC/EQA panel for
HIV-1 RTRI were tested for homogeneity andstability according to ISO 13528:2022 statisticalstandard. The sample panels, including 72 recent,
72 long-term, and 60 negative samples, were sentfrom the Thai National Institute of Health (NIH) to
the Lao National Center for Laboratory andEpidemiology (NCLE) at ambient temperature inJune, July, and August 2022. NCLE further
distributed the sample panels to all 12 treatment
laboratories. Laboratories examined QC negative,
recent, and long-term samples using HIV-1 RTRI
and investigated causes of <100% satisfactory

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Poster Abstract

106

Revolutionizing HIV Viral Load
Testing: A Leap Towards NonInfectious, Stable Quality
Control Materials
Suparak S1, Ngueanchanthong K1, Unpol P1,
Jomjunyoung S1, Xayadeth S2, Somoulay V2,
Tasaneeyapan T3, Nookhai S3, XANGSAYARATH P2,
Rojanawiwat A1, Northbrook S3
Ministry of Public Health, Department of Medical Sciences,
Nonthaburi, Thailand, 2National Center for Laboratory andEpidemiology (NCLE), Ministry of Health, Veintain, Lao People's
Democratic Republic (Lao PDR), 3U.S. Centers for Disease
Control and Prevention, Division of Global HIV/ TB, Thailand andLaos, Nonthaburi, Thailand
1

Background: Quality control (QC) materials areindispensable in HIV Viral Load testing, serving as
benchmarks for accuracy and effectiveness inmonitoring antiretroviral therapy. Traditional QC
materials are sourced from infectious HIV plasma.
Challenges include inherent infectiousness, safetyconcerns, low stability, and the requirement forcold chain logistics. We addressed thesechallenges by developing a method for preparing
QC material for HIV Viral load that is noninfectious, stable at ambient temperature, andscalable, particularly in resource-limited areas.
Methods: The project focused on cultivating 8E5
cells (ATCC® CRL-8993), a lymphoblastoid cell linewith integrated HIV DNA, to harvest noninfectious
HIV RNA from the cell culture supernatant. A
protocol was developed where 50 microliters ofsupernatant were aliquoted into individual tubes
and dried at room temperature within a biosafetycabinet, followed by testing for homogeneity andstability per ISO 13528:2022 standards. In
collaboration with the Thai National Institute of
Health (Thai NIH), Department of Medical
Sciences, Ministry of Public Health, Thailand, andthe National Center for Laboratory andEpidemiology (NCLE), Ministry of Health, Lao
People's Democratic Republic (Lao PDR), the dried
QC material was distributed to 12 hospitals for QC
and proficiency testing from February to August2022 in the Lao People's Democratic Republic. QC
samples, sent monthly at two levels (4 log
copies/ml and 5 log copies/ml) over 6 months, met
the evaluation criteria of mean ± 2 standard

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129

deviations (SD). Proficiency testing, conducted inthree rounds with four samples each, assessed
performance using z-scores, meeting criteria when|z-score| was ≤ 2.00 compared to consensus from
12 member laboratories. Laboratories reporting
discrepancies identified and rectified sources oferror.
Results: The developed QC material exhibited ahigh concentration of non-infectious HIV RNA,
reaching levels up to 8 log copies/ml, a significant
achievement in terms of quantity. Moreover, thisnon-infectious QC material demonstrated
excellent homogeneity and maintained stability atroom temperature (20-30°C) for at least 22 days,
representing a notable improvement over the
existing serum/plasma infectious materials. Thisfeature particularly enhances its utility in areas
lacking cold chain facilities. Over 83% of thelaboratories reported accurate results, with 71%
exceeding precision within the acceptable Z-score
criteria (≤ 2.00). This high rate is indicative of the
QC material's reliability. The cause of discrepant
results was attributed to both the testingprocedure and the reconstitution of the dried
QC/EQA sample.
Conclusion: The non-infectious, roomtemperature-stable QC material for HIV Viral Loadtesting represents a significant improvement in
the quality and reliability of diagnostics andtreatment monitoring. The production process of
this dried QC material was registered forintellectual property at the Thai NIH. Thismethodology not only enhances safety but also
expands the accessibility and feasibility of accurate
HIV viral load testing, especially in resource-limited
settings.

Poster Abstract

107

Lessons learned from
implementing multilingual HIV
and syphilis testing events forinternational migrants in Japan
Kitajima T1, Sawada T2, Miyakubi H3, Hue T4, Li C5,
Ikushima Y6, Nakamura H7, Shinzato N8, Honda N9,
Shyakya S10
1Faculty of Social Sciences, Kyorin University, Tokyo, Japan,

2Minatomachi Clinic, Yokohama, Japan, 3Faculty of Foreign
Studies, Kyorin University, Tokyo, Japan, 4Faculty of Literature,
Kobe Women's University, Kobe, Japan, 5Tokyo College, The
University of Tokyo, Tokyo, Japan, 6Place Tokyo, Tokyo, Japan,
7University of the Ryukyus Graduate School of Medicine,
Nakagami, Japan, 8University of the Ryukyus Hospital ,Nakagami, Japan, 9Dokkyo Medical University Saitama Medical
Center, Koshigaya, Japan, 10Japan Foundation for HIV
Prevention, Tokyo, Japan

Background: As of 2023, about 3.2 million
international migrants lived in Japan, with 80%
from neighboring Asian countries. Nearly 50% of
the migrants are in their 20s and 30s. In 2022,
about 28% of international migrants in Japan were
not aware of their HIV status until they developed
HIV-related advanced symptoms.
Description: We organized 21 free and anonymous
multilingual HIV and syphilis testing events acrossmultiple prefectures in Japan, including Tokyo(since 2021), Okinawa (since 2022), Sendai (since2023), and Saitama (since 2023). The project isfunded by the Health Labour Sciences Research
Grant, aiming to improve access to HIV testing andmedical services among international migrants.
We advertised the testing events in multiple
languages (e.g., English, Chinese, Vietnamese, and
Nepali) via international social media platforms(e.g., Facebook), migrant communities, and dating
apps with direct links to the testing booking site inrespective languages. At testing sites, participants
could ask for online medical interpretation free ofcharge. A total of 247 people made reservations,of whom 67.7% (n=167, from 22 nationalities)
came to the event and received tests. About 81.0%
were male, 85.9% were in their 20s or 30s, and35.9% tested for HIV for the first time. One HIVpositive case (0.6%) and two new syphilis cases(1.2%) were identified and referred to medical
facilities accordingly. Nearly 50% of theparticipants opted for PrEP consultation.

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130

Lessons learned: Our HIV/syphilis testing project
demonstrated the feasibility of expanding HIV
testing among international migrants in Japanthrough multilingual outreach efforts and testing
services. Although PrEP has not been officiallyapproved in Japan, there is a substantial interest in
using PrEP as regular HIV prevention amonginternational migrants. The high non-attendance
rate among those who made online appointmentssuggests the potential barriers from the intentionof testing to actual testing uptake. More researchin diversifying HIV testing provision - especially in
non-clinical settings is highly needed.
Next steps: We want to explore the possibilities of(1) adding our multilingual testing model to HIV
testing services at public health centers andmedical facilities, (2) engaging international
communities in organizing the testing events, and(3) providing mail HIV testing in multilingual
formats.

Poster Abstract

109

Do young people prefer to use
HIVST? Evidence from a choice
experiment in northeastern
Thailand
Kitajima T1, Muadthong S2, Wattananamul V3,
Pagaiya N3, Muangyim K4
1Faculty of Social Sciences, Kyorin University, Tokyo, Japan,

2Sirindhorn College of Public Health, Khon Kaen, Khon Kaen,

Thailand, 3Independent researcher, Khon Kaen, Thailand,

4Siridhorn College of Public Health, Chon Buri, Chon Buri,

ThailandBackground: HIV testing represents the initialstage of linkage to the HIV care continuum.
However, in Thailand, as well as in many othercountries, many younger people are hesitant toundergo testing due to concerns attached tostigma from healthcare workers and have areluctance to be observed by others at HIV testingvenues. Although the Thai government recently
sanctioned the commercial use of HIV self-test kits
(HIVST), their adoption among young people,
particularly those in provincial areas, remains
limited. The factors conducive to promoting andimproving the uptake rates of HIVST among youth
have yet to be fully understood. Such insights
could prove invaluable in devising strategies forthe dissemination of HIVST. This study exploredyouth preferences regarding the utilization of
HIVST.
Materials and Methods: A generic discrete choice
experiment (DCE) was conducted amongindividuals aged between 15 and 24 residing in aprovince in northeast Thailand. DCE is a survey
method based on attributes designed to measure
preferences. Participants who reported engaging
in sexual activity within the previous six months
were recruited through social networking sites(SNS) and a non-governmental organization (NGO)focused on advocating HIV and STI prevention athigh schools in the province. They were presented
with the choice between HIVST provision scenario
1, scenario 2, or neither. The HIVST provisions
varied across six attributes: (1) location forreceiving the test kit (public hospital/NGO/private
hospital/convenience store/pharmacy/homedelivery), (2) pretest support (none/inperson/phone/online), (3) posttest support

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131

(none/online/phone/in-person), (4) anonymity(yes/no), (5) type of test (blood-based/salivabased), and (6) out-of-pocket payment amount.
Data analysis was conducted using a conditional
logistic regression model.
Results: Of 438 respondents, 42.7% were male,with an average age of 17.1±1.5 years; 80.8%
resided outside the capital district; 95.2% had
never undergone HIV testing previously, and 2.7%
had used HIVST. All attributes, except for the typeof test, significantly influenced the decision to opt
for HIVST. Among them, 79.2% preferred ascenario similar to the existing situation, where
they could obtain the free HIVST kit anonymously
from a public hospital, with in-person counselingfor both pre- and post-test procedures.
Conclusions: This study revealed that young
people in the province exhibit a preference forobtaining HIVST kits from public hospitals. Given
that the majority of participants had neverundergone an HIV test before, they may have felt
more assured and at ease accessing testing
services at public hospitals with in-person
counseling, rather than at locations such as
convenience stores. Additionally, individuals
residing outside the capital district may encounterchallenges accessing pharmacies and convenience
stores. Further research is warranted to ascertain
whether individuals with prior HIV testing
experience and those residing in urban areas sharesimilar preferences.

Poster Abstract

110

Introducing Social and Sexual
Network Testing in thePhilippines through Pilot
Capacitation of HIV Service
Delivery Sites in Greater
Manila: A Novel Step in
Expanding HIV Testing in thePhilippines
Salinas R1, Serrano J1, Pahang R1, Oclima M1,
Carrascal S1, Castañeda B1, Ismael C2, Echave R2,
Reyes J3, Ortiz D4
1Family Health International 360 - EpiC HIV Philippines, Makati,
Philippines, 2Regional TB and HIV Support Network, Pampanga,
Philippines, 3General Trias Social Hygiene Clinic, General Trias,
Philippines, 4Laguna Medical Center, Laguna, Philippines

Background: In 2019, the WHO recommended
Social and Sexual Network Testing (SSNT) as anadditional service for expanding HIV testing
services (HTS). SSNT is based on the idea that
individuals belonging to the same social network
carry similar risks and behaviors. It is conducted by
identifying people living with HIV or those withongoing risk of HIV, and engaging them toencourage those in their network to avail HTS.
Since 2022, the Philippines has recommended
SSNT in its guidelines for differentiated HTS.
However, SSNT has since remained
unsystematically practiced in the country. To
bridge this gap, the USAID-supported Meeting
Targets and Maintaining Epidemic Control (EpiC)
project in the Philippines selected 3 HIV service
delivery sites as targets to operationalize SSNT.
Description / Methods: Three sites were selected
for SSNT capacitation in the Greater Manila Area.
Given the network-based strategy of SSNT, theRegional TB and HIV Support Network (RTHSN)
was selected as it was the HTS community-basedorganization with the lowest reported reactivity
rate. In addition, the two facility-based HTS sites
with the most limited staffing for community
outreach were identified for capacitation, namely
the General Trias Social Hygiene Clinic (GenTri
SHC) and the Laguna Medical Center (LMC).

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132

Capacitation was provided since October 2022 on
the following themes: (1) SSNT framework
creation; (2) community engagement; and (3) data
analysis. SSNT framework creation included codevelopment of the workflow and staff training for
online HIV service booking (QuickRes.org).
Community engagement included network
mapping, recruiter enrollment, and focus group
discussions on SSNT. Meanwhile, data analysis
spanned deep dive sessions and optimization of
the SSNT pipeline based on real-time findings.
Following the sessions, RTHSN observed
incentivized SSNT, whereas GenTri SHC and LMC
followed a non-incentivized mode.
Lessons Learnt / Results: Since the first quarter of
SSNT capacitation (October to December 2022), an
uptick in HIV tests reached through SSNT was
reported for all sites (RTHSN: Δ65; GenTri SHC: Δ5;
LMC: Δ20). RTHSN displayed an expanding
network based on increasing SSNT-reached HIV
tests (R=0.81), tapping 90 individuals by Q4 2023.
Meanwhile, a weakly positive enrollment growthin GenTri RHC (R=0.47) and static enrollment in
LMC (R=-0.05) were reported. The average shareof SSNT-reached tests over total HIV tests
conducted was determined (RTHSN: 3.31%, GenTri
SHC: 0.94%, LMC: 16.88%), peaking at Oct-Dec
2023 for RTHSN (4.72%) and GenTri SHC (1.29%),and immediately following capacitation for LMC(35.71%).
Conclusion: The introduction of SSNT in thePhilippines has provided a valuable tool for
expanding HIV testing, with SSNT accounting for
up to 35.71% of total HTS referrals immediately
after capacitation in LMC. However, SSNT
generally tapered, suggesting saturation of
networks or greater resource requirements.
RTHSN, which followed an incentivized SSNT
pipeline, displayed consistent expansion inreferrals, suggesting that incentivization may help
sustain SSNT networks. The implementation of
SSNT could be replicated in other regions. Further
studies could likewise be conducted to (1)determine the factors leading to potential decline
in SSNT recruitment over time; and (2) evaluate
the resources and monitoring needed to preserve
expansion of SSNT networks.

Poster Abstract

111

Scaling-up Index Testing
Services through Qualitative
Evaluation and Capacity
Building for a Non-Profit
Organization for PLHIV in
Metro Manila, Philippines
Serrano J1, Valmores R1, Pahang R1, Carrascal S1,Bragado R2, Casabuena K2
1FHI 360 - EpiC HIV, Muntinlupa, Philippines, 2Positive Action

Foundation Philippines Incorporated, Manila, Philippines

Background: Positive Action Foundation
Philippines Incorporated (PAFPI) is a non-profit
organization of people living with HIV (PLHIV) thatprovides a comprehensive HIV service package
from prevention, testing, and treatment to careand support. As part of its HIV testing services,
PAFPI implements partner notification or Index
Testing (IT) as one of its case-finding strategies.
However, despite having a strong PLHIV staff andvolunteer network, there needed to be a faster
uptake of IT among clients, with only 4 PLHIV
enrolled in the service between October 2022 andJanuary 2023—the 13 referrals tested with anaverage reactivity rate of 15%.
Description: To scale up IT services, the USAIDsupported Meeting Targets and Maintaining
Epidemic Control project (EpiC) in the Philippines
worked with PAFPI between December 2022 toJanuary 2023 to evaluate the IT process. The
evaluation entailed collecting qualitative data
through key informant interviews (KII) and focusedgroup discussions (FGD) to identify barriers
hindering IT participation. EpiC co-developed withPAFPI capacity-building sessions that addressed
the identified barriers. PAFPI staff conducting IT
services from three sites in Manila, Navotas, andValenzuela (all in Metro Manila) attended thesecapacity-building sessions.
Lessons Learned: KIIs were conducted with 10 HIV
service providers attending, while 6 case managers
participated in the FGDs. During these
consultations, the following barriers wereidentified: 1) gaps in the IT guidelines workflow, 2)
the need for job aids in conducting the IT service,

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1333) lack of knowledge of providers in IT, and 4)
hesitancy of both PLHIV and their referrals toparticipate in due to low confidence in the IT
process. To address these barriers, EpiC worked
hand in hand with PAFPI to align the governmentprovided workflow of IT with international
standards, which included an extensive consent
process, encoding and monitoring of IT data, andinclusion of Intimate Partner Violence (IPV)
services in the workflow. Epic also helped develop
job aids localized in Filipino to be more accessible
to providers. Likewise, the developed capacitybuilding session that integrates IT, IPV, andMotivational Counseling aimed to increaseproviders' knowledge and improve the confidenceof clients and their elicited contacts to participate
in IT services. The capacity building session held on
January 23, 2023, was attended by 23 providers
across the 3 PAFPI sites. As of February 2024, 153
PLHIV availed the improved IT services, and of the
144 elicited contacts, 89 referrals (61%) proceededwith testing, contributing to an average reactivity
rate of 25%.
Conclusion: IT service uptake can be increased by
identifying barriers through an extensive
evaluation of the process, aligning the conduct of
the service based on the evaluation results, andproviding tailored capacity-building sessions toaddress concerns. From the lessons learned in thisinitiative, other facilities conducting IT services canreplicate the process to improve participation andincrease case finding.

Poster Abstract

112

Lessons Learned from
Cambodia's Integrated Pointof-Care Testing for Preventionof Mother-to-Child
Transmission (PMTCT) of HIV
Mohan S1, Vichea O2, Koeun C2, Mom C2, Narith R3,
Chhorn S4, Kim L1, Pong K1, Rioja M1
Clinton Health Access Initiative, Phnom Penh, Cambodia,

12National Center for HIV/AIDS, Dermatology and STD, Phnom

Penh, Cambodia, 3National Center for Tuberculosis and Leprosy
Control, Phnom Penh, Cambodia, 4National Maternal and Child
Health Center, Phnom Penh, Cambodia

Background: Cambodia has achieved significant
progress in reducing Mother-to-Child Transmission(MTCT) of HIV from rates of transmission droppingfrom 32% to 9.9% from 2007 to 2022. However,centralized testing and long wait times for of HIVviral load (VL) results in mothers and early infant
diagnosis (EID) remain a bottleneck as we try tomove towards elimination goals. Point-of-CareTesting (PoCT) using GeneXpert devices, currently
used for tuberculosis (TB) diagnosis, offer apotential solution to improve access and provide
rapid test result at the point of care.
Pilot Design and Objectives: A PoCT pilot program
was initiated in 2023. This initiative involved
collaboration between the National Centre for
HIV/AIDS, Dermatology and STD (NCHADS), theNational Centre for Tuberculosis and Leprosy
Control (CENAT), and the National Maternal Child
Health Centre (NMCHC) with an aim to integrate
HIV VL testing for HIV-positive mothers andexposed infants using GeneXpert devices inexisting health facilities.. The pilot assessedfeasibility, effectiveness, impact on service
delivery, patient outcomes, and programmatic
complexities. Key lessons learned during pilot
implementation are valuable for Cambodia’splanned national scale-up.
Lessons Learned:•Demonstrating Feasibility of Integrated Testing:
The pilot underscored the viability of utilizing
GeneXpert for integrated testing of HIV VL, EID,
and TB. This highlights the potential for
repurposing existing infrastructure and technology

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024134

to conduct multi-disease testing, in turn enhancing
efficiency and optimizing resources.
•Effective Stakeholder Engagement: Recognizing
the importance of strong coordination,communication, and shared accountability among
stakeholders at all levels. Clearly defining roles andresponsibilities among programs is pivotal for
successful implementation.
•Early Involvement of Clinicians and Laboratory
Staff: Acknowledge the significance of involving
Anti-retroviral therapy (ART) clinic and laboratory
staff from the outset. Their involvement ensures
optimal patient flow, accessibility of tests, andfosters demand for integrated testing, promoting
ownership and accountability.
•Emphasize Regular Monitoring and Supportive
Supervision: Highlight the necessity of proactive
monitoring and supervision to address challenges
promptly. This approach supports clinic and lab
staff in delivering integrated services andenhances documentation for informed decisionmaking and process improvement.
•Ensure Consistent Supply Chain: Understand thecritical importance of maintaining timely andconsistent supplies of cartridges and commodities
to prevent service disruptions due to stockouts or
expiry.
•Promoting High User Satisfaction: Feedback
obtained via a phone survey from healthcare staff
revealed a high level of satisfaction and trust in theavailability and results of PoCT. This positive
perception among healthcare providers is crucial
for fostering program adoption and ensuring
sustainability.
Challenges and Future Directions: Despite thepilot's success, challenges remain. The program
acknowledges the need to address relevant
programmatic complexities, such as ensuring
sustainable financing, integrating PoCT into
existing data management systems, andestablishing robust quality assurance mechanisms.
Conclusion: Cambodia's GeneXpert PMTCT PoCT
pilot proves integrated testing is feasible,
leveraging existing resources for multi-diseasediagnosis. Success hinged on stakeholder
engagement, clinician/lab involvement,
monitoring, and supply chain stability. High user
satisfaction suggests Point-of-Care Testing's (PoCT)
potential for wider adoption and sustainable
healthcare improvements in resource-limited
settings. These learnings are crucial for scaling up
integrated testing in similar contexts.

Poster Abstract

135

113

follow-up questionnaire and the baseline blood
tests were repeated every 3 months.

Real-world experience ofproviding HIV pre-exposure
prophylaxis for female sex
workers in Hong Kong

Results: Out of the 122 potentially eligible FSW,
14 were recruited and completed the baseline
assessment. All participants were Chinese withmedian age 44 (interquartile range [IQR] 29.5, 51)
and 33% received only primary education. The
median duration of commercial sex work was 2.5
years (IQR 1, 4). The commonest reasons for using
PrEP were protecting themselves from HIV (86%),
perceived high HIV risk (43%) and following advice
from others (25%). One participant had taken PrEP
before the study. Median monthly number ofregular clients were 8 (IQR 4, 19) and medianmonthly new clients were 10 (IQR 3, 20). Over half
(57% ) reported 100% condom use for vaginal sex
with all clients at baseline. Four were notprescribed PrEP after baseline assessment becauseof medical problems, concerns about side effects
and pill count, and equivocal HBsAg result. Ten
participants received PrEP and each had an
average of 3.3 follow-up visit. Four discontinued
PrEP because of gastrointestinal upset (3) orperceived low HIV risk (1). Reported PrEP intake
over 25 days in the past month was reported in
66% of all visits and most participants reported no
condomless vaginal sex unprotected by PrEP(70%). The commonest symptoms reported during
PrEP were lethargy (60%) and nausea (50%). Most
participants reported ‘confident in preventing HIV
infection’ (80%), ‘reduced worry about HIV’ (70%),
and two reported increased sexual pleasure while
on PrEP. Two reported ever having condomless sex
because of PrEP. No HIV incidence was recorded.

Lee K1,2, Wong N2,3,4, Chan D2,3, Kwan T2,3,4, Lui G5,
Lee S2,3
1Department of Psychiatry, LKS Faculty of Medicine, The

University Of Hong Kong, Hong Kong, Hong Kong, 2Stanley Hofor Emerging Infectious Diseases, Chinese University of Hong
Kong, Hong Kong, Hong Kong , 3S.H. Ho Research Centre for
Infectious Diseases, The Chinese University of Hong Kong, Hong
Kong, Hong Kong, 4Jockey Club School of Public Health andPrimary Care, The Chinese University of Hong Kong, Hong Kong,
Hong Kong, 5Department of Medicine and Therapeutics, The
Chinese University of Hong Kong, Hong Kong, Hong Kong

Background: Real-world experience on the use of
HIV pre-exposure (PrEP) prophylaxis for female sex
workers (FSW) in high-income countries is limited.
As part of a wider PrEP implementation study,
PrEP were offered to FSW in Hong Kong after
several presumably locally-acquired HIV infections
were detected among the FSW. This study
described the participants’ profile, theirtolerability and compliance of PrEP and attitudes
towards PrEP.
Materials and Methods: The study was conductedin August 2022 - June 2023. Medications and all
associated investigations were offered free-ofcharge at a local community organization. Female
aged 18 years old or above, tested anti-HIV
negative, had commercial sex and associated highrisk sexual behaviours in the past 6 months andintended to continue doing so in the following 6
months were eligible to participate. Exclusion
criteria were chronic HBV infection, impaired renal
function, pregnancy or planning a pregnancy.
Consented participants completed a baseline
survey, a doctor’s assessment and provided blood
samples for anti-HIV, HIV RNA, HBsAg andcreatinine. Pregnancy tests were offered if
necessary. Co-formulated Tenofovir Disoproxil
Fumarate 300mg / Emtricitabine 200mg (TDF/FTC)
was prescribed as a once-daily dose for 2 weeks
then subsequently for up to 4 weeks unlesscontraindicated. At each subsequent visit,
participants underwent a doctor’s assessment,
rapid tests for HIV and syphilis and completed a

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusion: Provision of PrEP for FSW at a
community organization was feasible. The uptakeof PrEP was low despite recent local infections andthe service being totally free-of-charge.

Poster Abstract114

Efficacy and Safety of
Switching to Dolutegravir plus
Lamivudine in HIV-1 infected
adults with virologicalsuppression and evidence of
TDF toxicity: interim analysis
through week 24
Zhang R, Wang Z, Liu L, Chen J, Wang J, Qi T, Sun J,
Song W, Tang Y, Xu S, Yang J
Shanghai Public Health Clinical Center, Shanghai, China

1

Purpose: This study aimed to investigate theefficacy and tolerability of dolutegravir plus
lamivudine (DTG+3TC) in HIV-1 infected adults
who were virologically suppressed andexperienced TDF-related renal toxicity.
Method: Participants in this single-center,
prospective, uncontrolled, open-label and singlearm interventional study were virologicallysuppressed (plasma HIV-1 RNA <40 copies/mL)
adults aged 18 to 75 years. Eligible participants
had been on a stable TDF-based regimen at least 6months prior to screening and exhibited TDFrelated renal toxicities. Participants switched to
DTG+3TC. The end point included the proportionof patients with virologic failure (HIV-1- RNA ≥ 40
copies/mL), CD4+ cell counts, lipid profile andrenal biomarkers etc.
Results: A total of the 36 participants with a
median age 44 years were included in this interim
analysis. Overall, 34 (94.4%) participants weremaintained HIV-1- RNA < 40 copies/mL (p = 0.5).
One subject had HIV-1 RNA 47.5 copies/mL atweek 24 but resuppressed thereafter, while
another subject had HIV-1 RNA 76.6 copies/mL atweek 24, requiring further follow-up. Neither
subject met confirmed virologic withdrawal
criteria nor needed regimen modification throughweek 24. The mean of CD4+ cell count changed
from 568.75 cells/mm3 at baseline to 582.90
cells/mm3 at week 24. For renal biomarkers,
through week 24, serum creatinine increased from89.05 μmol/L to 105.09 μmol/L (p < 0.05) andeGFR decreased from 87.36 ml/min*1.73m2 to

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71.58 ml/min*1.73m2 (calculated by serum
creatinine, p < 0.05). No change in serum cystatin c(0.88 mg/L to 0.87 mg/L, p = 0.663) was observed.
Urine microalbumin/creatinine ratio significantly
decreased from 37.99 μg/mg to 12.19 μg/mg (p =0.042) and urine β2-microglobulin obviously
decreased from 1163.39 μg/L to 360.60 μg/L (p =0.002), both indicating improvement in renal
function. For lipid parameters, through week 24,
HDL-C, TC and LDL-C increased from 1.14 mmol/L
to 1.19 mmol/L (p = 0.013), from 4.73 mmol/L to
4.75 mmol/L (p = 0.924) and from 2.70 mmol/L to
2.99 mmol/L (p = 0.04), respectively. TG decreased
from 2.07 mmol/L to 1.41 mmol/L (p = 0.002).
Conclusion: In virologically suppressed adults withexhibited TDF-related toxicity, switching to
DTG+3TC demonstrated durable efficacy, goodtolerability and favorable recovery of renal
function through 24 weeks. Mild changes increatinine consistent with previous studies, were
due to the nonpathologic inhibition of the organic
cation transporter 2 in the proximal renal tubules.
The impact on lipid profile was neutral and lacked
clinical significance. The study results further
bolster confidence in the clinical benefits ofswitching to DTG+3TC for patients experiencing
TDF-related renal toxicity.

Poster Abstract

115

Enhancing HIV Care: Rapid
Antiretroviral Therapy
Initiation in a CommunityBased Organization Clinic in
Kuala Lumpur, Malaysia
Basri S1,2,3, Mohamad Fauzi M3, Mohamad Salim S3,Tai R3, Raja Azwa R
University Malaya Medical Centre, Kuala Lumpur, Malaysia,

1

2Centre of Excellence for Research in AIDS (CERiA), Kuala

Lumpur, Malaysia, 3Community Health Care Clinic (CHCC), PT
Foundation, Sentul, Malaysia

Background: Rapid initiation of antiretroviraltherapy (ART) has shown to improve clinicaloutcomes for people living with HIV(PLWH).However, effectively implementing thisvital intervention, especially in resourceconstrained environments utilizing decentralized
methods like community-based organization (CBO)
services, poses a pressing challenge. In Malaysia,
the Community Health Care Clinic (CHCC) operated
by the PT Foundation stands out as a prominent
CBO, offering HIV care and sexual health services
through a socially entrepreneurial service delivery
model since late 2018. The potential of CBO-led
services to expand HIV care delivery in our nation
remains largely untapped. Thus, our study aimed
to evaluate the feasibility of rapid ART initiation
for newly diagnosed patients within this CBOoperated clinic.
Methods: CHCC serves as a comprehensive center
for STI/HIV screening, treatment, and prevention,offering near-patient diagnostics like the PIMA
CD4 analyzer and GeneXpert for HIV viral load
determination to facilitate rapid ART initiation.
This descriptive single-center study encompassed
all newly diagnosed HIV patients seen at CHCC or
referred to the clinic from January 2019 to
December 2023. Data on socio-demographics,
clinical characteristics, and ART initiation
outcomes were gathered. Rapid ART initiation was
defined as ART initiation within 7 days of the firstclinic visit upon the diagnosis.
Results: Among 293 newly diagnosed HIV patients,
92.8% were men (70.1% MSM), 5.1% were
women, and 2% were transgender. The median

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age at diagnosis was 32 (IQR 27-39) years, with a
median nadir CD4 count of 304 (IQR 201 – 430)
cell/mm3. The median time from the first clinic
visit to ART initiation was 7 (IQR 2 – 15) days. The
majority, 96.9% initiated TDF/FTC/EFV, in line with
our national guideline. Of the patients, 16.0%
started ART at same day, 19.5% had rapid ART
initiation, 41.6% experienced delayed ART
initiation while 22.9% were referred togovernment facilities without ART initiated,primarily due to cost and logistic issues (51.6%).
Delayed initiation was mainly attributed to clinic
structural barriers (63.3%) such as delayed
appointment following confirmatory tests;
followed by trimethoprim-sulfamethoxazole (TMPSMX) initiation before ART (19.3%), and patientrelated factors (8.3%), including denial andunreadiness to start ART.
Conclusion: This study underscores the feasibilityof rapid ART initiation within a CBO-led clinic in
Malaysia. Enhancements in clinic services are
crucial to ensuring timely ART initiation, in linewith updated WHO guidelines advocating for TMPSMX and ART initiation concurrently. Financial
support for rapid ART initiation before referral togovernment facilities is recommended to
streamline the process and optimize patient
outcomes.

Poster Abstract

116

Roles and experiences ofcommunity action workers in acommunity-based
antiretroviral therapy delivery
model for people living with
HIV in Cambodia: A mixedmethods cross-sectional study
Chhoun P, Zahari M1, Nagashima-Hayashi M1, Yam
E1, Chhoun P2, Samreth S3, Tian Z1, Ngauv B3, Ouk
V3, Tuot S2,4, Yi S1,2,5
1National University Of Singapore, Saw Swee Hock School of

Public Health, Singapore, Singapore, 2KHANA Center for
Population Health Research, Phnom Penh, Cambodia, 3National
Center for HIV/AIDS, Dermatology and STD, , Cambodia,
4
University of Tokyo, Graduate School of Medicine, Departmentof Community and Global Health, Tokyo, Japan, 5Touro
University California, Center for Global Health Research, Vallejo,
United States

Background: The Community-Based Antiretroviral
Therapy (ART) Delivery (CAD) model incorporates
Community Action Workers (CAWs) to enhancecare engagement for people living with HIV(PLHIV), thereby alleviating the burden on ART
clinics. This study delves into the roles andexperiences of CAWs in implementing CAD among
stable PLHIV in Cambodia.
Methods: This study utilized both quantitative andqualitative data collected in May 2023 to evaluate
the effectiveness of the CAD intervention within aquasi-experimental framework. The research
spanned the capital city and nine provinces of
Cambodia. CAW-related data, encompassing
incurred expenses, time allocation, support andsatisfaction levels, and perspectives on their roles
in program implementation, were analyzed.
Descriptive statistics assessed proportional
differences in categorical responses, while
qualitative data underwent coding and analysis
using a thematic analysis framework.
Results: Among the 76 participants, 52.6% weremale, and 61.8% were married. The mean age was
48.0 years, ranging from 18 to 72 years, with amean education completion of 8.4 years (ranging
from 0 to 16 years). Most participants (96.1%)
utilized motorcycles for travel, spending an

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average of 5.8 times per month (ranging from 1 to66) to meet people living with HIV. Participants
engaged with about 10 people living with HIV
monthly (ranging from 1 to 35). The majority
reported incurring expenses (84.2%), primarily
related to food (median 1.35 USD; IQR 0.37-2.45)
and travel costs (median 2.45 USD; IQR 1.96-4.90).
Participants expressed confidence in theirknowledge and resources to support theirmembers (93.4%), and 80.3% perceived theirrelationship with personnel at the ART clinics as
good. Their reported responsibilities included
distributing medicines, counseling, and organizing
meetings. They deemed their work essential, citing
significant contributions to community support,
assistance with ART medication accessibility, andpatient monitoring.
Conclusions: This study highlights the multifaceted
responsibilities undertaken by CAWs andemphasizes the significance of recognizing theirroles in augmenting the effectiveness of the CAD
model. As the CAD model assumes a pivotal role incommunity-based HIV care delivery, these insights
make valuable contributions to better
understanding and enhancing support for CAWs in
Cambodia and similar settings.

Poster Abstract

117

Construction and validation of
prognostic scoring models torisk stratify patients withacquired immune deficiency
syndrome‐related diffuse large
B cell lymphoma
Zhao H2, Liu R1, Tao Y1, Bertero L3, Feng L2, Liu B2,
Chen Z2, Guan J2, Liao B2, Li L2, He H2, You H11Children's Hospital Of Chongqing Medical University,

Chongqing, China, 2Guangzhou Eighth People's Hospital,
Guangzhou Medical University, , , 3 University of Turin

Objective: AIDS-related diffuse large B cell
lymphoma (AR-DLBCL) is one of the most common
ARL subtypes, accounting for approximately 45%of these tumors. AR-DLBCL often presents at anadvanced disease stage, with extra-nodal (EN)involvement, high risk of infection and the overallprognosis remains unsatisfactory. Early diagnosis
and treatment of AR-DLBCL is critical. However,there is no specific prognostic model for patientswith AR-DLBCL. Thus, we aimed to construct newclinical prognostic models.
Methods: Clinical features and prognostic factors
for OS and PFS were evaluated by univariate andmultivariate analyses. Variables identified as
significant factors in the univariate Cox analysis
were selected into the multivariate Cox
proportional hazards regression analysis to
identify the independent prognostic factors using
the Forward Stepwise (Conditional LR) method;
The screened factors were introduced into thelogistic regression equation to calculate theprediction probability of an outcome and to draw
the receiver operating characteristic curve (ROC).
The area under the curve (AUC) and Harrell'sconcordance index (C-index) were compared. The
Hosmer-Lemeshow test was used to assess the
goodness of fit of the model. The decision curve
analysis (DCA) was used to reflect the net benefitof the model.
Results: CNS involvement, OI at lymphoma
diagnosis and elevated LDH were selected toconstruct the OS model, namely GZMU OS model;
CNS involvement, OI at lymphoma diagnosis,

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elevated LDH and over 4 chemotherapy cycles
were selected to construct the PFS model, namely
GZMU PFS model. In the training cohort, thepredictive accuracy of prognostic model for OS, asmeasured by AUC was 0.786, compared with 0.555
of risk stratified by IPI, 0.638 of risk stratified by
aaIPI and 0.597 of risk stratified by NCCN-IPI. The
C-index values based on GZMU OS model, IPI, aaIPI
and NCCN-IPI were 0.712, 0.577, 0.649 and 0.587,
respectively. The predictive accuracy of prognostic
model for PFS, as measured by AUC was 0.829,
compared with 0.519 of risk stratified by IPI, 0.609
of the risk stratified by aaIPI and 0.572 of risk
stratified by NCCN-IPI. The C-index values basedon GZMU PFS model, IPI, aaIPI and NCCN-IPI were0.733, 0.536, 0.591 and 0.563, respectively. The
models we constructed showed better risk
stratification than IPI, aaIPI, and NCCN-IPI. In thevalidation cohort, the predictive accuracy ofprognostic model for OS, as measured by AUC and
C-index, GZMU models were the highest.
Furthermore, in combined cohort, the HosmerLemeshow test showed that the models weregood fits (OS: P = 0.8244; PFS: P = 0.9968) and the
DCA demonstrated a significantly better net
benefit. The prognostic efficacy of the proposedmodels was validated independently andoutperformed the currently available prognostic
tools.
Conclusion: In this study, novel prognostic models
with AR-DLBCL patients were constructed andvalidated, namely GZMU OS model and GZMU PFSmodel, which showed better prognosis prediction
efficiency and risk stratification ability than IPI,
aaIPI and NCCN-IPI scoring systems. These novel
prognostic models will help to tackle a clinically
relevant unmet need.

Poster Abstract

118

How well does a tailoredapproach work for the
implementation of anevidence-based intervention:
qualitative findings from a
hybrid type III trial of asystems navigation andpsychosocial counselingintervention (SNaP) for people
who inject drugs living with
HIV in Vietnam
Nguyen M1,2, Bartels S3, Sripaipan T3, Tran H2, Le
G1, Go V3, Miller W3, Powell B41Hanoi Medical University, Hanoi, Viet Nam, 2UNC Project
Vietnam, Hanoi, Vietnam, 3University of North Carolina at
Chapel Hill, Chapel Hill, United States, 4Washington University,
St Louis, United States

Background: People who inject drugs (PWID) beara disproportionate burden of HIV infection. SNaP isan evidence-based integrated systems navigationand psychosocial counseling intervention for PWID
living with HIV. We conducted a hybrid type III
implementation science trial to test two
approaches to SNaP implementation: a standard
multifaceted approach and a tailored approachthat involved the identification of site-specificbarriers combined with implementation
facilitation. We conducted a qualitative study to
explore HIV testing site staff and facilitators fromthe central research team’s perceptions of the
tailored approach and how it affected theirimplementation of SNaP.
Methods: HIV testing sites across Vietnam wererandomized 1:1 to either a standard or tailoredarm (n=42). A standard package of implementation
strategies was implemented by a central team inboth arms. For the tailored arm, a set of tailored
strategies was chosen by each site based on theirown barriers, and the central team met monthly
with sites to facilitate the implementation of thestrategies over time. At 24 months, we purposively
sampled six high-performing and six lowperforming sites in the tailored arm based on the

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primary outcome of fidelity to SNaP. We
conducted in-depth interviews with counselors,
clinic directors, and other staff at these clinics(n=36) as well as additional informal meetings withthe central team to explore their experience withand perceptions of the tailored approach.
Interviews were coded and analyzed using
thematic analysis.
Results: Participants discussed three importantcomponents in the tailored approach that were
beneficial for SNaP implementation: working withthe central team to create an implementation
plan, having implementation strategies tailored totheir site’s specific barriers and monthly meetings
with the central team to review the strategies.
Creating their own implementation plan at the
beginning of the study was perceived to not only
help site staff plan ahead and be more active in
the implementation of SNaP, but also made themfeel more empowered and motivated. Site staff
emphasized the necessity of having tailored
strategies because each site had different barriers
and facilitators to SNaP implementation due totheir available resources, organizational
characteristics and locations. It was also notedthat sites in the same provinces might have similar
characteristics, and learning across sites might beuseful. Participants reported that a few identified
strategies were inappropriate, or less helpful than
expected because of the lack of resources,
overestimation of the strategy’s efficiency orunanticipated barriers. Monthly meetings wereperceived as equally important in providing
continuous support, monitoring and reminders to
implement SNaP and the strategies. The central
team expressed some concerns about the utility ofmonthly meetings for sites with very low
recruitment rates, suggesting some modifications
to make this approach more sustainable, such as
reduced frequency of meetings and integration
with existing meetings.
Conclusions: The tailored approach wasconsidered important and useful for the
implementation of the SNaP intervention for PWID
with HIV in various ways. Some modifications tothis approach might be necessary to make it morefeasible and acceptable when being used in otherlow-resource settings.

Poster Abstract

119

Clinical Characteristics andOutcomes of AIDS-Related
Burkitt Lymphoma in China: A
Retrospective Single-Center
Study
Liu R1, Zhao H2, Xiao G2, Tao Y1, Tang X2, Feng L2,
Liao B2, Liu 2, Guan J2, Li L2, Chen Z2, He H2, You H1Children's Hospital Of Chongqing Medical University,
Chongqing, China, 2Guangzhou Eighth People’s Hospital,
Guangzhou Medical University
1

Objective: The epidemiology of acquired
immunodeficiency syndrome (AIDS)-defining
cancer has changed as a result of combined
antiretroviral therapy (cART), which reduced theincidence of primary central nervous systemlymphoma (PCNSL) and diffuse large B-cell
lymphoma (DLBCL), but showed no significant
effect on Burkitt lymphoma (BL), which remainedlargely stable or even increased over time.
However, there is still a lack of specific prognostic
model for AR-BL patients. Therefore, we analyzed
the clinical characteristics and outcomes ofpatients with AR-BL from our center andconducted a novel risk stratification model topredict prognosis.
Methods: To improve risk assessment, the clinicaldata of 34 patients with AR-BL were collected andthe factors associated with progression freesurvival (PFS) and overall survival (OS) were
evaluated in univariate and multivariate Coxmodels. Variables with a P value of < 0.05 in theunivariate analysis were all selected for themultivariate analysis, and the screened factors
were used with assignment method to calculate
the prediction probability of an outcome and to
draw the receiver operating characteristic curve(ROC). The area under the curve (AUC) and C-index
were compared. The nomogram and calibration
curve were drawn to predict the probability andaccuracy.
Results: With 37-month median follow-up, themedian PFS and OS for AR-BL patients were 14
months and 15 months, respectively. The overall
2-year PFS and OS rates were 40.50% and 36.18%,
respectively. The OS of patients received

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chemotherapy was better compared with those
without chemotherapy (P= 0.0012). Treatment
with an EPOCH-based regimen was associated withlonger OS and PFS compared with a CHOP-based
regimen (OS, P = 0.0002; PFS, P = 0.0158). Then we
established a novel prognostic risk stratification
model named AR-BL model with chemotherapy
and ECOG PS, which showed better stratification
ability than international prognostic index (IPI) or
Burkitt lymphoma international prognostic index(BL-IPI). The predictive accuracy of the here
proposed prognostic model for OS, as measured
by AUC was 0.713 (95%CI 0.535–0.89), comparedwith 0.741 (95%CI 0.566–0.916) of risk stratified by
IPI, and 0.700 (95%CI 0.517–0.883) of risk
stratified by BL-IPI. The C-index values based on
the present AR-BL model, IPI and BL-IPI were 0.76,
0.696 and 0.714, respectively. Furthermore, the Cindex of the nomogram used to predict OS was
0.884 in the entire cohort and the calibration
curve showed excellent agreement between thepredicted and actual results of OS. No HIV-related
factors were found to be associated with OS andPFS of AR-BL patients in our study.
Conclusion: Overall, the clinical characteristics andoutcomes in AR-BL were showed and prognostic
factors for OS and PFS were identified. In
conclusion, we analyzed the clinical characteristics
of a series of patients with AR-BL and designed anovel risk stratification model that could be easily
used in clinical research after validation in an
independent cohort.

Poster Abstract

120

Amphotericin B Colloidal
Dispersion is efficacious andsafe for the management oftalaromycosis in HIV-infectedpatients: Results of a
retrospective cohort study in
China
Liu M1, Yang H
1Chongqing Public Health Medical Center, Chongqing, China

Background: Talaromycosis (formerly known as
penicilliosis) is an invasive fungal disease causedby the dimorphic Talaromyces marneffei (TM)fungal organism.Currently, amphotericin B
deoxycholate (AmB-D) is recommended as theinitial antifungal treatment for TM infection, and isgenerally an effective therapeutic option.
However, the clinical applications of AmB-D are
greatly limited due to its high toxicity and theoccurrence of frequent adverse effects, and nongeneric liposomal AmB (L-AMB) is inaccessible in
China. In 2021, Amphotericin B Colloidal
Dispersion (ABCD) was approved as an antifungal
medicine for patients with invasive fungal
infections in China, and is particularly suitable forthose who fail to tolerate or respond to AmB-D. In
vitro and in vivo studies have demonstrated that
ABCD is as effective as AmB-D for treatment ofdisease caused by a wide range of fungal species,
including Aspergillus, Candida, Cryptococcus, andFusarium. However, there is a scarcity of data withregards to the efficacy and safety of ABCD use inpatients with talaromycosis. In the present study,
we aimed to compare the efficacy and safety of
ABCD and AmB-D for the treatment oftalaromycosis in HIV-infected patients.
Methods: From January 2018 to December 2022,
the data of HIV-infected patients withtalaromycosis who received ABCD or AmB-D wereretrospectively collected, and its efficacy andsafety were compared.
Results: 38 patients receiving ABCD and 33
patients receiving AmB-D were included, theconversion rates to fungal negativity at one week

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142

post-treatment were 86.84% (33/38) in the ABCD
group and 90.09% (30/33) and in the AmB-D
group, and reached 100.0% in both groups at two
weeks post-treatment. A higher symptom
remission rate at two weeks in the ABCD groupcompared with the AmB-D group (94.74% vs.
75.76%; p=0.003). At week two, the serum
creatinine level in the AmB-D group was
significantly higher compared to baseline, whereas
did not increase significantly in the ABCD group.
Significantly fewer patients discontinued
antifungal treatment due to drug intolerance in
the ABCD group, and the incidence of leukopenia
and elevated creatinine levels was lower in the
ABCD group than in the AmB-D group.
Conclusion: ABCD has a clinical efficacy
comparable to AmB-D, with higher symptom
remission rate, lower nephrotoxicity, and lower
bone marrow suppression, indicating that ABCD
may be an appropriate alternative option for theclinical management of talaromycosis.

Poster Abstract121

Evidence of peer-led
demedicalized delivery ofsame-day PrEP in various
community centers in thePhilippines
Dela Cruz J1, Rosadiño J1,2, Pagtakhan R1
1LoveYourself, Inc, Mandaluyong City, Philippines, 2Faculty ofManagement and Development Studies, University of thePhilippines - Open University, Los Baños, Philippines

Background: LoveYourself (LYS) serves a large
number of clients for HIV screening and PrEP
access through this peer-led approach in its
network of community centers in the Philippines.
Observed challenges were delay of PrEP initiation
due to long queues for medical consultation, long
turnaround time of ancillary tests and hesitancy ofclients who are on gender-affirming hormone
therapy or body-building supplements. To addressthese causes for delay, we explored the programthat shifted most PrEP operations to PrEPPY Peers,and proceeded with PrEP dispensing even in theabsence of baseline creatinine and hepatitis B
results.
Methodology: An algorithm (Figure 1) was
developed to guide PrEPPY peers to provide sameday PrEP, for those who tested negative at rapid
screening, without any symptom of acute
retroviral syndrome (ARS) within 30 days, age
between 18 to 50, body weight of between 35 and
90 kg, without kidney-related comorbidity, and if
without any medication or supplementation. They
were also trained how to compute creatinine
clearance with the use of a mobile application, andhealth teaching with regards to adherence andfollow up care. All charts were submitted to the
medical team for review and quality check.
For those who tested negative for HIV but had
remarkable findings during counseling, they areurgently referred to the medical doctor either onduty or on-call. They were assessed face-to-face or
via telemedicine prior to being prescribed with
PrEP. All PrEP-naive were advised daily PrEP
regimen for at least 3 months before considering
event-driven PrEP to closely monitor for theirrecent exposure within 3 months, and for early

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linkage to care if with seroconversion. A follow up
of 0-1-3-6-9-12 monthly interval was done withrepeat HIV screening at every visit, and otherlaboratory tests as prescribed every 6-12 months.
Results: Clients presenting with remarkable history
were properly endorsed by PrEPPY Peers to the
medical doctor or nurse and were mostly still
started on the same day. Some were deferred onlywith further probing of ARS or other high risk
exposures. Less queuing for medical consultation
regarding PrEP was observed, and medical doctors
were able to cater more STI symptomatic clients or
those needing HIV primary care services. Upon
demedicalizing PrEP, enrolled clients increased
from a moving average of 568 since Q3 2021 to1256 from Q2 2022 (Figure-2). The facility had atotal of 7,134 enrolled at the end of December
2022.
Conclusion: This study presents evidence thatpeer-led demedicalized delivery is possible. Thismechanism promotes task-shifting, showing thatpeers can provide PrEP at scale to high- priority
populations. This evidence also empowers
nonmedical providers through a medically-guided
approach.

Poster Abstract

122

HIV self-testing as an entry
point to HIV status-neutral
approach services fortransgender women:
Experiences from real-world
implementation at the
Tangerine Clinic in Thailand
Serkpookiaw P1, Janamnuaysook R1,2, Samitpol K1,2,
Termvanich K1, Amatsombat T1, Chancham A1,
Sripoonbun V1, Sittisatid P1, Boontho K1,
Watthanakittikul N, Suttanan K1, Jittjang S3,
Arunmanakul A3, Mills S3, Phanuphak N1,2
1Institute Of HIV Research and Innovation, Bangkok, Thailand,Center for Excellence in Transgender Health, Bangkok, Thailand, 3USAID/EpiC Thailand project, Bangkok, Thailand

2

Background: HIV self-testing (HIVST) has become
available through Thailand’s Universal Health
Coverage since October 2022 as one key strategy
in controlling HIV epidemic. There was limited
experience on how to integrate HIVST into existing
sexual health services for transgender women. We
described HIVST service uptake and linkages toantiretroviral treatment (ART) or pre-exposure
prophylaxis (PrEP) among transgender womenclients of the Tangerine Clinic, a transgender-led
gender-affirming sexual health clinic in Thailand.
Methods: From May 2022-September 2023,
HIVST kits were offered to transgender women at
the Tangerine Clinic and via Tangerine’s telehealthinstant-messaging (IM) service. Clinic-based HIVST
clients received HIVST kits, pre-test counseling anda demonstration video provided by transgenderpeer counselors prior to performing self-test at
home. Telehealth HIVST clients received HIVST kits
via postal delivery. Pre-test counseling,demonstration video and self-administeredbehavioral risk assessment were provided via IM
by transgender peer counselors. Test-result followup contacts were made at one week after theclients received the kits. Clients had an option toshare visual HIVST result with IM administratorsfor further support and linkage. Non-reactive
testers were offered PrEP via telehealth service.
Reactive testers were offered HIV confirmatory

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testing and ART initiation at the Tangerine Clinic orreferrals to their nearest community-led clinics orregistered health facilities.
Results: Of 262 transgender women who received
HIVST kits (16% clinic-based, 84% telehealth),
median (IQR) age was 26 (15-53) years, 35% wereHIV first-time testers, 24% engaged in sex work.
Among those receiving kits, 185 (71%) shared theirtest results and 22/185(12%) reporting reactive
results. Among those with reactive results,
17(77%) received HIV confirmatory testing, and 12(77%) had HIV infection confirmed. All 12 initiatedART, five within the same day of diagnosis. Median(IQR) CD4 count was 223 (203-330) cells/ul.
Of 163/185 (88%) non-reactive testers, 46/163(28%) received PrEP via telehealth (80% PrEP
initiation, 15% PrEP restart, and 5% PrEP
continuation).
Conclusions: HIVST is an effective entry point to
HIV status-neutral approach services fortransgender women. HIVST could facilitate not
only new HIV diagnosis and ART initiation but also
PrEP uptake, restart, and continuation amongtransgender women, including those who wereHIV first-time testers.

Poster Abstract

123

Improving Treatment
Outcomes in Medication for
Opioid Use Disorder throughLow-Cost Contingency
Management: Insights andRecommendations from aqualitative study in Vietnam
Nguyen H1, Nguyen T1, Phung T2, F. Go V3, C. Miller
W3
1
Hanoi Medical University, Hanoi, Viet Nam, 2Hanoi Center of
Disease Control, Hanoi, Vietnam, 3University of North Carolina,
Chapel Hill, North Carolina, , USA

Background: Nearly half of people receiving
medications for opioid use disorder (MOUD) dropout within the first year of treatment globally.
Contingency management, referring to the use of
rewards to reinforce health-promoting behaviors,
is effective in improving treatment outcomes for
MOUD participants. But it is often criticized for its
perceived as too costly when integrated with
MOUD treatment programs. Furthermore,variations in implementation protocols could be achallenge for the practitioners. Using a case from amethadone program in Vietnam, we aimed toprovide the MOUD practitioners suggestions on i)
key factors for contingency management
implementation protocols to improve treatment
outcomes, and ii) low-cost contingency
management schemes.
Methods: We conducted 12 focus group
discussions (n=80) among methadone providers(n=40) and clients (n=40) in 6 methadone program
sites in Hanoi, Vietnam. During these discussions,
we combined a Delphi technique for study
participants to rank the most important target
behaviors and the preferred rewards from July toAugust 2023. Qualitative data were analyzed bythematic analysis, using Atlas.ti software; whilequantitative data were undergone descriptive
analysis and managed by the Excel-based tool.
Results: Visiting methadone clinics daily was
identified as the most important target behavior
to be rewarded by both providers and clients.
Methadone take-home privileges were the

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preferred reward by clients, followed by cash or adiscount voucher for the monthly treatment fee.
Most clients indicated that the value of cash or
discount vouchers need not be high (ranging from4 to 8 US dollars per year for cash or a discountvoucher for 1 month after 12 consecutive months)
to be motivating. Clients indicated that receiving
the reward from methadone clinic leaders would
be the most impactful. They also suggested
receiving the reward on special occasions, such as
in June for World Drug Day (26th June) and during
Lunar New Year (usually in late January).
Conclusion: Our study identified solutions for nonmonetary or low-cost reward schemes to motivateclients to engage in treatment, including takehome privileges, low-cost cash vouchers, ordiscounted treatment fee vouchers. To maximize
the benefits of contingency management at a low
cost, the authority and timing of reward
distribution must be aligned with clients'
preferences.

Poster Abstract

124

Strategy for implementation oflong acting cabotegravir as
Prep in Australia - aperspective from generalpractice
Eu B1,2, Koh K3
1Prahran Market Clinic, Prahran, Australia, 2University of

Melbourne, Melbourne Medical School, Department of General
Practice, Melbourne, Australia, 3Gladstone Road Medical
Centre, Brisbane, Australia

Introduction: Injectable long acting cabotegravir(ILA-CAB) at 2-monthly intervals (after initiation of
2 injections 1 month apart) has been shown to beeffective as HIV Pre-Exposure Prophylaxis (PrEP)
across studies. In Australia, ILA-CAB PrEP wasapproved for use by the Therapeutics Goods
Administration (TGA) in 2022. In 2023, thePharmaceutical Benefits Advisory Committee(PBAC) recommended funding ILA-CAB PrEP on the
Pharmaceutical Benefits Scheme (PBS) and it isexpected to be available at a Governmentsubsidised price for general use in 2024. (Priced at
AUD30 per prescription, and AUD7 for low-income
individuals).
We will discuss the implementation challenges of
ILA-CAB PrEP, applying lessons learnt from theimplementation of ILA-CAB and rilpivirine (ILACAB/RPV) for HIV treatment at two large highcaseload HIV General Practice (GP) clinics in two
Australian capital cities (Melbourne and Brisbane).
Discussion: ILA-CAB/RPV for HIV treatment inAustralia has taken some time to achievesignificant uptake. Workforce capacity issues
resulting from more frequent contact with healthservices presented initial implementation
challenges, along with the need to increase the
ILA-CAB/RPV knowledge among health workers,
including training in the administration of these
injections, were common barriers.
HIV treatment, including ILA-CAB/RPV for HIV
treatment, is generally managed in hospital-based
centres and specialised community-based (GP)centres. However, as PrEP is more widely managed
outside of these HIV specialist community-based

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GP settings, a broader range of community-based
GP centres will need to plan ahead for the
implementation of ILA-CAB PrEP.
Implementation solutions may vary for different
health services, and between community-based
general practice (GP) and hospital-based centres
but some transferable lessons learnt from
implementing ILA-CAB/RPV include:
Education: Additional, and wider, education isrequired on ILA-CAB PrEP, its’indications/restrictions and use. Health
Practitioners’ concerns about follow up andmanagement of missed injections must be
addressed, specifically the risk of developing
acquired resistance to cabotegravir, and resource
consumption to manage missed injections.
Administration: Injection methods have beenaddressed in health services where ILA-CAB/RPV
for HIV treatment is used. However, as PrEP for
HIV is managed in more community-based GP
clinics, further training will be required in injection
methods for ILA-CAB PrEP in these clinics.
Follow up: Clinics that have used ILA-CAB/RPV for
HIV treatment have appropriate reminder
protocols for follow up; they can utilise the same
systems for ILA-CAB PrEP. Other clinics will need tohave this in place but would be able to build on
the experience of existing clinics.
Workforce capacity: Additional demands will beplaced on health services to provide 2 monthly
injections versus 3 monthly reviews as is current
practice for oral PrEP. The extent of additional
demand is unknown at this time, this will need tobe monitored.
Conclusion: Implementation of ILA-CAB PrEP
presents some challenges for success. Some havealready been addressed in health services using
ILA-CAB/RPV for HIV treatment. However as there
will be more health services offering ILA-CAB PrEP;
additional education will be needed. Workforce
capacity will need to be addressed as they arise,depending on the uptake of ILA-CAB PrEP at eachservice.

Poster Abstract

147

125

P<0.001), and among transgender women (Coef =49; 95%CI: 32-65; P<0.001).

The role of private sector
engagement in scaling up andsustaining access to preexposure prophylaxis (PrEP) in
Vietnam.

Conclusions: Engaging the private sector in PrEP
delivery is critical for accelerating PrEP scale-up
and sustainability in Vietam. Private clinics haveplayed a pivotal role in initiating and retaining
individuals on PrEP, ensuring its effective
utilization. These findings highlight the importanceof continued private sector engagement inachieving the Vietnam’s 2030 goal of ending AIDS.

Ngoc B1, Green K1, Khanh L1, Thu P1, Pham C1,
Khanh A1, Hong A1, Minh T1, Tran T1, Anh P1, Minh
V1, Van B1, Phan T1, Nguyen H1
1PATH, Hanoi, Viet Nam

Background: To achieve UNAIDS prevention
targets by 2030, accelerating PrEP scale-up is
crucial. PrEP was introduced in Vietnam in 2017and is now available in 210 clinics across 29
provinces. The private sector accounts for onefifth of these clinics, serving approximately 50% ofclients. We assessed the impact of private sector
engagement in scaling up PrEP in Vietnam throughthe USAID/PATH Healthy Markets (HM) and STEPS
projects, supported by the U.S. President’s
Emergency Plan for AIDS Relief (PEPFAR).
Description: We engaged 23 public outpatient
clinics and 17 private KP-led clinics offering free orcommercial oral PrEP. Using data from thenational HMED PrEP system, we assessed PrEP
initiation, retention, return, and dropout rates in
Hanoi, Ho Chi Minh City, and Dong Nai. We also
identified factors associated with PrEP
continuation.
Lessons learned: Between October 2017 and
September 2023, 32,064 individuals enrolled in
PrEP. Private clinics accounted for 80.1% of PrEP
uptake, while public clinics made up 19.9%. PrEP
initiations were at private clinics, ranging from
71.2% to 95.9% annually. Private clinic clients
represented a longer median duration of PrEP use(268 days) compared to public clinics (148 days).
The HIV sero-conversion rate among PrEP users
was lower in private clinics (0.03%) compared to
public clinics (0.13%). Multiple linear regression
analysis indicated that longer PrEP continuation
was associated with being enrolled in private
sector services (Coef = 116; 95%CI: 108-123;
P<0.001), enrollment in tele PrEP (Coef =92;
95%CI: 60-125; P<0.001), paying for
PrEP/commercial PrEP (Coef = 84; 95%CI: 75-93;

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Poster Abstract

126

Barriers and facilitators to
implementing a pharmacybased HIV pre-exposure
prophylaxis (PrEP) service
delivery model among key
populations, PrEP prescribers
and community pharmacists in
the Klang Valley, Malaysia.
Gan Y1,2, Lim S1,3, Hafidzar S3, Ahmad Zaki R1,4,
Ahmad Nizaruddin M5, Altice F3,6,7,8, Azwa I3,91Department of Social & Preventive Medicine, Universiti

Malaya, Kuala Lumpur, Malaysia, 2Malaysian HealthTechnology Assessment Section, Ministry of Health, Putrajaya,
Malaysia, 3Centre of Excellence for Research in AIDS (CERiA),
Universiti Malaya, Kuala Lumpur, Malaysia, 4Centre for
Epidemiology and Evidence-based Practice (CEBP), Universiti
Malaya, Kuala Lumpur, Malaysia, 5Department of Community &Pharmacy Practice, Faculty of Pharmacy, University ofCyberjaya, Cyberjaya, Malaysia, 6Section of Infectious Diseases,
Department of Internal Medicine, Yale School of Medicine, New
Haven, United States, 7Department of Epidemiology ofMicrobial Diseases, Yale School of Public Health, New Haven,
United States, 8Center for Interdisciplinary Research on AIDS(CIRA), Yale University, New Haven, United States, 9Infectious
Diseases Unit, Department of Medicine, Universiti Malaya,
Kuala Lumpur, Malaysia

Background: HIV pre-exposure prophylaxis (PrEP)
uptake remains inadequate in Malaysia, with anestimate of less than 5,000 people taking PrEP. As
community pharmacists are recognized as widely
accessible and trusted healthcare professionals,
there is potential to expand PrEP access through asimplified, demedicalised service delivery model inthe community pharmacy setting. This study
aimed to understand the barriers and facilitators
to implementing a pharmacy-based PrEP service
delivery model among key populations, PrEP
prescribers and community pharmacists in the
Klang Valley, Malaysia.
Methods: A qualitative study involving 38 semistructured in-depth interviews was conductedwith 18 key population members, 10 PrEP
prescribers and 10 community pharmacists in the
Klang Valley from January till April 2023. Key
population members included 6 men who have sex
with men (MSM), 5 transgender women (TGW), 3
female sex workers (FSW), and 4 people who inject

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drugs (PWID); among these members, 1 MSM and
4 TGW also engaged in sex work while 1 FSW
reported injection drug use. Participants wererecruited using purposive sampling. All interviews
were conducted online in English or Malay forabout an hour, audio-recorded, and transcribedverbatim. Thematic analysis was performed using
NVIVO.
Results: All groups identified common barriers:
privacy, confidentiality, affordability, and poorawareness about the pharmacy-based PrEP
service. Additional barriers identified among key
population members were poor awareness about
PrEP and the role of community pharmacists;
while PrEP prescribers highlighted barriers related
to unavailability of laboratory testing service andclient medical record documentation. Community
pharmacists reported other barriers such as lack oftraining, staff, time, and private space for
consultation, counselling, and testing. Most
participants expressed strong support for
implementing the service and perceived these
aspects as facilitators: availability of private space,assurance of confidentiality, affordable pricing,adequate training, effective advertising, digitalized
assessment, user-friendly appointment scheduling,
and collaboration with physicians and nongovernment organisation community healthworkers for seamless referrals.
Conclusions: This study provided valuable insights
on the barriers and facilitators to implementing apharmacy-based PrEP service in the Klang Valley.
The findings indicate there is a need and demand
for an additional choice of accessing PrEP. Future
research should focus on developing animplementation plan with key stakeholders
addressing identified barriers and capitalizing on
facilitators, followed by implementation of service
and evaluation of implementation outcomes toinform the viability of pharmacy-based PrEP
service delivery model as a novel implementation
strategy to increase PrEP uptake in Malaysia.

Poster Abstract

127

Barriers and facilitators of
implementation of a pay-itforward gonorrhoea andchlamydia testing programamong Chinese men
Zhu Z1, Li K2, Ramaswamy R4, Marley G1, Liu Y1,
Zhang L1, Tan R5, Tang W3, Tucker J3
1
UNC Project China, Guangzhou, China, 2University of California
Los Angeles, Los Angeles, United States, 3University of North
Carolina - Chapel Hill, Chapel Hill, United States, 4Cincinnati
children's hospital medical center, Cincinnati, United States,
5
National University of Singapore, , Singapore

Background: Pay-it-forward（PIF）in healthcare
services promotion is an intervention whereindividuals are offered free health care services(testing) as gifts paid by community members, andcan subsequently choose to donate to support
future health services end-users. We previously
used the PIF approach to increase gonorrhoea(NG) and chlamydia (CT) testing uptake among
men in China. However, implementation andscale-up of such programs have not been studied.
This study aimed to explore barriers andfacilitators of implementation of a PIF NG/CT
testing program among Chinese men in South
China.
Methods: This study was a parallel, mixedmethods study nested in the PIONEER study (trial
ID NCT05723263), a cluster randomized control
trial to promote NG/CT testing among MSM andmale STD patients in 12 clinics (6 public STD clinics
and 6 community-based organizations (CBO))
across six cities in Guangdong province, China. We
used constructs from the Consolidated Framework
for Implementation Research (CFIR) to identify
factors relevant to implementation. Quantitative
data was collected through participant surveys andsite feasibility checks through site visits. We
assessed the relationship between individual andinner setting level factors with donation using
multivariable logistic regression, with covariates ofage group, education level, monthly income.
Qualitative data were collected from a total of 13
co-creation focus group discussions that took
place between February 2023 to February 2024.
Data were analysed using a framework of barriers

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149

and facilitators of implementation using rapid
content analysis with coding according to the CFIR
constructs.
Results: A total of 455 participants (public STD
clinic=181, CBOs=274) were offered PIF NG/CT
testing from October 2023 to February 2024 with
114 (25.1%) participants donated. We identified 1
potential individual-level barrier and 2 separate
inner-setting-level facilitators for CBOs and public
STI clinics.
1.
Participants were lack of knowledge to
the PIF intervention, with only 31.7% (118/372,
public STD clinic=30, CBOs=88) participants hadcorrectly recognized (a) who paid for their tests
and (b) where their donations went. Participants
who did not knew where their donations went
were less likely to support other’s testing (aOR
0.51, 95% CI0.31-0.84).
2.
For community-based sites, CBO
representatives emphasized the need of funding
support to maintain service delivery. Quantitative
data suggested that participants recruited fromthe sites who received higher CDC supports ofvenue financing and hospital collaboration weremore willing to support other’s testing（aOR
15.44, 95% CI 1.88 -126.80).
3.
In public STD clinics, lower patient volume
and involving fulltime physicians into recruitment
helped facilitate the implementation. Lower
patient volume enabled physicians enough time togo through implementation procedures with eachparticipant, and positively associated withdonation decision (aOR 3.82, 95% CI 1.87-7.79).
Involving fulltime physicians helped to ensure theprocedures were followed steadily andcomprehensively compared to part-time volunteer
implementors, and also associated with higher
donation rate(aOR 5.75, 95% CI 2.53-13.04).
Conclusion: Barriers and facilitators of
implementation were associated with donation,
which further determines the sustainableupscaling of PIF intervention. These results caninform how and in which settings to implement
future PIF programs.

Poster Abstract

128

Empowering communities tooptimise uptake and use of
HIV pre-exposure prophylaxis(PrEP): Crowdsourcing open
calls in Australia, thePhilippines, Thailand andChina
Tieosapjaroen W1,2, Ongkoko A3,4, Yin Z5,
Termvanich K6, Tucker J7,8, Tang W5, Li C9, Zhang
Y1,2, Castillo-Carandang N4,10, Ong J1,2
1School of Translational Medicine, Monash University,

Melbourne, Australia, 2Melbourne Sexual Health Centre, Alfred
Health, Melbourne, Australia, 3National Institutes of Health,
University of the Philippines, Manila, The Philippines,
4
Foundation for the Advancement of Clinical Epidemiology, Inc.,
Manila, The Philippines, 5University of North Carolina Project
China, Guangzhou, China, 6Institute of HIV Research andInnovation, Bangkok, Thailand, 7Institute for Global Health andInfectious Diseases, University of North Carolina at Chapel Hill,
Chapel Hill, USA, 8Clinical Research Department, Faculty of
Infectious and Tropical Diseases, London School of Hygiene andTropical Medicine, London, UK, 9Tokyo College, The Universityof Tokyo, Tokyo, Japan, 10Department of Clinical Epidemiology,
College of Medicine, University of the Philippines, Manila, The
Philippines

Background: Crowdsourcing involves crowds
participating in a collaborative problem andsharing solutions. By facilitating collaboration
between community members and experts fromdiverse fields, these approaches have been
increasingly used to address complex healthchallenges. Scaling up HIV pre-exposure
prophylaxis (PrEP) has been slow in Asia. Tailored
strategies to increase PrEP uptake are needed. We
used crowdsourcing to seek ideas to increaseawareness and uptake and optimise the use of
PrEP by describing and analysing PrEP-related
crowdsourcing projects in Australia, thePhilippines, Thailand, and China.
Description: Crowdsourcing open calls wereconducted between 2021 and 2023 in Australia,
the Philippines, Thailand, and China to solicit
strategies to increase PrEP uptake among key andgeneral populations. Based on The World HealthOrganization (WHO) crowdsourcing in healthresearch practical guide, our open calls entailed:problem identification; committee formation with

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150

local groups; community engagement for idea
submission; evaluation of submissions; awarding
incentives to finalists; and solution dissemination
via web and social media.
Lesson learned: Our crowdsourcing meaningfully
engaged communities to address persistent
challenges (e.g., stigma and discrimination)encountered by socially marginalised populations,such as trans and gender-diverse people, and men
who have sex with men. The Australia, Philippines,
Thailand and China teams received 9, 22, 9, and 19
eligible submissions, respectively. Three themes
shared by the finalist ideas from all countries
included: 1) enhancing service delivery; 2)
optimising promotional campaigns; and 3)
generating person-centered promotional
materials. The final ideas from the Australian,
Filipino, Thai, and Chinese teams were an
anonymous online PrEP service, a printed readyto-wear garment to create awareness about PrEP,
PrEP kiosk, and posters on PrEP effectiveness,
respectively.
Conclusions/next steps: Crowdsourcing is usefulfor generating solutions across countries that
account for cultural differences, health systems,and HIV epidemics. Further implementation
research is needed to assess the effectiveness ofthe final solutions. This empirical evidence canaccelerate the adoption of these co-designed
innovations. The Australia team will conduct a trial
to utilise interventions from their crowdsourcing
open call (ACTRN12623001361695).

Poster Abstract

129

Association between attitudes
towards PrEP and its
adherence pattern: findings
from an implementation study
Wong N1, Lee K2, Kwan T1, Lui G1, Chan D1, Lee S1
The Chinese University of Hong Kong, Hong Kong, China, 2The
University of Hong Kong, Hong Kong, China

1

Background: The attitude towards PrEP was
associated with PrEP uptake. In this study, we aim
to examine the association between reported PrEP
attitude and pre-identified adherence pattern in
PrEP users.
Material and Methods: Monthly online survey
data of MSM who participated in a PrEP
implementation study in Hong Kong werecollected. In the study, participants were provided
with free PrEP (tenofovir disoproxil
fumarate/emtricitabine tablets) for 1 year
following medical consultations. Participants wereasked to actively make PrEP-refill appointments
online and self-arrange HIV testing before each 3monthly follow-up visit. Three latent classes of
PrEP users were pre-identified based on their PrEP
use pattern and sexual activity: Class 1 - daily
dominant PrEP, Class 2 - episodic PrEP, and Class 3- mixed PrEP schedule. Class 1 and Class 3 MSM
had similarly high PrEP executed adherence,
expressed as the proportion of days with HIV riskthat were protected PrEP and/or condom.
However, Class 2 MSM were less sexually active
and had lower executed adherence level. PrEP
attitude was retrieved from the monthly surveys,
which included binary items of feeling worried
about PrEP dependency for HIV prevention, PrEP
use disclosure for sex partner networking, andhiding PrEP tablets; 4 point Likert scale items offeeling less anxious of acquiring HIV with PrEP,
feeling relieved with HIV/STI regular testing,increased sexual pleasure with PrEP; and item offrequency of condomless sex while on PrEP. The
association of each item summarised across themonthly surveys with the 3 latent classes were
examined using multinomial logistic regression.
Results: The monthly survey data (February 2020 July 2022) of 213 MSM participants whose PrEP

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151

use pattern have been classified were analysed.
Among them, 87% had ever actively scheduled
PrEP appointment, 89% had reported condomlesssex while on PrEP. More than half totally agreed
that they had increased sexual pleasure with PrEP(65%), felt less anxious about HIV acquisition with
PrEP (78%), and felt relieved with HIV/STI regulartesting (88%). Comparing with MSM in Class 2(n=76), MSM in Class 1 (n=113) had been more
actively scheduling their appointments for PrEP
refill (p=0.001), and felt PrEP made them lessanxious about acquiring HIV (p=0.01). Comparing
with MSM in Class 2, MSM in Class 3 (n=26) had
also been more actively scheduling their PrEP refill
appointments (p=0.03) and reporting higher
frequency of having condomless sex while on PrEP
(p=0.001). There were no differences in terms ofworrying about PrEP dependency for HIV
prevention, PrEP use disclosure, increased sexualpleasure, and feeling relieved to have HIV/STI
regular testing.
Conclusions: The findings suggested that MSM
with more positive attitudes towards PrEP weremore likely to be on daily dominant regimen or
mixed schedule, both classes being associated withhigher PrEP executive adherence. Even when PrEP
access was at zero cost, MSM with less positive
attitudes towards PrEP might minimise theirusage, resulting in a suboptimal executive
adherence. Interventions in instilling positive
attitudes towards PrEP in episodic users areneeded to increase executive adherence level.

Poster Abstract

130

WILLINGNESSA ND COMFORTTO COUNSEL HIV PREEXPOSURE PROPHYLAXIS TO
CLIENTS AMONG
PHARMACISTS IN SELANGOR,
MALAYSIA
Che Ali M1
1Klinik Kesihatan Seksyen 7 Shah Alam, SHAH ALAM, Malaysia,
2PETALING HEALTH DISCTRICT, PETALING, MALAYSIA

Introduction: Tenofovir/Emtricitabine (Truvada) is
a US Food and Drugs Administration (US-FDA)approved prescription medication for preventing
HIV infection. Adhering to Pre- Exposure
Prophylaxis (PrEP) has been shown to reduce therisk of human immunodeficiency virus (HIV)infection by 18% among high-risk individuals. Daily
intake of PrEP has demonstrated a 99% risk
reduction from sexual transmission and a 74%
reduction from injection drug use. Pharmacists are
crucial in promoting and educating key
populations about HIV pre-exposure prophylaxis(PrEP), identifying the need for PrEP, and providing
consultation to clients. Studies have shown thatpeople find pharmacists' advice on medications
trustworthy and convenient.
Objective: This study aims to determine thewillingness and comfort of pharmacists in Selangor
to counsel clients on HIV Pre-Exposure Prophylaxis(PrEP).
Methodology: A cross-sectional study was
conducted from March to May 2023, involving 323
pharmacists working at public health clinics in
Selangor. Data was collected through a selfadministered online questionnaire distributed via
email and WhatsApp. The collected data wasanalysed using JASP version 0.16.2.0. Descriptive
and inferential analyses were performed, andcrude analysis was conducted using Pearson's chisquared test. Multiple logistic regression was used
to determine the association between
demographic characteristics, knowledge of HIV
PrEP medications, experience with HIV PrEP
medications, barriers, and the willingness andcomfort to counsel HIV PrEP to clients.

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Results: The majority of respondents were female(82.4%), aged 21-35 years old (75.5%), Malay(59.8%), Muslim (62.9%), held a bachelor's degree(87%), and had less than 10 years of working
experience (64.1%). Regarding knowledge, 52.9%
of respondents had inadequate knowledge, and47.1% had adequate knowledge of HIV PrEP
medication. Regarding the experience dealing with
HIV PrEP medication, 67.5% of respondents hadhigh experience dealing with HIV PrEP
medications. Regarding barriers, 57.9% reported
low barriers to counselling clients on HIV PrEP.
Multiple logistic regression revealed factors
associated with the willingness and comfort tocounsel HIV PrEP. For the willingness to counsel
HIV PrEP, individuals with high experience dealing
with HIV PrEP medications were significantly more
likely to counsel clients (AOR= 4.08; 95% CI 2.34,
7.10; p <0.001). For comfort to counsel HIV PrEP,
four factors were found significant: respondents
aged 21-35 (AOR= 2.30; 95% CI 1.14, 4.64; p=
0.020), Non-Malay (AOR= 2.07; 95% CI 1.15, 3.70;
p= 0.015), high experience dealing with HIV PrEP
medications (AOR= 3.39; 95% CI 1.88, 6.11; p<0.001), and low barriers affect pharmacists’
comfort to counsel HIV PrEP (AOR= 1.93; 95% CI
1.11, 3.37; p= 0.020.
Conclusion: This study examined the willingness
and comfort levels of pharmacists in Selangor tocounsel clients on HIV Pre-Exposure Prophylaxis(PrEP). Most pharmacists indicated high comfort
and willingness to provide PrEP counselling,demonstrating their readiness to play a vital role in
HIV prevention efforts. However, a significant
proportion of pharmacists still exhibited low
willingness or comfort, emphasising the need fortargeted interventions and training to improvetheir knowledge and skills in PrEP counselling.

Poster Abstract

131

Easy way to level up yourstrength of prevention. One
retrospective study at one HIVcare designated hospital since
2017-2023
Chu J1
1Taoyuan General Hospital, Taoyuan City, Taiwan

Objective: The study aims to analyze the "HIVScreening and Pre-exposure Preventive Drug
Administration Program" in Taiwan, focusing on
improving continuous participation rates among
high-risk individuals. Additionally, it questions theneed for a catch-up vaccine for individuals who
might lack permanent immunity against hepatitis B
despite neonatal vaccination.
Methods: Study participants from 2018 to 2023
were individuals enrolled in the HIV prevention
program. They underwent HIV screening andassessment for high-risk behaviors before
receiving medical services including PrEP
evaluation and consultations. Additionally,
hepatitis B antibody testing was conducted, withcatch-up vaccination recommended for thoselacking immunity.
Results: Between 2018 and 2023, 776 participants
were enrolled, primarily males (98.2%) andpredominantly homosexual (96.9%). Notably,
1.28% of subjects contracted HIV during the study
period, but PrEP demonstrated potential in
reducing infection rates. Withdrawals decreased
from 36% in 2021 to 19.3% in 2023, with newenrolled number from 111 increased to 264 at
same period of time.
In the 2022-2023 public PrEP program, there are atotal of 212 patients, 85 subject (40%) tested
negative for HBsAg or <10 mIU/ml and completed
hepatitis B vaccine vaccination according to the
CDC recommended administration schedule (0, 1,6), 44 subjects (20%) tested positive for Anti-bodyand its value between 10-100, and 69 people(32.5%) tested positive for Anti-body, and its value
is greater than 100, 9 people tested positive for
HBsAg, and the other 5 people were unwilling toreceive hepatitis B vaccine.

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Conclusions: Currently, PrEP can be obtained at
public expense or at your own expense. If you are
not eligible for public funding, you can also consulta doctor about the Patient Assistance Program(PAP) to reduce the financial burden. Provide PrEP
integrated services, including drugs, HIVprevention and health education, consultation,
STD screening, drug addiction and mental statusassessment, and provide timely treatment orreferral services, etc. In 2023, Taiwan delivered thenumber of new HIV infections fell below 1,000 for
the first time. PrEP indeed made a huge
contribution to the epidemic.
Overall, the number of hepatitis B antibodies inpatients participating in the public PrEP program
has increased, but it can still be maintained after a
few years, still should set a plan to track thenumber of hepatitis B antibodies.

Poster Abstract

132

Restarting pre-exposure
prophylaxis (PrEP) for HIV: A
systematic review and metaanalysis
Soh Q1,3, Kiggundu R1,2, Tieosapjaroen W1,2,
Fairley C1,2, Tucker J4,5, Tang W5, Zhang L1,2,6, Ong
J1,2,3,4
1Melbourne Sexual Health Centre, Alfred Health, Melbourne,

Australia, 2School of Translational Medicine, Faculty of
Medicine, Nursing and Health Sciences, Monash University,
Melbourne, Australia, 3University Of Melbourne, Melbourne,
Australia, 4Faculty of Infectious and Tropical Diseases, London
School of Hygiene and Tropical Medicine, London, United
Kingdom, 5Institute for Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill, Chapel Hill, USA,
6Clinical Medical Research Center, Children’s Hospital of Nanjing
Medical University, Nanjing, China

Background: High coverage of pre-exposure
prophylaxis (PrEP) will reduce HIV transmission
and help end the HIV/AIDS pandemic. However,
PrEP users face various challenges, including longterm adherence. This study aimed to document
the proportions of individuals who restart HIV PrEP
after they stop and the reasons for restarting PrEP.
Material and Methods: This study is a systematic
review and meta-analysis. We systematicallysearched CINAHL, Embase, Emcare, Global Health,Medline, Scopus, and PsychINFO for peerreviewed with no date restrictions. A grey
literature search was conducted through Google
search, a search of abstract books of AIDS
conferences and the websites of WHO andUNAIDS. We extracted data on the proportion ofpeople who stopped and then restarted PrEP,
reasons for restarting and strategies to support
people restarting PrEP. We used a random-effects
meta-analysis to pool estimates of restarting. We
conducted meta-regression to determine potential
sources of heterogeneity. However, we deviatedfrom our original plan as we did not identify
enough publications for strategies to support
restarting PrEP (primary objective). Subsequently,
we revised our plan to strengthen our secondary
objective to quantify the proportion of people who
stopped and restarted PrEP, and explore possible
reasons for its heterogeneity. This study isregistered with PROSPERO, CRD42023416777.

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Results: Of 988 publications, 30 uniquepublications were included: 27 reported the
proportion restarting PrEP, and of these, 7 also
reported reasons for restarting PrEP, while 3
publications reported only on the reasons forrestarting PrEP. No publication evaluatedinterventions for restarting PrEP. For the metaanalysis, we included 27 publications. Most
publications were from high-income countries(17/27, 63%) or the Americas region (15/27, 56%).
Overall, 23·8% (95% CI: 15·9-32·7, I2=99·8%,
N=85,683) of people who stopped PrEP restarted
PrEP. There was a lower proportion of restarting inpublications from middle-income countries
compared to high-income countries (adjusted
odds ratio (aOR) 0·6, 95% CI: 0·50 - 0·73, p <0·001).
There was higher restarting in publications fromAfrica compared to the Americas (aOR 1·55, 95%
CI: 1·30 – 1·86), heterosexual populations
compared to men who have sex with men ortransgender women (aOR 1·50, 95% CI: 1·25 –
1·81, p <0·001) and in publications defining
restarting as those who had stopped PrEP for >1month compared to those who stopped <1 month(aOR 1·20, 95% CI: 1·06 – 1·36, p <0·001). Reasons
for restarting PrEP included perceived higher risk
for HIV acquisition and removal of barriers toaccess PrEP.
Conclusions: About a quarter of people who
stopped PrEP would restart, with substantial
variation across countries and populations. Thereremains a paucity of evidence to understand how
individuals who stop PrEP choose to restart PrEP
or not. Our review uncovered a low rate ofrestarting PrEP, which has implications for PrEP
programs to ensure those who stop PrEP but
remain at risk for HIV can be supported to restart
PrEP in a timely manner. It is important tounderstand the motivations and contextual factors
influencing restarting PrEP and the support
systems to enable restarting PrEP for those atongoing risk.

Poster Abstract

133

Missed opportunities of HIV
Pre-Exposure Prophylaxis(PrEP) discussion amongclients attended for STI-related
care at a Community-Based
Organization (CBO)- led clinic
in Malaysia
Basri S1,2,3, Mohamad Fauzi M3, Mohamad Salim S3,
Chew H3, Tai R3
University Malaya Medical Centre, Kuala Lumpur, Malaysia,
Centre of Excellence for Research in AIDS (CERiA), Kuala
Lumpur, Malaysia, 3Community Health Care Clinic (CHCC), PT
Foundation, Sentul, Malaysia

12Introduction: Despite the proven effectiveness of
HIV Pre-Exposure (PrEP) in preventing HIV
transmission, the uptake still remains low in
Malaysia. The World Health Organization (WHO)recommends PrEP for individuals at substantial
risk of HIV acquisition including sexually-active
adults particularly those with recent bacterial
sexually transmitted infections (STIs). The
Community Health Care Clinic (CHCC) of PT
Foundation, stands out as one of the largest
Community Based Organization (CBO)-led clinics in
Malaysia, offering comprehensive HIV and STIcare, prevention and treatment services all under
one roof. This audit was conducted to evaluate the
PrEP discussion and uptake among clients seeking
STI-related care at our clinic, serving as afoundational step towards enhancing service
quality within the clinic.
Methods: A retrospective audit covering all clientsfor STI testing, consultation, and treatment at
CHCC from January 1st till December 31st 2023
was conducted. Visits for PrEP or HIV-related
services, counselling and other types of clinic
appointments were excluded. Clients who had
underwent anonymous testing also were excluded.
Data on socio-demographics, clinical characteristic
and PrEP outcomes were documented for each
audited visit.
Results: In 2023, CHCC saw 909 clients, accountingfor 1341 STI-related care visits. Among these, 699(76.9%) were male (37.6% MSM, 19.3%

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heterosexual, 43.1% undocumented); 206 (22.7%)
were female, and 4 (0.4%) were transwomen.
51.3% of the visits were for STI screening, 38.9%
for symptomatic STIs and/or treatment, and 9.8%
for various other reasons. Of all clients, 10 werescreened HIV positive during their first visit andimmediately linked to care except for one client
who refused treatment; 66 people living with HIV(PLWH) on treatment, and 84 were already on
PrEP. PrEP discussions occurred in only 17.8% of
the rest of the visits, with a PrEP uptake rate of
26%. Surprisingly, HIV screening was notconducted in 16.9% of visits. Discussions about
PrEP were more prevalent when clients interactedwith healthcare workers (34.9%) compared tocommunity workers (0.4%). Male gender was
associated with a higher likelihood of PrEP
discussion, with an odds ratio, OR of 1.856 (95% CI
1.262 – 2.729). Among MSM, 40.5% were offered
PrEP, compared to 26.7% of heterosexual men and2.2% men with no documented sexual orientation.
Clients with more than a visit within the year did
not associated with PrEP discussion, OR 1.036(95% CI 0.755 – 1.422).
Discussion: The audit revealed substantial missed
opportunities for PrEP discussion and uptake
among clients at CHCC seeking STI-related care. To
address these gaps, forthcoming initiatives include
conducting a focus group discussion involving
stakeholders and clinic staff, in-depth interviews
with clients and re-training of the community
workers. These strategic actions aim to identify
barrier and facilitators for enhancing service
quality within the clinic, utilizing this audit as afoundational assessment for ongoing
improvement efforts.

Poster Abstract

134

Sexual risk compensation andretention of PrEP: a HIV PrEP
Demonstration Study in South
Korea
Baek Y1, Han M2, Kim J2, Ahn J2, Lee S2, Choi J2
Soonchunhyang University College of Medicine, Seoul, South
Korea, 2Yonsei University College of Medicine, Seoul, South
Korea

1

Background: Pre-exposure prophylaxis (PrEP) withemtricitabine and tenofovir disoproxil fumarate(FTC-TDF) is an effective intervention for HIV
prevention. However, the feasibility of PrEP in
South Korea has not yet been evaluated. This
study aimed to evaluate the retention in PrEP, thesafety of daily PrEP, rates of adherence, tenofovir(TFV) concentrations, incidence of other sexuallytransmitted infections (STIs), and risk
compensations when men who have sex with men(MSM) in South Korea are provided open-label
FTC-TDF as PrEP.
Material and Methods: In this study, HIV-negative
MSM in South Korea were screened. Eligible
participants were prescribed a daily FTC-TDF
regimen and were followed-up at the outpatient
clinic. At each visit, adverse reactions, adherence,and sexual behavior were assessed using aquestionnaire, and residual pills were collected,
along with regular laboratory tests. TFVconcentrations in plasma and urine were analyzed.
Results: A hundred participants were enrolled,with a median follow-up time of 392 days. The
retention-in-the-care rate was 77 % from June
2020 to January 2023. The HIV incidence was 0.97
per 100 person-days (95 % CI, 0–0.20), whereasthat of other sexually transmitted infections(Neisseria gonorrhoeae, Chlamydia trachomatis,
Mycoplasma hominis, Mycoplasma genitalium,
Trichomonas vaginalis, and Ureaplasma
urealyticum) was 13.67 per 100 person-years (95% CI, 0–85.05). None of the patients experienced
any serious adverse events. Both renal and liverfunctions remained stable without significant
changes. Residual pill count and self-reported
adherence were not associated with plasma TFVdrug levels. Plasma TFV concentrations > 40 ng/mL
were achieved in 55.3 % (47/85) of the

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participants at week 28 and 41.7 % (25/60) at
week 52. The proportion of condomless receptive
anal intercourse decreased progressively from68.4 % (65/95) at baseline to 49.3 % (31/77) atvisit 6. Additionally, the frequency of condomlessinsertive anal intercourse declined throughout theperiod of PrEP uptake. Notably, the occurrence ofother STIs remained consistnet between Visit 4 or
6 (10.47 vs. 14.29 per 100 person-years, p = 0.48).
A positive test for STIs was associated with aplasma TFV concentration > 40 ng/mL (adjusted
odds ratio 3.45, p = 0.047).
Conclusion: Daily oral PrEP was safe and effective
in MSM in South Korea and demonstrated 77 %retention rate. The phenomenon of risk
compensation was not observed, with affirming
the role of PrEP in the prevention of HIV
transmission. Counselling and early testing of STIs
in PrEP clinics could contribute to the control of
HIV and other STIs.

Poster Abstract

135

Community-led same day
antiretroviral therapy
initiation successfully closes
linkage to treatment gaps at asex worker-led clinic in
Bangkok, Thailand
Phunkron A1, Sumalu S1, Thepwong P1, Wongsa A2,
Janamnuaysook R2, Sinchai K2, Boonruang J2,
Thitipatarakorn S2, Teeratakulpisarn N2,
Arunmanakul A3, Mills S3, Phanuphak N2, Janyam
S1, Ramautarsing R21Service Workers In Group Foundation, Bangkok, Thailand,Institute of HIV Research and Innovation, Bangkok, Thailand,

2

3FHI 360, Bangkok, Thailand

Background: To address low linkage toantiretroviral therapy (ART) services among key
populations diagnosed with HIV in community-led
clinics in Bangkok, Thailand, the Service Worker inGroup (SWING) Foundation, a sex worker-led
organization in Bangkok implemented communityled and delivered same day ART (SDART). Here we
report the ART-initiation cascade of the first year.
Description: Thai nationals who test HIV-positiveat SWING, are at least 13 years and have neverreceived ART, are eligible for and offered SDART. If
accepted, clients are screened for opportunistic
infections (OIs), and referred for OI treatment if
indicated, or initiated on ART. After follow-up of
45 days, clients are referred to their long-term ART
maintenance facilities. All procedures, including
HIV testing, OI screening and ART initiation, areconducted by trained key population lay providers.
Data from clients presenting between April 2022April 2023 were analysed to depict an HIV
treatment cascade for this period.
Lessons learned: A total of 13,747 clients received
HIV testing, 475/13,747 (3.5%) were confirmed
positive: 440 (92.6%) men who have sex with men,
28 (5.9%) transgender women, 7 (1.5%) female sex
workers. 266/475 (56%) were eligible and offered
SDART, 266/266 (100%) accepted and 261/266(98%) initiated ART: 236/261 (90.4%) on the day of
HIV diagnosis, 24/261 (9.2%) within 3 days, 1/261(0.4%) after 7 days. At their long-term ART

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157

maintenance facilities, 166/261 (63.6%)
underwent viral load testing, 161/166 (97.0%)
achieved viral suppression. 5/266 (1.9%) clients
who did not initiate SDART showed symptoms of
OIs and were referred; all (100%) have initiatedART at their referred hospital. Of 209/475 (44.0%)
clients who were not eligible for SDART, 67/209(32.1%) were non-Thai and were referred to ART
migrant support funds , 142/209 (67.9%) werediagnosed out of SDART service hours, and werereferred out. All 209 initiated ART at their referredfacility.
Conclusions: Community-led SDART, delivered bytrained lay providers is feasible, acceptable andcloses linkage to treatment gaps among key
populations in Bangkok. Community-led SDART
service hours should be extended. National
policies should integrate community-led SDART in
the health system and to allow non-Thai to receive
ART at community-led clinics to ensure equitable
health access to all.

Poster Abstract

158

136

observed in both BSRS-5 (t=-2.55, p=0.019) and
BDI-II (t=- 2.61, p=0.02).

The Impact of a MultiIntervention Program on
Depression in HIV-Positive
Patients Engaging in Chemsex:
A 42-Week Study

Conclusion: This study underscores theeffectiveness of the 42-week multi-intervention
program in improving depression scores among
HIV-positive individuals engaging in chemsex. The
findings suggest that sustained participation in the
program, especially with an attendance rate of
50% or more, yields more significant
improvements in emotional well-being.
Future research should delve into the broader
applicability and feasibility of this multiintervention program. Understanding its impact ondiverse populations and exploring potential
modifications or additions could enhance its
effectiveness in addressing the mental healthchallenges faced by HIV-positive individuals
involved in chemsex. Ultimately, this study
contributes valuable insights into developing
targeted interventions to improve the mental
health outcomes of this specific population.

Sun N1, Cheng C1, Cheng S1
1Taoyuan General Hospital, Tao Yuan City, Taiwan

Background: This study aimed to investigate theefficacy of a comprehensive multi-intervention
program in alleviating depression among HIVpositive individuals engaging in chemsex. Utilizinga pre- and post-test design, the study assessed thephysical and mental health of 24 participants
through the Brief Symptom Rating Scale (BSRS-5)
and the Chinese version of the Beck Depression
Inventory-second edition (BDI-II) before and aftera 42-week intervention.
Methods: The 42-week multi-intervention
program consisted of weekly 2-hour sessions,encompassing drug harm reduction, psychodrama,
dance art therapy, and other diverse activities
promoting participant engagement. The
participants, all HIV-infected men who have sex
with men (MSM), had an average age of 38 years(±8 years).
Results: After the completion of the program,
there was a significant improvement in depression
scores measured by BSRS-5 and BDI-II (p<0.05).
Notably, participants with an attendance rate of
50% or higher exhibited more substantial
improvements in depression scores (p<0.05).
Specifically, among the 24 participants, emotional
distress, as measured by BSRS-5, decreased in 33%
of individuals, while 25% experienced a reduction
in depression problems according to the BDI-II preand post-test results. Paired sample t-tests
comparing pre- and post-test scores revealed asignificant improvement in emotional well-being,as indicated by BSRS-5 (t=1.16, p<0.01) and BDI-II(t=.966, p<0.01). Further analysis comparing posttest scores based on attendance rates
demonstrated that higher attendance rates (50%or more) correlated with better improvements inparticipants' mood, with significant differences

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Keywords: HIV-positive patients; Chemsex; Harm
Reduction; Depression ScalePoster Abstract

137

Impact of Local Civil Society
Organizations on Early
Diagnosis in the Thailand Test
and Treat Contest: Assessmentof Provincial Short-Term andLong-Term OutcomesThammajaruk N1, Thongsuksangcharoen S1,Pengnonyang S1, Suriwong S1, Tasomboon W1,
Benjarattanaporn P2, Sirisinsuk Y3, Lertpiriyasuwat
C4, Noknoy S4, Lumyai S5, Triamvichanon R1,
Phanuphak N1, Phanuphak P1
1Institute of HIV Research and Innovation (IHRI), Bangkok,

Thailand, 2Joint United Nations Programme on HIV/AIDS(UNAIDS), Bangkok, Thailand, 3National Health Security Office(NHSO), Bangkok, Thailand, 4Division of AIDS and STIs,
Department of Disease Control, Ministry of Public Health,
Nonthaburi, Thailand, 5National Institute of Health, Departmentof Medical Sciences, Ministry of Public Health, Nonthaburi,
ThailandBackground: Civil society organizations (CSOs) in
Thailand are legalized to conduct HIV testing as anentry point to HIV treatment and prevention. CSOs
and government partners, including the Ministryof Public Health, initiated Thailand Test and Treat
Contest (TTTC) using prize and financial incentives
to enhance early HIV diagnosis through task
sharing between CSOs and public healthauthorities at a provincial level.
Methods: Of 77 provinces invited, 16 applied for
TTTC (4 in Phase I: March-September 2022 only, 3
in Phase II: February-July 2023 only, 9 in bothphases). The proportion of newly diagnosed clientswith CD4 count <200 cells/mm³ (%CD4<200) andmedian CD4 counts at diagnosis/prior to treatment
during the 6-month pre-contest phase werecompared to those during the contest phase.
Comparisons were classified into short-term (onephase contest duration) and long-term (two-phase
contest duration). Provinces were stratified by theability of CSOs to perform HIV testing beyond
reach and recruit.
Results: There were 4,837 new HIV cases in the
short-term comparison from 16 provinces, with
4,325 verified CD4 counts. Overall, %CD4<200 was
significantly lower during the contest (46.1% vs.

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159

48.5%, p=0.036), compared to pre-contest phase.
This was true only in the 11 provinces with CSOs
conducting HIV testing (45.1% vs. 47.8%, p=0.027)
but not in the other 5 provinces without (53.4% vs.
52.7%, p=0.809). Median CD4 count during thecontest phase was significantly higher than the
pre-contest phase only in provinces with CSOs
conducting HIV testing (235 vs. 217, p=0.027).
Long-term comparison identified 6,730 new HIV
cases in 9 provinces, with 5,972 verified CD4
counts. Significantly lower %CD4<200 and higher
median CD4 count were seen during the contest,
than the pre-contest phase, in these provinces(44.5% vs. 48.3%, p=0.003, 240 vs. 215, p=0.004,
respectively). Only 1/9 province lacked CSOs withHIV testing capability. Bangkok, with the largest
number of CSOs capable of performing HIV testing,exhibited the highest improvement in median CD4
count (268 vs. 232, p=0.003).
Conclusions: HIV testing conducted by CSOs could
significantly enhance early HIV diagnosis. Holding anational contest is a successful strategy which
could stimulate serious collaborations between
CSOs and public health authorities at a provincial
level.

Poster Abstract

138

Enhancing motivationalcounseling training for HIV
service providers in Vietnam
ahead of national rollout:
Insights into perceived
applicability and barriers
among trainees
Tran H1, Nguyen A1, Coley R1, Vo S1, Tran D1,
Nguyen V1, Phan H2, Pham M2, Nguyen N2, Levitt
D1
1FHI 360 Vietnam, Hanoi, Viet Nam, 2Vietnam Administrationfor HIV/AIDS Control, Hanoi, Vietnam

Background: Vietnam’s national strategy to end
AIDS by 2030 includes enhancing service provider
capacity. Motivational counseling (MC) inbehavioral communication strategies has shown toincrease program effectiveness across the HIV
service cascade. Recognizing its evidence base, theUSAID/PEPFAR-funded Meeting Targets andMaintaining Epidemic Control (EpiC) project
collaborated with the Vietnam Administration for
HIV/AIDS Control (VAAC) to provide MC trainings
for HIV service providers from provincial centers
for disease control, regional and national
institutes, and community partners. EpiC
administered in-training and post-training surveys
to gain insights into participants’ perceived
applicability of MC and used these data to informthe development of the national training
curriculum.
Description: From September 2022 to August
2023, EpiC and the VAAC trained selected facility
and community-based healthcare providers from59 of 63 provinces in Vietnam on motivationalcounseling. During training wrap-up, 275
participants took a survey measuring selfperceived confidence and commitment to applying
MC, and evaluating training objectives,
applicability, content, design, and facilitation.
Three to six months later, 158 participants
completed a second survey on their use of MC andbarriers to effective application.

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160

Lessons learned: The in-training survey responses
showed increased confidence using MC (5-point
scale, pre-training: mean: 2.24, 95% CI: 2.14 to
2.34, post-training: mean: 4.12, 95% CI: 4.05 to4.19) and commitment to applying MC after the
training (10-point scale, mean 8.71, 95% CI: 8.56 to8.86). Feedback on training objectives,
applicability, content, design, and facilitation was
positive. The 158 respondents who filled out the
post-training survey noted the training was:applicable to their work (98.6%) and personal life
(98.1%); a worthwhile use of their time (98.1%);
and that they had seen positive results using MC
since the training (98.1%) or were expecting
positive results (98.1%). Reasons provided forsuccessful application included participation intraining (61.7%), personal motivation (46.2%),
provided training materials (44.3%), recognition(31%), and knowledge recaps (27.8%). Only a few
participants (1.9%) mentioned lack of motivation
to apply MC to their work and perceived
usefulness to their jobs as barriers to effective
application. Participants identified key concepts
that needed more focus during trainings to
maximize their use, including dealing withresistance, eliciting talk about change, andrecognizing when clients are talking about change.
Recommendations include more in-person
trainings with increased opportunities for practice,
more relevant scenarios, and in-depth explorationof the most challenging modules.
Conclusions: Understanding participant
perceptions of the utility of MC training is crucial
to strengthen its applicability. The use of in- andpost-training surveys can provide valuable
feedback to inform the development of morepractical exercises, such as more relevant roleplay
scenarios, and appropriate time for each module.
Ongoing efforts by EpiC and the VAAC to improve
MC trainings will be reflected in the codeveloped
national MC training curriculum for public andnon-government providers working in HIV, with afocus on key populations, launching in 2024.
Further investigation is needed to evaluate client
outcomes as a result of MC trainings.

Poster Abstract

139

Using a rule-based algorithm
to automatic classify cause of
mortality from free-text on
death certificates: AIDSrelated mortality results
among PLHIV registered in the
National AIDS Program,
Thailand, 2008-2022
Lertpiriyasuwat C1, Kiatchanon W2, Punsuwan N1,
Namahoot P3, Aungkulanon S2, Noknoy S1,Wareechai P3, Naiwatanakul T2, Kanphukiew A2,
Northbrook S2
1Division of AIDS and STI, Department of Disease Control,

Ministry of Public Health, Nonthaburi, Thailand, 2Division of
Global HIV/AIDS and TB, Thailand and Laos, U.S. Centers for
Disease Control and Prevention, Nonthaburi, Thailand,
3National Health Security Office, ◌Bangkok, ThailandฺBackground: The Thai National AIDS Program(NAP) has collected demographic, behavioral, andHIV-related data for all people living with HIV(PLHIV) under Universal Health Coverage since2008. NAP links individual data with the National
Death Registration with non-coded, free-text data
documenting causes of death. We developed arule-based methods to automatic classify cause ofdeath and analyzed major causes of death todetermine geographic disparities from 2008 to
2022.
Methods: A rule-based algorithm was developed
to classify cause of death (COD) from free-text on
death certificates and patient characteristics (ageand clinical information prior to death). We
applied text mining technique to categorize freetext into 3 major groups: AIDS-related causes, nonAIDS related causes including non-communicablediseases, and ill-defined COD following Thai HIV
case surveillance definitions and WHO HIV clinicalstaging guidelines. Accuracy evaluation involved
expert reviews of both free-text and algorithmderived causes. We calculated the ratio of AIDS to
non-AIDS-related deaths to measure geographicaldisparity and assessed potential determinants of
AIDS-related mortality using multiple regression(SAS v 9.4).

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161

Results: The cause of death algorithm achieved
92% accuracy. Of 120,793 deaths, 58.1% were
AIDS-related, 37.8% non-AIDS-related, and 4.1% illdefined causes. Tuberculosis, pneumocystis
pneumonia, and other pneumonia were mostcommon among AIDS-related causes. Trend of
AIDS-related deaths declined from 60.6% in 2008
to 48.7% in 2022, with a significant decrease in thenumber of provinces with high AIDS-related deaths
and proportion of AIDS-related deaths in the lower
northern, northeastern, and central provinces.
Factors associated with AIDS-related mortality
included baseline CD4 <200, age <24 years, female
gender, key populations (men who have sex withmen, sex workers), and no ART history.
Conclusion: AIDS-related causes accounted for the
majority of deaths using a rule-based algorithm.
Targeted interventions to increase ART coverage
and TB prevention, diagnosis, and treatment are
critical to reduce AIDS-related deaths.

Poster Abstract

140

Bridging the gaps:
Identification of capacity andfinancing needs to integrate
and sustain community
complementarity to thenational HIV response in
VietnamNguyen H1, Levitt D1, Coley R1, Nguyen H1, Ngo T2,
Do T3, Nguyen H3
USAID supported EpiC Vietnam. FHI360, Ha Noi , Vietnam,
USAID Vietnam , Ha Noi , Vietnam, 3Vietnam Administration of
HIV/AIDS control (VAAC), Ha Noi , Vietnam
1
2

Background: The 2023 AIDS Epidemic Model foundthat 33% of all new HIV infections are in Vietnam’s
Mekong Delta region. Therefore, the Vietnam
Administration for HIV/AIDS Control (VAAC) is
calling for more comprehensive HIV services in the
Mekong Delta and expanded community
complementarity to the response. National efforts
are increasingly focused on access to financing andinvestment mechanisms for community-basedorganization (CBO) service providers, considering
PEPFAR plans to transition funding by 2030.
However, no national database exists on HIVfocused CBOs and services provided. The
PEPFAR/USAID-funded EpiC project, in partnershipwith the VAAC, is implementing a national
community assessment in 11 of 63 provinces, ofwhich five provinces are analyzed herein.
Materials and Methods: Leaders from twenty
CBOs in the Mekong Delta completed aquestionnaire regarding services, reach, andstrategic needs of CBOs in the region.
Results: According to the respondents, CBOs
target a range of key populations, including men
who have sex with men (90%), people living withHIV (55%), transgender men (45%), transgenderwomen (40%), female sex workers (40%), andpeople who inject drugs (25%).
All CBOs engage in behavior change
communication, distribution of harm reductioncommodities, and referral to HIV andcomplementary services. Most (90%) conduct HIV

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screening; 40% screen for hepatitis B and C andother sexually transmitted infections. A limited
number of CBOs refer clients for sexual andreproductive health (35%); screen for mental
health (30%); counsel on amphetamine-type
stimulants and chemsex (20%); sell
pharmaceuticals and supplements (15%); and/or
provide HIV treatment (10%).
Among CBOs, 55% generate their own strategicplans, 30% rely on donor direction, and 15% do
not have a strategy. Half of strategy development
focuses on income generation activities, and only
55% of organizations conduct planning for at leasta year at a time. Most leaders (85%) obtain
additional part-time work to sustain themselves.
To improve their utility and effectiveness, CBOs
desire more donor interest in their work (95%);
and more opportunities for capacity building
through training, conferences, and seminars(85%); more recognition (50%); and clear andspecific legal provisions (20%). Only 25% of CBO
leaders indicated that they are looking for a statemanaged mechanism to fund services.
Conclusions: Mekong Delta CBOs in Vietnam candeliver a wide range of HIV interventions and may
be best suited to implement front-end-of-thecascade services as the country moves toward
epidemic control, especially among key
populations. However, reliance on donor funding
and international support for registration andcapacity building limit the extent to which
community partners can complement the national
response in the face of decreased donor
assistance. Lack of sufficient financial resources
also requires most leaders to divide theirprofessional lives between CBO work and otherincome-generation activities.
However, not all community partners areinterested in government financing mechanisms.
Additional efforts are needed to create
opportunities for community and government
complementarity through diverse funding
mechanisms, and to build community interest inaccessing them. Vietnamese community partners
will also need tailored capacity strengthening toensure they can effectively and sustainably engage
in last-mile interventions.

Poster Abstract

141

Perception Towards the
Implementation of the Iloilo
City Anti-Discrimination
Ordinance (IC-ADO) to theAccessibility of HIV Preventive
Services (HIV-PS) among Gay,
Bisexual, and Men who have
Sex with Men (GB-MSM)
Martinez F1,2, Bacayo M1, Sarabia K1, Encila F1, Ejor
A1, Ellama C1, Aguirre A1, Bermudez E1, Bionat J2,3
1Team Dugong Bughaw, Iloilo City, Philippines, 2Young Voices
3
Count, Iloilo City, Philippines University of San Agustin, Iloilo

City, Philippines

Background: The discrimination faced by LGBT
individuals, particularly GB-MSM, has an impact on
their behavior when it comes to seeking healthcare
services. According to previous studies, initiatives
and policies have been established to advance andsafeguard the rights of GB-MSM. Measures such as
the Anti-Discrimination Ordinance (ADO), havebeen put into effect at a local level, specifically in
Iloilo City. However, there is a lack of sufficient dataon the effectiveness of these ordinances inprotecting GB-MSM individuals. Thus, this study
tried to understand the perception towards theimplementation of IC-ADO in facilitating
accessibility of HIV-PS among GB-MSM.
Methods: This study utilized a narrative research
design to understand the perception of GB-MSM
towards the implementation of IC-ADO to theaccessibility of HIV-PS. The data was gathered
through key informant interviews (KII) fromFebruary 15, 2023 to March 2, 2023. Audio
recordings were transcribed and translated using aforward-backward approach, and underwent
Braun and Clarke’s thematic analysis to analyze thecollected data.
Results: A total of 20 participants were included in
the KIIs with age ranging from 18-45 years old. The
primary themes identified in this study include the(1) HIV prevention services - where it was revealed
that most common services that they acquire in

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sexual health facilities are HIV-PS such as HIV
testing and PrEP; (2) accessibility of HIV-PS - having
the clients’ priority revolve around physical,
financial, and information accessibility; (3) abilities
of GB-MSM - focusing on their health beliefs andtrust when accessing healthcare, (4) experiencesof discrimination, and (5) the awareness andperception of GB-MSM towards theimplementation of IC-ADO in facilitating HIV-PS,
generating mix responses where some GBMSM
believed that the ordinance would improve theirsense of safety in accessing sexual health services
while others claimed that there is much workneeded on a city-wide discussion to make surethat GBMSM are fully aware of the ordinance.
Conclusion: The IC-ADO ordinance can enhance
the accessibility of HIV-PS for GB-MSM individuals
by promoting equality and providing safe healthservices. However, in order to consider the IC-ADO
ordinance as effectively implemented, it is crucial
to assess awareness as a key factor. Despite
employing initial methods to disseminate
information, there are still barriers contributing toa lack of awareness about the ordinance such aslack of initiative or interest, fear of association,
insufficient campaign, and religious beliefs . While
the IC-ADO has the potential to facilitate
accessibility of HIV-PS, accessibility encompasses
other several aspects – physical access, financial
affordability, and availability of information.
Although participants in this study shared
information indicating that facilities and HIV-PS
were accessible, their ability to perceive, seek, andengage are factors that affect their access to HIVPS. Experience of discrimination acts as an overallbarrier for GB-MSM individuals seeking access to
HIV-PS. Therefore, it is necessary to intensify the
campaign for the IC-ADO in order to create an
inclusive and safe environment that prioritizes therecognition and addresses the unique needs of GBMSM.

Poster Abstract

142

Thailand’s First Comprehensive
Integrated Prevention andTreatment for HIV, TB, and STI
in Bangkok Metropolitan
Administration’s Primary
Health Clinic
Luengwattanapong R1, Palakawong Na Ayuthaya
T2, Brukesawan C3, Nandavisai C1, Pattharasikarin
S2, Khongjaroensakun S2, Poomlek V2, Panutat P2,
Lerdtriphop K3, Chaiphosri P3, Lolekha R1,
Isarankura Na Ayuthaya N3, Northbrook S1,Sunthornchart S3
1Division of Global HIV and TB, U.S. Centers for Disease Control

and Prevention, Nonthaburi, Thailand, 2Public Health Center 28,
Health Department, Bangkok Metropolitan Administration,
Bangkok, Thailand, 3Health Department, Bangkok Metropolitan
Administration, Bangkok, Thailand

Background: Since 2017, the Public Health Center
28 (PHC28) of the Health Department, Bangkok
Metropolitan Administration, has implemented an
integrated care model for people living with HIV(PLHIV). This model uniquely combines services forsexually transmitted infections (STIs), tuberculosis(TB), and HIV, offering comprehensive caredelivery.
Description: To expedite diagnosis andintervention while minimizing potential
antiretroviral therapy (ART) delays, PHC28 utilizes
a standardized patient flow:
1.
Initial Assessment: All clients undergo
rapid anti-HIV and Syphilis tests.
2.
HIV-Negative Clients: Receive preventive
education, regular HIV and STI screenings, and pre/post-exposure prophylaxis (PrEP/PEP), withfollow-up appointments every 1-6 months.
3.
HIV-Positive Clients: Undergo further
assessments, including history taking, physicalexamination, psychologist consultation, and index
partner testing.
4.
Hospitalization Triage: Clients requiring
hospitalization are referred for treatment.

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5.
ART Initiation Evaluation: Clients not
requiring hospitalization undergo same-day
investigations (Cryptococcus antigen test, chest Xray, and fundus photography) to assess forcontraindications to same-day ART initiation.
Additional laboratory tests are performed, withresults available within 1-2 weeks.
6. Treatment Initiation and Follow-up: Clients
without contraindications start ART, receive
treatment for STIs and opportunistic infections(OIs), and have follow-up appointments within 1-2
weeks to assess adverse drug reactions, OI
prophylaxis initiation, or TB preventive treatment.
The clients then have follow-up appointments
every 1-6 months thereafter.
This approach eliminates lengthy laboratory
processing times, allowing for interventions basedon the assessments, following the Thai National
HIV/AIDS Guidelines. Additionally, a status-neutral
approach ensures that all individuals regardless of
HIV status receive HIV prevention or ART initiation
services on the very first visit and reduces visit
frequency.
Lessons Learned: Comparing data from the
Bangkok Smart Monitoring System and HIV-Info
Hub show that between 2021 and 2022:
1.
Client Growth: PHC28 witnessed
increases in the number of PLHIV (3,880 to 4,763),
PrEP (2,314 to 2,868), PEP (289 to 377) clients, andSTI treatments (189 to 217).
2.
Surpassing National Benchmarks: PHC28
consistently achieved high ART coverage (94.2%
and 96.8%, exceeding the national average of
91.0% and 90.2%), 100% same-day/rapid ART
initiation in PLHIV without contraindications inboth years (compared to the national average of
36.2% and 39.7%). From the data, PHC28 showedsignificantly lower all-cause mortality rates (1.0%
and 0.5% versus the national average of 3.0% and2.6%) and higher percentages of patients achieving
undetectable viral load (97.1% and 95.5%,
compared to the national average of 92.9% and93.2%) after one year of ART initiation.
3.
High Engagement and Improved
Outcomes: PHC28 demonstrated exceptional
patient engagement, with minimal patient loss one
year after ART initiation (3.5% and 0.3%).
Additionally, the program achieved a 100% TB curerate among PLHIV for both years evaluated.

Poster Abstract

These results suggest improvements in client
engagement, outcomes, and service delivery
efficiency.
Conclusions: PHC28’s integrated care model for
PLHIV serves as a model for primary health clinics
in Thailand, streamlining diagnosis and treatment
while providing holistic, patient-centered care.
This program’s impact on patient outcomes, 100%
same-day ART initiation, aligns with the goals ofnational HIV epidemic control with a potential forfurther expansion.

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Poster Abstract

143

Sustaining high-quality HIV
services through the HIV
Disease-Specific Care
Certification program in
Thailand, 2020-2023
Fujitnirun C1, Lolekha R2, Munsakul W3, Khusuwn
S4, Saiyarin J5, Yukong C6, Nandavisai C2, Srisodsai
S7, Limpanyalert P7, Noknoy S8, Northbrook S2,
Lertpiriyasuwat C8
1Bhumibol Adulyadej Hospital, Directorate of Medical Services,Royal Thai Air Force, Bangkok, Thailand, 2Division of Global HIV
and Tuberculosis, U.S. Centers for Disease Control andPrevention, Nonthaburi, Thailand, 3Faculty of Medicine Vajira
Hospital, Navamindradhiraj University, Bangkok, Thailand,
4Chiangrai Prachanukroh Hospital, Chiangrai, Thailand, 5Klang
Hospital, Department of Medicine, Bangkok Metropolitan
Administration, Bangkok, Thailand, 6Ratchaphipat Hospital,
Department of Medicine, Bangkok Metropolitan
Administration, Bangkok, Thailand, 7Healthcare Accreditation
Institute, Nonthaburi, Thailand, 8Division of AIDS and STIs,
Department of Disease Control, Thailand Ministry of Public
Health, Nonthaburi, Thailand

Background: Since 2016, the Thailand Ministry of
Public Health, Healthcare Accreditation Institute(HAI), and PEPFAR Thailand have collaborated tocreate the HIV Disease-Specific Certification (DSC)
program, which includes a standardized approachand certification metrics based on national HIV
guidelines, ensuring that hospitals deliver highquality HIV services. To obtain DSC, hospitals mustachieve second and third 95 targets along the HIV
cascade and recertify every 3 years.
We describe HIV outcomes of DSC-certified
hospitals participating in the DSC program in 2020and monitored changes in HIV treatment
outcomes during 2020-2023.
Methods: In 2020, ten hospitals applied for DSC.
Participating hospitals established aninterprofessional team composed of nurses,
physicians, pharmacists, laboratory technicians,and quality improvement specialists.
During 2020-2022, we conducted baseline
assessments, DSC standards training, and onsite(at least 2 times a year) and virtual coachingsessions (1 session per month per site) at ten
hospitals in four certification areas: leadership and

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166

program management, support system for HIV
service delivery (laboratory, pharmacy, infection
control, environment, and information system),clinical care delivery (counseling and testing,antiretroviral treatment (ART), opportunistic
infections, preventing mother-to-childtransmission, and sexual transmitted infections),
and performance measurement.
In the DSC-certified hospitals, we compared 2020
baseline vs. 2022 certification year vs. 2023 after
certification to ensure sustained gains using Chisquare and McNemar’s test.
Results: Of ten hospitals, five (50%) tertiary care
hospitals received DSC certification (one University
hospital, two Bangkok Metropolitan
Administration hospitals, one Air Force hospital,and one regional hospital) in 2022.
The remaining five hospitals have yet to submit arequest for certification due to delays in finding
responsible teams to cover the four certification
areas. Of the five certified-DSC hospitals, thefollowing indicators significantly increased(P<0.001) in 2022 compared to baseline data, %newly diagnosed PLHIV receiving ART (73.6%(411/558) vs. 97.7% (506/518)), % initiating rapid
ART within 7 days (55.2% (227/411) vs. 84.4%(427/506)), % PLHIV currently on treatment (91.1%(9,924/10,891) vs. 98.2% (9,568/9,744)), %receiving viral load (VL) test (89.0% (8,832/9,924)
vs. 96.7% (9,251/9,568)), and % VL suppressed(84.2% (8,353/9,924) vs. 95.8% (9,168/9,568)).
Three indicators increased in 2023 compared to2022, including % initiating same-day or rapid ART
within 7 days (84.4% (427/506) vs. 87.5%(529/660), P<0.062), % currently on treatment(98.2% (9,568/9,744) vs 99.2% (11,360/11,447),
P<0.001), and % VL suppressed (95.8%(9,168/9,568) vs. 96.8% (10,465/10,815), P<0.001).
Two indicators slightly decreased in 2023 but
remained >95%, including % newly diagnosed
PLHIV receiving ART (97.7% (506/518) vs. 96.0%(660/687), P<0.117) and % VL testing (96.7%(9,251/9,568) vs. 95.2% (10,815/11,360), P<0.001).
All certified hospitals reported improved HIV
workflow, referrals, consultations, and treatment
linkage due to better teamwork, communication,and leadership engagement.
Conclusion: HIV DSC promotes multidisciplinary
teamwork to improve PLHIV treatment outcomes,
increase visibility of HIV program to hospitalleadership, and sustain quality after certification.
The DSC model could be expanded to otherPoster Abstract

hospitals as a best practice. Continuous monitoringof key indicators after certification is critical toensure sustained gains.

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167

Poster Abstract

144

Understanding multistakeholder perspectives oncomprehensive chemsex
services for young men who
have sex with men in Thailand:
Qualitative findings from the
CLYMAX study
Hiransuthikul A1,2, Phongsinghwithaya C1, Siriphan
J3, Chayaananchot T1, Tangmunkongvorakul A4,
Sripitathanasakul T1, Khomshuk P1, Hongchookiat
P1, Nonenoy S1, Boonruang J1, Phanuphak N1
1Institute of HIV Research and Innovation (IHRI), Bangkok,

Thailand, 2Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University, c, Thailand,
3Foundation for AIDS Rights (FAR), Bangkok, Thailand,
4Research Institute for Health Sciences, Chiang Mai University,
Chiang Mai, Thailand

Background: The increasing visibility of chemsex
among men who have sex with men (MSM) in
Thailand underscores the urgent need for wellestablished and comprehensive chemsex services.
The lack of knowledge regarding the essential
components of comprehensive chemsex services
for MSM in Thailand poses a substantial obstacle
to the development such services. We exploredperspectives from various stakeholders on thenecessary components of comprehensive chemsex
services.
Material and Methods: Semi-structured, in-depth
interviews were conducted in-person with 60 key
informants in March 2023: 40 MSM aged 16-35
years who use chemsex, 10 peers/family
members, and 10 healthcare providers. Interviews
were recorded and transcribed verbatim. A
codebook was developed based on a priori themesof the interview guide and emergent themes fromtranscripts. Analyses were conducted using
Dedoose software.
Results: We identified four components thatshould be incorporated into comprehensive
chemsex services.
1.
Promoting substance use literacy is the
top priority. In particular, people who use chemsex

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168

value a reliable source of information on chemsexrelated harms and mitigating strategies.
2.
Mental health counseling from specialists,such as psychologists or psychiatrists, due torelationships between mental health and chemsex
use.
3.
Sexual health services, including routine
sexually transmitted infections screening, and theprovision of preventive measures such as PrEP andcondoms.
4.
Legal consultation and social/family
support are crucial in the context of country’s
punitive laws and common abusive practices
towards people who use substances.
Some MSM prefer onsite services for a more
professional feel and effective communication,
while others prefer online services due toexperienced/anticipated stigma and discrimination
when receiving in-person services or fears ofstreet-side urine drug tests by the police which
could lead to harassment, bribery, and legal
proceedings. Regardless, campaigns tonormalize/decriminalize chemsex are critical for
people to access healthcare services.
Other suggestions include establishing an
emergency hotline, offering mailed tools for safe
chemsex use, providing on-site chemsex
merchandise, and involving former users incounseling.
Conclusions: Chemsex-specific literacy, mental
health services, sexual health services, legal
consultation, and social/family support wereidentified as key chemsex service components,
and their inclusion in comprehensive chemsex
services for MSM in Thailand should be further
explored.

Poster Abstract

169

145

priorities, healthcare affordability and drugreconciliation.

A multidisciplinary teammeeting approach for the careof persons ageing with HIV in aresource-limited setting

The complex care of 14 PWH were discussed fromFebruary 2023- February 2024. The median age
was 57 years (IQR 51-65), with median duration ofliving with HIV of 19 (IQR 9-24) years. All
participants were virologically suppressed on
antiretroviral therapy and had a median of 4 (IQR
3-5) chronic comorbidities. Each session lasted twohours, with two cases discussed and the ID
physician was primarily responsible for all action
points and patient communication. Cases werediscussed more than once following theinterventions to monitor for progress.

Wong P1,2, Hisham S1, Basri S1, Lim L1,2, Lim Q1,2,
Hee N1,2, Lim S1,2, Wan Md Adnan W1,2, Tan C1,
Mohamed Fauzi M1, Syed Omar S1,2, Rajasuriar R1,2
1Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia,

Universiti Malaya, Kuala Lumpur, Malaysia

2

People living with HIV (PWH) are living longer,
however they encounter multimorbidity and issuesof ageing much earlier compared to the general
population. The goals of HIV care need to movebeyond viral suppression and embrace personcentered care.
Models of care where infectious disease (ID)specialists are the sole healthcare providers for
PWH are often ill-equipped to make this pivot, like
Universiti Malaya Medical Centre, a tertiary care
centre in Malaysia providing HIV care toapproximately 1400 PWH. In 2023, 34% of clinic
attendees were 50 years or older and 30%
between the ages of 40 to 49 years.
PWH with multimorbidity were referred out toother single-organ specialties increasing thenumber of hospital appointments, laboratory
investigations and polypharmacy. Clinical decisions
were made in silo by individual specialties with nofeedback to the primary HIV provider, leading to
disjointed management.
To address this, in February 2023 a monthly, IDphysician led multidisciplinary team (MDT)
meeting was established comprising an
endocrinologist, nephrologist, geriatrician,pharmacist and social worker as part of a quality
improvement initiative. Each specialty wasapproached personally by the ID team toparticipate in the meetings, and to nominate analternate. PWH with poorly controlled
comorbidities and complex social needs wereselected by the ID team and highlighted prior tothe meeting so each specialty had time to review
the case. During the meetings, physical and social
aspects of care was discussed, focusing on PWH’s

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

The MDT meetings directly resulted in reduced
number of clinical and blood test appointments
saving both cost and time for PWH, drug reviews
and reconciliation leading to reduced
polypharmacy, and increased access to subsidized
medications and home monitoring devices throughwelfare assistance and non-HIV specific financial
programs. Provider and patient communication
improved with patients being more open about
their care challenges. From a provider perspective,
the MDT meetings established a platform forongoing interdisciplinary knowledge exchange,
improved communication between specialties,
helped identify champions for the future planningof integrated HIV care and improved confidence inthe management of complex comorbidities among
ID physicians.
The main challenge was ensuring the availability ofeach specialty for the meetings. This was
overcome by engaging more than one individualfrom each specialty and identifying an individual tocoordinate the meetings.
In settings with limited resources to fully integrate
HIV care services, regular MDT meetings provide
an opportunity to pivot to a patient-centered caremodel for PWH who are ageing and have complex
care needs.

Poster Abstract

146

The facilitators and barriers to
the access of mental healthservices and support forpeople living with HIV in China:
A qualitative study from thepatient's perspective
Lei Z1, Hu H1, Shi Y1, Wu D1
1Nanjing Medical University, Nanjing, China

Background: People living with HIV (PLHIV) inmainland China face significant mental healthburdens, including depression, anxiety, andsuicidal tendencies. The mental health needs of
PLHIV remain unmet due to the fragmented
nature of the Chinese healthcare system. Mental
health screening, treatment, and referral services
are lacking in the HIV clinic, and mental healthcare
providers lack expertise and empathy in HIV care.
This dual service gap contributes to fragmentationin the HIV care cascade. The aim of this study was
to explore the factors that influence access tomental health services from the perspective of
PLHIV in mainland China.
Methods: This qualitative research, through online
in-depth semi-structured interviews, wasconducted with 26 PLHIV nationwide in mainland
China between November 2023 and March 2024.
The interviews explored participants’
understandings and experiences of HIV diagnoses,
mental health copying, help-seeking behaviors,
and related social and health services for mental
health, as well as perceived facilitators andbarriers to accessing those services. Data wascoded in NVivo 14 employing the Anderson service
utilization model.
Results: 26 PLHIV, mostly identifying as men who
have sex with men (MSM) with 2 elderly
heterosexual women, were recruited with various
education and income backgrounds and ages
ranging from 25 to 59. Half of the participants
have experience in coping with and accessing
related services when confronted with mental
health challenges through various routes. The key
barriers encompass deficient mental healthcare

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170

infrastructure and acquaintance-based healthcare
environments at the contextual level. Limitedaccess, privacy concerns, and misconceptions
toward HIV/AIDS and mental healthcare at theindividual level. For the elderly communities,
internet improficiency was the key barrier toaccessing services and up-to-date information
about HIV/AIDS and mental health. Stigma anddiscrimination associated with HIV and MSM,
strained doctor-patient relationships, andstandardization of HIV providers’ behaviors
without mental healthcare were identified as
barriers at the health behavior level. The key
facilitators involved CBO-led care linkage at thecontextual level. At the individual level, facilitators
included self-acceptance, economic capital,
awareness and destigmatization of mental
healthcare, adequate knowledge of HIV/AIDS, andsocial support from peers, CDC workers, doctors,
relatives, and other social networks. Streamlined
healthcare logistics and mental health counselors
with expertise were identified at the healthbehavior level. Designated hospitals with mental
healthcare and referral services were preferred for
PLHIV due to privacy protection, culture
adaptation, and empathy of service providers. The
novel online mental health counseling services
were preferred by the younger generation as it
offer flexible schedules and encourage expressing
intent.
Conclusion: Our findings underscore theimportance of addressing disparities in healthcare
access and information, ensuring privacy
protection, fostering cultural competence among
healthcare providers, and establishing an inclusive
environment within the mental healthcare setting.
Future research should consider the provider’s
perspective on the barriers and facilitators inservice delivery in mainland China.

Poster Abstract147

In-person pick-up versus postaldelivery: PrEP service and its
association with adherence
and retention among Chinese
MSM
Li C1,2, Yin Z1, Li Q3, Li L3, Wu S4, Liang K4, Marley
G1, Fan C1, Dai Y1, Huang H5, Hazra A6, Lio J6, Tang
W1,7, Sherer R6, Tucker J1,7,8
1UNC Project China, Guangzhou, China, 2Tokyo College, theUniversity of Tokyo, Tokyo, Japan, 3Guangzhou Eighth People’s
Hospital, Guangzhou, China, 4Zhongnan Hospital of Wuhan
University, Wuhan, China, 5Wuhan Tongxing LGBT Center,
Wuhan, China, 6Department of Medicine, University of Chicago,, USA, 7Institute for Global Health and Infectious Diseases,
University of North Carolina at Chapel Hill, , USA, 8ClinicalResearch Department, Faculty of Infectious and Tropical
Diseases, London School of Hygiene and Tropical Medicine,
London, UK

Background: Differentiated services are critical for
scaling up PrEP in diverse settings. Postal deliveryof PrEP drugs could help people who are doing
well and do not need an in-person encounter. We
conducted a demonstration study to compare theeffects of in-person pick-up and post-mail delivery
on facilitating PrEP retention and adherence
among Chinese MSM.
Methods: MSM in Wuhan and Guangzhou, China
were recruited by online ads, clinic flyers, andcommunity referrals to a PrEP demonstration trial
to start a 12-month TDF/FTC as oral PrEP.
Behavioral data were collected at baseline andquarterly follow-ups over 12 months. At eachfollow-up, participants were allowed to refill the
medication either by in-person pick-up at the
study hospital or by post-mail delivery.
Generalized linear models were used to assess
associations between key outcome variables (selfreported good adherence [primary definition:<60% vs. 60% to almost 100% compliance with
PrEP dosing schedule in last 30 days], loss tofollow-up [LTF], and usage of postal PrEP),
adjusting for age, sexual orientation, employment
status, monthly income, and PrEP dosing
strategies. We defined LTF as either voluntary
withdraw or not completing the survey within 4
reminders of scheduled follow-up.

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171

Results: By September 8th 2023, 945 MSM (meanage=28.2, IQR 24.1-31.4) were enrolled and shouldhave reached their 6-month follow-up. A quater(n=199) of participants were LTF before six
months. About 54.4% of the participants used only
in-person PrEP pick-up, 19.6% only used postal
PrEP, and 26.0% used both delivery methods
during follow-up. No sociodemographic
characterstics were found significantly associatedwith postal PrEP usage. In multivariable-adjusted
models, participants who ever used postal delivery(aOR=0.17, 95% CI=0.11-0.27), had lower monthly
income (<715 USD versus >1430 USD, aOR=0.55,
95% CI=0.31-0.97), and of younger age (aOR=0.92,
95% CI=0.88-0.95) were less likely lost to follow
up. Self-reported good adherence to PrEP was notdifferent among those who used postal PrEP andin-person PrEP (aOR=0.63, 95% CI=0.30-1.31).
Conclusions: Postal PrEP delivery is feasible andwell-accepted among Chinese MSM and has thepotential to increase PrEP persistence byincreasing accessibility. Future research into
diversifying PrEP provision models outside of
traditional clinical settings while maintaining highadherence and quality of care is needed.

Poster Abstract

172

148

testing. Interviews were transcribed and analyzed
using thematic analysis.

Feasibility of implementing
cognitive testing in atransgender health clinic in
Thailand: qualitative insightsfrom transgender women
living with and at risk for HIV
and their healthcare providers

Thailand, 2Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 3Center of Excellence in Transgender Health (CETH),
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 4Research Institute for Health Sciences, Chiang Mai
University, Chiang Mai, Thailand, 5Department of Psychiatry,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 6Cognitive, Clinical and Computational Neuroscience,
Chula Neuroscience Center, Department of Medicine,
Chulalongkorn University, Bangkok, Thailand, 7HIV Center for
Clinical and Behavioral Studies, New York State PsychiatricInstitute and Columbia University, New York, United States,
8
Division of Vulnerable Populations, School of Medicine,
University of California San Francisco, San Francisco, UnitedStatesResults: Participants included 13 transgenderwomen aged ≥40 years (6 with HIV) and 8
healthcare providers. Transgender participants
agreed that cognitive function is an important
health aspect, and appreciated the integration of
cognitive testing into transgender care to enhanceaccess to cognitive health services. Barriers tocognitive services included: lack of awareness ofcognitive health, uncertainty about where to seekcare, and perceived high costs. Transgenderparticipants described how cognitive healthreceived less attention during visits than other
health priorities. Cognitive health stigma was not
identified as a barrier, but individuals living withHIV may hesitate to seek cognition care due tofear of HIV stigma and discrimination. The tabletbased cognitive testing tool was well-received,
particularly for its interactivity and ease of use.
While most transgender participants indicatedthat the test took approximately 30 minutes tocomplete and expressed satisfaction with theduration, providers noted that this length could
impact their overall workload. Transgenderparticipants reported that raising awareness about
cognitive health and advertising availability ofcognitive services would be key for successful
implementation of cognitive services in thetransgender health clinic. Providers further
stressed the importance of having adequate
testing devices, staffing, and on-site specialists fora streamlined referral system.

Background: Disparities in multi-level psychosocioeconomic factors place transgender womenat higher risk for cognitive impairment, including
potential variations by HIV-status. We therefore
explored the feasibility of implementing cognitive
testing in a transgender health clinic.

Conclusions: Implementing tablet-based cognitive
testing at a Thai transgender health clinic was
acceptable and feasible. Addressing barriers to
implementation is crucial for enhancing cognitive
health services integration to the specific needs ofthis population.

Hiransuthikul A1,2, Samitpol K1,3, Janamnuaysook
R1,3, Tangmunkongvorakul A4, Hemrungrojn S5,
Chunamchai S6, Chunharas C6, Mellins C7, Philbin
M8, Phanuphak N1,3
1Institute of HIV Research and Innovation (IHRI), Bangkok,

Material and Methods: From August-October
2023 we implemented peer-led cognitive testingat the Tangerine Clinic in Bangkok, Thailand. We
used a tablet-based version of the Thai-validated
Montreal Cognitive Assessment (MoCA), a 10-15
minute cognitive test. In contrast to the original
pencil-and-paper version, the tablet-based version
allows for self-administration and standardized
test delivery. Guided by the Consolidated
Framework for Implementation Research, we
conducted semi-structured interviews withtransgender women and their providers to explore
acceptability and feasibility of implementing this

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Poster Abstract149

Co-creating an integrated
gonorrhea and chlamydia
testing program at communitybased HIV testing centers formen who have sex with men inChina
Li K1, Marley G2,3, Zhang L2,3, Zhu Z2,3, Tan R4, Tang
W5, Tucker J6,7
1Division of Infectious Diseases, School of Medicine, Universityof California Los Angeles, Los Angeles, United States, 2Social
Entrepreneurship for Sexual Health Global, Guangzhou, China,
3
University of North Carolina Chapel Hill – Project China,
Guangzhou, China, 4School of Public Health, National Universityof Singapore, Singapore, Singapore, 5Department of
Epidemiology, School of Public Health, University of North
Carolina Chapel Hill, Chapel Hill, USA, 6Division of Infectious
Diseases, School of Medicine, University of North Carolina
Chapel Hill, Chapel Hill , USA, 7Department of Global Health,
School of Medicine, London School of Hygiene and Tropical
Medicine, London, United Kingdom

Background: Many Chinese men who have sex
with men (MSM) rarely access care throughtraditional healthcare channels due to social
stigma. Community-based organizations (CBOs)
have emerged as an important provider of HIV
testing services for MSM. However, few CBOs offer
integrated testing for Neisseria gonorrhea (NG) or
Chlamydia trachomatis (CT). We co-created andimplemented a CT/NG testing program inpartnership with six CBOs in Guangdong Provincethat normally provide rapid HIV, syphilis, and HCV
testing for MSM as part of the PIONEER RCT(NCT05723263).
Description: From February to November 2023,
we co-created a program for CT/NG testing alongwith 12 community MSM and 4 CBO staff
members. The program was implemented from
July to December 2023. CBO staff approached
MSM presenting for routine HIV testing ≥18 years
old who had not tested for CT/NG in the past year.
At baseline, sociodemographic information andprior STI testing history were collected.
Participants were offered pooled urethral,pharyngeal, and rectal CT/NG nucleic acidamplification testing. CBO implementors collected
and pooled all samples and shipped samples to an
external lab weekly. They also provided results

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notification for participants through WeChat andreferred positive testers for treatment at local
hospitals.
Lessons Learned: 393 MSM were approached from
July to December 2023. The mean age was 32.9
years (SD 10.2). At baseline, 374 (95%) reported
ever testing for HIV, 372 (95%) for syphilis, and349 (89%) for hepatitis C. Only 216 (54%) reported
ever testing for NG and 211 (54%) for CT. Across all
sites, 291 (74%) participants received CT/NG
testing. 10 (3.4%) tested positive for NG and 60(20.6%) for CT, including 5 CT/NG co-infections.
With support from the research team, CBO staff
successfully integrated CT/NG testing procedures,
including counseling for results and referrals forfurther care, with routine workflows for HIV rapid
testing. CBO leadership was critical for reaching
and maintaining the trust of community MSM.
Conclusions/Next steps: Through an integrated
CT/NG testing program, CBOs reached new CT/NG
testers and diagnosed high rates of CT/NG in MSM
at risk for HIV. Next steps include optimizing
follow-up and treatment and analyzing costs sothat these programs can be sustained.

Poster Abstract

150

Cognitive Health Matters:
Facilitators and Barriers to The
Integration of A MultiDisciplinary Cognitive
Rehabilitation Programme for
Persons Living with HIV(PWH)
in an HIV Clinic in Malaysia :A
Pre-Implementation,
Qualitative Study.
Hasmukharay K1, Ming Hui H2, Mohd Mahyudin N2,
Salleh A3, Pui Li W3, Kukreja A3, Meng Li C3, Xin
Woen T3, Hisham S3, Lovero K4, Ross J5, Rajasuriar
R6
1Geriatric Unit, Department of Medicine, University Malaya,

Kuala Lumpur, Malaysia, 2Faculty of Medicine, University
Malaya, Kuala Lumpur, Malaysia, 3Infectious Diseases Unit,
Department of Medicine, Faculty of Medicine, University
Malaya, Kuala Lumpur, Malaysia, 4Columbia University,
Mailman’s School of Public Health, New York, United States ofAmerica, 5Therapeutics Research, Education and AIDS Training
in Asia (TREAT Asia), amfAR – The Foundation for AIDS
Research, Bangkok, Thailand, 6Department of Medicine, Facultyof Medicine, University Malaya, Kuala Lumpur, Malaysia

Background: In the antiretroviral therapy era,
aging persons living with HIV (PWH) face increased
prevalence of cognitive impairment (CI), attributed
to both biological aging and long-term effects ofHIV. Despite proven efficacy and widespreadutilization of evidence-based cognitive
interventions in the general population, a gap
persists in providing targeted services to address
CI in aging PWH. This qualitative study aims to
explore facilitators and barriers associated withintegrating multidisciplinary cognitive
rehabilitation (mCR) programme into an HIV clinic,
through a multidomain approach which includes
dietary guidance, physical activity, cognitive
training and intensive management of metabolicand vascular risk factors.
Materials and Methods: PWH attending theInfectious Diseases(ID) clinic at University Malaya
Medical Centre, Malaysia, between November
2023-February 2024 were approached toparticipate in this study. Purposive sampling wasused to ensure participant diversity; ethnicity,

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gender, age (40-60 and > 60 years old) andeducation level. In-depth interviews wereconducted using semi-structured guides developed
based on the Consolidated Framework for
Implementation Research 2.0 domains to explore
PWHs understanding of cognitive health and their
willingness to engage with an integrated mCR
programme as part of routine HIV care.
Participants answered a modified Patient’s
Assessment of Own Functioning Inventory
questionnaire, to orientate them to the common
symptoms of CI and they were introduced to thestructure of the proposed integrated programme
before interviews commenced. All interviews wereaudio-recorded and transcribed. Thematic analysis
was used to analyse the data using Dedoose.
Results: Fourteen in-depth-interviews wereconducted. The median age was 50 years(IQR:48.5-57), eight (57.1%) were males and 50%
had a tertiary degree. There was a near total lackof awareness that PWH are susceptible at younger
ages to cognitive impairment and its associatedimpact on well-being and independence.
Participants also were not aware on the potential
roles of multidomain interventions to address CI.
Barriers to mCR integration in HIV clinics include
competing priorities related to HIV specificcare(CD4/viral load) and other medicalcomorbidities(hypertension, diabetes,
dyslipidemia) deemed to be total HIV care, lack oftime to discuss “non-HIV-related issues” with
providers, logistic and time constraints in engaging
in regular on-site rehabilitation activities,
reluctance for app-based cognitive training, cost ofengaging with multiple expertise and competing
caregiver responsibilities particularly among
women. Facilitators to service uptake following
integration of mCR included if prescribed by their
ID physicians, provision of a home or non-clinicbased rehabilitation programme, presence of
remote support and follow-ups with the mCRteams, and self-empowerment on cognitive healthmotivated by their need to care for others.
Conclusion: We found a major lack of knowledge
about cognitive health and the role ofmultidisciplinary interventions among PWH,
underscoring the need for comprehensive
educational initiatives to enhance awareness,promote informed decision-making, and facilitate
the integration of mCR strategies as integral
components of their healthcare journey. Seeking
additional perspectives from other stakeholders
will offer nuanced insights and will inform thedevelopment of tailored implementation

Poster Abstract

strategies that can address the specific needs andchallenges, ultimately enhancing the care for PWH.

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Poster Abstract

151

A crowdsourcing open call for
reducing hepatitis stigma
among healthcare providers in
China
Wang Y1, Tao Y1, Zhang S1, Wu D1,2
School of Public Health, Nanjing Medical University, Nanjing,
China, 2Clinical Research Department, Faculty of Infectious andTropical Diseases, London School of Hygiene and Tropical
Medicine, London, UK
1

Background: Stigma among healthcare providers
towards people living with hepatitis B and C cancompromise quality of care, and negatively impact
patient health outcomes. Stigmatizing perceptions,attitudes, and behaviors are common among
young people but effective interventions andmedical curriculum to reduce stigma among
medical students are lacking. Crowdsourcing
allows a group of individuals to solve a publichealth issue, and then share optimal solutions
back to the community. We organized a universitywide crowdsourcing open call among medical
students to generate community-created solutions
for stigma reduction.
Methods: This open call was conducted in Nanjing
Medical University with a total of 12000 students
and 2000 staff. The open call involved four steps:
1) formation of a multi-stakeholder steeringcommittee to set up rules and oversee the open
call process; 2) promotion of the open call throughonline and offline channels, and receiving
submissions; 3) screening and judging ofsubmitted entries using pre-specified criteria andeach submission was scored using a scale of 1-10
by at least 3 independent judges. A mean score of
1 indicates the poorest quality, and 10 indicatesthe highest quality; 4) sharing and implementing
finalist ideas . Entries were accepted as text,
poster or comic, and video in Chinese and English.
Thematic analysis of all relevant entries was
conducted to identify themes and potential
solutions.
Results: The open call was conducted from
September 15th to October 15th in 2023. A totalof 114 entries were submitted online, and there
were 9 videos, 54 posters or comics, and 51 text
submissions. Thirty-three entries scored more

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176

than 8 out of 10, with the highest score of 9.07
and the lowest score of 8.53 among the top 10
entries, which were selected as finalist
submissions for future dissemination andevaluation. Among all participants, 24.6% of themhad family or friends affected by viral hepatitis and38.1% of them ever participated in hepatitisrelated volunteer activities. Most participants
knew the open call via a student group (46%) andsocial media (43%).
Of the 114 entries, 83 mentioned that public
misconceptions about viral hepatitis, like hepatitis
can be spread by daily contact, can be addressedby more authority-led educational campaigns.
Forty-nine submissions suggested the need forlegislation or enforcement of existing laws tosafeguard rights among people living with
hepatitis and to prevent stigmatizing practices likedenial of a job position or school entrance. Fortyone highlighted that improving healthcare
services, like strengthening research on medicine
and public health policy can reduce thestigmatization towards people living with hepatitis,and 32 argued that a more inclusive andempathetic society, for example, getting thecommunity involved in, can reduce thestigmatization of people living with hepatitis.
Conclusion: Within a month period of time, we
solicited a wide range of entries, suggesting an
open call is a feasible and viable way to engage
university students in co-creating studentcentered learning materials for hepatitis-related
stigma reduction. Future evaluation of theeffectiveness of these crowdsourced materials isneeded.

Poster Abstract

177

152

anticipated negative thoughts and negative
thoughts toward self.

HIV-related stigma among
young people growing up withHIV during transition frompediatric to adult care in
Thailand: a mixed-methods
study

From qualitative interviews, most YPHIV
mentioned anticipated stigma. Their coping
strategies included selective disclosure, avoidanceof situations, and limited social activities, whichallowed them to receive social support andnavigate their life for years. YPHIV describedenacted stigma in their childhood experiences,mostly due to prejudice and stereotypes related totheir physical appearance (e.g., visible scars frompast infections, short stature). Some YPHIV werediscriminated against by relatives or friends (e.g.,
excluded from sharing meals, joining activities),and denied entrance to academic institutions or
employment due to their HIV status.

Aurpibul L1, Songtaweesin W2,3, Masurin S1,
Saisaengjun C2, Taweehorm W1, Jumpimai T2,
Suwanlerk T4, Puthanakit T2
1Research Insititute for Health Sciences, Chiang Mai University,

Muang Chiang Mai, Thailand, 2Department of Pediatrics,
Faculty of Medicine, Chulalongkorn University, Bangkok ,Thailand, 3School of Global Health, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 4TREAT
Asia/amfAR – The Foundation for AIDS Research, Bangkok,
ThailandBackground: HIV-related stigma is a significant
issue for people living with HIV that can affectwell-being and treatment outcomes. In this study,
we explored HIV-related stigma in the perception
and experiences of young people in Thailand withperinatally acquired HIV (YPHIV) and assessed
their effects on healthcare transition.
Methods: We conducted the study at two sites in
Chiang Mai and Bangkok. Inclusion criteria were:
1) having perinatally acquired HIV 2) aged
between 18-30 years, 3) receiving antiretroviraltreatment (ART) in pediatric HIV clinics (group A)
or after transfer to an adult clinic (group B), Stigma
was assessed by the 8-item Thai Internalized HIV
Stigma Scale (IHSS), which was validated for use inmeasuring negative thoughts and their effects
toward self, family and access to healthcare
services. It rated stigma levels as low (8-15)
medium (16-23) and high (24-32). In-depth
interviews were performed to assess stigma andexperiences during transition to adult HIV clinics.
Results: From December 2023 to January 2024 20
YPHIV were enrolled, with 10 (50%) each in groups
A and B; 12 (60%) were female, median age was 23(IQR 22-25) years, median duration on ART was 18(IQR 15-21) years. The median IHSS score was 14(IQR 11-17), with 2 (10%) high, 6 (30%) medium,and 12 (60%) low levels of internalized stigma. The
two components with the highest scores were

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

YPHIV mentioned feeling safe and more
comfortable in pediatric clinics with a familiar
environment and well-established social networks.
Those who remained in pediatric clinics were
aware of the need to transition care but wanted todelay it as long as possible. The 10 YPHIV who hadtransitioned care reported they did not perceive
anticipated HIV-related stigma while moving to theadult clinic. However, YPHIV noted adult clinics
were crowded with long waiting times. It was
problematic to have more frequent clinic visitswith limited flexibility in appointments due to theneed to excuse themselves from work/class, which
led to their employers/colleagues being curious
about the reasons for the frequent absences andrisked unintended disclosure, which discouraged
them from remaining in HIV care.
Conclusions: We found that YPHIV faced
anticipated and enacted HIV-related stigma duringchildhood. With some coping strategies, they
could manage their life in school and thecommunity, adhere to antiretroviral treatment,
and receive social support. With the presence ofinternalized stigma, YPHIV who transitioned toadult HIV care did not report anticipated stigma.

Poster Abstract

153

Quality of Life determinants
among people living with HIV:an Australian HIV
Observational Database(AHOD) sub-study
Rupasinghe D1, Sowden D2, Hoy J3, Roth N4,
Bopage R5, Carr A6, Gunathilake M7, Baker D8,
Petoumenos K1
1The Kirby Institute, University of New South Wales, Sydney,

Sydney, Australia, 2Clinic 87, Nambour Hospital, Sunshine Coast
Hospital and Health Service, Nambour, Australia, 3The Alfred
Hospital, Melbourna, Australia, 4Prahran Market Clinic,
Prahran, Australia, 5Western Sydney Sexual Health Centre andWestmead Clinical School, University of Sydney, Parramatta,
Australia, 6St. Vincent's Hospital, Darlinghurst, Australia, 7Clinic
34, Centre for Disease Control, Northern Territory Department
of Health, Tiwi, Australia, 8East Sydney Doctors, Surry Hills,
Australia

Background: As HIV treatments continue toimprove longevity of people living with HIV, thefocus for the clinical management is directedbeyond achieving undetectable HIV viral load toinclude the ongoing management of other factors
such as achieving good health-related quality oflife (QoL). In this analysis, we will explore selfreported QoL among people with HIV in Australian
HIV Observational Database (AHOD).
Methods: Participants enrolled in the AHOD wereinvited to participate in a QoL and sociodeterminants of health sub-study. Participants
self-completed a survey that included the POZQOL(a 13-item QoL questionnaire validated in people
with HIV), the SF-36 (physical, functional, andmental health survey), and Berger HIV stigma scale
instruments. The survey also included questions
on social determinants of health, self-reported
comorbidity, and ART adherence.
An overall mean PoZQoL score ≤3.53 was used todefine low or moderate QoL. The SF-36 instrument
was used to determine the composite physicalhealth (PH) and mental health (MH) scores. PH<50
or MH<50 was used to define low QoL. Significant
stigma was defined as having a total score higher
than the mean score using the Berger HIV Stigma
scale.

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178

Descriptive statistics was used to assess the
proportion and characteristics of those with
PoZQoL score≤3.53 and PH/MH<50 using SF-36.
Results: To date, 99 participants consented to thesub-study. The majority were male (89%),
Caucasian (88%), with a median age of 61 years(IQR 54–69). Most (76%) acquired HIV through sex
with a man. The majority (95%) had an HIV viralload <50 copies/mL and a median CD4 count of
642 cells/µL (IQR 514-931). Most participants had
a university or post-graduate education (36%),
were retired or not working (46%), and had anincome between $30,000-$99,000 (35%). The
majority were socially (95%) and physically (56%)
active and reported being adherent to their
antiretroviral medication (94%). Almost half theparticipants were affected by stigma (49%), and
57% reported more than one comorbidity.
Approximately a third (34%) of total participants
had a PoZQoL score ≤3.53 and 30% had low (<50)
SF-36 PH/MH scores. Participants in each group
had similar HIV-related characteristics (CD4 countover 650 cells/uL; over 95% with HIV viral load <50
copies/mL) to the total study population. Majorityof each group had an income <$30,000 (PoZQoL≤3.53: 38%; SF-36 PH/MH<50: 47%), experienced
significant stigma (PoZQoL ≤3.53: 79%; SF-36
PH/MH<50: 57% ) and comorbidities (PoZQoL≤3.53: 65%; SF-36 PH/MH<50: 76%).
More women reported PoZQoL ≤3.53 compared tomen (60% vs 30%) and a higher proportion of
Other ethnicity had PozQoL ≤3.53 compared to
Caucasians (54% vs 32%). Those ≤60 years of age
had a higher proportion with PozQoL ≤3.53
compared to those >60 years of age (41% vs. 28%).
Conclusions: While the sample size was small,
despite favourable CD4 cell counts and controlledviremia, we found a substantial proportion ofpeople with poor QoL. With high levels of stigma
and reported comorbidities among those withpoor QoL in AHOD participants, improved
management of comorbidities and programs toassist with stigma reduction are necessary to
improve their QoL.

Poster Abstract154

HIV-related knowledge, stigma
attitudes, and intent todiscriminate in healthcare
settings among medical andnursing students: A crosssectional study in Bangkok
Maneesriwongul W1, Lolekha R2, Prajankett O3,
Piyaraj P4, Maude R5, Karuchit S2, Muktier S2,
Northbrook S2, Rosa D6, Visudtibhan P1
1Ramathibodi School of Nursing, Faculty of Medicine

Ramathibodi Hospital, Bangkok, Thailand, 2Division of Global
HIV and TB, U.S. Centers for Disease Control and Prevention,
Nonthaburi, Thailand, 3The Royal Thai Army Nursing College,
Phramongkutklao Hospital, Bangkok, Thailand, 4Department of
Parasitology, Phramongkutklao College of Medicine, Bangkok,
Thailand, 5Division of Infectious Diseases, Faculty of Medicine
Ramathibodi Hospital, Bangkok, Thailand, 6Division of AIDS and
STIs, Department of Disease Control, Ministry of Public Health,
Nonthaburi, Thailand

Background: People living with HIV (PLHIV)
globally report experiencing discrimination byhealthcare providers. We assessed HIV-related
knowledge, stigma attitudes (worries about
getting HIV infection), and intent to discriminate(intent to modify behavior in unnecessary ways)
among medical and nursing students in Bangkok.
Methods: A convenience sample was chosen to
enroll 4th to 6th year medical and 3rd and 4th year
nursing students from 2 institutions during a 24week period in 2022/2023. Enrolled participants
completed an online questionnaire using Google
Form and Moodle after providing informed
consent. Differences between nursing and medical
students were assessed by Chi-square forcategorical variables (attitudes and intent todiscriminate) and independent t-test forcontinuous variables (knowledge scores) using R.
Results: The survey enrolled 570 students,
comprising 204 (35.8%) medical and 366 (64.2%)
nursing students. Overall, the median age was 21
years and 76% were female. Fifty-seven percent of
medical students and 20.2% of nursing students
had ever contacted/taken care of PLHIV (p<.001).
Of these, nursing students were more likely to use
double gloves when caring for PLHIV than medical
students (71.6% vs. 55.1%, p=.022). No significant

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179

difference in scores on HIV transmission
knowledge (6.2/9 vs. 6.3/9, p=.12) was observedby type of provider-in-training. Nursing students
scored higher on standard precaution knowledge
than medical students (8.8/11 vs. 8.4/11,
p<.0001). Both groups reported that following
standard precautions is very important. Most
students (90%) in both provider-in-training groups
reported not being worried or a little worried
when performing non-invasive procedures (i.e.,measuring blood pressure). Eighty percent of theparticipants reported feeling a little or somewhat
worried when performing invasive procedures and
85% reported having the intention to discriminate
while performing such procedures (i.e., taking
unnecessary precautions or avoiding physicalcontact). No significant differences in stigma
attitudes or intent to discriminate when providing
care for PLHIV were found.
Conclusion: Medical and nursing students had
moderate knowledge of HIV transmission andgood standard precautions knowledge. Somestudents lacked experience in caring for PLHIV andshowed intention to discriminate. Futureinterventions for medical and nursing students arenecessary to reduce stigma and discriminatory
behavior when providing care to PLHIV in Bangkok.

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180

155

people living with HIV (PLHIV) are entitled to thesame level of care as any other living person.

Breaking Barriers and Stigmas:
Lessons Learned from
Malaysia's First Kidney
Transplant on a Person Livingwith HIVAt UMMC, his case received a comprehensive
evaluation, extending the workup period to six
months—twice the usual duration. Multiple teamdiscussions involving experts in nephrology,
infectious diseases, and urology were conductedto ensure meticulous patient selection andevaluation. This collaborative effort tackled
logistical and medical challenges for a successfultransplantation. He remained well post-transplant,
experiencing a notable improvement in his qualityof life, aligning with the target of “fourth 95” ofHIV care.

Ng R1,3, Lee Y2, Ng K2, Raja Azwa R1,3
1Infectious Diseases Unit, Department of Medicine, University

Malaya Medical Centre (UMMC), Lembah Pantai,, Malaysia,

2Nephrology Unit, Department of Medicine, University Malaya

Medical Centre (UMMC), Lembah Pantai,, Malaysia, 3Centre of
Excellence for Research in AIDS (CERiA), Universiti Malaya,
Lembah Pantai,, Malaysia

Background: In Southeast Asia, an estimated 7,000
individuals with HIV infection face the challenge ofend-stage renal disease (ESRD). Traditionally,
patients in Malaysia encountering ESRD with HIV
infection have been limited to peritoneal dialysis,
lesser with hemodialysis, while kidneytransplantation is a relative contraindication innational guidelines. However, the groundbreaking
kidney transplant conducted at the University
Malaya Medical Centre (UMMC) in 2022 heralds atransformative shift in Malaysia's medicallandscape.
This abstract shares insights and reflections fromthis pioneering procedure, aiming to foster
dialogue and inspire advancements in
multidisciplinary healthcare practices with equity
for all.
The man, in his 50s, prolonged battle with HIV
infection, ultimately had ESRD induced bytenofovir nephropathy. His health deteriorated
rapidly while on dialysis, experiencing several
complications from peritoneal dialysis (PD) thatsignificantly impacted his quality of life. Seeking abetter life, he and his wife embarked on arelentless quest for a kidney transplant, consulting
over ten specialists locally and overseas, only toface rejection at every turn, despite the fact thatthe wife volunteered to be the donor. This
underscores the pervasive stigma andmisconceptions surrounding HIV-positive
individuals' eligibility for organ transplantation.
Their strong belief and perseverance in the right tolife for all individuals is a powerful message that

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

This pioneering endeavor yielded invaluablelessons. Patient advocacy and perseverance areparamount in navigating healthcare systems
fraught with stigma and bias. Transplantation canbe successfully performed with careful patient
selection and multidisciplinary collaboration.
Stigma and discrimination surrounding PLHIV’s
eligibility for organ transplantation underscore theneed for heightened education and awarenessinitiatives among healthcare professionals todispel misconceptions and eradicate stigma. Posttransplant care should closely monitor for HIV viralload, drug interactions, and quality of life, withfollow-up protocols aligned with standardpractices with a personalized touch. National-level
policy reforms are crucial to advocate for
equitable access to transplantation for PLHIV.
Conclusions: In conclusion, solid organtransplantation in PLHIV exemplifies the resilienceof the human spirit in the face of adversity. By
personalizing this narrative, we hope to shed lighton the challenges faced by PLHIV and underscorethe importance of equitable access to organtransplants. Lessons learned encompass patientadvocacy, careful patient selection, combating
stigma and discrimination, optimizing posttransplant care, and advocating for national-level
policy reforms to ensure the inclusivity of PLHIV in
healthcare systems.
This abstract invites attendees to engage in open
dialogue, share their own experiences, andcollectively propel multidisciplinary approaches tohealthcare delivery in the Asia-Pacific region andbeyond.

Poster Abstract

156

Promoting Inclusivity in HIV
Care: The Evolution of the
Combating Stigma in HIV and
Key Populations Programme(SHAKE UP!)
Kumar A1,2, Zhi Hui T1, Ferdous Z1, Chiaw Yee C1,3,
Pei Hua L1,3, Chen Seong W1,3,4
National Centre for Infectious Diseases, Singapore, Singapore,

1

2Singapore Institute of Technology, Singapore, Singapore, 3Tan

Tock Seng Hospital, Singapore, Singapore, 4Yong Loo Lin Schoolof Medicine, Singapore, Singapore

Background: The National Centre for Infectious
Diseases (NCID) Enhanced HIV Programme (EHIVP)in Singapore addresses the healthcare needs of adiverse cohort, including men who have sex withmen, transgender individuals, people who use
drugs, and sex workers. Despite NCID's expertise inHIV, communication gaps, including the use ofincorrect language, create potential barriers tocare and heightened stigma. In response, the
EHIVP launched the SHAKE UP 2.0 programme toimprove healthcare workers' sensitivity andinclusivity.
Description: In 2022, EHIVP collaborated with
community groups to launch a one-day HIV
sensitivity training workshop covering gender
identity, sexuality, sex work, drug use, and HIV
stigma. In 2023, in response to feedback, theworkshop was extended to two days,
incorporating additional interactive activities.
There was an emphasis on refining sensitive verbal
and non-verbal communication skills, along with
the inclusion of a new topic on HIV basics. Thisaddition aimed to educate participants, including
new staff, on HIV, prevention, treatment, and
U=U.
Lessons: The workshop experienced high demand,with over 65 participants expressing interest, butvenue limitations capped attendance at 51. A preworkshop survey (n=41) revealed 46 instanceswhere participants witnessed staff stigmatisingpatients based on their sexuality, gender identity,
sex work, drug use, and HIV status, highlighting theneed for sensitivity training.

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181

The workshop received a 97% overall satisfaction
rating. Participants reported increased knowledge(20% increase) and confidence in sensitive
communication (21% increase), as well as
confidence in intervening if staff witnessed patient
stigma (30% increase). All participants found theworkshop relevant, practical, easy to apply, valued
the new knowledge gained, and would
recommend the workshop to others.
Participants valued the need for mindfulness insensitive communications, and involving
community groups in workshop development.
Participants expressed transformative sentiments
about the workshop's impact on their perspectives
as healthcare workers.
Conclusions: Active community involvement is
crucial for EHIVP's SHAKE UP programme, ensuring
cultural relevance, tailoring approaches, andfostering trust. Establishing a feedback loop forcontinuous improvement, community involvement
in healthcare initiatives challenges social norms,
reduces stigma, and creates a more inclusive
environment. The EHIVP plans to conduct annual
workshops to promote sensitivity and inclusivity
among healthcare workers in Singapore.

Poster Abstract

157

Patterns of Internalized HIVrelated Stigma among Youth
Living with HIV in Thailand: A
Cross-Sectional Study
Padungkiattisak P1
Center Of Excellence In Pediatric Infectious Diseases And
Vaccines, Faculty Of Medicine, Chulalongkorn University.,
Bangkok, Thailand

182

experienced negative thoughts towards theirfamily or access to health care, ‘I have brought
shame on the family’ or ‘I fear accessing
healthcare will disclose my HIV status to others’.
Another 43.5% of participants reported
experiencing stigma in anticipated negative
thoughts, ‘others think it serves me right having
HIV’ or ‘my relationships will be disrupted from mydiagnosis’. Interesting, only 11.8% of youth
reported effects of negative thought towards self,‘I feel hopeless about my HIV’. There were no
significant correlations between depressive
symptoms and stigma scores.

1

Background: Internalized HIV-related Stigma (IHS)
refers to social views and negative stereotypes
about HIV/AIDS which people living with HIV haveincorporated into their self-concept. IHS may
affect emotional well-being and mental health.
This study aimed to characterize patterns of IHS
among youth living with HIV (YLHIV).
Materials and Methods: We conducted a crosssectional study at Buddy CU Clinic, a youth-friendly
HIV service in Bangkok, Thailand. Inclusion criteria
were YLHIV (1) aged 15-24 years, 2) who had
acquired HIV horizontally. Mental health wasroutinely assessed at clinic visits using patient
health questionnaires (PHQ9). PHQ9 scores werecategorized as 5 to 8 mild, > 9 moderate to severe
depressive symptoms. Assessment of IHS was
performed using the adapted brief Thai
Internalized HIV-related Stigma Scale, a series of 8questions, consisting of 2 items in each of thefollowing domains: negative thoughts towards
self; effects of negative thoughts towards self,
negative thoughts towards family or access tohealth care, and anticipated negative thoughts.
Results: From September to December 2023, 85
youth with a median (IQR) of age 21.3 (19.2 to22.9) years were enrolled. Median (IQR) time sincediagnosis was 32 (14 to 53) months. Participants
included 71 (84%) men who have sex with men, 7(8%) transgender women and 7 (8%) cisgenderfemales. There were 13 (15.3%) and 19 (22.4%)
participants who had mild and moderate to severe
depressive symptoms respectively.
Overall, 61 (71.8%) of participants reported
experiencing at least one item assessed in the
stigma scale. Some 41.2% experienced negative
thoughts towards self, ‘I am ashamed of having
HIV’ or ‘I have HIV due to karma’. A further 38.8%

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions: Although rates of internalized HIV
related stigma were high, this was not associatedwith hopelessness or depressive symptoms inyouth living with HIV. Further study should be
performed to find appropriate interventions toalleviate internalized stigma.

Poster Abstract

158

Empowering Youth: PrEP4U
campaign as an innovativeintervention in HIV prevention
and demand generation for
HIV services.
Tran T1, Phan T1, Nguyen H1, Thanh L2, Tran T2,
Thoa C3, Nguyen T4, Nguyen P5, Do K2, Pham S2,
Nguyen P6, Green K1, Ngo T7, Nguyen D7, Doan A7
1PATH, Hanoi, Viet Nam, 2Galant Clinic, Ho Chi Minh City, Viet

Nam, 3Vietnam Administration of HIV/AIDS (VAAC), Hanoi, Viet
Nam, 4Alo Care, Ho Chi Minh City, Viet Nam, 5MCare Clinic, Ho
Chi Minh City, Viet Nam, 6My Home Clinic, Ho Chi Minh City,
Viet Nam, 7United States Agency for International Development(USAID), Hanoi, Viet Nam

Background: HIV infections in Vietnam areincreasing among young people, including
students. To achieve Vietnam’s goal of HIV
epidemic control by 2030, it is imperative that
uptake of pre-exposure prophylaxis (PrEP) be
scaled up via joint efforts from HIV service delivery
partners. Co-designed by USAID/PATH STEPS,
Vietnam’s Ministry of Health, the Ministry of
Education, and youth leaders, the national PrEP4U
campaign (where “U” stands for both “you” and“university”) uses a suite of edutainment(“educational entertainment”) activities atuniversities and high schools to enhance student
knowledge about SRH and safer sex, andencourage the use of HIV and STI testing, PrEP for
HIV prevention, and other SRH services.
Description: PrEP4U campaign employs diverse
approaches such as talk shows, interactive
edutainment games, integration with other sex-ed
programs at schools, and booth exhibitions wherestudents can interact with staff from communitybased primary care clinics and receive HIV testing,
PrEP counseling, and referrals for other services.
The campaign also runs across online platforms
and leverages a network of PrEP4U Ambassadors
and a PrEP4U Facebook page blending informativeand humorous content derived by youth tomotivate viewers to seek PrEP/SRH informationand services.
Lessons learned: In 2023, STEPS and partners
integrated digital innovations in the PrEP4U
campaign, such as 1) an online registration

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platform to effectively link individuals to free STI
testing and HIV services at Glink clinic; 2) an online
Virtual Reality (VR) gallery showing SRH
information; and 3) an online survey to evaluate
SRH knowledge levels of students. From March2022 to —September 2023, PrEP4U campaign
hosted 44 offline events and reached more than
11,000 students, distributed 1,445 HIV self-test
kits and enrolled 804 individuals on PrEP. The
PrEP4U Facebook page has become a hub oftrustworthy SRH and PrEP information forstudents, supporting the campaign to garner over
2.4 million views across-platform since its launchin May 2022.
Conclusions/Next steps: Youth-focused PrEP/SRH
campaigns with targeted edutainment activities
centered around principles of choice, equity, andpeople1centeredness ensures that PrEP and sexed knowledge resonated with different youth
segments to achieve Vietnam’s twin goals of
ending AIDS and ensuring universal healthcoverage by 2030.

Poster Abstract

159

Empowering Choices for
Health and Beyond: A StatusNeutral Demand Generation
Campaign to Proactively
Combat HIV Transmission in
the Philippines
Brines R1, Rosadino J1, Lomarda L1, Cruz D1,Domingo R1, Tangcalagan K, Pagtakhan R1, Revalde
A, Cabio J, Brines I
1Loveyourself Inc., Mandaluyong, Philippines

Background: According to the latest data, thePhilippines is far from its 95-95-95 targets,registering at 64-66-97. Diagnosed cases are
increasing, with 50 Filipinos diagnosed with HIV
per day. Current approaches in HIV-related
demand generation strategies include serosorting, risk-based, and messages involving
behavior change for key populations. Here, we
present #WhatWorksForU: a status-neutral
demand generation campaign developed by key
communities in the Philippines.
Description: A crowdsourcing inviting key
populations were conducted to facilitate
discussions in creating the framework of thedemand generation campaign. In the discussions,the following were considered: demographics(such as age, occupation, activities during the day,etc.) and technographics (social media accounts
they use, how they interact, etc.). The campaign
made sure to use a range of sub-campaigns
targeted at specific age groups and relationshipdynamics, emphasizing self-empowerment andinspiring others to do the same. The campaign also
highlighted the integration of the status- neutral
approach, recognizing that HIV prevention andcare is everyone's responsibility, regardless of
their HIV status.
Lessons learned: The developed campaign,#WhatWorksForU, is a demand generation
campaign that aims to promote HIV testing andcombination prevention among individuals
regardless of their HIV status and gender. The
campaign's status-neutral approach recognizes
that HIV care is everyone's responsibility,

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regardless of their HIV status and demographics.
Also, the different sub-campaigns will cater to thedifferent needs of individuals, encouraging themto access free and/or subsidized sexual healthpackages and services. The sub-campaigns will also
educate individuals on how to protect themselves
and their partners from HIV and other STIs,
depending on their specific relationship dynamics.
Conclusions/Next steps: In conclusion, the#WhatWorksForU campaign is a comprehensive
approach to HIV prevention and care that aims toincrease HIV awareness and combination
prevention among individuals of all HIV statuses
and genders. Through a series of sub-campaigns
targeting different relationship dynamics andsexual experiences, the campaign empowers
people to take charge of their sexual health. With
the help of key people and the entire community,
and the power of social media, the#WhatWorksForU campaign seeks to create alasting impact and a world where everyone cantake proactive steps to protect themselves andothers.

Poster Abstract

160

Empowering HIV prevention:
Strategies to more meaningful
engage key population (KP)and community leaders indriving tailored HIV preexposure prophylaxis (PrEP)
communications in Myanmar
Phyo San M2, Wai Lynn P2, Sone Phoo A2, Zinn
Thann K2, Canagasabey D1PATH, Washington DC, United States, 2PATH, Yangon,
Myanmar

1

Background: HIV in Myanmar is concentrated
among KP; 2019 data shows 34.9% prevalence
among people who inject drugs (PWID), 8.8%
among men who have sex with men (MSM), and8.2% among female sex workers (FSW),
necessitating focused prevention efforts. Despite
PrEP's introduction in July 2020, demand remains
suboptimal due to low literacy and awareness,
non-inclusive messaging, and stigma. Greater
emphasis on community-informed/led
communications is required to address PrEP
demand and uptake barriers. PATH, through the
USAID-funded HIV/TB Agency, Information, andServices project, led an assessment to understandand recommend strategies to enhance community
engagement in PrEP awareness-raising campaigns.
Description: Our assessment comprised eight
focus group discussions with 32 representatives
from MSM, transgender women (TGW), FSW, and
PWID communities and 30 key informant
interviews with influencers, PrEP providers, andtechnical experts from Yangon and Kachin.
Qualitative discussion/interview information was
manually coded and analyzed to extract themes.
Lessons learned: Our findings showed suboptimalcommunity involvement in existing PrEP
awareness-raising initiatives. Some organizations
engage KP in campaign planning and design ascontent/messaging creators or campaign webpage
administrators, while others involve community
influencers in PrEP promotional events. However,influencers’ involvement tends to be shortterm/one-time engagements, leading to minimal

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185

interest in continued and/or voluntary promotionof PrEP. Greater community/peer engagement in
PrEP awareness-raising and counselling is
especially critical among tighter-knit PWID and
FSW networks, where peer-based outreach is
better received and trusted.
Participant-recommended strategies to empower
KP peers and enhance community engagement in
PrEP promotion include:● Ensuring holistic community participation acrossthe entire campaign process, from ideation andimplementation to monitoring and evaluation.
● Establishing a “PrEP champions" network (withrepresentatives across diverse KP segments) for
continuous online and offline PrEP promotion.
● Adjusting messaging and sensitization efforts toaddress potential user and providers’ questions
and concerns to improve PrEP acceptance andprescription.
● Cultivating trust in PrEP by enhancing PrEP
literacy via peer-to-peer mobilization, interviews
with key opinion leaders/experts, and user
experience-sharing.
Conclusions/Next steps: Our assessment
underscored the need to engage community
stakeholders more meaningfully in PrEP
awareness-raising efforts to drive uptake andeffective use of PrEP among populations
vulnerable to HIV and enable Myanmar to reach
95-95-95 goals.

Poster Abstract161

HIV-related knowledge,
attitude, and practice (KAP)
among nurses towards people
living with HIV in Singapore.
Kumar A1,2,3, Chua T1,2, Fan E2, Renganathan K1,2,
Wong Y1,2
1National Centre for Infectious Diseases, Singapore, Singapore,
2Tan Tock Seng Hospital , Singapore, Singapore, 3Singapore

Institute of Technology, Singapore, Singapore

Background: Despite the transformation of HIV
into a treatable chronic illness throughantiretroviral therapy (ART), nurses remain pivotal
in addressing the multifaceted needs of people
living with HIV (PLHIV), extending their roles
beyond biomedical aspects to encompass social
complexities. However, nurses may lack adequate
HIV-related knowledge, impacting the quality ofnursing care and underscoring the necessity forenhanced education and training initiatives tobridge these gaps. Effective HIV nursing carenecessitates not only spending time with patients
but also accurate knowledge to facilitate nonjudgmental communication and comprehensively
address the biopsychosocial needs of PLHIV.
Hence, this study aims to expand local research on
nurses' knowledge, attitudes, and practices (KAP)
regarding HIV in Singapore. Current studies are
outdated or narrow in scope, often focusing on
low to middle-income settings and not highresource settings like Singapore. By assessing
nurses' current KAP towards PLHIV, this study
seeks to inform tailored HIV education andtraining programmes in Singapore.
Methods: This study was conducted in two tertiary
hospitals in Singapore. A sample of 350 nurses wasrecruited through purposive sampling, regardlessof prior experience with HIV patients, and data
was collected via surveys distributed during rollcalls, emails, and posters. Participants completed amodified HIV KAP survey, and validity andreliability were ensured through expert review andprevious studies' findings. Descriptive statistics
were used for data analysis to provide insights into
nurses' attitudes and practices towards PLHIV.

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186

Results: Out of the 350 participants who weresurveyed, 202 (57.7%) were from TTSH, and 148
were from NCID. 165 (47.1%) of the participants
had more than 10 years nursing experience, and210 (60%) of the participants have had everreceived training/education in aspects of HIV
nursing care. Nurses generally showed goodknowledge by understanding that HIV does nottransmit through touch (329 [94%]), and saliva(275 [78.6%]). However, only 196 (56%) of thenurses knew that PLHIV with an undetectable viralload have zero risk of transmitting the virtual
sexually, and 108 (30.9%) felt that PLHIV acquired
HIV from sexual promiscuity. When asked if PLHIV
only have themselves to blame for acquiring HIV,38 (10.9%) agreed to the statement. 306 (87.4%)
felt that PLHIV should have the right to the same
quality of care as other patients. Interestingly, 64(18.3%) felt worried that they might get HIV fromcaring for a PLHIV. In terms of practice, 291(83.1%) mentioned that they practice standard
precautions when caring for PLHIV, and 291(83.1%) do advice PLHIV to adhere to their ARTs.
Conclusion: This study offers one of the initiallarge-scale insights into nurses' HIV-related KAP in
Singapore. Despite overall positive indicators,
areas for improvement exist, particularly in
educating nurses about undetectable =untransmittable and dispelling transmission
misconceptions. Further research should explore
nurses' qualitative experiences in caring for PLHIV,
informing targeted interventions to enhanceholistic care provision and reduce stigma in
Singapore's healthcare settings.

Poster Abstract

162

Harmonizing a global vision
with local action: safeguarding
clients in HIV programming in
VietnamNguyen A1, Tran H1, Coley R1, Levitt D1
FHI360, Hanoi, Vietnam

1

Background: Participants of HIV interventions,especially those from key populations, arevulnerable to sexual exploitation and abuse (SEA),
child abuse and trafficking in persons. In July 2022,
FHI 360 launched new global safeguarding
standards to support harm reduction for program
participants across all projects. The
USAID/PEPFAR-funded, FHI 360-implemented EpiC
project in Vietnam, which includes HIV-focusedinterventions, sought to align global guidance withlocal context and participant needs.
Description: In October 2022, EpiC Vietnam
assessed the project’s vulnerability, and risks that
increase SEA and other harms towards program
participants, the project’s compliance withsafeguarding actions, and implementing partners'
adherence to safeguarding standards using four
self-assessment checklists for project and its
implementing partners.
Identified risk factors included data collection forminors, service provision for key populations,contextual challenges, gender imbalances, andsupplier- and media-related risks. Project staff
then formulated anti-trafficking compliance andaction plans to address identified risks andharmonize global policies with local practices.
EpiC integrated safeguarding topics into trainings,
adjusted consent forms, reviewed relevant local
requirements, improved supplier monitoring,
disseminated reporting channels, and organizedawareness-raising activities. The team thenconducted a reassessment in September 2023
using the same tools.
Lessons learned: EpiC Vietnam has high SEA
vulnerability ratings (16 in 2022,12 in 2023 with ≥4
indicating high risk) because of its work withvulnerable populations and high-risk setting. This

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187

underscores the importance of internal
compliance measures to mitigate risk and the needto ensure internal controls.
In 2022, compliance scores varied across the eight
domains with pre-intervention scores ranging from
42% to 100%. Scores were developed by indicatingnot- (0), partially- (1), and fully implemented (2)for each question within each domain. The total
score for the domain was aggregated fromquestion scores.
Substantial improvements were observed in 2023
after the implementation of global standards.
Compliance scores increased in five domains: risk
assessment and action planning (2022: 83%, 2023:92%), supplier agreements and monitoring (2022:
42%, 2023: 92%), training and capacity
strengthening (2022: 50%, 2023: 100%),
complaints and reporting mechanisms (2022: 67%,2023: 83%), and awareness raising among program
participants and staff (2022: 50%, 2023: 75%).
Domains on staff recruitment and hiring,
safeguarding focal point, and safeguarding
networks maintained perfect scores across bothassessments.
Challenges meeting global standards arose fromdiscrepancies between global safeguarding
requirements and local compliance and standards
especially in applying more comprehensive andinter-disciplinary SEA interventions, and from
common to more stringent practices (e.g., age andconsent for services). With FHI 360’s authorization,
EpiC adapted age and consent requirements toalign with Vietnamese law and strategy topromote HIV testing among younger populations.
These changes worked within local standards
while adhering to the goal of enhancing safety.
Conclusions: Safeguarding program participantsrequires significant effort. Despite strong teamcommitment to adopt new guidance, EpiC still
faced discrepancies adapting global policy to the
local context. Yet, reliance on local policies alone
may prevent implementing partners fromadvancing efforts enough. To proactively mitigate
SEA risks, ongoing efforts are required to tailor
safeguarding interventions, ensure effective risk
mitigation, and measure compliance.

Poster Abstract

163

Clinical features-based
machine learning models toseparate sexually transmitted
infections from other skindiagnoses
Soe N1,2, Latt P1,2, Yu Z2,4, Lee D1, Kim C3, Tran D3,
Ong J1,2, Ge Z4, Fairley C1,2, Zhang L1,2,5
Melbourne Sexual Health Centre, Melbourne, Australia,

1

2Central Clinical School, Faculty of Medicine, Nursing and Health

Sciences, Monash University, Melbourne, Australia, 3Melbourne
Medical School, Faculty of Medicine, Dentistry and Health
Sciences, The University of Melbourne, Melbourne, Australia,
4
Monash e-Research Centre, Faculty of Engineering, Airdoc
Research, Nvidia AI Technology Research Centre, Monash
University, Melbourne, Australia, 5Clinical Medical ResearchCenter, Children's Hospital of Nanjing Medical University,
Nanjing, China

Introduction: Many sexual health services are
overwhelmed and cannot cater for all theindividuals who present with sexually transmitted
infections (STIs). Digital health software that
separates STIs from non-STIs could improve theefficiency of clinical services. We developed andevaluated a machine learning model that predicts
whether patients have an STI based on theirclinical features.
Methods: We manually extracted 25 demographic
features and clinical features from 1,315 clinicalrecords in the electronic health record system at
Melbourne Sexual Health Centre. We examined 16
machine learning models to predict a binary
outcome of an STI or a non-STI diagnosis. We
evaluated the models’ performance with the area
under the ROC curve (AUC), accuracy and F1scores.
Results: Our study included 1,315 consultations, ofwhich 36.8% (484/1315) were diagnosed with STIs
and 63.2% (831/1315) had non-STI conditions. The
study population predominantly consisted ofheterosexual men (49.5%, 651/1315), followed bygay, bisexual and other men who have sex withmen (GBMSM) (25.7%), women (21.6%) andunknown gender (3.2%). The median age was 31
years (intra-quartile range (IQR) 26-39). The top 5
performing models were CatBoost (AUC 0.912),
Random Forest (AUC 0.917), LightGBM (AUC

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188

0.907), Gradient Boosting (AUC 0.905) and
XGBoost (AUC 0.900). The best model, CatBoost,achieved an accuracy of 0.837, sensitivity of 0.776,
specificity of 0.831, precision of 0.782 and F1score of 0.778. The key important features werelesion duration, type of skin lesions, age, gender,
history of skin disorders, number of lesions,dysuria duration, anorectal pain and itchiness.
Conclusions: Our best model demonstrates areasonable performance in distinguishing STIs
from non-STIs. However, to be clinically useful,
more detailed information such as clinical images,
may be required to reach sufficient accuracy.

Poster Abstract

189

164

reviewers with 1 being the least concordant while
5 is the most concordant.

Can AI Chatbots Assist
Clinicians in Managing HIVRelated Opportunistic
Infections? A Comparative
Evaluation of Accuracy andReadability of ChatGPT 3.5,
Gemini, and Microsoft Copilot

Result: Gemini demonstrated the highest
concordance with DHHS guidelines (meanscore=3.7), followed by ChatGPT 3.5 (meanscore=3.4) and Microsoft Copilot (mean score=3.0). The readability score for all LLMs ranged from
9.5-17.6 for the Flesch Reading Ease Score and14.2-16.2 for the Flesch–Kincaid Grade Level
indicating that the responses required university
graduate level understanding. Only Gemini andMicrosoft Copilot cited references. All three LLMs
emphasized they cannot provide medical advice
and recommended consulting healthcare
professionals. All LLMs could provide
recommendations but their details varied,particularly in types of antimicrobial and dose,treatment duration, and chronic maintenancetherapy. For toxoplasmosis, all chatbots
demonstrated commendable concordance as they
were able to provide first-line treatment therapies
and nuanced approaches to ART, but no specificdrug dosages on Gemini and Copilot. All LLMs
offered accurate information about preferredtreatments for Pneumocystis pneumonia (except
Copilot), alternative therapies (except Gemini),
and adjunctive corticosteroids. Responses for
Cytomegalovirus retinitis treatment aligned wellwith DHHS guidelines, except for Copilot, which
lacked individualized therapy choices andpreferred regimen details. All LLMs responses for
Cryptococcal meningitis treatment included
overviews of induction, consolidation, andmaintenance therapy. However, Gemini and
Copilot's responses lacked duration for treatment
phases, and Copilot suggested initiating ART within
two to four weeks after starting antifungal
therapy, which deviates from DHHS guidelines
which recommended within four to six weeks.

Ng R1,2, Goh S3, Kukreja A1,2, Syed Omar S1,2, Raja
Azwa R1,2
Division of Infectious Diseases, Department of Medicine,
University Malaya Medical Centre, , Lembah Pantai , Malaysia,
2Centre of Excellence for Research in AIDS (CERiA), Faculty of
Medicine, Universiti Malaya, , Lembah Pantai,, Malaysia,
3Department of Medicine, Faculty of Medicine, Universiti
Malaya, Lembah Pantai,, Malaysia
1

Introduction: Opportunistic infections (OIs) are
the leading cause of death in people living withHIV (PLWH). Managing OIs can be complex andrequires clinicians to have readily accessible andaccurate guidance. The emergence of chatbots
powered by Large Language Models (LLMs) canserve as potential interactive reference tools forhealthcare professionals. This study aimed toevaluate the performance of LLM-poweredchatbots namely ChatGPT 3.5, Gemini, andMicrosoft Copilot as support tools for juniordoctors by assessing their concordance with the
US Department of Health and Human Services(DHHS) guidelines on OIs (ClinicalInfo.HIV.gov:
Guidelines for the Prevention and Treatment of
OIs in Adults and Adolescents with HIV), along with
their readability.
Methods: ChatGPT 3.5, Gemini, and Copilot were
prompted with eight questions about the
management of four common OIs namely cerebral
toxoplasmosis, Pneumocystis jiroveci pneumonia,
Cytomegalovirus retinitis, and Cryptococcal
meningitis as well as the optimal time to initiate
antiretroviral therapy (ART). Responses were
evaluated against DHHS guidelines forconcordance, and their readability assessed using
the Flesch Reading Ease Score and Flesch–Kincaid
Grade Level. Concordance to guidelines was rated
on a Likert scale of 1 to 5 by two independent

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusion: The concordance of LLM responses
with DHHS guidelines varied, with Gemini
demonstrating the highest concordance. LLMs may
support self-directed learning and provide
valuable clinical decision support for junior doctors
but should only be used as a supplement toestablished guidelines and expert consultation.
Managing OIs in PLWH necessitates a personalized
approach and adherence to ethical standards.
While chatbots hold potential in infectious disease
management, continual training, development,
and updates are crucial to ensure reliableguidance.

Poster Abstract

165

Improving Treatment
Management Efficiency andOutcomes of People Livingwith HIV Using an Online
Reservation Application in
Laguna Medical Center,
Philippines
Mercadillo C1, Oclima M1, Ortiz D1
1FHI 360, Makati City, Philippines

Background: By the end of December 2022,
among total enrolled clients in the Philippines(N=86,792), 23% had interrupted treatment.
Focused group discussions and interviews
highlighted ineffective case management due toburdened human resources as a common problem
contributing to treatment interruption.
With the implementation of QuickRes - an online
service booking platform launched in 2022, Laguna
Medical Center (LMC) and PEPFAR USAIDsupported Meeting Targets and Maintaining
Epidemic Control (EpiC) Project saw theopportunity of maximizing QuickRes for client task
management and prioritization.
Description / Methods: With other service
delivery approaches such as multi-monthdispensing, enhanced case management, anddecentralized drug distribution, QuickRes' online
reservation function was used to schedule and set
reminders for client refills and arrange client
queuing per day. The LMC staff, composed of 1
doctor, 1 nurse and 1 case manager, prioritized theclient refills and other requested HIV services per
day based on the specified needed time and risk
assessment results in QuickRes.
Lessons Learned / Results: By September 2023,
LMC has 382 clients currently on ART visiting
quarterly for medication refills. Among theseclients, 245 (64%) booked their refills throughQuickRes. These clients are prompted andreminded of their next visit schedules using the
SMS function of QuickRes.

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190

With the use of QuickRes, LMC has improved thetime spent with each client from 30 minutes to 1
hour per client to 15 mins per client refills and 30
minutes for in-depth client consultation. From 7%
treatment interruption in March 2023, LMC wasable to reach 5% by the end of September 2023.
Conclusion: Advances in technology such
QuickRes, can support the service delivery process
and optimize use of time of limited humanresources. Alleviating the burden of staff for task
management can improve efficient
implementation of case management approaches
for better client outcomes.

Poster Abstract

166

Implementation and
Evaluation of Electronic
Patient Reported Outcomes(ePRO) in Japanese Clinical
Practice
Yoshino Y1, Wakabayashi Y, Kitazawa T
1Teikyo University, School of Medicine, Tokyo, Japan

Background: In the realm of HIV treatment, theemphasis has shifted towards maintaining a highhealthcare-related quality of life. Achieving thisnecessitates patient-centered care, wherein the
integration of patient-reported outcomes (PROs)
into clinical practice has proven instrumental.
Herein, we introduce a novel cell phone
application designed for real-time PRO monitoring
within clinical settings. This study presents thefindings from a feasibility test evaluating theapplication's viability.
Methods: Between July and December 2022,
individuals living with HIV (PLWH) receiving care at
Teikyo University Hospital were recruited withinformed consent for utilizing the cell phone
application as an electronic (e)PRO in their medical
management. Subsequently, PLWH were tasked
with responding to HIV-Symptom Index queries via
the ePRO tool between one week prior to and on
the day of the scheduled clinic visit. The obtained
ePRO data were incorporated into their clinicalevaluation during the subsequent visit. Post-ePRO
usage, participants completed a questionnaire
assessing their experience with the tool, including
its perceived usefulness. The collected ePRO data
were analyzed, and its impact on clinical decisionmaking was evaluated based on medical record
entries.
Results: Twenty-seven PLWH were enrolled in the
study, with their ePRO data analyzed for insights.
Notably, over 40% of participants reported
experiencing symptoms related to mental health,such as nervousness, anxiety, and sleep
disturbances. Feedback from the post-usage
survey indicated unanimous agreement among
respondents regarding the usefulness of ePRO in
their routine medical assessments, with 76%
expressing a desire to continue its use. Moreover,

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191

17 cases (63%) prompted referrals to othermedical departments, and one case led to theidentification of a previously undetected medical
condition.
Conclusions: The findings underscore the potentialof ePRO in enhancing the quality of care within
real-world clinical contexts. Future endeavors will
focus on longitudinal investigations to further
elucidate the utility of ePRO in clinical practice.

Poster Abstract

167

Is there demand for longacting injectable cabotegravir
for HIV prevention inAustralia? Results from across-sectional survey of men
who have sex with men
Chan C1, Fraser D1, Schmidt H2,3, Phanuphak N4,
Ong J5,6, Murphy D7,8, Wright E8,9, Cornelisse V1,5,10,Cassell M11, Tieosapjaroen W5, Zhang L5,12, Tang
W13, Grulich A1, Bavinton B1
1Kirby Institute, Sydney, Australia, 2UNAIDS, , Switzerland,

3World Health Organization, , Switzerland, 4Institute of HIV

Research and Innovation, , Thailand, 5School of Translational
Medicine, Monash University, , Australia, 6London School ofHygiene and Tropical Medicine, , United Kingdom, 7La Trobe
University, , Australia, 8Alfred Health, , Australia, 9Monash
University, , Australia, 10NSW Health, North Coast Sexual HealthServices, , Australia, 11FHI360, , USA, 12Melbourne Sexual HealthCentre, Alfred Health, , Australia, 13The University of North
Carolina at Chapel Hill Project-China, China

Background: Oral HIV pre-exposure prophylaxis(PrEP) is currently the most common method of
HIV prevention in Australia among gay, bisexual,and other men who have sex with men (GBMSM).
Long-acting injectable cabotegravir (CAB-LA) has
received regulatory approval in Australia but is not
yet available. This analysis aims to assess thedemand for CAB-LA, and the characteristics ofparticipants who are likely to take CAB-LA.
Material and methods: An online cross-sectional
survey was conducted in Australia between MayNovember 2022 among GBMSM aged 18 or over,self-reported as not living with HIV, and reported
about their willingness to take existing andhypothetical forms of PrEP. Participants wererecruited through social media and gay dating
apps. Demographic and behavioural characteristics
of participants who were willing to take CAB-LA
were compared with those who were not willingusing logistic regression.
Results: We recruited 1,687 GBMSM in this study.
The mean age was 40.2 years (SD=12.7). Most
participants identified as either gay (n=1,294,
76.7%) or bisexual (n=296, 17.6%). Approximately
half (n=929, 55.1%) had a university education and
1,149 (68.3%) were in full time employment. In our

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sample, 1070 (66.2%) had ever taken PrEP, and359 (21.7%) had heard of CAB-LA prior to thesurvey. In this sample, 423 (25.1%) were willing totake CAB-LA. Among PrEP-experienced
participants, 343 (32.1%) were willing to take CABLA which was higher compared to PrEP-naïve
participants (n=80, 13.0%). The most common
reasons they would use CAB-LA included notneeding to remember to take pills (n=1,097,
65.0%), protection from HIV (n=1,076, 63.8%) andlong-term protection compared to other methods(n=791, 46.9%). Common concerns included notknowing enough about it (n=788, 46.7%), cost
(n=752, 44.6%) and potential side effects (n=547,
32.4%). There were 654 (40.3%) participants who
would only use CAB-LA if they could switch backand forth with other forms of PrEP, and 425(26.4%) thought it would be easy to switch
between CAB-LA and oral PrEP. Participants weresignificantly more likely to be willing to take CABLA if they were in full-time employment(aOR=1.41, 95%CI=1.05-1.88, p=0.021), have evertaken PrEP (aOR=1.95, 95%CI=1.36-2.79, p<0.001),
had 11 or more sexual partners in the last six
months (compared to fewer; aOR=1.52,
95%CI=1.16-2.01, p=0.003), knew some people on
PrEP (aOR=1.54, 95%CI=1.13-2.09, p=0.006),
would consider trying CAB-LA if it was more
effective than oral PrEP (aOR=2.04, 95%CI=1.442.88, p<0.001), and belief that CAB-LA will be more
effective than event-driven PrEP (aOR=1.49,
95%CI=1.10-2.01, p=0.009)
Conclusions: Up to one third of Australian GBMSM
would be willing to use CAB-LA, with a higher
likelihood observed in PrEP experienced GBMSM.
Those with PrEP experience who would prefer nottaking pills may benefit from long-acting
protection. However, more work is needed toaddress concerns about cost and side effects, andgenerally increasing awareness of CAB-LA’seffectiveness. Flexibility in switching between PrEP
options also was important for participants. As
PrEP programmes introduce CAB-LA in conjunction
with oral PrEP, simplified guidance on switching
between PrEP options may enhance interest in anduptake of CAB-LA.

Poster Abstract

193

168

HIV-related service use andpreferences among key
populations (KPs) in Vietnam:
Results from a consumer study
to support the private sector
with strategies for HIV
prevention services.
Green K , Khan L , Pham C , Ngoc B , Tran T , Ngo
T2, Doan A2, Nguyen D2, Duong A3, Phan H3, Tran L4
1

1

1

1

1

PATH, Hanoi, Viet Nam, 2United States Agency forInternational Development (USAID), Hanoi, Viet Nam, 3Vietnam
Administration of HIV/AIDS (VAAC), Hanoi, Viet Nam, 4VN
Health, Ho Chi Minh City, Viet Nam
1

Background: The Government of Vietnam has
permitted private hospitals and clinics to offer HIV
related services, increasing accessibility for
individuals willing to pay for services rather thanrely on state-run facilities. This interest in paying
for services represents an opportunity forproviders such as key population (KP) led
Community Based Organizations (CBOs) and social
enterprises (SEs). Consumer research is thus
critical to support the private sector withinvestment, demand generation, and guidance
strategies for HIV prevention services.
Methods: From July to October 2023, a crosssectional study involving 3,370 KPs (transgenderwomen (TGW), men who have sex with men(MSM), people who inject drugs (PWID), people
living with HIV (PLHIV), and sero-discordant
couples (SDCs)) was conducted across 12 selected
provinces in Vietnam. The study employed amixed-methods approach, combining qualitativeand quantitative methods to characterize thehealthcare services utilization, preferences, andwillingness to pay among KPs.
Results: 3,730 participants were enrolled in the
study with an average age of 29 years. In terms ofsocioeconomic status, mean monthly income wasat 8.1 million VND, and the majority of participants
were employed as daily laborers, in construction,
or drivers (20.9%), followed by the entertainment
sector (14.4%), and office workers (13.4%).
Approximately 70% had used community testing,

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

condoms, lubricants and antiretroviral therapy(ARTs), while access to Post Exposure Prophylaxis(PEP), HIV self-tests and low dead space syringes
among PWID was limited. Strong preference fornon public sector services was observed for all
HIV-related services. Private clinics and those led
by KPs were preferred for PrEP (Pre Exposure
Prophylaxis) and PEP, community basedorganizations for testing services (HIV-testing and
HIVST), and public facilities for ART. Notably, asignificant percentage expressed willingness to pay
for HIV related services and commodities, with
ART and HIV testing being the highest (84%).
Conclusions: The study reveals a strong preference
and willingness to pay among KPs for non-public
HIV services in Vietnam. The results highlight
opportunities to engage private and community
providers to address unmet needs and leverage
willingness to pay. Targeted initiatives to build
private sector HIV service capacity and demand
creation are warranted, particularly for testing,
PrEP, PEP and harm reduction.

Poster Abstract

169

iPARTY2: Increasing PreExposure Prophylaxis (PrEP)
Access and Reach throughTelehealth for Young Men
Who Have Sex with Men(YMSM) in Singapore 20222023
Lee P1,2, Kumar P2, Tan Z2, Tan R2, Choy C1,2, WongC1,2,3
1
Tan Tock Seng Hospital, Singapore, Singapore, 2National
Centre for Infectious Diseases, Singapore, Singapore, 3Yong Loo
Lin School of Medicine, National University of Singapore,
Department of Medicine, Singapore, Singapore, Singapore

Introduction: The iPARTY Project discovered that
PrEP telehealth services seemed feasible,
acceptable, and in demand among young men
who have sex with men (YMSM) in Singapore. Our
objective is to continue evaluating daily PrEP
adherence, risk compensation-informed sexuallytransmitted infections (STIs) counselling service
and the demand for PrEP services.
Description/Methods: We enrolled self-reported
HIV-negative YMSM aged 18-29 in Singapore forparticipation in this 12-month demonstration
project. The majority of consultations wereconducted through a secure telecommunications
platform, while laboratory tests, baseline andquarterly surveys were performed to assess PrEP
adherence, sexual behaviour, and the incidence of
HIV and sexually transmitted infections (STIs). All
consultations, tests, and generic daily PrEP were
provided at no cost.
Lesson Learned:•
Between June 2021 and 2022, 53
participants were enrolled and 35 participants(66%) completed the 12-month follow up. The
median age of the cohort was 24 years old, withthe majority being of Chinese ethnicity (69.81%),
followed by Malay (22.64%) and Indian (7.55%)
participants.
•
We observed a significant decrease in
self-reported PrEP adherence among participantsconsistently taking 7 pills per week, the adherence

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194

rate declined from 55.56% at Visit 2 to 37.14% at
Visit 5.
•At visit 5, there was a reduction inreported condom use for anal intercourse withboth regular and casual partners. Specifically, therates decreased from 15 out of 53 (28.30%) to 4
out of 35 (11.43%) for regular partners, and from30 out of 53 (56.60%) to 10 out of 35 (28.57%) for
casual partners.
•
A slight increase in STI incidence wasobserved after PrEP initiation among participants;
nevertheless, the overall number remained
consistent (n=6, visit 1; n=10, visit 5)•
The majority of participants provided
positive feedback regarding teleconsultation andall participants showed a keen interest incontinuing daily PrEP, even if physicalconsultations were required.
Conclusion: The real-life findings of this pilot
project have shown that PrEP provides anopportunity for YMSM to access sexual healthtesting, treatment and counselling. Additional
efforts should be directed towards improving daily
PrEP adherence. Collaborative initiatives are
crucial to enhance the affordability andaccessibility of PrEP in Singapore, with the supportof telehealth services.

Poster Abstract

170

Barriers and facilitators of payit-forward interventions for
HIV/STI research: A systematic
review and qualitative
evidence synthesis
Ho D1, Liu Y2, Tucker J3,4
1Department of Health Policy and Management, Gillings Schoolof Global Public Health, University of North Carolina at Chapel
Hill, , USA, 2UNC project China, Guangzhou, China, 3School of
Medicine, University of North Carolina at Chapel Hill, , USA,
4London School of Hygiene and Tropical Medicine, ClinicalResearch Department , London, UK

Background: Pay-it-forward interventions involve
someone receiving a free health service, thenmaking a monetary or non-monetary donation to
support someone else’s health service. Pay-itforward interventions have been used to
distribute HIV self-test kits, increase STI test
uptake, and distribute sterile needles. The purposeof this qualitative evidence synthesis was to
examine barriers and facilitators of pay-it-forward
interventions in HIV/STI research.
Methods: We used the Cochrane Handbook andregistered the review in PROSPERO(CRD42024499448). Five databases (PubMed,
CINAHL, Embase, PsycInfo, Scopus) were searched
for qualitative studies on pay-it-forward
interventions in HIV/STI research. Thematicsynthesis was used to summarize findings. CASP
was used to assess the quality of individual
studies; GRADE-CERQual was used to assess
confidence in review findings.
Results: Twenty-six studies examined pay-itforward interventions. Twenty studies assessed
secondary distribution of HIV self-tests (i.e.
distributing HIV self-tests within social networks);
five assessed secondary syringe exchange; and one
assessed a pay-it-forward approach for STI tests.
Studies included heterosexual partners (10studies), LGBTQ individuals (eight studies), people
who inject drugs (seven studies), pregnant women(seven studies), and female sex workers (fivestudies). Study settings included high- (sevenstudies), middle- (12 studies), and low-income
countries (10 studies).

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Pay-it-forward interventions increased participant
agency and informed sexual and injection
decisions (14 studies, moderate confidence).
Distribution was motivated by altruistic concern
for the health of partners, clients, and peers,sometimes with moral obligations (11 studies,moderate confidence). In established marital,
sexual, and peer relationships, distribution wasmediated by mutual trust and responsibility,aligning with an ethic of care (16 studies,moderate confidence). Though uncommon,
distribution to peers without a prior relationshipwas facilitated by a shared social identity (10studies, low confidence). For female partners andsex workers, the key barrier to distribution was
anticipated negative recipient reactions, especiallyviolence and abandonment (15 studies, moderateconfidence).
Conclusion: Pay-it-forward interventions leverage
agency, altruism, and relationality to decrease
HIV/STI transmission among key populations.
Social network distribution can empower
participants as health agents and draw on apropensity for care to enhance HIV/STI services.

Poster Abstract

171

Strengthening Community
Systems: A strategic
advancement for sustainable
HIV Response in India
Jangid N1, Agrawal S1, Pandey S1, Shekhar S1, Singh
V1
1Hindustan Latex Family Planning Promotion Trust, Noida, India

Background: The National AIDS Control
Programme (NACP) in India places communities at
the forefront of its HIV/AIDS response. Community
System Strengthening (CSS) is pivotal in achieving
program goals, focusing on targeted interventions,
reducing stigma, enhancing treatment literacy, andfostering community involvement. To fortify
Community System Strengthening (CSS), a
community resource pool of 100 Community
Master Trainers was created at the national level,taking into account typology (MSM, FSW, PWID,
PLHIV, and H/TG), geography, and linguistic
requirements as well as over 4900 Community
Champions at sub-national level (state and districtlevel). The master trainers underwent acomprehensive training program aimed ataddressing the dynamic challenges in CSS whereas
Community Champions were trained on the 6
thematic areas identified and prioritised forcapacity building through need assessment.
Description: As one of the core components ofcommunity system strengthening initiative under
NACP - V, Community Resource Pool at thenational and sub-national level has been createdaiming to be available for their communities aswell as with the NACP. The capacity building
modules were developed referring to the priority
areas identified through need assessment inconsensus with the community experts. The
Training Program for Master Trainers on CSS aims
to update their knowledge, enhance training andfacilitation skills, foster networking, and promote
innovative approaches. Covering six thematic
modules and additional sessions, the program
ensures comprehensive skill development.
Followed to the Expression of Interest released by
the SACS/DACS, interested community
representatives identified as Community
Champions through a rigorous process led by the

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196

Community Resource Group. Capacities of theseidentified Community Champions were built byengaging Master Trainers from the regions. The
training covered essential components, including
advocacy, community networks, linkages,
partnerships, coordination, resource mobilization,
demand generation, organizational and leadershipstrengthening, and CLM with knowledge
management. Community Champions are local
resources for the community members to link withservices, and advocate for the community
issues/concerns identified including stigma anddiscrimination for their redressal.
5861 Community Champions were selected from9801 nominations received against the EoI
released for Community Champions. 4965
Community Champion are trained against the total
training load of 6722 in 34 States/UTs through 176
batches by engaging 72 Master Trainers.
Lessons Learnt: A community resource pool of the
100 master trainers has been created at thenational covering all typologies across geographiesand over 4900 community and sub-national levelwith the representation of communities (2 CCsfrom each of the typologies in each of the districts)
and is available for communities. The dynamic
nature of community systems requires ongoingtraining and adaptability through refresher
training batches. The role of CCs is found crucial in
linking with community hard-to-reach and hidden
populations.
Conclusions/Next Steps: Periodic refresher
training is vital for addressing evolving challenges.
Expected outcomes include optimized service
delivery, enhanced organizational capacity,
accessible evidence-based services, andstrengthened monitoring and evaluation systems.
Empowering Community resource pool supports
sustainable CSS interventions, aligning with India's
commitment to end AIDS by 2030.

Poster Abstract

172

The differences in attitude andwillingness to recommend
PrEP among health personnel
in rural and urban areas of
Iloilo, Philippines
Gonzales J1, Olete R2, Almeñana L1, Potato J1, Ong
P1, Macalalag A1, Labiano R1
Team Dugong Bughaw, , Philippines, 2National Cheng Kung
University - Department of Public Health, ,1

Background: Antiretroviral Pre-Exposure
Prophylaxis (PrEP) has revolutionized HIV
prevention and is currently undergoing nationwide
implementation in the Philippines. Issues such as
limited knowledge of PrEP, moralistic attitudes
among healthcare personnel, and stigmatization of
PrEP users have been well-documented, leading to
obstacles in its adoption. This dearth of data on
PrEP-related barriers in Iloilo could hinder national
efforts to combat HIV in the Philippines. This study
aims to compare the knowledge, attitudes, andwillingness to recommend PrEP among healthprofessionals in rural and urban areas of Iloilo,
Philippines.
Methods: An online cross-sectional survey was
conducted from January 5 to February 20, 2024,
utilizing an adapted, validated questionnaire.
Demographic data included age, gender, religion,
occupation, location, years of experience, andhospital level. Additional aspects covered wereyears of experience, hospital level, availability of
HIV PrEP, management of key populations at risk,
and patient load. It also gauged knowledge of PrEP
(10-item, true/false), attitude towards PrEP
(negative attitude=1-2, neutral=3, positive
attitude=4-5), and willingness to undergo HIV
testing (0-not willing; 9-very willing). Data analysis
utilized descriptive statistics, composite scoring forknowledge and perception, and multivariable
regression analysis.
Results: Among 142 participants, the mean age
was 36.4 years (SD=12.9), with 37.12% male and62.88% female. Most were Roman Catholic(84.85%), with 12.88% medical doctors, 53.79%
nurses, and 33.33% others. The majority worked inrural areas (55.30%), with an average of 4.92 years

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197

of experience (SD=2.57). About 23.48% had accessto HIV PrEP, and 68.18% had managed key
populations at risk. The mean willingness torecommend PrEP was 5.25 (SD=2.09), with anaverage knowledge score of 13.73 (SD=0.0648).
Health personnel located in urban areas displayed
higher knowledge levels of PrEP compared tothose in rural areas (64.3% vs 35.7%, p=0.001) andexhibited greater willingness to recommend PrEP
(55.4% vs 44.6%, p<0.001). Composite scoresindicated positive attitudes: positive attitude ofhealth personnel in rural areas (mean=3.54,
SD=0.71), positive attitude of health personnel inurban areas (mean=4.27, SD=0.71). Multivariable
regression analysis demonstrated positive
associations between knowledge of PrEP, attitudes
toward PrEP, and willingness to recommend PrEP
(aOR=7.91; p=0.012 and aOR=3.28; p=0.03,
respectively).
Conclusion: A study conducted in Iloilo,
Philippines, underscores differences in attitudes
and willingness among healthcare personnel
regarding recommending Pre-Exposure
Prophylaxis (PrEP), with variances observed
between rural and urban areas. It emphasizes theimportance of improving PrEP knowledge andpromoting its recommendation, especially in rural
settings, to bolster HIV prevention efforts. The
findings suggest the necessity for collaborativeinterventions aimed at ensuring equitable accessto and utilization of PrEP across various healthcare
settings.

Poster Abstract

173

A global review of nationalguidelines of post-exposure
prophylaxis for the preventionof HIV
Zhang Y1,2, Maisano M1,2, Tran D3, Macdonald V4,
Baggaley R4, Ford N4, Johnson C4, Ong J1,2,5
1Central Clinical School, Faculty of Medicine, Nursing and Health

Sciences, Monash University, Melbourne, Australia, 2Melbourne
Sexual Health Centre, Alfred Health, Melbourne, Australia,
3Melbourne Medical School, The University of Melbourne,
Melbourne, Australia, 4Global HIV, Hepatitis and STI
Programmes, World Health Organization, , Switzerland, 5Facultyof Infectious and Tropical Diseases, London School of Hygiene
and Tropical Medicine, , United Kingdom

Background: The World Health Organization(WHO) recommends the use of antiretroviral drugs
as post-exposure prophylaxis (PEP) for preventing
HIV infection for occupational and nonoccupational exposures. To inform thedevelopment of global WHO recommendations on
PEP, we reviewed national guidelines of PEP for
their recommendations.
Methods: Policies addressing PEP from 38 WHO
HIV priority countries were obtained by searching
governmental and non-governmental websites
and consulting country and regional experts; thesecountries were selected based on HIV burden, newinfections and the number of HIV-associateddeaths. We reviewed national guidelines published
as of August 2023 to collate data on where PEP
can be offered, who can prescribe PEP, PEP
eligibility, recommended drug regime, linkage toother interventions, recommended investigationsprescribed with PEP, HIV self-test
recommendation related to PEP and stopping rules
for PEP.
Results: In total, 46 guidelines across 36 countries
were included, with the majority (70%) of
documents published on or after 2020. There wassignificant variation across guidelines regarding
where PEP can be accessed and who can provide
or prescribe PEP. Six countries (17%) describedbeing able to access PEP from a primary carefacility, four countries (11%) from hospitals andtwo (6%) from community-based services. Only
three countries (8%) specifically considereddispensing PEP by professionals other than doctors

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198

(e.g. nurses). None mentioned pharmacists asprescribers. We found a lack of consistency acrosscountries regarding who is eligible for PEP,
regimens used, interventions integrated into PEP
provision and recommended investigations for PEP
users. No country guidance provided
considerations on using HIV self-tests for startingor after stopping PEP.
Conclusions: Despite PEP being recommended formore than three decades, many national policies
were inconsistent or lacking in terms of PEP
guidance. The findings from this review
underscore the need for a globally unified
approach to PEP recommendations that is in linewith best practices and the latest evidence. Thisshould include recommendations fordecentralisation and task-sharing to achievesufficient scale for impact. Improving timely accessto PEP among those who need it would contributeto reducing the incidence of HIV globally.

Poster Abstract174

Pay-it-forward gonorrhea andchlamydia testing among men
who have sex with men andmale STD patients in China:
Interim findings from the
PIONEER pragmatic, cluster
randomized controlled trial.
Marley G1, Ye L1, Li K2, Tan R3, Zhu Z1, Zhang L1,
Wang T1, Sun M1, Tang Q1, Sheng Q1, Ramaswamy
R4, Wu D5, Sylvia S6, Wang C7, Zhao P7, Yang L7, Luo
D1, Gray K6, Van-Duin D6, Tang W6, Tucker J81University Of North Carolina Chapel Hill-Project China,
Guangzhou, China, 2UCLA, , USA, 3National University ofSingapore, , Singapore, 4Cincinnati Children's Hospital Medical
Center, , USA, 5Nanjing Medical University, Nanjing, China,
6University of North Carolina at Chapel Hill, , USA, 7Dermatology
Hospital of Southern Medical University, Guangzhou, China,
8
LSHTM, , UK

Background: Sexual health services are closing or
being restricted in many jurisdictions because oflimited funds. Pay-it-forward (PIF) interventions,where individuals receive a free healthcare service(test) accompanied by personalized messages andan opportunity to support others throughdonations, may increase STD test uptake andgenerate funds. We report interim results from a
PIONEER trial in China, which evaluates PIF
strategies that encourage gonorrhea/chlamydia
testing among men compared to the standard-ofcare.
Methods: The PIONEER study (NCT05723263) is acluster RCT comparing PIF implementation
strategies for promoting dual
gonorrhea/chlamydia testing in 12 clusters (sixMSM-led and six public STD clinics) in six cities in
Guangdong Province, China. Men were recruited
2:1 into pay-it-forward compared to standard- ofcare (self-pay). Men over 17 years old and nottested for CT/NG in the last six months who wereseeking STD care services at an MSM-led or public
STD clinic were recruited. The primary outcome
was gonorrhea/chlamydia testing. Pre-specified
subanalyses focused on MSM compared to nonMSM participants, clinic type (MSM-led or not),and PrEP eligibility (based on number of sexual
partners, engagement in unprotected sex, and HIV

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199

testing). The uptake between PIF and standard-ofcare was compared using Chi-square and GEE
analyses.
Results: By December 18, 2023, 617 men, with anaverage age of 34 years (SD=11.2), were recruited
into the standard-of-care (n=177) and PIF arms
(n=440). Overall, 63.9%(n=395) reported sex withother men, 72.6%(n=442) had ever tested for HIV,and 34.4% (n=212) were PrEP-eligible.
Gonorrhea/chlamydia testing uptake was
71.3%(n=440) in the PIF arm and 3.4% (6/177) inthe standard-of-care arm. 25.2%(n=111) of PIF
participants donated 267 USD. Testing uptake wassignificantly higher in the PIF than in the controlarm (proportional difference: 70.0%;
95%CI=63.60%~76.90%). In subgroup analysis,
more MSM than non-MSM participants(proportional difference:24.3%; 95%CI=0.21~0.29)
tested for gonorrhea and chlamydia. Testing was
also higher among MSM-led clinic participants
than public STD clinic participants (proportional
difference:22.4%; 95%CI=0.19~0.26) and PrEPeligible participants than non-eligible participants(proportional difference:8.9%; 95%CI=6.70~11.60).
Conclusions: The PIF intervention increased
gonorrhea/chlamydia testing among men indiverse settings. Hence, scaling up PIF could
potentially promote other STD services uptake andimprove financial support for differentiated HIV
prevention services.

Poster Abstract

175

Preferences and Acceptabilityof Testing for Sexually
Transmitted Infections in an
HIV pre-exposure prophylaxis
clinic in Hanoi, Vietnam
Bui H1, Adamson P2, Nguyen T1, Dau N1, Nguyen K1,
Pham L1, Le G1, Klausner J3
Center for Training and Research on Substance Abuse-HIV,
Hanoi Medical University, Hanoi, Viet Nam, 2Division of
Infectious Diseases, David Geffen School of Medicine, Universityof California, Los Angeles, Los Angeles, USA, 3Department ofPopulation and Public Health Sciences, Keck School of Medicine,
University of Southern California, Los Angeles, Los Angeles, USA
1

Introduction: Men who have sex with men (MSM)
on HIV pre-exposure prophylaxis (PrEP) have highrates of STIs and routine testing is recommended
by many guidelines. Understanding STI testing
preferences and the acceptability of self-collected
specimens are important for improving uptake of
STI testing within this population. We assessedfeasibility and acceptability of self-collection for
STI testing and used conjoint analysis to identify
factors associated with preferences for STI testing
among MSM who use PrEP in Hanoi, Vietnam.
Methods: From January 10 to December 16, 2022
we recruited MSM, aged 16 and older, enrolled in
the HIV PrEP program at the Sexual Health
Promotion. Study participants self-collectedpharyngeal, anal, and urine samples for Chlamydia
trachomatis (C. trachomatis) and Neisseria
gonorrhoeae (N. gonorrhoeae) testing. Data werecollected on behaviors, experience andacceptability with sample self-collection, andtesting preferences. Eight hypothetical C.
trachomatis/N. gonorrhoeae testing profiles werecreated varying across five testing attributes forconjoint analysis. Participants were asked to rateeach profile using Likert preference scales (0 to 5).
An impact score was generated for each attributeby taking the difference between the two scores. A
two-sided one-sample t-test was used to assess fordifferences and generate p values.
Results: In total, 529 participants out of 591 men,
who were referred to study, were included. All
were male and the median age was 25.1 years(IQR: 21.7-29.5). Specimens from all three sites

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200

were provided by 97.9% (518/529). Meansatisfaction with self-collection was 4.3 (SD 1.0),
and 99.4% reported they would perform again.
Conjoint analysis revealed that cost (free vs.
US$17) had the highest impact on preference(Impact Score: 25.2 p <0.001). For the attribute‘Time to test result notification’ 1-week wassignificantly preferred to 90 minutes (Impact
Score: -0.8; p =0.03).
Conclusion: Our study found high acceptability ofsample self-collection for STI screening in MSM
PrEP clients in Vietnam. The findings indicate that
testing cost was the most important factor for
testing uptake. Self-collection and innovation tolower cost for STIs could promote uptake of STI
screening among MSM.

Poster Abstract

176
Abstract 176 has been withdrawn.

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201

Poster Abstract

177

Pre-Exposure Prophylaxis(PrEP) option preferencesamong sex workers (SW) inseven provinces in Thailand: anational cross-sectional study
Sukthongsa S1, Sumalu S1, Somwaeng A1,
Phaengnongyang C1, Janyam S1, Manopaiboon C2,
Clarke D2, Girault P2, Vannakit R2
1SWING - Service Workers in Group Foundation, Bangkok,

Thailand, Bangrak, Thailand, 2BIRD – Bangkok Interdisciplinary
Research and Development, Thailand, Phayathai, Thailand

Background: Despite Thailand offering free PrEP
under Universal Health Coverage since 2019, only
8% of users are sex workers (SW) – males (MSW),
females (FSW), and transgender females (TGSW) Thailand Ministry of Public Health, 2023. As part ofa PrEP study among SW in Thailand, current PrEP
uptake status and preferred PrEP options reported
by SW were investigated.
Methods: A national cross-sectional study was
conducted from April-December 2023 by SWING
Foundation and BIRD (Bangkok Interdisciplinary
Research and Development) in seven provinces inThailand. This study investigated PrEP uptake andassociated factors among SW using aquestionnaire that included questions on current
PrEP status and preferred PrEP options: i) PrEP oral
dose; ii) long-acting injectable cabotegravir (CABLA); and iii) PrEP vaginal ring. Regarding PrEP
options, interviewers provided information onthese, mentioning that some options have not yet
been registered in Thailand. The study enrolled a
total of 1,511 Thai SW (FSW: 621 – MSW: 452 –TGSW: 438), aged ≥18 years old, HIV-negative, andengaged in sex work in the past three months.
Data collection was conducted face-to-face bytrained outreach workers.
Results: The median age of SW was 32 years. Outof the total, 35.9% had started sex work in the past
12 months, 136 (9.0%) reported currently using
PrEP, 370 (24.5%) reported not being interested in
PrEP, and 898 (59.4%) were willing to initiate PrEP.
After explanation of the different options,injectable CAB-LA was the most preferred option(FSW: 43.6%; MSW: 40.0%; and TGSW: 43.6%)

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followed by daily oral dose (FSW: 30.6%; MSW:
28,8%; and TGSW: 38.1%). Among SW who
reported not being interested in PrEP (n=370),
after receiving further information, 71.8% selected
a PrEP option, with 40% stating a preference for
CAB-LA and 17.3% for daily oral dose.
Conclusions: Information provided to SW about
different PrEP options can increase demand
among those previously reporting no interest.
Such information enabled interested SW to selectthe PrEP option best suited to their needs.
Enhanced information provision for SW will beneeded for PrEP scale up. Different PrEP options
need to be made available and accessible for SW,
including affordable injectable CAB-LA, in the
public health system.

Poster Abstract

178

Ground-Up Harm Reduction
Practices for Chemsex in theContext of Punitive Drug Laws:
A Qualitative Study Among
Sexual Minority Men in
SingaporeOng E1, Tan R1, Naidu K1,2
1Saw Swee Hock School of Public Health, National University ofSingapore, , Singapore, 2Department of Psychological Medicine,National University Hospital, National University Health System,, Singapore

Background: Harm reduction responses forchemsex remain suboptimal around the world,
and are limited by the presence of punitive druglaws. This qualitative study explored how sexual
minority men in Singapore, in the absence of aformal or state-driven harm reduction framework,
rely on ground-up approaches to negotiate harm
reduction in the context of chemsex.
Methods: Semi-structured in-depth interviews
were conducted with 33 purposively sampled
GBMSM seeking treatment for chemsex in
Singapore. Interview topics included participants’experiences and life histories of chemsex,
substance use, incarceration, trauma, and ongoingrecovery from chemsex. Interviews were audiorecorded and transcribed verbatim. Data were andanalyzed via inductive thematic analysis.
Results: Participants articulated a context
characterised by punitive drug laws and a lack offormal and safe resources for Chemsex. In light of
this, participants highlighted several ground-up
means through which they navigated harm
reduction in the context of Chemsex. First, at theindividual level, participants learnt through theirinteractions with others how to develop
personalised safe drug use practices. These
included safety in the context of dosing and mixing
drugs, routes of administration, and recognisingdependence. Second, at the interpersonal level,
participants articulated issues around negotiating
safety during Chemsex sessions, including how torecognise overdose and harms typically associatedwith Chemsex, protecting oneself from sexualtransmissions, and learning how to trust others.

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Third, at the community level, participants learnt
how to stay safe from drug enforcement agencies,
including developing a ‘safe’ lexicon of drug use
terminologies, understanding the evolving
enforcement practices that such agencies
undertook, as well as techniques of seeking out
necessary formal health services while navigating
risks of prosecution. Nevertheless, participantsalso recalled instances in which reliance onground-up knowledge sometimes led toexperiencing harms associated with Chemsex.
Furthermore, reliance on informal harm reduction
knowledge was premised on interpersonal trustand social capital, which varied across individuals
and threatened to widen inequities in harm
reduction vulnerabilities and practices.
Conclusions: Communities engaging in Chemsex
exhibit the ability to develop ground-up harm
reduction practices even in the absence of formal
frameworks. Community interventions mayleverage such ground-up dynamics should toaddress gaps that deepen harm reduction
inequities.

Poster Abstract

179

Factors associated with PreExposure Prophylaxis (PrEP)
uptake among female, maleand transgender female sex
workers in seven provinces inThailandJanyam S1, Phaengnongyang C1, Sumalu S1,
Sukthongsa S1, Somwaeng A1, Manopaiboon C2,
Clarke D2, Girault P2, Vannakit R2
1SWING - Service Workers in Group Foundation, Bangkok,

Thailand, Bangrak, Thailand, 2BIRD – Bangkok Interdisciplinary
Research and Development, Thailand, Phayathai, Thailand

Background: Despite Thailand offering free PrEP
under Universal Health Coverage since 2019, only
8% of users are sex workers (SW) - males, females,
and transgender females (Thailand Ministry of
Public Health, 2023). On the basis of thesefindings, a national PrEP study among SW of all
genders was conducted to investigate PrEP uptake
and associated factors.
Methods: A cross-sectional study, led by SWING
Foundation and BIRD (Bangkok Interdisciplinary
Research and Development), was implemented
between April and December 2023. The study
enrolled Thai male sex workers (MSW), female sex
workers (FSW) and transgender female sex
workers (TGSW) in hotspots, aged ≥18 years old,
HIV-negative, and engaged in sex work in the past
three months. To identify factors associated with
PrEP uptake, covariates with a p=value <0.20 in
the univariable analysis were entered into the fulllogistic regression model (backward selection).
Adjusted odd ratios (AOR) with 95% confidence
interval were calculated.
Results: A total of 1,511 SW from seven provinces
were enrolled: 621(41%) FSW, 452(30%) MSW,
and 438(29%) TGSW. FSW were more likely to beolder (median age 37 years old) than TGSW (31years old) and MSW (30 years old). PrEP uptake
was low across the SW population (9%). However,TGSW (65 –14.8%) and MSW (63–13.9%) weremore likely to report PrEP use than FSW (8–1.3%).
In multivariable logistic regression, key factors
associated with PrEP uptake (p<0.05) included:

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metropolitan sites (Bangkok: AOR = 2.34–Pattaya:
AOR = 3.67); study populations (MSW: AOR =8.41–TGSW = 3.81); HIV testing in the last 12
months (AOR = 6.77); sexual violence in the last 12
months (AOR = 2.07); more than 5 clients in thepast week (AOR = 2.05); good knowledge of PrEP
(AOR = 4.05); and know of peer using PrEP (AOR =1.76). Reporting any concerns on PrEP wasinversely associated with PrEP use (AOR = 0.42).
Conclusions: PrEP uptake among SW in studied
sites remains low despite free PrEP, reported highrisk behaviors and unsafe work environments.
Improving risk awareness, enhancing PrEP
knowledge and reinforcing HIV testing are crucial
for PrEP scale up among SW. PrEP influencers canbe mobilized in support.

Poster Abstract

180

High prevalence of genderbased violence among amongfemale, male and transgenderfemale sex workers in sevenprovinces in Thailand – A crosssectional study
Phaengnongyang C1, Janyam S1, Sumalu S1,
Somwaeng A1, Vannakit R2, Vannakit R2, Vannakit
R2, Vannakit R2
1SWING - Service Workers in Group Foundation, Bangkok,

Thailand, , Bangrak, Thailand, 2BIRD – Bangkok Interdisciplinary
Research and Development, Thailand, Phayathai, Thailand

Background: Sex workers (SW) are particularly
vulnerable to different forms of gender-based
violence (GBV) resulting in significant
consequences in physical and mental health and
impeding access to health, social and legal
services. The issue of GBV is not included in the
HIV response in Thailand (National Strategy to End
AIDS, 2017-2030). As part of a national PrEP study
among SW in Thailand, the prevalence and typesof GBV reported by SW were studied.
Methods: A cross-sectional study, led by SWING
Foundation and BIRD (Bangkok Interdisciplinary
Research and Development), was implemented
between April and December 2023. This study
explored PrEP uptake and associated factors using
a quantitative questionnaire, which included GBVrelated questions, administered face-to-face torespondents. A total of 1,511 SW was enrolled
including Thai male sex workers (MSW), female
sex workers (FSW) and transgender female sex
workers (TGSW), aged ≥18 years old, HIV-negative,and engaged in sex work in the past three months.
A descriptive analysis was conducted using
univariate analysis. Pearson's chi-squared test wasused to determine the relationship between two
variables examined during this analysis.
Results: The total sample included 621 FSW (41%),452 MSW (30%), and 438 TGSW (29%). The
median age of SW was 32 years old. More than athird (35.8%) of SW reported experiencing any
form of GBV in the past 12 months. The highest
rates were found among TGSW (45.5%) and MSW

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205(36%). Verbal violence was the most common
form reported (22.7%) followed by intimidation(17.3%), physical (9.9%) and sexual (7.2%)
violence. Clients were the most common
perpetrator of GBV mentioned by SW (40%). In
univariate analysis, any reported GBV wassignificantly associated (p-value<0,05) with SW
history of incarceration, drug use in the past 12
months, group sex in past 3 months, and HIV highrisk perception.
Conclusions: GBV needs to be integrated in thenational HIV response, involving a multi-sectoral
response ensuring safety in the workplace and thecommunity for SW together with training of
establishment staff, community-based outreachworkers and law enforcement agencies. Linkages
to health, social and legal services should be
developed to respond to the needs of GBV
survivors.

Poster Abstract

181

Negotiating safer chemsex: Aqualitative study among sexual
minority men who engage inchemsex in Singapore
Ong E1, Tan R1, Naidu K1,2
Saw Swee Hock School of Public Health, National University ofSingapore, , Singapore, 2Department of Psychological Medicine,National University Hospital, National University Health System,, Singapore
1

Background: Chemsex, or the confluence of
substance use and sexual activity among certain
populations has been identified as a potential
driver of HIV transmission. In Singapore, stringent
and punitive drug laws and HIV criminalization
laws persist that limit research and the reach andimpact of community- led interventions. This study
explores the subculture of safer chemsex, as
individuals navigate the complex interplay
between legal frameworks surrounding HIV
disclosure and drug use, with the role ofnegotiation within the subculture of safer chemsex
as a protective mechanism against harms typicallyassociated with chemsex, including HIV
transmission.
Methods: Semi-structured in-depth interviews
were conducted with 33 purposively sampled
GBMSM seeking treatment for chemsex in
Singapore. Interview topics included participants’experiences and life histories of chemsex,
substance use, incarceration, trauma, and ongoingrecovery from chemsex. Interviews were audiorecorded, transcribed and analyzed using inductive
thematic analysis, from which the negotiation
within the subculture of safer chemsex emerged.
Results: Our findings highlight the centrality ofnegotiation in the practice of safer chemsex.
Participants engage in comprehensive
negotiations, covering diverse aspects crucial forrisk reduction. Negotiations around HIV
prevention methods were common, withparticipants actively discussing and agreeing upon
the use of condoms or PrEP. Negotiations aroundHIV status and individuals at sessions
demonstrated a commitment to transparency andinformed decision- making. The negotiation ofsession duration emerged as a factor influencing

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risk, with participants recognizing the correlation
between prolonged sexual activity and increased
vulnerability to HIV. Establishing ground rules wasa prevalent subcultural practice, contributing to
the co-creation of consensual and safer spaces.
Power dynamics in negotiation, such as theexchange or payment of drugs and control overtheir type and administration also played a pivotalrole.
Conclusions: This study sheds light on themultifaceted nature of negotiation within the
subculture of safer chemsex and its potential role
as a protective mechanism against harms typicallyassociated with chemsex, including HIV
transmission. Recognizing negotiation as a
subcultural practice and ritual in safer chemsex isessential for designing targeted interventions thatharness existing protective behaviors.
Understanding and leveraging negotiation
dynamics can inform HIV prevention strategies
tailored to the unique challenges presented in
Singapore.

Poster Abstract

182

Association between Sexual
Orientation Disclosure,
Community Engagement, andHIV/STI Testing Uptake among
Men who Have Sex with Men
in Guangdong Province, China:
A Mediation Analysis.
Fan J5, Marley G1, Li K2, Ye L1, Zhang L1, Tucker J3,Tang W
1
University Of North Carolina Chapel Hill-Project China,
Guangzhou, China, 2UCLA, , USA, 3University of North Carolina
at Chapel Hill LSHTM, , UK, 4University of North Carolina at
Chapel Hill , , USA, 5SESH Global LLC, , China

Introduction: An individual's sexual orientation
disclosure can affect their participation incommunity engagement activities and impact theirhealthcare utilization. Community-based
interventions frequently employ events topromote the utilization of sexual health services
among key populations such as MSM by fosteringcommunity engagement. This study aimed to test
the mediation effect of community engagement insexual orientation disclosure and HIV/dual
gonorrhea (NG) and chlamydia (CT) testing among
Chinese MSM.
Methods: This study uses cross-sectional datafrom a study conducted in Guangdong, China. The
study enrolled individuals who were assigned malegender at birth, 18 years or older, who had ever
had sex with other men from MSM-led and public
STD clinics in six cities until December 20, 2023.
The study assessed community engagement at theindividual level based on data from 9 items. Linear
and logistic regressions were used to assess therelationship between community engagement,
sexual orientation disclosure, and HIV and CT/NG
testing. We also conducted a mediation analysis tounderstand how the two variables affect eachother and facilitate HIV/STI testing uptake.
Results: Overall, 380 men who reported everhaving sex at other men at baseline were included,with a mean age of 32 years old (S.D=10.1).
74.7%(284) of participants had never beenmarried, 29.7%(133) had ever disclosed their

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sexual orientation to a healthcare provider,
92.6%(351) had ever tested for HIV, and35.0%(135) had ever tested for CT/NG. We foundno significant direct effect of sexual orientation
disclosure to healthcare providers on HIV (coefficient=-0.008± 0.029, p=0.783) and CT/NG
testing (co-efficient=-0.044± 0.050; p=0.383)
among participants [Figure 1]. However,community engagement was a significant positive
mediator of sexual orientation disclosure (coefficient=0.113± 0.040; p=0.005) and theprobability of HIV testing (coefficient=0.236±0.037; p<0.001) and CT/NG testing(co-efficient= 0.165± 0.071; p=0.021).
Conclusion: Our research suggests that community
engagement has a mediation effect in facilitating
HIV and CT/GN testing among MSM who havedisclosed their sexual orientation to healthcare
providers. While disclosing sexual orientation is a
crucial step towards improving accessibility to
HIV/STI services for MSM, engaging with thecommunity could further increase the likelihood of
actually getting tested. Therefore, incorporating
community engagement activities and strategies
to promote sexual health services may help
enhance HIV/STI testing uptake.

Poster Abstract

183

Self-reported HIV testing
behaviors among migrants in
Okinawa, Japan
Tran Thi H1, Tsutomu K2, Sawada T3, Hiroko M2,
Nakamura H4, Shinzato N5, Shakya S6, Chunyan L7
1Kobe Women's University, Kobe, Japan, 2Kyorin University,

Mitaka-shi, Japan, 3Minami-motomachi Clinic, Yokohama,Japan, 4University of the Ryukyus, Nishihara, Japan, 5Universityof the Ryukyus Hospital, Nakagami, Japan, 6Japan Foundation
for AIDS Prevention, Chiyoda, Japan, 7Tokyo University, Bunkyo,
Japan

Background: HIV testing early can facilitate timely
linkage to HIV prevention and treatment services
for migrants. Migrants are at high risk for delayed
HIV testing and diagnosis, and migrant populationin Japan also seem to face barriers to accessing
HIV/AIDS care. This study aims to examine theprevalence of HIV testing, HIV-related sexual risk
behaviors and associated factors with HIV testing
among migrants in Okinawa, where the number of
HIV per 100,000 population was the six highest
among the 47 prefectures and that of AIDS was
the top of all the prefectures in Japan (as of 2022).
Methods: From January 2023 to February 2023,
we conducted an online survey on HIV-related
sexual risk behaviors, self-reported HIV testing
behaviors and their correlates among 474
Southeast Asians, Americans and Brazilians living
in 14 districts in Okinawa.
Results: The study found a low level of HIV testingand high rates of unprotected sex. Within thesample, only 35.6% (n=169) of participants
reported having ever been tested for HIV. Among
those who reported never having received HIV
testing, 42% (n=128) reported not using condoms
during their most recent sexual encounter.
Multivariable logistic regression analysis revealed
that, among foreign residents in Okinawa, thosefrom Southeast Asian countries (OR=20.926, 95%
CI: 2.827-154.90), having higher Japanese
language skill (OR=1.148, 95% CI: 1.026-1.284),
those who reported good health condition(OR=7.726, 95% CI: 1.958-30.474), having any HIVrelated sexual risk behaviors (OR=2.803, 95% CI:
0.974-8.070), and familiar with HIV testing
locations (OR=7.726, 95% CI: 1.958-30.474), wereassociated with a higher HIV testing status.

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Conclusions: Overall, a low level of HIV testing
rate, high rates of unprotect sex, and the
difficulties in accessing HIV test among the study
participants point to a need to increase theawareness about HIV screening and prevention
among migrants, and more migrant-focusedoutreach programs are suggested to improvemigrant’s access to HIV healthcare in Japan.

Poster Abstract

184

High potential for HIV
exposure among sex workers
in Thailand: a cross-sectional
study of pre-exposure
prophylaxis (PrEP) among Thaisex workers
Janyam S1, Sumalu S1, Sukthongsa S1, Somwaeng
A1, Phaennongyang C1, Manopaiboon C2, Girault
P2, Clarke D2, Vannakit R2
1BIRD – Bangkok Interdisciplinary Research and Development,

Thailand, Phayathai, Thailand, 2SWING - Service Workers inGroup Foundation, Bangkok, Thailand, , Bangrak, Thailand

Background: HIV prevention in Thailand has beena success story, particularly among female sex
workers (FSW) with 0.7% HIV prevalence in 2018
(Thailand Ministry of Public Health, 2023).
However, other SW sub-populations display higher
prevalence rates: males (MSW: 3.8%, 2018) withno available data on transgender females (TGSW).
Investigation of HIV risk behaviors were included
in a cross-sectional study of pre-exposure
prophylaxis (PrEP) among Thai SW.
Methods: This study was conducted from AprilDecember 2023 by SWING and BIRD (Bangkok
Interdisciplinary Research and Development) inseven provinces in Thailand. This investigated
PrEP uptake and associated factors using aquestionnaire including HIV risk behaviors. The
study enrolled a total of 1,511 MSW, FSW and
TGSW, aged ≥18 years old, HIV-negative, andengaged in sex work in the past three months. A
total of 1,511 respondents (FSW: 621 – MSW: 452– TGSW: 438) were interviewed face-to-face bytrained outreach workers. A descriptive analysis ofbehaviors associated with potential HIV exposure
was conducted.
Results: 702 respondents (46%) perceived they
were at high or medium risk of HIV exposure. Low
levels of HIV testing were reported in the context
of the 95-95-95 targets: 172 (11.4%) SW had neverbeen tested and 493 (32.6%) not tested in the past
12 months. 324 (21.4%) SW (n=324) reported
participating in group sex in the past 3 months
with the highest rates among MSW (25.6%) and

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209

TGSW (29.6%). Of these, 95% reported
condomless sex: TGSW 99.0 %; FSW 96.1% and
MSW 91.0%). Recreational drug use in the past 12
months before or during sex with clients wasreported by 11.8% of SW (MSW: 17.3%; TGSW:
15.1%; and FSW 5.5%). About half (780 or 51.6%)
had ever been screened for a sexually transmitted
infection (STI); 168 (21.5%) had been diagnosed
and treated for a STI in the past 12 months.
Gender-based violence (GBV) was reported acrossall sub-populations (35.8%, n=541), perpetrated
largely by clients.
Conclusions: Significant HIV risks and vulnerability
were reported by SW underscoring their need for
PrEP. HIV testing and prevention strategies for SW
should be revisited. HIV programming for SW
needs to be reprioritized with a differentiatedapproach covering the full spectrum of SW risk
behaviors and vulnerable populations. PrEP
programming for SW must be rapidly intensified.

Poster Abstract

185

High rates of HIV Serostatus
Self-Disclosure Amongst
Adolescents and Young Adults
Living with HIV in Thailand
Ganguli S1, Saisaengjan C2, Padungkiatisak P2,
Srisuksai J3, Pitikawinwong L2, Deeglum P2,
Phinitwongwitthaya P4, Songtaweesin W2,5,
Puthanakit T2,3
National Health Service England (NHSE), London, United
Kingdom, 2Center of Excellence for Pediatric Infectious Diseases,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 3Department of Pediatrics, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand, 4King College
International School, Bangkok, Thailand, 5School of Global
Health, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand1

Background: HIV self-disclosure is associated withhealth benefits including increased support,
treatment adherence and HIV testing. However,concerns exist regarding the potential social
harms, such as isolation, relationship breakdown
and discrimination. The rate and patterns of HIV
self-disclosure vary significantly among different
populations, however remain poorly understoodamongst adolescents and young adults (AYA) livingwith behaviourally-acquired infection. This study
aims to address this knowledge gap by describing
the rate, patterns and factors associated with HIV
status self-disclosure within this group.
Materials and Methods: We conducted a mixedmethods, cross-sectional study at the CU Buddy
Clinic, a youth-friendly HIV service in Bangkok,
Thailand. The inclusion criteria were: 1) aged 15-24
years, and 2) living with behaviourally-acquired
HIV infection. We completed semi-structured
interviews to examine the rate and patterns of HIV
self-disclosure. Qualitative data was collected
relating to factors associated with HIV selfdisclosure, attitudes and outcomes. Descriptive
statistical analysis was performed; rate andpatterns of self-disclosure were presented as arate with 95% Confidence Intervals (95%CI). An
inductive thematic analysis approach was used tosummarize the benefits and negative
consequences of self-disclosure.

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Results: Between September and December 2023,
85 youth were enrolled with a median age of 21.3
years (IQR 19.2-22.9). The median time since HIV
diagnosis was 32 months (IQR 14-53). 82.4%(95%CI 72.6-89.8) had an undetectable HIV viralload (<50 copies/mL) at the time of enrolment.
Participants comprised of 71 (84%) men who havesex with men, 7 (8%) transgender women and 7(8%) cisgender females.
The overall rate of self-disclosure was 84.7%(95%CI 75.2-91.6). Among those who had
disclosed their HIV serostatus, the median numberof persons disclosed to was 3 (IQR 1 to 7).
Participants disclosed their HIV status to expartners (75%), current partners (68%), friends(50%), mothers (49%), siblings (27%), fathers(25%), wider family members (23%), colleagues(19%) and teachers (14%). 92% of those who had
disclosed to family members did so within one
month of receiving an HIV diagnosis, comparedwith 51% and 49% to partners and friends,
respectively.
Despite a majority (72%) of participants statingthat disclosing their HIV status to others was notan easy process, 83% of those who had disclosed
reported that it had improved their mental health.
The most commonly cited motivations fordisclosure were to strengthen relationship ties
(94.3%) and for practical/emotional support(90.0%). Of participants who had disclosed their
HIV serostatus to current partners, 57% did so topromote HIV prevention.
From inductive thematic analysis, participants
described several benefits of self-disclosure,including increased practical support, improved
treatment adherence and uptake in HIV testing.
Reported negative consequences included enacted
stigma and discrimination, relationship breakdown
and isolation.
Conclusions: The majority of adolescents andyoung adults in this study had disclosed their HIV
status to partners and family members within thefirst month of diagnosis. Most reported that it had
had a positive impact on their mental health.
Support for AYA wishing to disclose their HIV
status should be considered as part of acomprehensive package of care for youth livingwith HIV.

Poster Abstract

186

Mental health knowledge andattitudes among social
workers: Quantitative datafrom an implementation study
assessing integration of mental
health screening for PLHIV in
the Philippines.
Alonto A1, Ditangco R1, Melgar I2, Sornillo J1, Ross
J3, Dizon T1
Research Institute For Tropical Medicine, Muntinlupa,
Philippines, 2Ateneo de Manila University, Quezon City,
Philippines, 3TREAT Asia, Bangkok, Thailand

1

Background: Mental health screening is notroutinely practiced in HIV treatment hubs andprimary HIV clinics in the Philippines because of
scarcity of mental health services and specialists.
This quantitative study aims to assess social
workers’ knowledge and attitudes about mental
health conditions and the feasibility of integrating
mental health screening into their social work casemanagement of people living with HIV (PLHIV).
Materials and Methods: The Mental Health
Literacy Scale (MHLS) was used to assess social
workers' knowledge and attitudes on mental
health conditions. It was administered throughResearch Electronic Data Capture (REDCap)
between January and February 2024. Using a
Likert Scale, survey respondents were asked toindicate their level of agreement with each of 35
statements covering six domains: ability torecognize mental health conditions, knowledge on
risk factors and causes, self-treatment,
professional help available, help-seeking behavior,
and attitudes promoting recognition or support formental health conditions. Social workers wereidentified and contacted for participation in the
online survey following random selection from aprovided listing of their names and contact details
by facilities across the country. Descriptive
statistics, specifically frequencies and proportions,were used to report on MHLS domains.
Results: Of the surveyed social workers to-date(N=71), 82% were females, almost half (48%) were
26 to 35 years old, and the majority (89%) work in

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211

government hospitals. Over the past 6 months,
63% reported managing or assisting PLHIV in theirfacility. Over two-thirds (68%) reported assisting
mental health cases. Responses to the survey
indicated varying abilities to recognize different
mental health conditions. Symptoms ofGeneralized Anxiety Disorder, Major Depressive
Disorder, Bipolar Disorder, and Persistent
Depressive Disorder are highly recognized by atleast 90% of the respondents. Social worker
attitudes towards mental health were generally
positive with only 3% agreeing that mental illness
is not a real medical illness, 92% disagreeing thatpeople with mental illness should be avoided so as
not to develop similar problems, and 94%
disagreeing that professional treatment for amental illness would not be effective. Significantly,
respondents reported good attitudes that promoterecognition, with only 6% agreeing people withmental illness are dangerous. A very small
percentage (only 2%) of the respondents agreed
they would not seek help from mental healthprofessionals if they were facing mental healthconditions. This contrast with the overall positive
response of 94%, indicating that most of the social
workers have a favorable attitudes that promote
appropriate help-seeking behavior for mental
health conditions.
Conclusion: Social workers have a high knowledge
and ability to recognize mental conditions, andpositive attitudes that promote recognition andhelp-seeking behavior. Their knowledge level andattitudes can possibly support integration ofmental health screening into social work casemanagement for PLHIV through HIV Treatment
Hubs and Primary HIV facilities in the Philippines.

Poster Abstract

187

Moving beyond condomlesssex as an indicator of HIV risk:
an analysis of national HIV
diagnoses and behaviouralsurveillance among men who
have sex with men in Australia
2012-2022
Chan C1, Holt M2, King J1, Broady T2, Smith A2,
MacGibbon J2, Mao L2, Wilcock B3, Bavinton B1
1
Kirby Institute, UNSW Sydney, Sydney, Australia, 2Centre forSocial Research in Health, UNSW Sydney , Sydney, Australia,
3Health Equity Matters, Sydney, Australia

Background: Condomless sex has been a standard
measure of risk in behavioural HIV research andmonitoring since the 1980s. However, as the useof pre-exposure prophylaxis (PrEP) andundetectable viral load (UVL) for prevention
increase among gay, bisexual, and other men who
have sex with men (GBMSM), relying exclusively
on condomless anal intercourse with casual
partners (CLAIC) as a measure of HIV risk may be
misleading in efforts to identify people at risk of
HIV and in need of more effective prevention
methods.
Materials and Methods: Data were collectedusing national, repeated, cross-sectional surveys(the Gay Community Periodic Surveys) conducted
at LGBTQ+ venues, events and online during 20122022. Participants were eligible if they were aged
18 or over if recruited face-to-face or 16 or over if
recruited online, identified as gay, bisexual, or as aman who had had sex with another man in the last
5 years, and lived in Australia. These surveys
included questions on condom use, PrEP use, andviral load. Trends in engagement in any CLAIC, useof biomedical prevention (PrEP or UVL), andhigher-risk CLAIC (i.e. CLAIC without PrEP or UVL)
in the last 6 months were assessed using logistic
regression. Any CLAIC and higher-risk CLAIC werecorrelated with publicly available data aboutannual HIV diagnoses among GBMSM from thenational HIV surveillance system over the same
period.

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Results: During the study period, 54,297
participants who reported casual sex (out of a totalof 90,212) were included for analysis. The mean
age of participants was 37.2 years (SD=12.7). Most
participants identified as either gay (n=47,894,
88.5%) or bisexual (n= 4,449, 8.2%). Most wereborn in Australia (n=37,865, 70.0%). The
proportion reporting any CLAIC increased from
34.4% in 2012 to 67.3% in 2022 (OR=1.17,
95%CI=1.17-1.18, p<0.001) but those reporting
higher-risk CLAIC decreased from 33.1% to 21.5%(OR=0.94, 95%CI=0.93-0.95, p<0.001) as use ofbiomedical prevention increased from 8.9% to56.6% (OR=1.36, 95%CI=1.36-1.37, p<0.001). HIV
diagnoses among GBMSM decreased from 780 in2012 to 316 in 2022 (a 59.5% reduction). Any
CLAIC was negatively correlated with annual HIV
diagnoses (r=-0.92, p<0.001) but higher-risk CLAIC
was positively correlated with annual HIV
diagnoses (r=0.93, p<0.001).
Conclusions: We found a statistically significant
negative correlation between condomless sex andHIV diagnoses. This demonstrates the conceptual
limitations of focusing exclusively on condom use
when measuring HIV risk as we would haveexpected more people reporting condomless sex
to be associated with more HIV diagnoses.
Factoring PrEP and UVL into HIV behavioural risk
measures produces more conceptually valid
results and is predictive of HIV diagnoses in the
expected direction in the current period. HIV
research should standardise measuring biomedical
prevention alongside condom use and condomlesssex, as focusing on condomless sex in isolation
among GBMSM may overestimate HIV risk.

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188

Survival probability and risk
factors associated withmortality among people livingwith HIV in Thailand, 20082021
Kiatchanon W1, Noknoy S2, Namahoot P3,
Naiwatanakul T1, Aungkulanon S1, Northbrook S1,
Punsuwan N2, Wareechai P3, Kanphukiew A1,
Lertpiriyasuwat C2
1Division of Global HIV/AIDS and TB, Thailand and Laos, U.S.

Centers for Disease Control and Prevention, Nonthaburi,
Thailand, 2Division of AIDS and STI, Department of Disease
Control, Ministry of Public Health, Nonthaburi, Thailand,
3National Health Security Office, ◌Bangkok, ThailandฺBackground: Survival of people living with HIV(PLHIV) is a key outcome of the Thai national HIV
program. We examined survival probabilities andrisk factors associated with mortality from 2008
through 2021.
Methods: We conducted a retrospective cohort
analysis of PLHIV registered in the National AIDS
Program (NAP) as of 31 January 2023.
Demographics and clinical data were collected atregistration and follow up visits following nationalguidelines. Death data was linked by national
citizen identification number in the national Death
Certificate database. Survival time was calculated
in days as the time between date of diagnosis anddate of death and mortality rates were calculated
as the number of deaths per 100 person-years.
Cumulative survival probability was estimatedusing the Kaplan–Meier method. A Cox
proportional hazards regression model was
performed to explore associations with survival
using SAS version 9.4.
Results: Of 485,551 PLHIV diagnosed from over
1,000 sites in NAP, 111,566 deaths were reported(3.1 per 100 person-year). Survival probabilities
were 89.8% at 1 year, 87.2% at 2 years, 82.0% at 5
years, and 74.7% at 10 years. Elevated death risks
were observed among males (adjusted hazard
ratio [aHR]: 1.28, 95%CI: 1.26-1.30), those aged
25-54 years (aHR:1.67, 95%CI:1.63-1.70) and aged
>55 years (aHR: 2.64, 95%CI: 2.57-2.72) comparedto ≤24 years, non-KP (aHR: 1.13, 95%CI: 1.11-1.15),

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those with a baseline CD4 <200 cells/μL (aHR:
2.30, 95%CI: 2.26-2.34), and no history of
antiretroviral treatment (aHR: 6.78, 95CI: 6.696.87).
Conclusion: Survival probability declined rapidly inthe first year after diagnosis but slower over time.
Elevated mortality risk factors included malegender, older age, and baseline CD4 <200. Tailoredinterventions for males and older age groups alongwith implementation of targeted active casefinding with rapid linkage to antiretroviraltreatment are critical to improve probability ofsurvival among PLHIV in Thailand.

Poster Abstract

189

Factors Associated with Global
and Domain-Specific
Neurocognitive Impairment
Among People Living with andwithout HIV in Malaysia
Ahamed F1, Chen P2, Neelamegam M3, Hisham S4,
Lim J4, Ho W4, Chong M1,4, Cheong J4, Tan X4, Syed
Omar S1,4, Wong P1,4, Rajasuriar R1,4
1Department of Medicine, Faculty of Medicine, University of

Malaya, Kuala Lumpur, Malaysia, 2School of Psychology,
University of Nottingham Malaysia, Semenyih, Malaysia,
3School of Public Health, University of North Texas, Fort Worth,
United States of America, 4Centre of Excellence for Research in
AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur,
Malaysia

Background: Successful antiretroviral treatment(ART) has extended the lifespan of people livingwith HIV (PLWH), but they are still burdened withearly-onset geriatric illnesses including
neurocognitive impairment (NCI). The extant
literature on global and domain-specific NCI
among PLWH, and factors influencing them, isscarce in the Asia-Pacific region. The current study
attempts to address these gaps in Malaysia, anupper middle-income country.
Materials and Methods: Participants were from
the Malaysian HIV and Ageing cohort which
recruited PLWH attending University Malaya
Medical Centre and community controls (PWOH)(2021-2023, nPLWH=206, nPWOH=106). The
inclusion criteria were age ≥35 years and all PLWH
on ART for at least 12 months. All participants
underwent neurocognitive assessments, including
global neurocognition (Montreal Cognitive
Assessment), sustained attention and taskswitching (Colour Trails Test 1 and 2), finger
dexterity and motor coordination (dominant handand assembly scores from Purdue Pegboard Test)and processing speed (Symbol-Digit Modalities
Test). Sociodemographic, lifestyle, clinical andpsychosocial information were collected using
standardised questionnaires. Neurocognitivescores were compared between PLWH and PWOH
using Mann-Whitney U-test and Kruskal-Wallis Htest, and factors associated with neurocognitionassessed with Pearson correlation.

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Results: Mean age was similar in both groups(Mean PLWH=51.61 years, Mean PWOH=50.55
years, p=0.632), but sex distribution varied (Males:
79% PLWH and 50% PWOH,p<0.001). PWOH had asignificantly higher education level compared to
PLWH (p=0.023). 92% PLWH had HIV RNA<50copies/mL and 69% with CD4 count ≥500
cells/mm^3.
PWOH performed significantly better on global
neurocognition (p=0.014), processing speed(p=0.001) and finger dexterity (p<0.001),
compared to PLWH. Differences on sustained
attention, task-switching and motor coordination
were not significant (all p>0.08).
Among the PLWH, better performance on global
neurocognition was associated with being male,
higher grip strength and gait speed, better
nutrition and not having diabetes. Surprisingly, lowcurrent CD4 count was associated with betterscores. In PWOH, only polypharmacy was
associated with poorer global neurocognition.
Correlates for sustained attention and taskswitching ability were mostly comparable in PLWH
and PWOH. Higher scores were associated withmale sex, better education, larger social network,
fewer non-ART medications, not having
hypertension and diabetes. Higher scores forfinger dexterity and motor coordination wereassociated with younger age, better education andlower blood pressure (BP) in PLWH and PWOH.
Additionally in PLWH, fewer non-ART medications,higher grip strength and gait speed, lower fat
mass, lower baseline viral load, fewer AIDSdefining illnesses, not having diabetes and nohearing difficulties improved these domains.
Among PLWH and PWOH, younger age, higher
education level, higher grip strength and gait
speed, lower BP, and lower fat mass had better
processing speed. In PWOH, larger social networkand fewer medications improved this domain
while not having hearing difficulties and diabetes
improved it in PLWH.
Conclusion: The majority of factors influencing NCI
in PLWH and PWOH are modifiable throughlifestyle changes. Interventions addressing
polypharmacy and hearing difficulties may also be
helpful. Motor skills in PLWH appear to be
uniquely affected by viral factors. Further studies
utilising machine learning approaches are needed
to better identify factors associate with cognitive
phenotypes in PLWH.

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190

Shining a Light on the Unseen:
Assessing Mycoplasma
genitalium in Bangkok's STI
and HIV Screening Efforts
Pattanachaiwit S1, Chumpa N2,3, Pipattaweepon T1,
Pankam T1, Sri-Laor A1, Barisri S1, Pichitchok Y1,
Putcharoen O1,2,3, Kerr S4
1The Thai Red Cross AIDS Research Centre, Bangkok, Thailand,

Thai Red Cross Emerging Infectious Diseases Clinical Center,
King Chulalongkorn Memorial Hospital, Bangkok, Thailand,
3Division of Infectious disease, Department of Medicine, Facultyof Medicine, Chulalongkorn University and King Chulalongkorn
Memorial Hospital Thai Red Cross, Bangkok, Thailand, 4HIVNAT, The Thai Red Cross AIDS Research Centre (TRCARC)
2

Background: The Thai Red Cross AIDS ResearchCentre in Bangkok initiated a pivotal study todetermine the prevalence of sexually transmitted
infections (STIs), focusing primarily on
Mycoplasma genitalium (MG), in addition toChlamydia trachomatis (CT) and Neisseria
gonorrhoeae (NG). This research was especiallycritical in light of the global concern regarding
MG's developing antibiotic resistance and its
relatively undocumented prevalence in Thailand.
The study aimed to illuminate the prevalence ofMG and evaluate its impact on STI management
across a diverse demographic spectrum.
Methods: Conducted from May to December
2020, this study involved clients visiting our clinic
for STI screening. The Alinity m STI assay was
employed to test for CT, NG, and MG. The study's
analytical approach was designed to provide a
detailed overview of the prevalence of these
infections, with a focus on categorizing data by
gender, HIV status, and the route of pathogen
detection. This methodology offered valuable
insights into the distribution and dynamics ofthese infections in various demographic andclinical contexts.
Results: The study revealed an MG prevalence of
8% (24 out of 300 samples), with a gender
distribution of 25% in females, 58.3% in males, and16.7% in transgender individuals. For CT,
prevalence rates were observed as 13.3% in
cervical, 32.5% in anal, 8.9% in oropharyngeal, 7%
in urine, and 31% in pooled samples. NG was

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identified with a prevalence of 13.3% in cervical,
55% in anal, 17.8% in oropharyngeal, 5% in urine,and 19% in pooled samples. A significant finding
was the notably higher prevalence of NG among
People Living with HIV (PLH), with PLH being 19.7%
more likely to test positive for NG (95% ConfidenceInterval: 9.9 to 29.5%; P<0.001). This trend was
not paralleled in CT cases.
Conclusions: This study significantly contributes tothe understanding of STI prevalence in Thailand,particularly highlighting the underreported
prevalence of MG. The findings emphasize thecritical need to incorporate MG in STI diagnostic
processes, especially in cases of non-gonococcal
urethritis that do not respond to standard
treatment protocols. Additionally, the results
underline the importance of comprehensive STI
screening, inclusive of MG, in clinical settings, bothfor effective STI management and for augmenting
HIV prevention and care strategies.

Poster Abstract

191

Mortality Rate and Cause of
Death in People Living with
HIV in Long Term Antiretroviral
Therapy at HIV-NAT, Bangkok,
Thailand.
Apornpong T1, J. Kerr S1,2,3, Lwin H1, Gatechompol
S1, Thammapiwan S1, Sophonphan J1, Nochaiwong
T1, Ubolyam S1, Avihingsanon A1,4
1HIV-NAT - The Thai Red Cross Aids Research Centre, Bangkok,
Thailand, 2The Kirby Institute, University of New South Wales,
Sydney, Australia, 3Biostatistics Excellence Centre, Faculty of
Medicine, Chulalongkorn University, bangkok, Thailand, 4Centerof Excellence in Tuberculosis, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand

Background: With increased access to effective
antiretroviral therapy (ART), life expectancy ofpeople with HIV (PWH) has significantly improved.
However, mortality rates remain higher than those
without HIV. Several deaths can be averted if
cause of death could be modified and treated. We
therefore investigated the causes and predictor ofdeath among PWH on long term ART in Thailand.
Methods: We retrospectively analyzed data froma prospective long term adult PWH (aged ≥18
years) cohort at HIV-NAT, Thai Red Cross AIDS
Research Centre, Thailand. This cohort wasestablished in 1996. Participants were followed-up
6 monthly. Follow up time was calculated from thefirst visit until death. Cumulative all-cause
mortality incidence was calculated with losses andtransfers considered competing events.
Results: A total of 3,156 PWH (70 % male, medianage 32 years, median CD4 240 (IQR:111-376
cells/mm3) were enrolled. During median duration
follow-up of 6.5 (2.5-14.8) years, 227 (7.2%) PWH
died, 18/227 (7.9%) died within a year of ART
initiation. The cumulative incidence of all cause
mortality at 10 year and 20 year were 4.53 per 100
person-years (95%CI: 3.75-5.42) and 11.29 per 100
person-years (95%CI: 9.80-12.89). Almost 56% ofthem died from non-AIDS related, following by
AIDS-related (24%) and unknown cause (20%). The
most common causes of death were TB (37:
16.3%), cardiovascular disease (26: 11.5%),
hepatocellular carcinoma (12: 5%), and suicides(5%). At the time prior death, median age was 49

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years, 68% had HIV RNA < 50 copies/ml and 50(22%) PWH had prior TB disease. For those withprior TB, 52% died from non-AIDS. In a
multivariable model, older age (sub-hazard ratio[sHR]: 1.05, 95%CI: 1.04-1.07), heterosexual male(sHR: 1.72, 95%CI: 1.23-2.43), and ever having TB(sHR: 1.62, 95%CI: 1.13-2.32) were associated withhigher mortality after adjusting for baseline CD4count, and hepatitis B/ C co-infection
Conclusions: Ever having TB infection was anindependent and potentially modifiable risk factor
for all-cause mortality. TB prevention in PWH
should be aggressively pursued to reduce
mortality risk.

Poster Abstract

192

HIV mortality trends andspatial distribution among
persons living with HIV,
Thailand, 2008–2022
Naiwatanakul T1, Punsuwan N2, Kiatchanon W1,
Namahoot P3, Lertpiriyasuwat C2, Aungkulanon S1,
Noknoy S2, Wareechai P3, Kanphukiew A1,
Northbrook S1Division of Global HIV/TB, U.S. Centers for Disease Control andPrevention, Nonthaburi, Thailand, 2Division of AIDS and STI,
Department of Disease Control, Ministry of Public Health,
Nonthaburi, Thailand, 3National Health Security Office,◌ฺBangkok, Thailand
1

Background: Despite notable advancements inhealthcare, challenges in health equity remain,
specifically in HIV-related mortality. We comparedage-sex adjusted all-cause mortality trends among
persons living with HIV (PLHIV) registered in the
National AIDS Program from 2008 to 2022 inThailand.
Method: We conducted a retrospective analysis of
all reported PLHIV from over 1,000 facilities
registered in the National AIDS Program (NAP) asof 31 January 2023. Demographics and all cause
death data were classified according to Thai HIV
case surveillance definitions and WHO HIV clinicalstaging guidelines to calculate age-sex adjusted
mortality rate and standardized mortality ratio(SMR). The average Thai population age and sex
structure during 2008-2022 was used as thestandard population. Age-sex adjusted rates were
calculated by dividing the number of observed
deaths by the population standard and multiplying
by 100,000. Standardized mortality ratio was
calculated by dividing the number of observed
deaths by the number of expected deaths andmultiplying by 100. Spatial autocorrelation of SMR
was measured by the Moran’s I coefficient using
SAS v 9.4.
Result: Of 666,157 diagnosed PLHIV registered in
NAP, 157,319 (23.6%) died from all causes. The
age-sex adjusted mortality rate increased from
14.9 per 100,000 in 2008 to 16.8 per 100,000 in2015 to 18.9 per 100,000 in 2022. Moran’s I
revealed positive values, indicating spatial
clustering of high SMR. In 2022, SMR remained

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high in Bangkok and central provinces near
Bangkok, northern Myanmar and Laos border, andeastern seaboard industrial provinces.
Conclusion: Increase in age-sex adjusted mortality
rates and geographic disparities in SMR emphasize
the need to identify risk factors for death among
PLHIV to address gaps. Our findings underscorethe importance of ongoing monitoring and acomprehensive approach to address bothindividual risk factors and regional disparities toreduce mortality among PLHIV in Thailand.

Poster Abstract

193

Trend and associated factors
for late and advanced HIV
diagnoses in 2011-2023 in
Melbourne, Australia
Tieosapjaroen W1,2, Tran A2,3, Maisano M2, Kim
C2,3, Ong J1,2
1School of Translational Medicine, Monash University,

Melbourne, Australia, 2Melbourne Sexual Health Centre, Alfred
Health, Melbourne, Australia, 3Melbourne Medical School, The
University of Melbourne, Faculty of Medicine Dentistry and
Health Sciences, Melbourne, Australia

Background: Most HIV transmission in Australia is
attributed to individuals who have partners with
undiagnosed HIV. If people living with HIV do notknow their status, they also risk having a late- or
advanced diagnosis or presenting with an AIDSdefining event, which increases their risk ofmorbidity and mortality because of delays in theinitiation of life-saving antiretroviral therapy (ART).
We investigated trends of late- and advanced
diagnosis of HIV and factors associated withdelayed HIV diagnosis at Melbourne Sexual HealthCentre (MSHC), Melbourne, Australia.
Methods: A retrospective cohort study was
conducted using data extracted from theelectronic medical records at MSHC between 2011
and 2023 to compare the differences in individuals
newly diagnosed with early diagnosis of HIV versus
those with late- and advanced diagnoses. We
described the demographic and clinicalcharacteristics and calculated the proportion oflate- (CD4 count <350 cells/µL) and advanced HIV
diagnoses (CD4 count <200 cells/µL). Univariable
and multivariable logistic regression analyses were
performed to identify the factors associated withlate and advanced HIV diagnosis.
Results: Among 637 individuals, 210 (33%) had alate HIV diagnosis, and 63 (9.8%) had an advanced
diagnosis. Regarding those with late HIV diagnosis,
the median age was 29 (IQR 26,38), 98% were men
who have sex with men (MSM), 71% were bornoverseas, 49% were newly arrived in Australia (<5years), 46% were Medicare-ineligible, 69%
reported having more than one sexual partner inthe past three months and 59% were diagnosed
with a sexually transmitted infection (STI) on the

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same visit. There is an increasing trend in the
proportion of late HIV diagnoses from 17% (8/47)
in 2011 to 37% (7/19) in 2022 (Ptrend=0.0007).
Similarly, the proportion of advanced HIV
diagnoses increased from 4% (2/47) in 2011 to
11% (2/19) in 2022 (Ptrend=0.0078). Factors
associated with late HIV diagnosis included beingborn overseas (adjusted odd ratio (aOR) 1.93, 95%
confidence interval (CI) 1.20-3.08, P=0.006), lack of
HIV testing in the last 12 months (aOR 2.30, 95%CI
1.29-4.49, P=0.006), low perceived risk of HIV
infection (i.e., no reported condomless sex in thepast 12 months, no history of drug use, and noprevious STI diagnosis) (aOR 1.66, 95%CI
1.02=2.69, P=0.041). Factors associated withadvanced HIV diagnosis included being older (aOR
1.045, 95%CI 1.011-1.079, P=0.008), low perceived
risk of HIV infection (aOR= 1.904, 95%CI 1.0633.412, P=0.03), and having one (aOR 0.151, 95%CI
0.049-0.465, P=0.001) or more than one sexual
partner (aOR 0.135, 95%CI 0.048-0.378, P<0.001)
in the past three months, compared to those
without sexual partners.
Conclusion: Our findings highlight challenges in
HIV diagnosis and care among overseas-born
MSM. Low perceived HIV risk contributes to late
and advanced diagnoses, impeding timely ART
initiation and increasing the risk of HIV
transmission within the community.

Poster Abstract

194

PrEP Re-initiation among Men
Who Have Sex with Men in
Guangzhou and Wuhan, China:
a Multi-center Cohort Study
Dai Y1,2,3, Yin Z3, Li C4, Fan C3, Huang H5, Li Q6, Wu
S7, Hazra A8, Lio J8, Sherer R8, Tucker J9,10,3, Tang
W10,3
1Southern Medical University, school of public health,

Guangzhou, China, 2Dermatology Hospital of Southern Medical
University/Guangdong Provincial Dermatology Hospital,
Guangzhou, China, 3UNC-Project China, Guangzhou, China, 4The
University of Tokyo, Tokyo College, Tokyo, Japan, 5Wuhan
Tongxing LGBT Center, Wuhan, China, 6Guangzhou Eighth
People's Hospital, Guangzhou, China, 7Zhongnan Hospital of
Wuhan University, Wuhan, China, 8University of Chicago,
Chicago, United States, 9London School of Hygiene and Tropical
Medicine, London, United Kingdom, 10University of North
Carolina at Chapel Hill, Institute for Global Health and infectious
diseases, Chapel Hill, United States

Background: Promoting consistent use of HIV preexposure prophylaxis (PrEP) is vital for protecting
at-risk populations, especially men who have sex
with men (MSM). In China, with the increasing
adoption of PrEP among MSM, discontinuation iscommon. Facilitating the re-initiation of PrEP
among those who discontinue may mitigate therisk of HIV transmission. This study aims toinvestigate the factors influencing PrEP reinitiation.
Method: We conducted a multi-center PrEP
Demonstration Trial in Guangzhou and Wuhan,
China, providing 12 months of TDF+FTC for PrEP to1200 MSM. After trial completion, participants
were invited for online follow-ups to assess PrEP
usage. Categorization included PrEP continued(persistent use), PrEP discontinued (absence for >7days for daily users, or no use during sex for ondemand users), and PrEP re-initiated (resumed
after discontinuation), based on their self-reported
PrEP usage history after the trial. The follow-up
survey also collected sociodemographic
information and behaviors. The analytical
approach involves log-binomial regression todetermine the risk ratio (RR) of factors influencing
PrEP re-initiation.

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Results: From March to December of 2023, 192
participants responded to the survey with a mean
age of 30.5(SD=5.3). Of those, 70.3% (N=135/192)
reported PrEP discontinuation, while 37.8%(N=51/135) re-initiated PrEP. For participants whoreported reasons for discontinuation, 34.9% citedthat it was no longer necessary to use (N=30/86).
Univariate analysis indicated that compared toindividuals who discontinued PrEP but not reinitiated (reference group), people who havemultiple sexual partners (RR=2.20, 95%CI: 1.303.74), have casual sexual partners (RR=2.51,
95%CI: 1.45-4.35), used Rush (RR=1.76, 95%CI:
1.17-2.67), and have serodiscordant sexual
partners (RR=1.98, 95%CI: 1.20-3.25) in the past 6months were more likely to re-initiate PrEP.
Consistent condom use (RR=0.54, 95%CI: 0.300.98) was negatively associated with prep reinitiation. Meanwhile, a significant association was
found between drug use in the past 3 months and
PrEP re-initiation (aRR=1.54, 95%CI: 1.03-2.28),
suggesting that inhaled amyl nitrate users have ahigher likelihood of re-initiating PrEP.
Conclusion: Our study underscores the importanceof targeted interventions to address PrEP reinitiation among PrEP users who discontinued PrEP
but remain eligible for PrEP. Our findings provide
valuable insights for designing effective
interventions to enhance PrEP adherence inpeople with behaviors associated with potential
HIV exposures.

Poster Abstract

195

Epidemiological impacts andcost-effectiveness of daily andon-demand oral Pre-Exposure
Prophylaxis among key HIV
populations in China: an
economic evaluation
Su S1,2, Wei Y2, Dong W3, Sun J4,5, Wu Z3, Zhao R2,
Zhang L1,4,5
1The second affiliated hospital of Chongqing Medical University,

Chongqing, China, 2China-Australia Joint Research Center for
Infectious Diseases, School of Public Health, Xi’an Jiaotong
University Health Science Center, Xi'an, China, 3National Center
for AIDS/STD Control and Prevention (NCAIDS), Chinese Center
forDisease Control and Prevention (China CDC), Beijing, China,
4Melbourne Sexual Health Centre, Alfred Health, Melbourne,
Australia, 5Central Clinical School, Faculty of Medicine, Monash
University, Melbourne, Australia

Introduction: Pre-exposure prophylaxis (PrEP) is
highly effective in HIV prevention and wasapproved in China in 2020. This study evaluates
the effectiveness and cost-effectiveness of scaling
up PrEP among four key populations in China: men
who have sex with men (MSM), female sex
workers (FSW), people who inject drugs (PWID),
and the uninfected partners of HIV serodiscordant
couples (SDC).
Methods: Decision-analytic Markov models wereconstructed to simulate HIV transmission anddisease progression in cohorts of 100,000
individuals aged 18 or older for MSM, FSW, PWID,
and the uninfected partners of SDC over 40 years.
Three PrEP strategies (no PrEP, daily PrEP, and ondemand PrEP) were simulated for key populations
nationwide and among high-incidence provinces
only. Incremental cost-effectiveness ratios (ICERs)
were calculated with a willingness-to-pay
threshold of three times the gross domestic
product (GDP) in China (US$37,653 as of 2021).
One-way, two-way, and probabilistic sensitivity
analyses were conducted.
Results: Without a PrEP strategy, 30,960 MSM,
10,613 uninfected partners of SDC, 7,976 PWID,
and 237 FSW would acquire HIV over the next 40
years in each cohort of 100,000 individuals,
respectively. For MSM, on-demand PrEP was costeffective in both provinces with high HIV incidence

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(ICER: $1,045-$2,129/QALY) and nationwide (ICER:$4,554/QALY), averting 24.7% of HIV infections per
100,000 MSM nationwide. Additionally, Daily PrEP
was cost-effective for MSM on a national scalecompared to the status quo (ICER: $15,768/QALY).
For FSW, only on-demand PrEP in provinces withhigh HIV incidence (ICER: $25,399-$37,045/QALY)
was cost-effective, averting 2,934-3,730 HIV
infections per 100,000 FSW. For PWID, on-demand
PrEP in provinces with high HIV incidence wascost-effective ($10,361-$29,560/QALY), averting
2,550-4,665 infections per 100,000 PWID. Daily
PrEP would be cost-effective if the regional HIV
incidence among PWID reached 5.8 cases per 100
person-years. For SDC, on-demand PrEP was costeffective in both provinces with high HIV incidence
and nationwide, averting 4,189-4,510 HIV
infections per 100,000 uninfected partners of SDC
in high-incidence provinces. Daily PrEP was only
cost-effective for uninfected partners of SDC in
high-incidence provinces (ICER: $23,222$27,616/QALY). One-way sensitivity analysis
compared daily PrEP and on-demand PrEP
strategies, finding the top three influential factors
including effectiveness of daily PrEP, the cost ofdaily PrEP per year, and HIV incidence.
Conclusions: On-demand PrEP yields significant
health and economic benefits among all four key
populations in high-incidence provinces and is also
cost-effective in MSM and the uninfected partnersof SDC nationwide. Due to its high cost, daily PrEP
is not currently recommended as an optimal
strategy but might be offered as an additional
option to key populations living in high-incidence
regions

Poster Abstract

221

196

Impact of peer referral on PreExposure Prophylaxis
adherence and persistence
among Gay, Bisexual, andOther Men Who Have Sex with
Men: A cohort ctudy in China
Fan C1,2, Yin Z2, Marley G2, Li C3, Dai Y2, Li Q4, Wu
S5, Huang H6, Hazra A7, Lio J7, Liang K5, Li L4, Sherer
R7, Tucker J2,8,9, Tang W2,9
1Nanjing Medical University, Nanjing, China, 2 UNC Project

China, Guangzhou, China, 3Tokyo College, Tokyo, Japan,

4Guangzhou Eighth People's Hospital, Guangzhou, China,
5Zhongnan Hospital of Wuhan University, Wuhan, China,

6Wuhan Tongxing LGBT Center, Wuhan, China, 7University of

8London School of Hygiene and Tropical

Chicago, Chicago, USA,
Medicine, London, UK, 9University of North Carolina at Chapel
Hill, Chapel Hill, USA

Background: Peer referral as a strategy leveragessocial networks to reach and refer peers to healthservices. Peer referral could be used to enhance
PrEP uptake. This secondary analysis aimed toevaluate the potential impact of peer referral on
PrEP adherence and persistence.
Methods: From September 2021 to December
2023, a 12-month PrEP(FTC/TDF) Demonstration
Trial was conducted in Guangzhou, China.
Participants were asked whether they wererecommended by a friend who had alreadyenrolled in the trial at baseline, and all participantsreceived a quarterly follow-up survey to assess
PrEP usage. PrEP adherence was defined as taking
4 or more pills in past 7 days for daily users andtaking PrEP strictly following the 2+1+1
requirement at least 75% of the time in past 30
days for the event-driven regimen. PrEP
persistence was defined as the time from PrEP
initiation to first discontinuation, defined by 120
days without FTC/TDF in possession based on
medical refilling records. We analyzed the datafrom the 3rd and 6th month follow-ups.
Generalized estimating equations and Cox
regression models to assess the impact of peerreferral on PrEP adherence and persistence.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Results: Of the 563 participants who initiated
PrEP, 90 (16.0%) were referred by their peers. The
mean age was 27.2 (SD=5.8), and 90.0% of theparticipants had at least a high school education.
Overall adherence decreased over time (79.7% in
the 3rd month vs. 72.3% in the 6th month,
P<0.001). PrEP adherence among peer-referred
participants was 77.7% and 74.1% at the 3-monthand 6-month follow-ups, respectively, and 80.0%
at the 3-month and 72.0% at the 6-month followup among non-peer-referred GBMSM. There wasno significant association between peer referral
and PrEP adherence (aRR=1.01, 95%CI: 0.69-1.85).
Overall, 75.0% of participants continued to use
PrEP six months after initiation, 84.4% of peerreferred PrEP users and 73.2% of non-peerreferred participants were persistent users. Nonpeer-referred participants were 1.8 times as likely
to not persist compared to Peer-referredusers(aHR=1.8,95% CI:1.1-3.2).
Conclusion: In this study, peer referral appears to
be an innovative approach to enhancing thepersistence of PrEP among GBMSM and future
PrEP programs should take into account the
impact of peer referral.

Poster Abstract

197

Addressing the mental healthneeds of HIV program
beneficiaries: Outcomes of two
distinct screening approaches
in public and private clinics in
VietnamPham V1, Vuong T1, Dang H1, Levitt D1, Phan H2,
Do N2, Voi K3
1FHI 360, , Vietnam, 2Vietnam Administration of HIV/AIDS

Control, , Vietnam, 3USAID, , Vietnam

Background: In Vietnam, the prevalence of mental
health (MH) disorders is officially reported at
14.2%, however, one investigation suggests a
substantially higher rate among people living withHIV (PLHIV), at 43.5%. Internalized and social
stigma around HIV, gender identity, and MH
conditions have served as barriers for PLHIV andmembers of key populations (KP) to seek
specialized services. Additionally, the COVID-19
pandemic further exacerbated MH challenges
among these populations. To increase MH service
access, the Meeting Targets and Maintaining
Epidemic Control (EpiC) project has integrated
questions about depression and anxiety using thePatient Health Questionnaire-4 (PHQ-4), anationally validated brief screener, in routine
checkups at supported public HIV treatment
facilities and KP-led pre-exposure prophylaxis(PrEP) clinics in Vietnam since June 2022. Large
differences in those screened as “at risk” based onscreening implementation modalities prompted
efforts to expand the use of an innovative
methodology resulting in higher yields. This paper
explores adoption of this innovation.
Description: From June 2022 to March 2023, thePHQ-4 was used with PLHIV and PrEP clients at 21
clinics via self-administered screening at one clinic,
and counselor-led screening at 20. Substantial
variation in screening outcomes across clinics wasobserved, with self-administered screening
yielding the highest rates of those at risk for
depression or anxiety. After a south-to-south
exchange on self-administered screening for four
clinics in April 2023, one public HIV and one KP-led
PrEP clinic adopted the approach. Data were

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collected from EpiC’s program dashboard andanalyzed using Chi-square to demonstrateoutcome differences between the periods before
and after the exchange.
Lessons learned: Between June 2022 and April
2023, using the previous counselor-led
methodology, 38 clients (4.7%) were identified as
at risk of depression or anxiety at the public clinic,
and 26 clients (3.7%) at the KP-led clinic. The
client-administered approach was adopted in May,and from May through September 2023, screening
yields increased to 11.7% (p-value < 0.01) in the
public clinic and 11.4% (p-value < 0.01) in the KPled clinic. Across the other 18 clinics that did notparticipate in the innovation, yield did not change
significantly and varied between 0% and 5.8%.
Providers in the clinics using the innovation noted
the self-administered approach allowed clientssufficient time to reflect while completing thequestionnaires and that clients felt more
comfortable. However, providers also noted theself-administered process was more timeconsuming, including the need for time to explain
the form to clients with questions and time fordata entry once forms are completed.
Conclusions: Multiple stigmas faced by PLHIV andKP members, compounded by anxiety or
depression experiences, may make it challenging
for them to share MH challenges during providerfacilitated screening sessions. Client selfadministered screening may remove barriers topromote self-reflection and willingness to sharedifficult truths with others. While tailored, personcentric approaches are critical to enhancing MH
disorder identification among PLHIV and KP PrEP
clients, adequate provider training and timecommitment are essential to ensure a friendly
environment, and to assist clients withquestionnaire completion as needed as part ofclient flow algorithms.

Poster Abstract

198

Usage patterns, experiences,
harms, and sexual agency
among Thai young men who
have sex with men who use
chemsex: Quantitative findings
from the CLYMAX study
Hiransuthikul A1,2, Phongsinghwithaya C1, Siriphan
J3, Chayaananchot T1, Tangmunkongvorakul A4,
Sripitathanasakul T1, Khomshuk P1, Hongchookiat
P1, Nonenoy S1, Boonruang J1, Phanuphak N1
1Institute of HIV Research and Innovation (IHRI), Bangkok,

Thailand, 2Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 3Foundation for AIDS Rights (FAR), Bangkok, Thailand,
4Research Institute for Health Sciences, Chiang Mai University,
Chiang Mai, Thailand

Background: Despite the rise of chemsex among
men who have sex with men (MSM) in Thailand,significant knowledge gaps hinder thedevelopment of tailored services. The
Comprehensive Assessment in a Longitudinal
Study on Young Men who have sex with men
Attracted to ChemseX (CLYMAX) is a mixedmethod cross-sectional descriptive study aimed at
establishing models for comprehensive chemsex
services. We present quantitative findings fromthe pre-implementation phase of the study.
Material and Methods: MSM aged 16-35 years
who use chemsex were enrolled in March 2023.
Data were collected through self-administeredquestionnaires that explore four key chemsexrelated themes: usage patterns, positive/negative
experiences, associated harms, and autonomy indecision-making.
Results: Among 35 participants included in theanalysis (median [IQR] age: 30 [25.9-33.1] years),
the most common reasons for engaging inchemsex were sexual fulfillment (71.6%), influence
from social media encouraging experimentation(54.5%), and partner desires (45.7%). Sixty percent
reported using multiple drugs, with a maximum of
6 substances (14.3%). Poppers (62.9%) andmethamphetamine (51.4%) were the mostfrequently used substances. Smoking (65.7%) andoral ingestion (40.0%) were the most common

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administration methods, with 20% using
intravenous methods. The majority reported using
chemsex less than once a month (80%) and with aregular partner (57.1%). Sexual fulfillment wascited as positive experience by 68.6%. Negative
experiences included anxiety or insecurity (40.0%),changes in physical appearance or personality(31.4%), and having been detained or arrested bypolice officers (8.3%). Condomless sex waspracticed by 31.4%, 17.1% forgot to take PrEP,
8.6% reported experiencing violence, and 5.7%
had shared a needle during or due to chemsex use.
The majority felt that they can make decisions
about chemsex use (82.9%) and that they cannegotiate sexual activities with partners duringchemsex (91.4%).
Conclusions: Models for comprehensive chemsex
services for Thai MSM are required that accountfor their diverse usage patterns, sexual agency,
positive and negative experiences, and harms.

Poster Abstract

199

We Ask the Y (WAY): The
impact of capacity-building in
improving young people-led
initiatives for the HIV response
in Malaysia
Chong N1,2, Azwa I1,2, Yee Tan A1,2, Fauzi H3, Lasar
A, Al-Akraa H4, Raman N1, Mohammad Bashir A1Center of Excellence for Research In AIDS (CERiA), Kuala
Lumpur, Malaysia, 2Faculty of Medicine, Universiti Malaya,
Kuala Lumpur, Malaysia, 3Community Healthcare Clinic, Pink
Triangle Foundation, Kuala Lumpur, Malaysia, 4Refugee
Emergency Fund (REF), Kuala Lumpur, Malaysia

1

Background: Between 2017 and 2022, young key
populations in Malaysia have among the highest
HIV prevalence (15.5%) in the Asia-Pacific region(UNAIDS, 2022). Only 10% of individuals aged 15 to
24 have comprehensive knowledge of HIV andsexual health, while fewer than half of young key
populations were reached by HIV prevention
programs (Malaysia AIDS Monitoring Progress
Report, 2023). We Ask the Y (WAY) trained andchallenged young people, especially young key
populations in Malaysia, aged 18 to 30, using
participatory approaches and implementation
science to develop capacity and tackle root causes
within the HIV cascade.
Description: From July to December 2023, wetrained 30 participants; 53% (n=16) identified as
men who have sex with men, 3% (n=1) as other
LGBTQIA+ members, 20% (n=6) cisgender
heterosexual individuals, 13% (n=4) as refugees or
undocumented migrants, and 10% (n=3) who
preferred not to disclose. The training, whichlasted for 3 days, covered HIV epidemiology andprevention, sexual and reproductive health, sexual
orientation, gender identity, gender expression,
sex characteristics (SOGIESC), stigma, tackling
health inequities, and the Theory of Change.
Toward the end of the training, participants
pitched their HIV-related innovations in groups,
competing for a USD1500 seed grant. Participantsinterested in local community-based organization
projects were matched accordingly. HIV screening,
linkage to care, and PrEP were offered throughout
the training. We evaluated acceptability,
appropriateness, and feasibility.

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Lessons learned: Baseline HIV-related knowledge
increased from 77.8% to 84.4%. We improved the
proportion of individuals who know their HIV
status by 17.6% (n=6), all of which were negative.
23.3% (n=7) of participants were enrolled in an allexpense-paid PrEP service, including follow-up
appointments. The seed grant recipient completed
their project and reported on project
performance. 53.3% (n=16) showed interest in
local community-based organization projects; weachieved a 100% match rate. Mean acceptability,
appropriateness, and feasibility scores exceeded
4.0 out of 5.0.
We encountered several challenges in theexecution of the WAY training and the subsequentmonitoring and evaluation of the seed grantrecipients' project. Firstly, ensuring diversity andinclusion of young key populations during
recruitment was challenging. Despite reaching thetarget number of participants and collaboratingwith community-based organizations forrecruitment support, groups such as youngtransgender women, young female sex workers,
and young individuals who inject drugs were
underrepresented. Secondly, post-training
feedback highlighted that sociodemographic
factors such as educational level, proficiency inEnglish, previous training experience, and thebrevity of the training sessions acted as barriers toeffective teaching and learning. Lastly,
unanticipated conflicting commitments among theseed grant recipients led to delays in thecompletion of the proposed initiatives.
Conclusion/next steps: Capacity-building trainingof young people in Malaysia, particularly young
key populations, can be harnessed to scale up
tailored interventions that enhance the HIV
response. We identified several areas of
improvement: (1) Tailoring capacity-building
initiatives to specific key populations, (2)Leveraging teaching approaches that meet theneeds of individuals, i.e., providing translation
services and personalized teaching, and (3) longer
training duration.

Poster Abstract

200

Unitour Campaign: How
public-private sector
engagement enhanced youth
access and uptake of HIV andsexual and reproductive health(SRH) services in Vietnam.
Tran T1, Green K1, Phan T1, Tran T2, Thanh L2, Thoa
C3, Tran L4, Ngo T5, Nguyen D5, Doan A5
1PATH, Hanoi, Viet Nam, 2Glink Clinic, Ho Chi Minh City, Viet

Nam, 3Vietnam Administration of HIV/AIDS (VAAC), Hanoi, Viet
Nam, 4Durex , Ho Chi Minh City, Viet Nam, 5United States
Agency for International Development (USAID), Hanoi, Viet
Nam

Background: HIV transmission through sexualintercourse has increased among youth inVietnam, from 65% in 2013 to 82.2% in 2022
(Vietnam Administration of HIV/AIDS Control[VAAC]), exacerbated by low access to accurate
information and youth friendly SRH services. To
increase awareness and uptake of HIV and sexuallytransmitted infections (STIs) services among youth,
USAID/PATH STEPS partnered with the VAAC,
Durex, Glink Academy, and Glink Clinic toimplement the Unitour campaign.
Description: Unitour was implemented in twophases: 1) “Break the Shame, Come Together”(August 2022-July 2023) focused on reducing
stigma around SRH and promoting health-seeking2) “First time to break” (launched August 2023) toencourage youth to use safe sex practices fromtheir first sexual encounter and facilitate access to
SRH and HIV services. The second phase comprised
50 offline events at academic institutions across 03
provinces, an expansion from 18 events held in thefirst phase. Offline events were complemented byan online component, with a campaign website
and youth influencers promoting content acrosssocial and mass media channels (e.g., YouTube,
TikTok, Facebook, e-newspapers). Campaign
materials directed individuals towards an online
registration platform for free STI testing at Glink
Clinic.
Lessons learned: Unitour reached more than
30,000 students through 68 offline events from
November 2022-January 2023, resulting in 1,257

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225

people registering for STI testing at Glink Clinic and1,017 people tested for STIs. 154 (15%) received apositive result and were referred for follow-up
care. 280 HIV self-tests were distributed at
campaign events and 344 individuals booked
appointments for pre-exposure prophylaxis (PrEP)
counseling and eligibility screening. Robust,ongoing engagement with youth
champions/influencers to co-design andimplement Unitour was critical to highengagement, with 12.9 million campaign
followers, and the campaign going viral, garnering
15.6 million views. The campaign offered youth aspace for self-discovery, enabling them torecognize their emotions and sexual orientation,
which contributed to greater comfort with
SRH/HIV health-seeking behaviors to protect
themselves and their partners.
Conclusions/Next steps: Unitour campaign
represented a strong public-private collaborationand community engagement that enhanced
awareness and access to SRH information andincreased uptake of HIV preventative services
among youth in Vietnam.

Poster Abstract

201

Insights and Strategies: The
Evolving Landscape of
HIV/AIDS Cases Pre and Post
the COVID-19 Pandemic in
Hong Kong
Chan A1,2, Lam W2,3,4, Wong T2, Yan E1
1Department of Applied Social Sciences, The Hong Kong

Polytechnic University, Hong Kong, Hong Kong, 2Hong Kong
AIDS Foundation , Hong Kong , Hong Kong , 3Chiron Medical, , ,4Queen Elizabeth Hospital

Background: Understanding the dynamics of
HIV/AIDS cases is crucial for effective public healthmanagement, especially amidst the challenges
posed by the COVID-19 pandemic. Hong Kong, as adensely populated urban center, faces uniqueobstacles in HIV/AIDS prevention and control. This
study analyzes the trends in HIV/AIDS cases inHong Kong over a three-year period, considering
the influence of the COVID-19 pandemic on
disease transmission and diagnosis. By
comprehending these trends comprehensively, we
can devise efficient strategies to combat HIV/AIDS
in the region.
Methods: We systematically collected andanalyzed data on HIV/AIDS cases in Hong Kongfrom 2019 to 2021 (N=8929). Using
epidemiological data provided by relevant healthauthorities, we focused on the annual counts of
new HIV cases and AIDS diagnoses. We employedstatistical methodologies to discern trends andpatterns in disease incidence and prevalence.
Results: Our analysis revealed dynamic
fluctuations in HIV/AIDS cases throughout the
study period. In 2019, Hong Kong reported 110
new HIV cases, which declined by 16.4% to 92
cases in 2020, followed by a 9.8% increase to 101
cases in 2021. AIDS diagnoses showed an erratic
trajectory, starting at 10 cases in 2019, escalatingby 30% to 13 cases in 2020, and regressing to 10
cases in 2021. Cumulative HIV cases consistentlyrose from 7,258 in 2019 to 7,451 in 2021, withannual growth rates ranging from 1.3% to 1.4%.
Similarly, cumulative AIDS cases gradually
increased from 1,455 to 1,478 over the same
period, with annual increments ranging from 0.7%

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226

to 0.9%. These numerical findings underscore thepersistent prevalence and transmission of
HIV/AIDS in Hong Kong, despite concerted efforts
to control the epidemic.
Conclusion: Our findings highlight the enduring
challenge of HIV/AIDS in Hong Kong, exacerbatedby the complexities introduced by the COVID-19
pandemic. Public health initiatives, preventive
strategies, and societal behaviors substantiallyinfluence disease dynamics. Tailored interventions
are imperative to address the evolving landscapeof HIV/AIDS and mitigate its impact on publichealth in Hong Kong. This study provides
invaluable insights for policymakers andhealthcare professionals, facilitating theformulation of effective strategies to combat
HIV/AIDS in the region.

Poster Abstract202

Co-create innovative PrEP
service approaches with thecommunity: Experiences from
PrEP users in China
Yin Z1, Li C2, Dai Y1, Fan C1, Li Q3, Wu S4, Huang H5,
Hazra A6, Lio J6, Liang K4, Li L3, Sherer R6, Tang W1,7,
Tucker J1,7,8
1UNC Project China, Guangzhou, China, 2Tokyo College, theUniversity of Tokyo, Tokyo, Japan, 3Guangzhou Eighth People's
Hospital, Guangzhou, China , 4Zhongnan Hospital of Wuhan
University, Wuhan, China, 5Wuhan Tongxing LGBT Center,
Wuhan, China, 6University of Chicago, Chicago, USA, 7Universityof North Carolina at Chapel Hill, Chapel Hill, USA, 8London
School of Hygiene and Tropical Medicine, London, UK

Background: Co-creation is an iterative,
bidirectional strategy that includes researchers
and relevant to create knowledge, that may help
inform the development of innovative HIV
prevention and sexual health services. This study
describes the workflows on how we leveraged cocreation groups to understand the barriers to PrEP
adherence among Chinese MSM PrEP users andcollaborate with them to develop mobile phonebased adherence enhancement materials.
Methods: Three rounds of co-creation groups
were held between 2021 and 2023 in China todevelop mobile phone-based PrEP adherence
enhancement materials. Six researchers and 19
Chinese adult MSM PrEP users enrolled in the PrEP
demonstration trial (NCT04754139) joined thegroups. For each co-creation session, we adopted
a three-step approach informed by Hawkins andLeask’s framework of co-creation activities, which
includes participants’ consultation, co-production,and evaluation (on the advantages, deficiencies,
and suggestions of the co-creation group).
Results: After extensive discussion on theadherence intervention content themes and visualdesigns during the co-creation sessions, a total of
25 products (19 posters, 3 videos, and 3 text
messages) were generated, iterated, and finalized.
Among those, 17 products were sent to 910 PrEP
users in the demonstration trial via WeChat
messages (a popular Chinese chat app). These
products received average scores of 8.25/10,
7.86/10, and 7.25/10 on relevance to the topic,

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227

feasibility of utilization, and elaboration,
respectively. The most common barriers to PrEP
adherence identified during the co-creation
sessions include concerns about side effects,
perceived PrEP stigma, and difficulties in
integrating PrEP into daily life routines.
Participants underscored the effectiveness of
product generating, localized community
engagement, and self-empowerment during theparticipation while pointing out the need to 1)
thoroughly synchronize the activity aims, include
diverse users to enrich solicited foci during theconsultation; 2) overcome the subjective andobjective barriers that hindered proactivenessbuilding, and balance the engagement andproducing avoiding productivism when coproduction; 3) actual intervention effects andfollow up activities disclose were needed forevaluation.
Conclusion: Co-creation can generate culturally
appropriate PrEP adherence enhancement
materials for Chinese MSM PrEP users,
demonstrating high acceptability and feasibility.
Trials are needed to understand the effectivenessof this approach.

Poster Abstract

203

Analysis of Mpox Knowledge
and Associated Risk Factors
Among Men Who Have Sex
with Men with Different HIV
Infection Status in Jiangsu
Province, China
Li J1,2
1Jiangsu Provincial Center For Disease Prevention And Control,

Nanjing, China, 2Nanjing medical university, Nanjing, China

Background: Mpox, caused by the monkeypox
virus, poses a significant public health threat
globally. Understanding Mpox knowledge and risk
factors among Men Who Have Sex withMen(MSM), especially those with HIV, is crucial for
effective prevention strategies. Jiangsu Province
faces increasing Mpox cases, necessitating tailoredinterventions based on comprehensive data.
Material and Methods: From August 22 toSeptember 5, 2023, the Jiangsu Provincial Center
for Disease Control and Prevention conducted an
online survey on the awareness rate of Mpox
prevention and control knowledge among MSM.
The questionnaire link was mainly promoted by
MSM volunteer groups and HIV-infected caregroups, and QR codes were posted in voluntary
counseling and testing (VCT) clinics across theprovince.Data was analyzed with SPSS 20.0.
Results: A total of 3,695 MSM from Jiangsu
Province were recruited, including 1,554 HIVpositive and 2,154 HIV-negative individuals. The
baseline awareness of Mpox among HIV-positive
MSM was 48.2%, significantly lower than HIVnegative individuals (56.4%). Differences wereobserved in awareness rates for Mpox basic
information(66.0% vs. 73.9%) and also personal
protection-related knowledge (54.2% vs. 57.5%).
Out of 111 individuals reporting Mpox infection or
symptoms (3.0%), no statistical difference wasfound between HIV-positive (3.6%) and negative(2.5%) groups. Among them, 41.4% with typical
Mpox symptoms had not received professional
diagnosis.

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228

In the past six months, 20.2% of HIV-positive and28.5% of negative individuals engaged in sex withmore than two male partners. Proportions forhaving female-sex partners were 6.9% and 11.0%.
And 4.5% had recent international exposure orsexual contact with foreigners.
Regarding Mpox knowledge, 56.9% felt
moderately or very knowledgeable. 89.9%
primarily acquired information through online
platforms, and 59.8% believed Mpox healthknowledge should be promoted through social
network apps. No statistical differences wereobserved between HIV-positive and negative
groups in these findings.
Conclusion: The awareness rate of Mpox
knowledge among HIV-positive MSM in Jiangsu
Province is generally lower than that of negative
individuals, indicating that Mpox prevention andcontrol work should pay special attention to HIVpositive individuals due to their higher infection
risk, and specific measures should be formulated
based on the characteristics of the population toensure precision and effectiveness.
Many self-reported individuals with typicalsymptoms have not sought medical diagnosis,
suggesting that next step work should strengthen
symptom recognition and medical treatment
promotion. It is also necessary to conduct Mpox
epidemic monitoring and early warning tohighlight detection and control.
The Internet and new media are the main channels
for MSM to obtain Mpox knowledge, indicating
the need to strengthen Mpox knowledge
dissemination through online media and increase
public awareness.
More than 20% MSM (including HIV-positive
individuals) reported recent sexual contact withfemale, suggesting the need for Mpox knowledge
dissemination among female population.

Poster Abstract

229

204

promote PrEP to their peers. We used a reflexive
thematic analysis to interpret the data.

Promoting PrEP among
overseas-born and newly
arrived gay, bisexual, andother men who have sex withmen (GBMSM): An Australianperspective

Results: The mean age of participants was 30
years, and the mean length of stay in Australia was
2.5 years. Participants resided in various Australianstates and territories. Participants came fromSoutheast Asia, Central Asia, South Asia, SouthAmerica, North America, the Middle East, andEurope. Many participants believed that a simple
and easy to understand information about PrEP
has the potential to increase PrEP knowledge
among this population. Participants stressed theimportance of using conversational English and for
information to be available in various languages.
Participants said that community members should
be involved in the development of the material toensure the contents are relevant to their culturesand lived experiences. Participants would like to
see specific information about the full cost of PrEP
without Medicare, including medical andpathology fees, the full process of obtaining PrEP,
and the safety of PrEP. Participants suggested
distributing information through various avenues,
including in hostels and bars, tertiary education
institutions, and student accommodation. Website
and social media were seen as an importantchannel to promote PrEP, and for information to
be fun, informative, and delivered by community
members. Participants believed that implementing
various strategies to promote PrEP has thepotential to increase PrEP knowledge and uptake
among this population.

Sudarto B1, Chow E1,2,3, Phillips T1,2, Ong J1,2,4, Ong
J1,2,4
1School of Translational Medicine, Monash University,

Melbourne, Australia, 2Melbourne Sexual Health Centre, Alfred
Health, Melbourne, Australia, 3School of Population and Global
Health, The University of Melbourne, Melbourne, Australia,
4Faculty of Infectious and Tropical Diseases, London School ofHygiene and Tropical Medicine, London, United Kingdom

Background: HIV PrEP (pre-exposure prophylaxis)
has been available in Australia since 2016. In 2018,
PrEP was subsidised by the Australian government
under Medicare, Australia's universal healthinsurance scheme for Australian citizens andpermanent residents. However, many overseasborn gay, bisexual, and other men who have sex
with men (GBMSM) are ineligible for Medicare.
Consequently, they have to pay the full price of
PrEP (approximately US$32 - 100 per month) in
addition to medical appointment and pathology
fees. Additionally, many members of thispopulation were either unaware or have very little
knowledge of PrEP, as well as not accessing it due
to concerns over cost, confusion around navigating
the Australia's healthcare system, unsure of theprocess to obtain PrEP without Medicare, andworries over the long-term side effects of PrEP.
PrEP hesitancy could play a factor in an upward
trend of new HIV cases among this population,
which is in contrast with a declining trend of new
HIV cases among Australian-born GBMSM with
Medicare. In our study, we explored overseas-bornand newly arrived GBMSM's perspectives on ways
to communicate and promote PrEP to thispopulation to increase PrEP literacy and uptake.
Material and Methods: Between February 2021
and September 2021, we conducted in-depth,
semi-structured qualitative interviews with 22
overseas-born and newly arrived (less than 5 years
in Australia) GBMSM with varying PrEP use. We
asked participants for their opinions on ways to

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusion: Involving overseas-born and newly
arrived GBMSM in the development andimplementation of a comprehensive PrEP
campaign is important to ensure that information
is easy to understand and accessible to them. Thishas the potential to increase PrEP literacy andencourage PrEP uptake among this population.

Poster Abstract

205

Community engaged
interventions and advocacy
efforts for hepatitis B/Celimination: a global
systematic review andcrowdsourcing open call
Li Y1, Kpokiri E2, Elasi D2, Conyers H2, Wu D31West China School of Public Health and West China Fourth

Hospital, Sichuan University, Chengdu, Sichuan, China, 2Facultyof Infectious and Tropical Diseases, London School of Hygiene
and Tropical Medicine, London, UK, 3Department of Social
Medicine and Health Education, School of Public Health,Nanjing Medical University, Nanjing, Jiangsu, China

Background: Community engagement is critical forthe elimination of viral hepatitis, especially in lowand middle-income countries (LMICs) where
publicly funded testing and treatment services arelimited. Community-engaged interventions
provide a mechanism for community input,
increase relevance to people living with thedisease, and enhance accountability. However,comprehensive documentation of existing
interventions for policy makers and stakeholders islacking. This study draws on a global systematic
review of community-engaged viral hepatitis
interventions and a worldwide crowdsourcing
initiative, focusing on advocacy efforts in LMICs.
Methods: The global systematic review, conductedin June 2021 and updated in June 2023,
encompassed searches across six databases:
PubMed, Web of Science, Scopus, OvidSP Embase,and Wiley Cochrane Library. Inclusion criteria
comprised reporting on viral hepatitis B/C care
continuum outcomes or preventive vaccination,
employing community-engaged interventions witha comparator group, being in English, and the dataof primary outcome being available. Levels ofcommunity-engaged interventions were coded
into lower- (inform, consult), and higher-level
engagement (involve, collaborate, and empower).
Hepatitis care outcomes across the continuum
included vaccination, testing, linkage to care,treatment and adherence, and sustained virologic
response (SVR). These outcomes were estimatedusing random-effects models for meta-analyses byengagement levels.

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In collaboration with the World Hepatitis Alliance,
a global crowdsourcing open call was organizedfrom 15 January 2021 to 30 April 2021 to solicit
personal stories or advocacy efforts related to viral
hepatitis. Thematic analyses identified key themes
among 28 top-ranked submissions.
Results: The systematic review yielded 12,104
citations, and 24 articles met inclusion criteria (12focused on HBV, 10 on HCV and 2 on HBV&HCV).
Among these, 20 studies were conducted in North
America and Europe, and 18 studies wererandomized controlled trials. Community-engaged
interventions encompassed peer involvement,
community workers, interactive education, andcrowdsourced interventions. Community
engagement interventions demonstrated
significant effects on HBV vaccine completion rates(RR 1.95, 95% CI 1.23-3.09), HBV/HCV testing
uptake (RR 2.83, 95% CI 2.07-3.85), linkage-to-care(RR 1.63, 95% CI 1.19-2.21), and SVR (RR 1.27, 95%
CI 1.05-1.52), compared with the control group.
However, adherence rates remained unaffected(RR 1.10, 95% CI 0.95-1.29).
The global open call received 119 submissions, and85 were relevant to the topic. They were from 27
countries across five continents. Six entries werefrom high-income countries, 64 from middleincome countries, and 15 from low-income
countries. Thematic results underscored thepivotal role of advocacy from people with lived
experiences of hepatitis and civil society
organizations in combating stigma, raisingawareness, and addressing key determinants ofhepatitis service development and delivery.
Conclusion: Community engagement interventions
and advocacy efforts may help improve outcomes
across the viral hepatitis care continuum. Thesemay have implications for African and Asian
contexts most of which were not captured byacademic research. Crowdsourcing is a viableapproach to identify those community-led
initiatives but more resources need to be directedto these LMICs settings.

Poster Abstract

206

Gaymi as a Bridge: Campaign
Evaluation of HIV Self-testing
Secondary Distribution amongYSMSMYin Z1, Cao B2, Yang Z3, Feng T4
1
UNC Project China, Guangzhou, China, 2Shenzhen University,
Shenzhen, China, 3Shenzhen Pingshan Center for Disease
Control and Prevention, Shenzhen, China, 4Shenzhen Center for
Disease Control and Prevention, Shenzhen, China

Background: Gaymi refers to females’ intimate gay
friends. This relationship found the potential forsexual health promotion for gay men bycomprising HIV self-testing secondary distribution.
As innovative strategies are needed to expand HIV
testing coverage among young students men who
have sex with men (YSMSM) in China, this study
aimed to explore the effectiveness of the Gaymi
relationship-leveraged HIV testing promotion for
YSMSM.
Methods: In December 2020, we conducted an
HIV testing promotion campaign at a university in
China. Online outreach and offline activities were
performed by the on-campus community
organization. Female college students who had
YSMSM friends were recruited as the index (whodistribute HIV testing kits). After paying a
returnable deposit, indexes obtained an HIV selftesting package comprising a urine testing kit,educational brochures, and a postcard facilitateddeposit retrieval. Once the HIV self-testing kits
were used by YSMSM (alters, who received HIV
testing kits), alters were instructed to upload
results for their female friends' deposit
reimbursement. Subsequently, both index andalter participants would receive a mixed-method
assessment for the process evaluation and effectevaluation following the distribution of HIV selftesting kits.
Results: A total of 40 HIV self-testing kits wereapplied with 50% utilized by the alters. 60%(12/20)
of YSMSM attempted first-time testing, reporting
high perceived ease of use (4.95/5) and intention
to use (4.90/5) HIV self-testing. The perceived
instructional and emotional support reached 4.85
and 4.625. Qualitative results from in-depth
interviews with 28 participants revealed that the

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Gaymi relationship was acceptable for thesecondary distribution as indexes were sexual
minority friendly. Through in-person inspection,and informing before delivering, indexes actively
eliminated the on-campus stigma to protect theirYSMSM friends. Post-intervention, the knowledge
and willingness for HIV self-testing of alters wereenhanced. Moreover, the Gaymi relationshipbenefitted those testing unaccessible alters fromdistant sites. For alters, receiving care from theGaymi relationship facilitated reducing stigma,
contributing to self-identification. Gaymi's
intervention indirectly made the sexual minorities
visible in China, presenting high sustainability for
future iterations.
Conclusion: The Gaymi relationship played afeasible bridging role in HIV self-testing
distribution, presenting effectiveness in reaching
new testers, improving HIV knowledge and testing
behavior, bringing emotional support, andfacilitating stigma reduction for YSMSM.

Poster Abstract

207

Implementation of virologicalpoint-of-care testing for HIVpositive mothers and exposed
infants to increase testing andtimely clinical action:
Cambodia’s experience
Kim L1, Samreth S2, Vichea O2, Koeun C2, Mom C2,
Narith R3, Chhorn S4, Mohan S1, Pong K1, Rioja M1
1Clinton Health Access Initiative, Phnom Penh, Cambodia,

2National Center for HIV/AIDS, Dermatology and STD, Phnom

Penh, Cambodia, 3National Center for Tuberculosis and Leprosy
Control, Phnom Penh, Cambodia, 4National Maternal and Child
Health Center, Phnom Penh, Cambodia

Background: Cambodia has made substantial
progress in reducing Mother-to-Child Transmission(MTCT) of HIV, with rates dropping from 32% in2007 to 9.9% in 2022. However, centralized testingfor HIV viral load (VL) in mothers and early infant
diagnosis (EID) remained a bottleneck. In
response, Cambodia initiated a pilot program in
2023 to integrate Point-of-Care Testing (PoCT) for
HIV VL and EID using GeneXpert devices, currently
utilized solely for Tuberculosis (TB) diagnosis. This
involved collaboration between three national
programs- the National Centre for HIV/AIDS,
Dermatology and STD, the National Centre for
Tuberculosis and Leprosy Control, and the National
Maternal Child Health Centre. The research
conducted aimed to assess the feasibility andeffectiveness of PoCT in improving service delivery
and patient outcomes within the MTCT program.
Methodology: First, 15 co-located TB andAntiretroviral Therapy (ART) sites excess testing
capacity and with at least 15 annual cases ofpregnant women living with HIV were selected.
This ensured efficient integration of PoCT within
existing healthcare infrastructure and minimized
potential disruption to existing TB services.
Second, the program compared testing volume
and turnaround time (TAT) for both centralized
and PoCT for HIV VL and EID services, aiming toquantify the impact of PoCT on service efficiency
and potential improvements in patient care.
Additionally, the program assessed the impact ofadding HIV testing on the existing TB service
capacity at the selected sites.

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Furthermore, to gain deeper insights into theoperational dynamics and their influence on
patient outcomes, phone interviews wereconducted with key hospital staff involved in thepilot program. This qualitative approach aimed tocapture the perspectives and experiences ofhealthcare workers, providing valuable
information for program optimization.
Results: From February to December 2023, a totalof 52 HIV VL tests, 175 EID tests, and 18,444 TB
tests were conducted across 15 sites. Compared tocentralized testing with TAT of 7 and 14 days for
HIV VL and EID, respectively. PoCT significantly
reduced TAT to an average of 5 hours for HIV VL
and 7 hours for EID. This rapid TAT facilitatedfaster clinical decision-making and enabled swift
initiation of ART for HIV-positive infants within a
day of diagnosis.
Moreover, the pilot maintained sufficient TB
testing capacity at the selected sites despite
adding HIV testing. This demonstrates thefeasibility of integrated testing on GeneXpert
devices.
Findings from the phone survey showed thepositive impact of PoCT. Survey respondents
reported 100% (13/13) satisfaction with PoCT
results and 92.3% (12/13) trusted the accuracy of
results. Healthcare workers’ positive response is
an important pillar for improved service delivery.
Conclusion: The PoCT integration pilot in
Cambodia showcased the feasibility andeffectiveness of integrating PoCT into the PMTCT
program, notably reducing HIV VL and EID testingturnaround times to 5 hours (<1day). This enabledquicker clinical decisions and timely ART initiationfor HIV-positive infants. While at the same time, it
maintained TB testing capacity and received highsatisfaction and trust ratings from survey
respondents. Therefore, national-scale
implementation has been recommended.

E-POSTER ABSTRACTPRESENTATIONS
Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

27 – 29 June 2024
Hong Kong

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E-Poster Abstract

208

Effect of inter-cellµlar HIV-1
Nef transfer on the liverdiseases in HIV-1/HCV Coinfected Patients
Zou S, Zou W
Background: The Human Immunodeficiency Virus
was first discovered nearly 40 years ago andcontinued to threaten human life today. In themeantime, Hepatitis C virus infection was theleading cause of serious liver diseases. Because
HIV and HCV shared the same route oftransmission, the rate of overlapping HIV-1/HCV
infection was approximately 8.3%. HIV had beenreported to use a variety of proteins andmechanisms to react with HCV replication.
However, the mechanisms of HIV-mediatedregulation of hepatitis C virus were not fully
understood. In this study, we found that Nef
proteins derived from R5 virus played an
important role in HIV pathogenesis, interactedwith hepatitis C virus.
Methods: Lymphoma cells were infected HIV virus
derived from R5 and then hepatocytes were cocultured with HIV-infected cells. Flowcytometry、WB、qPCR、luciferase assay wereexerted to investigate the objective of our study.
Results: The HIV-1 Nef protein was transferredfrom nef-expressing lymphoma cells tohepatocytes through the ducts. In addition, Nefaltered the size and number of lipid droplets andupregulated HCV replication in target subgenomic
replicating cells. Nef also significantly increasesd
the production of reactive oxygen species (ROS),
thereby accelerating the development of HCC.
Conclusions:HIV-1 Nefwas a key factor inaccelerating the progression of liver pathogenesis
by enhancing HCV replication.

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E-Poster Abstract

209

High satisfaction with point-ofcare Chlamydia andGonorrhoea testing incommunity-led clinics amongclients and key population lay
providers in Thailand
Thongsuksangcharoen S1, Thammajaruk N1,
Mingkwanrungruang P1, Suriwong S1, Tasomboon
W1, Phunkron A2, Sangpasert T3, Pasansai T4,
Thanmarak N5, Mills S6, Phanuphak N1,
Ramautarsing R1
1Institute of HIV Research and Innovation, Bangkok, Thailand,Service Workers In Group Foundation, Bangkok, Thailand,

2

3Rainbow Sky Association of Thailand, Bangkok, Thailand,

4
Mplus Foundation, Chiang Mai, Thailand, 5Service Workers In
Group Foundation, Chonburi, Thailand, 6FHI 360, Bangkok,
ThailandBackground: Chlamydia trachomatis (CT) and
Neisseria gonorrhoeae (NG) are prevalent sexuallytransmitted infections (STIs) in Thailand,particularly among men who have sex with men
and transgender women. To increase STI testing
access, we implemented point-of-care (POC)
CT/NG testing in community-led clinics as part of astudy. Counseling and testing were delivered bytrained key population lay providers. We assessedsatisfaction with POC CT/NG testing among clientsand laboratory staff.
Methods: The study was conducted between
August 2019-September 2021 across fourcommunity-led clinics in Thailand. Individuals athigh risk of HIV and STIs were invited to complete
a survey assessing Cepheid Xpert CT/NG testingsatisfaction at baseline and subsequently every
three months. Laboratory staff were asked tocomplete surveys at month (M) 1, andsubsequently every 6 months. Responses of“satisfied” or “very satisfied” were grouped as“satisfied,” and “agreed” or “strongly agreed” as“agreed”. Data from follow-up visits werecompared with baseline using a Two-sample testof proportions.
Results: Client participants included 1,696 men
who have sex with men and 194 transgenderwomen, median age was 29 (interquartile range 23

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235

- 34) years. The survey was completed 5,975 times(M0: n=1,890, M3: n=1,297, M6: n=1,128, M9:
n=956, M12: n=704). From baseline to M12
participant satisfaction with waiting times forresults increased (95.64% to 98.01%, p<0.01),
preference for testing at community-led clinics
over hospitals increased (96.08% to 99.57%,
p<0.001), and willingness to pay for testing atthese clinics increased (79.79% to 84.66%, p<0.05).
Among six lay providers surveyed, 83.34% weresatisfied with training at M1, and all were satisfied
with testing procedures and time efficiency. At M1
50% agreed that POC NG/CT testing was suitablefor community-led clinics. This increased to 100%
at M12.
Conclusions: Clients and laboratory staff were
exceedingly satisfied with POC CT/NG testing
delivered in community-led clinics by key
population lay providers. Clients overwhelmingly
preferred community-led clinics as testing
locations, and a majority were willing to pay for
POC CT/NG testing in this setting. Scale-up of thisservice delivery approach across Thailand could
increase access to STI testing and improve healthoutcomes among key populations.

E-Poster Abstract

210

Addressing TB-HIV
management gaps in Nepal:
collaborative strategies andpolicy recommendations
Sah P, KC P, Khatri S
Background: Tuberculosis and Human
Immunodeficiency Virus present intertwined
public health challenges in Nepal, withsignificant morbidity and mortality. This reportanalyses the critical management gaps incoexisting TB and HIV conditions and provides
evidence-based recommendations to enhancecare and treatment outcomes.
Methods: A comprehensive triangulation
approach incorporating desk reviews, stakeholder
consultations, and field interactions for assessing
coexisting TB and HIV conditions management
gaps in Nepal from October, 2023 to December,
2023. Key issues such as diagnostic gaps,
treatment access, and service integration were
scrutinized, alongside public health strategies andinternational best practices.
Results: The report identifies notable gaps,
including insufficient HIV testing among TB clients(24% diagnosed with TB were not tested for HIV),
inadequate provision of Tuberculosis Preventive
Treatment (TPT was supplied only for 300 PLHIV
out of the total PLHIV population in Nepal in thelast two years), and suboptimal coordination
between the National Centre for AIDS and STD
Control (NCASC) and the National Tuberculosis
Control Center (NTCC). The workshop with healthexperts, including the Health Secretary, yielded a
range of recommendations to address resource,
capacity, and systemic challenges.
Conclusions: Implementing the proposed
strategies necessitates prioritizing communicablediseases and improving collaborative efforts
between TB and HIV services. The health system
must enhance testing and treatment coverage,
promote data integration, and supportsocioeconomic interventions. These
recommendations aim to close the identified
management gaps, improve care delivery, andalign Nepal's health policy with the Sustainable

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236

Development Goals' commitment to universal
health coverage and the end of the TB epidemic.

E-Poster Abstract

211

Treatment Outcomes andAssociated Factors among
Tuberculosis-Human
Immunodeficiency Virus Coinfection Patients at Bicol
Medical Center: a
Retrospective Cohort Study
Taday J1, Rañola J1, Pornillos E1
1Bicol Medical Center, Naga City, Philippines

Background: Human Immunodeficiency Virus
infection (HIV) is the single greatest risk factor for
developing active Tuberculosis (TB). Additionally,
TB-HIV co-infection is a major public healthproblem worldwide especially in developing
countries. Monitoring of treatment response is
one of the important cornerstones of disease
treatment.
Objectives: This study aimed to assess theprevalence of TB-HIV co-infection, to determine
treatment outcomes, and to identify the factorsthat influence outcomes among patients who
underwent TB treatment at Bicol Medical Center(BMC), a tertiary hospital in Bicol Region,
Philippines, from year 2018 to 2022.
Methods: The investigators employed aretrospective cohort design. An ethical clearance
was sought from the institution Ethics Review
Board. The study participants included HIVconfirmed and at the same time TB diagnosed
patients who have completed the standard DOTS
(Direct Observed Treatment Short-course)
treatment. Data were collected via medical charts
review and were analyzed using Stata MP version
17 software. Screening of potential factors
affecting treatment were entered into a regression
model using simple logistic regression analysis.
Afterwards, model building was performed bymultiple logistic regression analysis with Firth’s
bias correction and backward elimination
technique to determine the factors associatedtreatment outcome.

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Results: Four hundred three HIV patients wereenrolled in BMC HIV treatment hub from 20182022. Of these, 142 (35.24%) had TB with themedian time of diagnosis at 0 months (almost
same time of establishment of diagnosis). Majority
were around 31 years old (early adults), males(93%), high-school and college graduates (42%),and were employed (69%). Clinically, they were
mostly bacteriologically-confirmed cases (63%),
with low level of CD4 cell count of <200 cells/μL at
the time of TB diagnosis (82%). Sixty three percent
of patients were in the advanced disease stage(HIV stage 4). There were 61% of patients who had
successful TB treatment outcomes. Only two
factors remained statistically associated with poor
TB outcome after the multivariable analysis
statistical analysis. Patients who were unemployed[Crude OR 5.23; Adjusted OR 4.04], who are
bedridden [Crude OR 43.24; Adjusted OR 18.41]
and with HIV stage of stage 4 [Crude OR 30.16;
Adjusted OR 22.35] have higher odds of poor TB
treatment outcome.
Conclusion: The prevalence of TB among HIV
patients at BMC was high, whereas TB treatment
outcome remain low. Poor TB treatment outcome
among these patients is associated with low
functional status, and advanced disease clinicalstage. A wider multi-center study may be done inorder to explore the other additional clinical andsocial factors related to treatment outcomes. This
is to help enforce our current strategies inaddressing this disease double burden.

E-Poster Abstract212

What lies beneath: Multi-drugresistant disseminatedtuberculosis of the bonemarrow, GI and lymph nodes
in a 31-year old PLHIV withsevere aplastic anemia: A CASEREPORT
San Diego M1, Yanes R1, Calapis R1, Edrada E1, dela
Cruz L1, Arevalo A1
San Lazaro Hospital, Metro Manila, Philippines

1

Background: Hematological abnormalities are
frequent in HIV patients, however, there havebeen only anecdotal case reports of SAA in thesetting of HIV infection. To our knowledge, this is
the first case of PLHIV with disseminated MDR
EPTB (bone marrow, GI and LN) and SAA
presenting as pancytopenia in the Philippines.
Clinical Scenario: We present a 31 year old male,
PLHIV since 2017, off ARV and on 4TH month of GI
TB regimen with 3-week history of easy
fatigability, body weakness and episode of loss of
consciousness. Progression of symptoms
associated with shortness of breath, prompted
consult and admission. Noted weak-looking, withpale palpebra and nailbeds, multiple papular
pustular eruption on extremities, nohepatosplenomegaly, tight sphincteric tone, no
blood on tactating finger upon DRE. Workups
showed: pancytopenia and whole abdomen CT
scan consistent with EPTB. BMA with biopsy
showed aplastic anemia, given ciclosporin and folic
acid. Referred to PMDT for possible treatment
failure. Individualized treatment regimen withbedaquiline, levofloxacin, clofazimine andcycloserine started. ARV shifted to TDF + 3TC andnevirapine. Mtb not detected in gene Xpert andculture of BMA. The final histopathology result
showed lymphogranuloma compatible with TB. He
was discharged improved.
Key Words: severe aplastic anemia (SAA), MDR,
EPTB, HIV, AIDS

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Discussion: The most common infectious agentsassociated with HIV-related anemia include M.
tuberculosis. Both tuberculous bacilli and anti-TB
therapy have been implicated in pathogenesis ofanemia and pancytopenia. (Prasad et. al, 2021).
Our case presented with MDR EPTB involving thebone marrow, LN and GI. BMA result compatible
with aplastic anemia, suspicious for TB. Finalhistopathology showed lymphogranuloma
compatible with TB. Diagnostic yield in EPTB has
higher sensitivity >70-80% if obtained from biopsy.
TB of the bone marrow is life-threatening EPTB
and rarely seen in PLHIV with CD4 count below
200/ul.
Conclusion: Disseminated MDR EPTB is rarely
reported, and bone marrow TB is extremely rare.
The isolation of M. tuberculosis from bone marrow
indicates disseminated disease with high mortality
rate and requires prompt initiation of appropriate
treatment. It is recommended that in a settingwith high incidence of HIV, all BMA should beroutinely examined for AFB and sent for TB
culture.

E-Poster Abstract

213

False-Negative Serum
Cryptococcal Antigen Test due
to Post-zone Phenomenon in
an Advanced HIV Patient
Abordo-Dioso A1
Research Institute For Tropical Medicine, Alabang, Muntinlupa
City, Philippines

1

Among Cryptococcal Capsular Polysaccharide
Antigen (CrAg)-based tests, lateral flow assay (LFA)
has the highest sensitivity and specificity for all
CrAg serotypes for detecting cryptococcal
infection. Since 2018, our institution had
unpublished reports of negative serum CrAg LFA
results in microbiologically confirmed cases ofcryptococcal infection. We present a case of
Cryptococcus neoformans meningitis presenting
with a negative serum CrAg-LFA.
A 31-year-old Filipino male with advanced HIV
disease presented with 2-week history ofheadache, fever and meningismus. Initial serum
CrAg LFA is negative and cranial CT scan was
unremarkable. Elevated intracranial pressure wasnoted at lumbar puncture. CSF studies showed
lymphocytic pleocytosis with and normal protein
and glucose. India ink was positive, CSF CrAg LFA
had a titer of 1:12560 and fungal culture isolated
C. neoformans. Blood cultures from 2 sites also
isolated the same fungus. Amphotericin B
deoxycholate and Fluconazole were given basedon the current treatment guideline with resolutionof infection. Dolutegravir-based antiretroviralregimen was started after induction phase of anticryptococcal treatment.
A negative serum CrAg LFA result in a case ofconfirmed disseminated C. neoformans infection
happens due to prozone phenomenon. This
happens when the antigen concentration is highand excess antibodies prevents cross-linking andprecipitation of the antibody-antigen complex
leading to a false negative result. This results todelayed diagnosis, advanced clinical presentationand late initiation of appropriate anti-fungal
treatment.

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239

Our case reflects the diagnostic limitation of
antigen assays despite of high reported sensitivity
and specificity. Patients with advanced HIV disease
presenting with symptomatic CNS infections andnegative antigen assays warrant further
investigation and confirmatory studies.

E-Poster Abstract

214

HIV knowledge and attitudes
of women toward PLHIV in
Iloilo City, Philippines
Cataluna E1, Macalalag A1, Tinguban K3, Yap M4,
Macalalag A2
1Iloilo Doctors' College- Biological Science Department, Iloilo

City, Philippines, 2Iloilo Doctors" College- Basic Education
Department, Iloilo City, Philippines, 3Iloilo Doctors' College College of Midwifery, , , 4Iloilo Doctors' College- College ofMedicine, Iloilo City, Philippines

Background: In the Philippines, people living withHIV face a great amount of perceived stigma dueto their serostatus, seen as a marker of sin andimmorality. National Demographic and Health
Survey found that 7 in 10 Filipino women aged 1549 years old who have heard of HIV holddiscriminatory attitudes towards people living with
HIV. This study emphasized the need to raise
women HIV awareness because stigmatization anddiscrimination of PLHIV often occur due to the lackof knowledge about the issue.
Methods: Four hundred (400) women resided in 7
districts of Iloilo City participated in the study,
Their ages were clustered to ≤ 21 years old (42%),and ≥ 22 years old (58%). Most participants werestudents (43%) at college level (67%). They were
singles (69%) and had family incomes of PHp 5,000
to 10,000 per month (42.3%). A validated
questionnaire consisted of a mix of right andwrong knowledge about HIV and an adapted
Stigmatizing Attitudes towards PLHIV Scale wereadministered to the target participants. In
assessing the attitudes, the two extreme
agreements were taken for discussion. The
association between participants'’ profile andlevel of their knowledge in HIV was determinedusing Chi-square test and Spearman r test forcorrelation between participants'’ level ofknowledge and attitudes. The data were processed
through the use of SPSS version 25 for statisticalanalysis at 95% confidence interval.
Results: More than half of the women (55%) had
high level of knowledge while almost half (45%)
had low knowledge in HIV. Women were strongly
agreed the banning prostitution can control the
spread of HIV& other STDs (39%); screening for
HIV and other STDs is good (47%) and go to clinic

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240

for STDs (56%), However, women were strongly
disagreed that a man can have premarital sex, but
a women should not (42%) and it is better for men
to have sexual experience before marriage (48%).
An association was found between knowledge on
HIV and demographics of the participants such as
employment status (p=.008), family income(p=.001), and level of education (p= .002)
Spearman r test results revealed that womenstrongly suggested to go to clinic for STDs
(p=.000); Screening for HIV and other STDs is good
(p=.000); Towards gender equality as related tosexuality (p=.001); A man can have premarital sex,
but a women should not (p=.000); had significant
correlation with the level of knowledge of thewomen on HIV AIDS .However, the level ofknowledge of the women were negatively
correlated with their attitudes: Patients pay theprice for their immoral life (p=.001); AIDS patientsshould be isolated for the safety of others(p=.014); and it is better for men to have sexual
experience before marriage (p=.001).
Conclusions: Women have high knowledge on HIV.
Their attitudes revealed that they have strong
desired to reduce the transmission of the disease.
They also want gender equality and put to end
discrimination on vulnerable and marginalizedgroup of people in the society. . .

E-Poster Abstract

215

Factors associated withprevalence of cryptococcal
capsular antigen amongpeople living with HIV: aretrospective observational
cohort study.
Da F1, Cao Y1,2, Guo P1, Zhang Y1, He Y1, Li Y1, Li Q1,
Tan W1, Hou H1, Zhao H1, Li L1
1
Infectious Disease Center, Guangzhou Eighth
People's Hospital, Guangzhou Medical University,
Guang Zhou, China, 2Nanhai District People's
Hospital of Foshan, Foshan, China
Objective: Cryptococcosis, caused by
Cryptococcus, is an invasive fungal disease thatposes a significant health risk, particularly topeople living with HIV (PLHIV), who are considered
one of the most vulnerable groups. In 2016, theWorld Health Organization recommended
cryptococcal capsular antigen (CrAg) screening for
AIDS patients with CD4+ T cell count below 100
cells/μl before initiating antiretroviral therapy(ART). This strategy has been implemented
successfully in numerous countries and regions,yielding significant results. However, research
related to this strategy has only recently
commenced in China, and there is limited
reporting on this matter. The primary objective of
this study is to identify the factors associated withthe prevalence of CrAg among PLHIV in southern
China.
Methods: PLHIV were recruited from a designated
HIV/AIDS clinic in southern China during the period
from March 1, 2018, to December 31, 2019. Serum
CrAg was qualitatively detected using colloidal
gold immunochromatography (LFA). Additionally,
fungal culture and pathological examinations of
cerebrospinal fluid (CSF) were performed.
Statistical analyses were conducted using the Chisquared test and Wilcoxon rank‐sum test to assess
factors associated with the prevalence of CrAg.
Results: The study cohort included a total of 1478
PLHIV, among whom 297 (20.1%) were classified
as ART-naive, while 1181 (79.9%) were ARTexperienced. The median of CD4+ T cell count was
43 cells/μl [interquartile range (IQR):13-117]. The
overall CrAg positive rate was determined to be

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241

5.1% (75/1478). Notably, the majority of CrAg
positive patients (71/75, 94.7%) had a baseline
CD4+ T cell count ≤ 200 cells/μl. When stratified by
ART status, the CrAg positive rates were 6.4%
(19/297) among ART-naive patients and 4.7%
(56/1181) among ART-experienced patients. There
was no significant correlation between the CrAg
positive rate and ART status (P=0.245). However,within the ART-experienced group, CrAg-positive
individuals displayed lower baseline and latest
CD4+ T cell counts (P＞0.05). Among the 75 CrAg
positive patients, 63 patients underwent fungal
culture or pathological tests. 51 patients (51/63,
81.0%) were diagnosed with cryptococcosis,
including 34 previously diagnosed patients and 17
newly diagnosed patients (14 untreated patientsand 3 treated patients). Significantly, none of thepatients with newly diagnosed cryptococcosis had
a CD4+ T cell count exceeding 200 cells/μl.
Conclusion: The CrAg positive rate in ART-naïvePLHIV was similar with that in ART-experienced.
Lower CD4+ T cell count was the primary factors
associated with prevalence of CrAg among HLHIV.
Serum CrAg screening should be recommended forboth ART-naive and ART-experienced PLHIV with
CD4+ T cell counts ≤200 cells/μl.
Keywords: PLHIV, ART, prevalence, CrAg

E-Poster Abstract

216

The willingness for HIV testing
among risk women population
and reasons for not getting
testedTinguban K1, Macalalag A2, Cataluna E2, Yap M4,
Leonor E3
1Iloilo Doctors' College - College of Midwifery, Iloilo City,

Philippines, 2Iloilo Doctors' College - Biological Science
Department, Iloilo City, Philippines, 3Amlig Operations, ,Philippines, 4Iloilo Doctors' College - College of Medicine, Iloilo
City, Philippines

Introduction: In the Philippines, HIV testingremains focused among the aforementioned key
populations with limited information about theprevalence of HIV testing among the high risk
women including the pregnant population. The
prevalence of having ever tested for HIV in the
country is very low and is far from the 90% targetof the Philippine Department of Health (DOH) and
UNAIDS, thus, the study addresses this gap inresearch by examining women population
identified at risk and to determine the associationof HIV testing and their reasons of not getting
tested.
Method: Survey questionnaires were given to 658
women aged between 15-49 years old resided in
Iloilo City. The answers of women in some factors
in the questionnaire were indicators that identified
them as risk individuals. A total of 261 women
were found to be at risk. Almost half of women(48%) were young (≤ 23 years old) and more thanhalf (52%) were old (≥ 24 years old). To examine
the association between HIV testing andrespondents’ reasons of not getting tested, Chisquare was used. The level of significance was set
at .05 alpha.
Results: More than half of the respondents werecollege (59%) students (69%), unemployed (31%)
with low monthly family income (48%). 54 (21%)
pregnant women participated in the study. These
were the indicators that identified the
respondents as at risk: 67/204. (33%) wereplanning to get pregnant; 54/253 (21%) have had
unprotected sex; 4/252 (1.5%) have sharedneedles or other injecting equipment; 2/260 (8%)
have recently been diagnosed with another

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242

sexually transmitted infection; 178/260 (68%)
worried about HIV and want to put their mind atease. There were 190 (72%) women willing to betested and 71 (28%) were not willing to be tested
for HIV. The common reasons of these women not
to be tested either willing or not are: they havenever been at risk for infection (61% ); their life
won’t be the same if they find out they are HIV
positive (60% ); they always use protection (57%);
they are afraid that others would know that theyare HIV positive ( 54%); and they fear the lack ofconfidentiality of the health care personnel (48% ).
Only level of education was significantly
associated with their willingness to be tested for
HIV with p=.001. For the reasons: afraid of bloodand needles (p=.001) and prefer not to know if
infected (p=.001) had significant associations withthe willingness of the women to be tested for HIV.
Conclusion: The most common reason of womenfor not getting tested for HIV is -they have neverbeen at risk for infection. .HIV testing is very
important especially to risk population. People
who get tested and learn they don’t have HIV canmake decisions about sex, drug use, and healthcare that can help prevent HIV. Detection of early
HIV infections is important for individual health,prevention of HIV transmission, and measurementof HIV incidence..
Keywords: willingness, HIV testing, risk, women,
population, reason

E-Poster Abstract

217

Disseminated Non-tuberculous
Mycobacterial Infections
among People Living with
Human Immunodeficiency
Virus: A Systematic Review
and Meta-Analysis
Ming-Zher N1, Ong L¹, Loh A¹,
1Faculty Of Medicine, University Of Malaya, Kuala Lumpur,

Malaysia

Disseminated Non-tuberculous Mycobacterial
Infections among People Living with Human
Immunodeficiency: A Systematic Review andMeta-Analysis

243

Results: 16 studies comprised a total cohort of3480 patients diagnosed with disseminated NTM
infection among PLHIV. The prevalence ofdisseminated NTM infection in PLHIV was 4% (95%CI, 1 – 14%). The prevalence of disseminated NTM
infection was higher in the studies conducted in
the pre-HAART era (12%, 95% CI, 0.4 – 84%)
compared to the studies conducted in the postHAART era (2%, 95% CI, 1 – 10%). The prevalenceof disseminated NTM infection in PLHIV withpositive NTM isolation was 29% (95% CI, 9 – 63%).
60% (95% CI, 11 – 95%) of the patients had
concomitant other opportunistic infections 54%(95% CI, 13 – 90%) of patients with disseminatedNTM infection were on HAART. Slow growing
mycobacteria (SGM) were accounted for majorityof the cases with a prevalence of 86% (2393/2797)
and rapid growing mycobacteria (RGM) were only
accounted for 0.4% (10/2420) of the cases. The
most common NTM isolated was Mycobacterium
avium complex (MAC) (84.1%, 95% CI 82.3 –
85.8%), followed by M. avium (62.7 %, 95% CI 30.8
– 86.4%), and M. abscessus (10.0%, 95% CI 1.39 –
46.7%). The overall mortality rate was 33% (95%CI, 20 – 49%).

Introduction: Disseminated nontuberculous mycobacterial(NTM) disease is more commonly observed in individuals
Conclusion: The incidence of disseminated NTM
with advanced human immunodeficiency virus (HIV) or
infection was low among PHLIV. However, theacquired immunodeficiency syndrome (AIDS). However, themortality rate was despite the introduction ofincidence of disseminated NTM infections has
HAART.
declined among people living with HIV (PLHIV)
following the introduction of highly active
antiretroviral therapy (HAART). Despite a decline
in the incidence of disseminated NTM infection
among people living with HIV with HAART andprimary prophylaxis, disseminated NTM infection remains
a severe infection with high mortality
rates and frequent associations with otheropportunistic infections, necessitating prolonged
treatment. This study aims to investigate theprevalence, clinical characteristics, microbiologicalcharacteristics, and outcome of disseminated NTM
infections among PLHIV.
Methods: A systematic literature search was
conducted in PubMed, ScienceDirect and Ovid SPfrom inception up to 31st January 2024 to identify relevant
articles. Prevalence and mortality were expressed as
proportions. Pooled prevalence and mortality were
calculated using the randomeffects generic inverse variance model with a 95%
confidence interval (CI). All the statistical analysis
was conducted in R programming.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract218

Epidemiological investigationon the incidence and mortality
risk of Kaposi's sarcoma
associated with HIV in Japan
Ishikawa K1,2,3,4, Muramatsu T2, Kaneko S2, Harada
Y2, Miyashita R2, Kamikubo Y2, Yamaguchi T2, Ichiki
A2, Chikasawa Y2, Bingo M2, Sekiya R2, Yotsumoto
M2, Hagiwara T1, Amano K2, Kinai E2Tokyo Medical University Ibaraki medical center, Amicho,
Japan, 2Tokyo Medical University, Shinjuku, Japan, 3St Luke's
international hospital, Chuo, Japan, 4Edogawa hospital,
Edogawa, Japan
1

Background: Kaposi's sarcoma is an Acquired
Immunodeficiency Syndrome (AIDS)-defining
illness. Although it frequently occurs in individuals
with HIV, the characteristics and prognosis ofpatients at the onset are not well understood inJapan.
Method: We conducted a retrospective review ofthe medical records of patients diagnosed with
HIV-associated Kaposi's sarcoma at the
Department of Laboratory Medicine, Tokyo
Medical University, from 2000 to 2023, toinvestigate their profiles at diagnosis andsubsequent outcomes.
The diagnoses of Kaposi's sarcoma were confirmedby biopsy. A p-value of < 0.05 was considered
statistically significant, and analyses wereconducted using SPSS 29.0.1(IBM, Chicago, USA).
Results: We identified a total of 70 cases. The
median age was 42 years with an Interquartile
Range (IQR) of 14 years; 100% of the cases weremale. Among them, 34 (48.6%) were smokers and6 (8.6%) had alcohol intake. The median HIV viralload at diagnosis was 150,000 copies/ml with an
IQR of 297,500 copies/ml. The CD4 count was
69.0/μL with an IQR of 175.7/μL (range from 4 to
1,121). The median time from the start of
Antiretroviral Therapy (ART) to the diagnosis of
Kaposi's sarcoma was 24 days, with an IQR of 92.5
days (range from 0 to 7,778 days). However,Kaposi’s sarcoma was diagnosed before thecommencement of ART in 43 (61.4%) patients.
Two cases occurred after long-term initiation of
ART (7,778 and 5,866 days). Visceral lesions were

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found in the gastrointestinal tract (25 cases,
35.7%), oropharynx (10 cases, 14.3%), andbronchial/lung (4 cases, 5.7%). Chemotherapy wasadministered in 40 cases (57.1%), with Doxorubicin
being used in 35 cases (87.5%) for a median of 3
cycles (maximum of 47 cycles). Kaposi sarcoma
inflammatory cytokine syndrome (KICS) accounted
for 5 cases (7.1%). There were 10 deaths (14.3%),
including 2 from pancreatic cancer, progressive
multifocal leukoencephalopathy 2 cases, and 4
from KICS. The median observation period was 8.7
years (IQR, 12.65). Kaplan-Meier survival curves
were drawn based on the presence or absence of
KICS, showing significantly higher mortality inpatients with KICS (p < 0.01). Moreover, even after
adjusting for age, CD4 count, HIV RNA levels,
smoking, alcohol consumption, and systemic
chemotherapy, KICS was significantly associatedwith an increased risk of mortality. The Hazard
Ratio was 26.8 (95% Confidence Interval, 4.5158.6, p < 0.01).
Conclusion: Kaposi's sarcoma can occur regardlessof CD4 count and the duration of ART. If KICS is notpresent, with proper diagnosis and treatment, themortality rate may be low, even for cases withvisceral lesions.

E-Poster Abstract

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219

years, 14 (10.1%) received HPV vaccination, and 6
vaccinated PLWHs developed GWs.

Genital Warts in People Livingwith HIV in Korea: A
Retrospective Descriptive
Study.

Conclusions: The prevalence of GWs in PLWH wascommon among young and MSM PLWHs in Korea.

Lee S1, Lee J1,2, Lee S1,2, Lee S1,2
Pusan National University Hospital, Seo-gu, South Korea,

1

2Pusan National University School of Medicine, Seo-gu, South

Korea

Background: Genital warts (GWs) are one of themost common forms of sexually transmitted
disease and common in People Living with
HIV(PLWH). However, there is scarce informationon the epidemiology of genital warts in PLWH in
Korea.
Methods and Materials: Between January 2023
and December 2023, a cross-sectional survey on
GWs was conducted at the study hospital. Thissurvey was conducted as a part of routine care at
the outpatient HIV care clinic, and an interview
survey was offered to male PLWH. Patients wereasked if they had ever experienced GWs
diagnoses, and if so, when they were diagnosed
with GWs. Where the GWs occurred and how they
were treated. The patient's medical records werealso reviewed to obtain epidemiological andclinical data.
Results: The mean age of 538 enrolled male PLWH
was 52.28 ± 14.72 years, and 99 were < 35 years(18.4%). Among 538 enrolled patients, 97 (18.02%)
had ever experienced Genital warts. The mostcommon sites of GWs were the anus (81/97,
83.5%), following genitalia (17/97, 17.5%), oralcavity (2, 2.1%) and another site (1, 1.0%). Fourpatients (4.1%) had experienced GWs in multiple
sites.
Overall, GWs development was significantly moreprevalent in the men who have sex with men(MSM) than men who have sex with women(MSW); MSW 91.7% vs. MSW 57.5%, P <0.001.
GWs were also more prevalent in the younger age
group (<35 years (younger group 30.3% vs. nonyounger group 15.3%, p=0.001). associated withage (p=0.001) and HPV vaccination status(p=0.026). Among the 138 PLWHs with age ≤ 40

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract

220

Exploring sexual behavior
patterns in women with HIV
and cervical dysplasia: A
descriptive study on early age
at first intercourse andnumber of sexual partners
Pratiwi N1, Somia I1, Astuti N1, Adelaida M1, Sawitri
A1, Dwija I1, Pidari D1, Winarti N1, Gayatri A1,
Budiana I1, Merati K1, Pinatih K1
1Faculty Of Medicine, Udayana University, Denpasar, Indonesia

Background: Women living with HIV have a sixfold
higher risk of developing cervical cancer comparedto those without HIV. The compromised immune
system in women with HIV makes them more
susceptible to HPV transmission, which increases
the risk of cervical dysplasia. Women with HIV, asa vulnerable group, often exhibit sexual behaviors
that can elevate the risk of cervical dysplasia. Early
age at first intercourse and multiple sexual
partners have been identified as significant risk
factors.
Method: This study aims to examine the
distribution of first sexual intercourse and thenumber of sexual partners in women with cervical
dysplasia. The research design employs aquantitative descriptive method.
Results: The accessible population consists ofwomen living with HIV aged 18-50 years, attending
HIV clinics in Bali, regularly from July 2023 to
December 2023, with a sample size of 239
subjects. Sampling will be done consecutively(non-probability technique). Results show that 71
subjects (29.7%) had ≥5 sexual partners in the last
six months, with 6 subjects (8.5%) having cervical
dysplasia. Additionally, 159 subjects (66.5%) had
their first sexual intercourse ≤21 years, and 17
subjects (10.7%) experienced cervical dysplasia.
The research also explored the history of routine
pap smears, finding that 126 subjects consistently
undergo pap smears. The findings show arelatively small percentage of women with HIV
experiencing cervical dysplasia from the groupwith ≥5 sexual partners and those with sexual
debut ≤21 years old. This shows a high awareness

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246

in population regarding reproductive health risks,particularly cervical cancer risk. The study
participants have taken preventive action, as
evidenced by 52.7% routinely undergoing pap
smears.
Conclusion: In conclusion, the findings suggestthat self-awareness and preventive actions among
women with HIV contribute to lowering cervical
dysplasia risk. However, understanding
participant's perceptions and further research arenecessary. Recommendations include enhancing
cervical cancer prevention initiatives, especially for
women with HIV, emphasizing education, HPV
vaccination, and regular examinations. This study
provides a foundation for developing targeted
health policies to improve the well-being of
women with HIV.

E-Poster Abstract

247

221

conditions such as malignancy are consideredfactors causing CD4 lymphopenia.

Erythema Nodosum Leprosumin an HIV patient with Poor
CD4 Cell Recovery: A True CoInfection

In treating HIV patients with Leprosy, no further
dosage adjustments are required for most HAART
when co-administered with once a month highdose rifampicin. Standard dose
Lopinavir/Ritonavir-based ART and Dolutegravirbased ART co-administered with monthly
rifampicin may still achieve virological suppression
in HIV-1-leprosy coinfected patients.

BUENAFE B1, GARCIA J1
Research Institute for Tropical Medicine, Muntinlupa,
Philippines

1

Background: As of 2021, leprosy is still considered
endemic in the Philippines with more than 1000
cases annually. With the increasing number of
PLHIV in the country, HIV-Leprosy co-infection has
also been noted to increase. Most documented
cases involve tuberculous leprosy-associatedimmune reconstitution inflammatory syndrome(IRIS) from treatment-induced immunologicalrecovery. Rarely, lepromatous leprosy is
encountered in the setting of severe
immunodeficiency with poor CD4 cell recovery.
Case Proper: We report a 51-year-old female withrectal adenocarcinoma and advanced HIV diseaseon Lamivudine + Zidovudine + Dolutegravir for
three months, presenting with multiple
erythematous tender papules with central
umbilication on the upper extremities, chest, andface. This was accompanied by bipedal edema,
facial swelling, and eruption of tender violaceous
nodules on the anterior leg. Skin punch biopsy
revealed foamy histiocytes and multinucleatedgiant cells consistent with Hansen’s Disease. She
was treated for Lepromatous Leprosy with
Erythema Nodosum Leprosum and started on a
12-month-MDT regimen with tapering doses ofprednisone. On follow-up, the lesions flattened
and edema and joint pains resolved.
Discussion: Lepra reactions are immunologicallymediated episodes of acute inflammation. In
patients with HIV, reactions are triggered by an
unstable immune system. Most cases of leprosy in
HIV are associated with IRIS after initiation ofhighly active antiretroviral therapy (HAART).
Despite three months of HAART, our patient’s CD4cell count decreased to 36 cells/mm from 68
cells/mm3. This decline is attributed to thepresence of ongoing co-infection between HIV-1
and leprosy. Untreated coinfections and medical

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusion: In HIV-Leprosy co-infection, it appears
that the patient’s cell-mediated immunity, and not
the HIV infection per se, alters the clinicimmunopathological spectrum of leprosy. A rangeof manifestations complicates diagnosis due to thevariability of the body’s immune response. No
treatment modification is required in cases of HIVLeprosy co-infection. However, potential
interactions between anti–Mycobacterium leprae
and anti-HIV medications should be considered.

E-Poster Abstract

222

HIV knowledge of young adults
and HIV testing
Macalalag A3, Macalalag A1, Cataluna E3, Tinguban
K2, Yap M4
1Iloilo Doctors' College- Basic Education Department, Iloilo City,

Philippines, 2Department of Health, Iloilo City, Philippines, 3Iloilo
Doctors' College- Biological Science Department, Iloilo City,
Philippines, 4Iloilo Doctors' College- College of Medicine, Iloilo
City, Philippines

Background: Young Filipinos who are aware of HIV
and AIDS had fallen to its lowest since 1994.
University of the Philippines Population Institute(UPPI) conducted Young Adult Fertility andSexuality which said that only 76 % of 15 to 24
year old have heard of HIV and AIDS in 2021. It
was a 19% point drop from 95 % in 1994. HIV and
AIDS awareness was still 95 % in 2002, but adecrease was seen in 2013, when the share ofyouth who have heard of the virus and the disease
fell to 83 %.The UPPI was concerning since a low
level of awareness and insufficient knowledge of
HIV and AIDS can stall efforts to arrest theincreasing number of infections in the Philippines.
Comprehensive knowledge on HIV is essential tointervene early before risky behaviors are formed.
Getting tested for HIV is also important for
prevention since limited data on the willingness ofthe young adults to be tested and have beentested are reported.
Methods: A total of 263 young adults, ages from15 to 24 years old were the participants of thestudy. They were categorized as to early young
adults (15-19 years old) and late young adults (2024 years old) which comprised approximately 39%
and 61% of the young population respectively.
Majority of them were single college students andfew were pregnant. Several young adults belonged
to low income family. A validated HIV knowledge
questionnaire was administered to gather thedata. Chi square was employed to determine theassociation between the level of knowledge andthe willingness of the young adults to have HIV
tested. The level of significance was set at .05
alpha.

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248

Results: Almost half of young adults (49.0%) had
high knowledge and more than half of them (51%)
had low knowledge in HIV. As to their age group,
more than half of late young adults (56%) andseveral early young adults (38%) had highknowledge in HIV. Furthermore, college (81%)
students (53%) and married (60%) young adults
with family income of Php 80,000 and above (65%)
displayed high level of knowledge in HIV. Half ofthe young adults (51%) were not pregnant hadhigh knowledge in HIV. More than half of young
adults (54.4%) were willing to be tested for HIV
and almost half of them (46%) were not willing.
Using Chi square test, age group of the young
adults had strong significant association (p=.005)
with their willingness to be tested for HIV and asignificant association (p=.000) between the levelof knowledge and the willingness to be tested for
HIV among young adults
Conclusion: Schools are a place for students tolearn comprehensive knowledge on HIV, They arein a unique position to help the students adopt
behaviors that reduce their risk for HIV and topractice skills that promote a healthy lifestyle. Lateyoung adults and have high knowledge is more
likely have strong willingness to be tested for HIV.
Keywords: HIV knowledge, young adult, and HIV
testing

E-Poster Abstract

223

FEATURES OF THE EPIDEMIC
PROCESS OF HIV INFECTION IN
THE CONDITIONS OF
PANDEMIC OF INFECTIOUS
DISEASE COVID-19
TURSUNOV R11Tajik Research Institute of Preventive Medicine, Dushanbe,

Tajikistan

249

In 2020, 1095 cases of HIV were detected, which is
20.5% lower than in 2019 (n=1320), i.e. before thepandemic period. In addition, in 2020, thecoverage of the population with HIV testing was
805,120 people, which is 1.3 times less
(n=1,062,509) in 2019.
At the beginning of April 2023, a total of 17,786
cases of coronavirus infection COVID-19 wereregistered in Tajikistan, of which the proportion of
those who recovered was 97.0% (17,264 cases),
and the number of fatal cases was 0.7% (125cases). The overall incidence rate of COVID-19 in
the country was 139.5 per 100 thousand
population, mainly among people 40-60 years old(43%), which correlates with the incidence rate
among the general population.

Introduction: The problem of the COVID-19/HIV
syndemic is of particular relevance due to theworsening prognosis and burden of the disease.
Objective: To study the characteristics of theepidemic process of the infectious disease COVID19 among people living with HIV infection (PLHIV).

During the COVID-19 coronavirus pandemic, theprevalence of COVID-19 among people infectedwith HIV was 0.31% of the total number of thiscohort of patients, that is, 29 cases among 9459
people living with HIV infection (as of April 2023),
of which one was fatal (3.4%).

Materials and Methods: Data on the incidence of
COVID-19 and HIV infection were retrospectively
analyzed based on materials of the Ministry of
Health and Social Protection of the Population of
the Republic of Tajikistan.

Conclusion: An analysis of the epidemic process
among people living with HIV who have sufferedfrom COVID-19 shows that, despite a slightdecrease in the incidence of HIV infection,
coronavirus infection at this stage did not have asignificant impact on the course of thedevelopment of the HIV epidemic in the country.

Results: A study of the epidemic process of HIV
infection in the current epidemic of the infectious
disease COVID-19 in the Republic of Tajikistan
revealed a slight decrease in the incidence rate. Asof December 31, 2023, the cumulative incidence of
HIV infection in Tajikistan for the entire
observation period (1991-2023) was 16,129 cases,of which 4,433 (27.5%) people died. Currently, thenumber of people living with HIV is 11,696 (72.5%)
people.
Cases of HIV infection are common among men(63.7%). The most susceptible age group is 15-49
years old, predominantly among PLHIV 30-39 years
old.
Among new cases of HIV infection, sexualtransmission (mainly heterosexual contacts)
predominates - 82.0%. Injecting HIV transmission
accounts for 8.0%, which is associated with nonmedical injection drug use. Over the past 10 years,
the level of sexual transmission of HIV has
increased by 25.0%, and the share of injection
routes has decreased by 2.5 times.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

This trend is, in particular, associated with adecrease in the volume of testing for HIV infection
and with restrictive measures introduced due tothe worsening epidemiological situation of COVID19, as well as with asymptomatic and relatively
mild COVID-19 in the country. Therefore, themajority of people living with HIV did not seek
medical help.

E-Poster Abstract

250

224

that these were not the influencing factors of
positive expression of CMV DNA in urine.

Analysis of Prevalence and Risk
Factors with Cytomegalovirus
Infection in People with
Human Immunodeficiency
Virus (HIV)Conclusion: The percentage of CD4+T cell of PWH
is a major risk factor for CMV DNA positive
expression in peripheral blood.

Zou M1, Zhu X1, Wang J1, Wu C1, Cao L1
1Department of Infection, The Third People's Hospital Of

Nantong, Nantong, China

Background: Cytomegalovirus (CMV) infection
may lead to tissue-invasive end-organ damage
including CMV enteritis, retinitis and other severecomorbidities, especially in immunodeficiency
individuals such as people infected with HIV(PWH). However, there were inconsistent reportson the prevalence of CMV infection in PWH. This
study is to identify the prevalence rate and the risk
factors of CMV infection through the examinationof CMV Deoxyribonucleic Acid (DNA) expression in
the peripheral blood and urine of PWH in China.
Methods: In this cross-sectional study on 267
PWH, data on CD4+ T cells, CD8+ T cells, B cells,
natural killer (NK) cells, and HIV Ribonucleic Acid
(RNA) in peripheral blood were all collected, andCMV DNA was examined in both peripheral bloodand urine. The risk factors of CMV infection wereanalyzed.
Results: Of the selected 276 patients, 2.5% (7/276)
had positive CMV DNA expression in peripheral
blood and 9.5% (24/252) had positive CMV DNA
expression in urine. There was no consistency on
CMV DNA expression between urine andperipheral blood (χ2=10.557, P<0.05). Populations
with positive expression of CMV DNA in peripheral
blood had significant lower percentage of CD4+ T
cell, CD4/CD8 ratio and higher HIV RNA levels
compared with CMV DNA negative populations (allP＜0.05). Multivariate analysis revealed that thepercentage of CD4+T cell was a strong risk factor
for positive expression of CMV DNA in peripheral
blood (HR=0.599, 95%CI: 0.397-0.902, P<0.05).
Populations with positive expression of CMV DNA
in urine had lower percentage of CD4+ T cell andCD8+ T cell, CD4/CD8 ratio and higher HIV RNA
levels, which is consistent with the data on
peripheral blood. Multivariate analysis showed

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract

225

Addressing the burden of
Hepatitis C among High-Risk
Groups: Learning from Punjab
ExperienceBadgujar S1
Network of Asian People who use Drugs (NAPUD), Pune, India

1

Introduction: Injection drug use (IDU) is fast
becoming the primary cause of new hepatitis C
virus (HCV) infection in several countries. Punjab, astate in India, has high number of drug users andthe prevalence of chronic hepatitis C (CHC) among
People Who Inject Drugs (PWID) was 8-10% incomparison to 3.6% among general population.
Approach: To address the challenge of increasing
hepatitis C, Government of Punjab launched the
Mukh Mantri (Chief Minister) Punjab Hepatitis-C
Relief Fund (MMPHCRF) in 2016 to provide freetreatment of Hepatitis-C to all the patients in theState. Further, in 2017, recognizing the need toreach out to high-risk individuals, the approach
was changed from passive screening to active
screening. The active screening for HCV wasundertaken among People Living With HIV/AIDS(PLHIV) at Antiretroviral therapy (ART) centres,
PWID at Opioid substitution therapy (OST) sites
and in Prisons, across the state. Four laboratories
were established for viral load testing and sample
transport networks were mapped to screening
centres thus minimizing the sample transportdistance, reducing costs, and optimizing lab
capacities.
Results: In 4 years, more than 200,000 people
were screened and 85,000+ HCV patients were
initiated on treatment. Out of these, 69,000+
patients have completed treatment and 52,000+
were completely cured. Besides that, financial
burden on the State, for tests and medicines was
greatly reduced through large scale procurement
and negotiations with suppliers.
Conclusion: Punjab's comprehensive approach to
Hepatitis C management showcases the feasibilityof large-scale screening and treatment in adecentralized public healthcare setting. Its success

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251

highlights the importance of integrating Hepatitis
C screening and treatment in public healthprogrammes and need to reduce the financial
burden among vulnerable patients.

E-Poster Abstract

226

HIV/TB Co-infection Managedwith Dolutegravir andLamivudine Combined with
Rifampin-based Antituberculosis Therapy
Nie J1, Sun W1, Mu L1, Luo Q1, Wu X1
1People’s Hospital of Chongqing Banan District, Chongqing,

China

Introduction: The interaction between rifampin
and dolutegravir (DTG) has traditionally been
managed by administering DTG twice daily.
However, this approach poses challenges,
including a high pill burden and an increase inadverse drug reactions. Previous research has
demonstrated effective virologic suppression witha single dose of dolutegravir, combined withlamivudine and tenofovir, in anti-tuberculosis
treatments containing rifampin. Current guidelines
advocate for dual therapy regimens as the firstline approach in clinical settings to minimize druginteractions and adverse reactions. This study aims
to preliminarily evaluate the virological outcomesin HIV patients co-infected with tuberculosis,
treated with a rifampin-based anti-tuberculosis
regimen alongside a dual therapy regimen,
specifically the fixed-dose combination of
dolutegravir/lamivudine antiretroviral therapy(ART).
Methods: This investigation was carried out onpatients co-infected with HIV-1 andMycobacterium tuberculosis at a hospital inSouthwest China. Participants were administered
standard anti-tuberculosis treatment (rifampin,
isoniazid, pyrazinamide, and ethambutol for the
initial 2 months, followed by isoniazid and rifampin
for 4 months). The ART regimen comprised
DTG/3TC (50mg/300mg, once daily) taken withmeals. The primary endpoint was the proportionof patients achieving virological suppression (HIV-1
RNA < 50 copies/mL).
Results: From May 1, 2023, to September 1, 2023,
5 participants (2 females, median age 51 years[Interquartile Range (IQR): 33-63]) were enrolled.
The median baseline CD4 cell count was 56
cells/µL (IQR: 145-316), and the median HIV-1 RNA

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was 5.1 log10 copies/mL (IQR: 4.2-5.7). By week
12, 3 out of the 5 patients had achieved virologicalsuppression. The remaining 2 patients experienced
a decrease in viral load by 3.1 log10 copies/mL and3.3 log10 copies/mL, respectively, with a medianincrease in CD4 cell count from baseline of 57
cells/µL (IQR: 37-107). By week 24, all 5 patients
had achieved virological suppression, with a
median increase in CD4 cell count from baseline of
100 cells/µL (IQR: 78-127). Key metabolic markers,
including total cholesterol (TC), low-density
lipoprotein (LDL), blood sugar, and safety
indicators such as alanine aminotransferase (ALT),
aspartate aminotransferase (AST), blood urea
nitrogen (BUN), and creatinine clearance (CrCl),
were monitored, revealing no significant
abnormalities.
Conclusion: HIV/TB co-infected patients receiving
the simplified dual therapy regimen of DTG/3TC, in
conjunction with a rifampin-containing antituberculosis treatment, exhibited stable virologicaland immunological responses at both 12 and 24
weeks, with favorable safety profiles. This regimen
has the potential to significantly alleviate
economic and pill burdens. However, further
validation through extensive real-world studies isessential.

E-Poster Abstract

227

Finding the TB missing case in
the areas of low reported TB
cases in Cambodia
Chry M1, Mom K1, Kheang S4, Heng B3, CHOUB S2,Tuot S2
1Cambodia Anti-tuberculosis Association (cata), Phnom Penh,
Cambodia, 2Khmer HIV/AIDS NGO Alliance (KHANA), Phnom
Penh, Cambodia, 3Cambodian Health Committee (CHC), Phnom
Penh, Cambodia , 4Health and Social Development (HSD), ,Cambodia

Background: Cambodia's estimated TB burden isApproximately 32% of TB cases were estimated to
be undiagnosed and untreated in 2022, with a
WHO estimation of 48,000 and a case notificationof 32,770. The disease's prevalence may rise as thecountry's population matures due to a lack ofquality TB diagnosis tools, health caremanagement, and accessibility of TB service
providers.
Intervention: A mobile active case finding (ACF)
intervention was conducted in 28 remotecommunities in four operational districts.The
trained village health support groups conducted
door-to-door screenings in their community. Close
contact with bacteriologically positive patients, theelderly aged 55 or more, HIV and diabetes patientwere was invited for a screen by CXR; they werethen asked to collect their sputum if they had a
CXR abnormality or TB symptom(s).
Result: Between February and August 2023, there
were 28 communities visited by ACF, resulting in ascreening of 11,682 people by CXR, and 1,754(15%) were tested by XpertMTB/RIF. A total of 506
new all-form TB cases, with 249 bacteriologically
positive, were treated at health facilities on thesame day of the diagnosis. NTP reported that in
2022 (before intervention), there were 133 TB
cases, including 63 that were bacteriologically
positive. In the period of intervention, the numberof all-form TB cases and bacteriologically positive
cases increased by +380% and +395% compared tothe same period in 2022, respectively.
Conclusion: In the case of low-reported TB cases,
they are often unaware of the extent of the TB
intervention. When combined with community
mobilization and the use of new tools, a series of

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roving, one-off ACF days were able to increase TB
diagnosis, treatment initiation, and treatment
outcomes in a key population with high TB
prevalence.

E-Poster Abstract

254

228

after eight weeks when standard drug rifampicin(RIF) was added to this combination.

Isoniazide and ofloxacinloaded PLG nanoparticles: apromising new treatment
option for tuberculosis

Conclusion: The most effective combination of
Isoniazide and ofloxacin is found in PLG
nanoparticles, which show promise forintermittent Tuberculosis therapy.

Singh D1
Department of Pharmaceutical Sciences, SHUATS, Allahabad,
India

1

Isoniazide and ofloxacin-loaded PLG nanoparticles:
a promising new treatment option for tuberculosis
Introduction: The potential for poly-(DL-lactide-coglycolide) (PLG) nanoparticles to improve azide
bioavailability has been shown in the literaure. As
a result, using Isoniazide and ofloxacin
encapsulated in PLG nanoparticles, either alone orin combination with other ATDs, may be a cuttingedge tactic in the fight against TB. We assessed thepharmacokinetic and chemotherapeuticcapabilities of Isoniazide and ofloxacin, either
separately or in combination, against murine
tuberculosis in this investigation. This work also
aimed to design a more effective TB regimen byevaluating the effects of Isoniazide and ofloxacin
encapsulated in poly-(DL-lactide-co-glycolide)(PLG) nanoparticle-encapsulated ECZ against drugsusceptible murine TB.
Material and Method: Oral administration of PLG
nanoparticles to mice was accomplished by theuse of the multiple emulsion and solvent
evaporation process. PLG nanoparticles wereadministered orally once, and the therapeutic drugconcentrations were maintained in plasma for up
to 5 days Isoniazide and ofloxacin, and up to 6
days in the organs (lungs, liver, and spleen). In
contrast, the same organs eliminated free
medicines in a matter of 12 to 24 hours.
Result: The formulation was found to beequipotent to 42 doses (ofloxacin administereddaily) or 84 doses (isoniazide administered twice
daily) of free medicines in mice infected with M.
tuberculosis when eight oral doses were supplied
weekly. Moreover, when compared to theindividual medications, the combination ofofloxacin demonstrated to be greatly effective.
The mice's organs were completely free of germs

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract229

Simplified ART with DTG/3TC
in an experienced HIV-Infected
Patient with 3TC Resistance: A
Case Report
Fang M1, Chen 1, Chi Y1, Feng W2, Hu Z1
Department of Infectious Disease, the Second Hospital of
Nanjing, 1-1 Zhongfu Rd., Nanjing, China, 2Hual'an No 4
People's Hospital, Hual'an, China

255

In January 2020, during a follow-up call, it wasnoted that the patient had discontinued
voriconazole without the consulting doctors.
Despite unsuccessful persuasion, and with abaseline hemoglobin was 91g/L, the ART was
adjusted to Lopinavir/ritonavir (LPV/r) +DTG+3TC.
In May 2020, the patient was hospitalized due toworsing symptoms, considering the possible
association with the discontinue of voriconazole,then voriconazole treatment was restarted, and
the ART was adjusted to AZT+DTG+3TC due to
DDIs between LPV/r and voriconazole.

1

Background: Although dolutegravir/lamivudine(DTG/3TC) is not typically recommended for HIVinfected individuals with a history of treatment
failure and 3TC resistance, the emergence ofopportunistic infections (OIs), drug resistance,
tolerance and financial constrains often limit
clinical antiretroviral therapy (ART) options. Here,
we present a case of an HIV-infected patient withOIs of Nocardia and fungal, along with 3TC
resistance and the patient's poor financial status,
who had to receive the ART of DTG/3TC.
Case Presentation: A 38-year-old man was
admitted to our center on December 5, 2019,
following a year-long history of persistent coughand sputum production, worsening over the last
three months. Diagnosed with HIV in 2016, heinitially declined ART but started Efavirenz (EFV) +Tenofovir (TDF) + 3TC treatment in June 2019 atanother clinical center, with an undisclosed viralload. Following a serious clinical testing, thepatient was diagnosed with pulmonary Nocardiosis
and sinus aspergillosis infections, in addition to
HIV infection, and received tailored treatment for
Nocardia and antifungal therapy, including
voriconazole. His plasma HIV viral load reached
97,400 copies/mL and CD4 counts were 2 cells/μL,
indicating treatment failure during the previous 6months of ART. Then HIV drug resistance testing
results revealed nucleoside reverse transcriptase
inhibitor (NRTI) mutation of K65R and Y115F withmoderate resistance to 3TC, Emtricitabine (FTC)and high resistance to TDF and Abacavir (ABC),
non-nucleoside reverse transcriptase inhibitors(NNRTI) mutation of K103N and Y106M resulting inhigh resistance to EFV, Nevirapine (NVP) andmoderate resistance to Doravirine (DOR), no
protease inhibitor (PI) related mutation.
Considering these results and DDIs, ART was
switched to DTG+AZT+3TC.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

In late August 2020, the patient's viral loaddecreased to 47 copies/mL, CD4 count rose to 116
cells/ul, but hemoglobin was 70 g/L. Considering
the high possibility of anaemia caused by AZT, theART was switched to DTG/3TC after extensive
discussion with the patient and the dosage of antiNocardia drugs was reduced. Subsequently, thehemoglobin level was gradually increased. In late
September, the HIV-1 viral load was lower than 20
copies/mL, and the patient continued to use
DTG/3TC. The viral load remained below 20
copies/mL by October 2023, with CD4 countincreasing to 457 cells/ul.
Conclusion:
In this case of a treatment-experienced HIV
patient with treatment failure history, drug
resistance, DDIs, and poor economic status, thesimplified treatment regimen of DTG/3TC waschosen, resulting in favorable long-term clinicaloutcomes.
Keywords: Resistance; Simplified ART; HIV;

E-Poster Abstract

230

Detection of KatG Ser315Thr
substitution in Mycobacterium
tuberculosis infected patientsusing PCR -RFLP method forscreening Isoniazid-ResistanceJadhav S1
1SUVIHAAN BIONOBEL SOLUTIONS, DHARWAD, India,
2MapMygenome , Hyderabad, India

Co-infection of HIV with Mycobacterium
tuberculosis is a common event, particularly indeveloping countries. The emergence and spreadof multidrug resistant tuberculosis (MDR-TB) is anincreasing public problem in India. The drugresistant M. tuberculosis strains are posing asignificant challenge to TB control. As perincreasing incidence of TB patients in developing
countries and the emergence of MDR-TB, DNA
sequencing is a very simple, cost-effective, andrapid method for the diagnosis before clinicaltreatment for patients. Sequencing along with
Spoligotyping improves the identification of M.
tuberculosis (MTB) isolates. The conventional
methods like sputum microscopy and chest X-ray
for detection and diagnosis for antibiotic
sensitivity are time consuming as compared tomolecular methods
The study used PCR to characterize mutations
inside the rifampicin resistance-determining region(RRDR) of the rpoB gene in the rifampicin-resistant
M. tuberculosis co-infected with HIV. All therifampicin-resistant strains had missense
mutations. Sequence analysis detected a single ormultiple hotspot mutations in the RRDR region of
the rpoB gene at codons 516, 512 and 531, in moststrains. Furthermore, mutations also occur atcodons 512, 514, 517 and 526. The results suggestthat hotspot mutations in the rpoB gene are not
the sole contributors to MDR-TB co-infected withHIV.
Sequencing of the PCR purified samples was
performed by capillary electrophoresis. The results
were screened for mutations in the rpoB gene withreference to M. tuberculosis H37Rv strain
sequence. In drug resistance pattern, there is anamino acid substitution or amino acid change at

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256

the codon position 531 in 81 bp hotspot region of
RRDR in the rpoB gene. It is known that the mostcommon mutation in the rpoB gene is at codon
531 with serine to leucine substitution (TCG to
TTG)
The results from this study suggest that mutationsin the rpoB gene hotspot may not be the only
factors associated with rifampicin resistance in TB
co-infected with HIV. Mutations at other sites may
also contribute to drug resistance. Therefore,
GenexPert focusing on targeted hotspot regions
may miss out mutations at other sites. Further
studies about these novel mutations in addition to
those in the hotspot region in the TB-HIV coinfected population would add more diagnostic
markers for the reliable prediction of drug
resistance. This will provide insight into developing
novel diagnostic tools for the detection of M.
tuberculosis co-infected with HIV in a high TB-HIV
endemic area like India.

E-Poster Abstract

231

Effectiveness and safety studyof DTG + 3TC duo simplified
regimen in HIV / AIDS
complicated with tuberculosis
infection
He J1, Long H1, He X1, Xie X1, Fu Y1, Luo X1, Peng Y1,
Xu B1
Infection Department, Guiyang Public Health Treatment
Center, Guiyang, China

1

Effectiveness and safety study of DTG + 3TC duo
simplified regimen in HIV / AIDS complicated withtuberculosis infection
Jinhong He, Hai Long, Xiangxi He, Xiaoxin xie,
Yanhua Fu, Xingxing Luo, Yinshuang Peng, Bin Xu(Infection Department, Guiyang Public Health
Treatment Center, Guiyang, Guizhou 550001)
Objective: To observe the efficacy and safety of
dolutegravir(DTG) + lamivudine (3TC) in HIV withtuberculosis infection.
Methods: From January 1,2020 to March 1,2023,
a retrospective single-center observation study
was conducted to analyze the HIV viral
suppression rate, immunological and biochemical
indicators, and the curative effect of tuberculosis
infection at 24 weeks and 48 weeks of treatment.
Results: A total of 42 patients were enrolled. The
HIV viral suppression rates at 24 weeks and 48
weeks were 73.8% and 95.2% respectively. And
the rates of those HIVRNA≥500,000cp/ml and HIV
RNA<500,000cp/ml were 28.5% & 82.9%
respectively at week 24, and 100% & 94.3%
respectively at week 48. And the rates of those
CD4+T≥200c/ul and CD4+T<200c/ul were 100.0%& 69.4% respectively at week 24, and 100% &94.4% respectively at week 48. At week 24 and 48,
CD4+T cell counts and CD4+/CD8+ratio were bothsignificantly increased compared to baseline (P<0.05). And HDL levels were significantly higher atweek 24 and 48 than at baseline (P <0.05). Bloodcreatinine levels also increased at week 24 and 48 ,while glomerular filtration rate based on
creatinine decreased from baseline at week 24 and
48 (P <0.001). Fourteen of these patients were

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257

complicated with extrapulmonary TB. The anti-TB
regimen was HREZ in 59.5% (25 / 42) patients,
4.8% (2 / 42) patients HLftEZ, and 35.7% (15 / 42)
patients HREZ + Mfl / Zfl, and 76.2% (32 / 42)
adjusted HLftEZ after initiation of anti- / reverse
retroviral therapy (ART). After 6 months of anti-TB
treatment, 33.3%(14/42) of patients were cured,
38.1%(16/42) of patients were cured after 9months of anti-TB treatment, and 28.6% (12/42) ofpatients were cured after 12 months of anti-TB
treatment.
Conclusion: DTG+3TC dual simplified regimen caneffectively suppress HIV replication, improve theimmune function of the body, and is with goodsafety, it can become one of the clinical optimaltreatment of HIV patients with tuberculosis.
Keywords: HIV; Tuberculosis infection; Dualsimplified regimen

E-Poster Abstract232

Efficacy and Safety of INIbased Regimens in TreatmentNaïve and Experienced HIV-1
Patients: A Real-World
Retrospective Study
Si G1, Long B1, Li L1, He H1, Rong X1
1Sichuan Mianyang 404 Hospital, Mianyang, China

Introduction: The evolution of Antiretroviral
Therapy (ART) has significantly transformed HIV-1
treatment, positioning Integrase Inhibitors (INIs)based regimens as the first-line recommendation.
This study aims to scrutinize the efficacy andsafety of INI-based regimens among treatmentnaïve and experienced HIV-1 patients, shedding
light on usage trends and clinical outcomes from2019 to 2023 in a southwestern Chinese city.
Methods: We conducted a thorough retrospective
analysis of HIV-1 patient records between January
1, 2019, and December 31, 2023. Eligibility criteria
included adults treated with INI-based regimens,
excluding those under 18, with Hepatitis B or C coinfections, treatments shorter than 48 weeks,regimen switches midway, and incomplete followup data. The cohort was divided based on theirregimens into DTG+3TC (D3), BIC/TAF/3TC (BIC),
and EVG/c/TAF/FTC (EVG) groups. We assessedvirological and immunological responses, alongwith safety profiles, comparing outcomes between
treatment-naïve and experienced patients acrossdifferent INI regimens.
Results: From a pool of 2374 patients, 1346 met
the inclusion criteria; 1094 were on NNRTI/PI
regimens, and 252 were on INI-based treatments:
145 on D3, 146 on BIC, and 65 on EVG. The
adoption of INI regimens peaked in 2022 and2023, with a notable preference for BIC, while EVG
usage declined. Comparative analysis throughIntention-to-Treat (ITT) and Per-Protocol (PP)analyses revealed no significant differences invirological suppression rates (VL<50copies/mL)
between D3 and BIC groups in both treatmentnaïve and experienced cohorts at 24 and 48
weeks. However, D3 demonstrated lower
suppression rates compared to EVG at 48 weeks
among treatment-naïve patients (53.45% vs.

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258

80.65%, p=0.012) and experienced patients(66.67% vs. 85.29%, p=0.045) in the ITT analysis,
with no significant differences in the PP analysis.
No statistically significant differences wereobserved in CD4 count changes or CD4/CD8 ratio
improvements across all groups. The safety profile
was comparable among the regimens, with D3
showing advantageous results in triglycerides andglucose levels, suggesting a potentially bettermetabolic profile.
Conclusion: Although INI regimens arerecommended as first-line ART in most guidelines,
their usage in southeast China is limited, with
about 18.7% usage observed in our study. Thesefindings reveal that while D3, BIC, and EVG
regimens provide effective virological control, D3
may offer metabolic benefits, crucial for long-term
management. This study contributes to a nuanced
understanding of INI-based treatments, facilitating
informed decisions in tailoring ART to individual
patient needs and optimizing clinical outcomes indiverse HIV-1 populations.

E-Poster Abstract233

Real-world efficacy, safety andfeasibility of different
initiation modes of
Dolutegravir/Lamivudine in
HIV treatment-naïve patients
Li A1, Zhang H1, Wang X1, Liu A1, Ye J1, Li J1, Wang
B1, Shao Y1, Li Z1,2Center for Infectious Diseases, Beijing Youan Hospital, Capital
Medical University, Beijing, China, 2Chinese Association of STD
and AIDS Prevention and Control, Care and Treatment
Committee, Beijing, China
1

Backgrounds: Dolutegravir/Lamivudine (DTG/3TC)
regimen has been incorporated into internationalguidelines as preferred first-line regimen in humanimmunodeficiency virus (HIV) treatment-naïve
patients. Here we conducted a real-world study toinvestigate the efficacy and safety of DTG/3TC in
HIV treatment-naïve patients. In addition, we also
explored the feasibility of DTG/3TC for rapid
initiation (starting antiretroviral therapy (ART) in 7days after HIV infection confirmed), or starting
ART before reporting viral load (VL) and/or drug
resistance (DR).
Methods: We conducted a single-center,retrospective study in Beijing Youan Hospital,
Capital Medical University, enrolled adultparticipants (≥ 18 years) who were newly
diagnosed with HIV-1 infection and given oral ART
DTG/3TC once daily. ART was modified if baseline
testing reported DR to DTG or 3TC, hepatitis B
virus (HBV) coinfection, as well as serum creatinine
clearance < 30mL/min/1.73m², but participants
would still be remained in the study cohort. The
primary endpoint was the proportion ofparticipants with HIV-1 RNA < 50 copies/mL at 24
week and 48 week (ITT and PP analysis). Secondary
endpoints included immunological results as well
as safety and tolerability data.
Results: 109 eligible participants (from February
2021 to December 2022) were recruited in thisstudy. Most of them were male (99.1%, 108/109),with median age 34 (27, 40) years, median plasma
HIV-1 RNA 4.1 (3.6, 4.7) log₁₀ copies/mL andmedian CD4 counts 367 (250, 507) cells/μL. The
proportion of baseline HIV-1 RNA ≥ 10⁵ copies/mL

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259

and CD4 counts ≤ 200 cells/μL were 17.4% and12.8% respectively. The median ART initiating time(from confirmed HIV-1 diagnosis to treatment) was
9 (4, 17) days. At week 24, 96.3% of all participants(105 of 109; ITT analysis) and 99.1% of participants
with available data (105 of 106; PP analysis)achieved virological suppressed (HIV-1 RNA < 50copies/mL). At week 48, 90.8% of all participants(99 of 109; ITT analysis) and 100% of participants
with available data (99 of 99; PP analysis) achievedvirological suppressed. Subgroup analysis showedthat different initiation modes (VL known but DR
unknown or both VL and DR unknown before ART),
rapid start of ART (ART initiating date ≤ 7 days),high VL at baseline (≥ 10⁵ copies/mL), andadvanced age (≥ 50 years) did not affect virologicalefficacy (all p > 0.05). The immune reconstitution
was satisfactory, with median CD4 counts of 558(417, 709) cells/μL at 24 weeks and 614 (484, 846)cells/μL at 48 weeks, significantly higher thanbaseline (p < 0.001). Overall, during the follow-up
timepoints, we found that there were very smallchanges in liver and kidney function, blood lipids,
as well as random blood glucose levels. No
patients discontinued DTG/3TC due to adverse
drug reactions.
Conclusions: This study proved DTG/3TC an
effective, safe and well-tolerated ART regimen for
HIV-1 treatment-naïve patients. It also provided
evidence for the feasibility of DTG/3TC in rapid
ART initiation, even in the absence of VL and/or DR
reports before ART initiation.
Keywords: DTG/3TC; first-line regimen; rapid
initiation; virologic suppression.

E-Poster Abstract234

Efficacy, Safety, and PatientReported Outcomes After
Reverting from DTG/3TC to
TDF+3TC+EFV Due to Financial
Difficulty
Nie J1, Wei S1, Mu L1, Wu X1, Ti Y1, Yu Y11People’s Hospital of Chongqing Banan District, Chongqing,

China

Introduction: Despite the TDF+3TC+EFV (TLE)
regimen not being a first-line treatment in current
guidelines (EACS 2023, IAS 2023, DHHS 2024), it isextensively used in China because it's provided
free of charge. Although numerous studies havereported switching from other regimens to
DTG/3TC (D3) regimen, financial difficulties
sometimes have forced a few patients to revert tothe cost-free TLE regimen. This real-world study
evaluates the efficacy, safety, and patientreported outcomes of such reversions.
Methods: Between April 2022 and April 2023, we
included patients who had been on TLE for over a
year and switched to D3 for at least six months.
Those who were planning to revert D3 to TLE
underwent comprehensive consultations withphysicians to ensure that financial constraints
were the only reason for the switch. Baseline
assessments included viral load, CD4 counts(cells/µL), routine laboratory tests, and WHOQOLHIV BREF evaluations. At 24 weeks post-reversion,
we reassessed viral load, CD4 counts, laboratory
tests, and WHOQOL-HIV-BREF scores to analyzechanges in efficacy, safety, and patient-reported
outcomes.
Results: 18 eligible participants were included
finally. At baseline, 100% patients achievedvirological suppression, with a median CD4+ cellcount of 260 cells/µL (IQR: 118-330). Afterreverting to TLE, 24-week follow-up data wereobtained for 14 patients, with no cases ofvirological failure and a median CD4+ cell count of
358 cells/µL (IQR: 261-484), showing a statisticallysignificant increase (p=0.002). Safety assessments,
including main metabolic indicators (TC, LDL,
glucose) and liver and kidney function markers(ALT, AST, BUN, CrCl), showed no significant

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260

differences. However, WHOQOL-HIV BREF
evaluations indicated significant deteriorations inseveral dimensions, including quality of life andpsychosocial aspects, after reverting to TLE.
Conclusion: Facing financial difficulties, patientssometimes revert from regimens with higher
resistance barriers back to ones with lower
barriers, despite guideline recommendations. In
this preliminary study, patients reverting from D3
to TLE did not experience new virological failures,and their CD4 counts significantly increased,suggesting efficacy is maintained. No significant
alterations in safety markers were observed,
although patient-reported outcomes markedly
worsened. These findings highlight the need forfurther research into the long-term effects ofeconomically motivated regimen changes.

E-Poster Abstract

235

Addressing Treatment
Interruption among people
living with HIV using asystematic monitoring tool
piloted in Bacoor City,
Philippines
Rabara M1, Bagasao T1, Castañeda B1, Marquez M2
1EpiC-HIV FHI 360, Makati City, Philippines, 2Bacoor Social

Hygiene Clinic, Bacoor City Cavite, Philippines

Background: Treatment interruption amongpeople living with HIV is a challenge in thePhilippines. As of September 2023, 22% of 95,399
total enrolled clients in the country interrupted
treatment due to the lack of a standard tracking
and risk factor assessment system for clients. The
PEPFAR USAID-supported Meeting Targets andMaintaining Epidemic Control (EpiC) Project in thePhilippines developed a Microsoft Excel-based"Client Monitoring Tool (CMT)” that optimizes
data from the national information system forclient follow-up and case management. The tool
was piloted in Bacoor Social Hygiene Clinic (BSHC)in October 2023.
Description / Methods: The CMT has uniquefeatures that automatically compute the date of
the next visit and color-coded the number of days
before it prompts urgent follow-up. From related
literature reviews, common client risks fortreatment interruption were included in the tool,scored, and classified by risk category of eachclient. Varied case management interventions
were recommended to address the risks. Throughdata review, facilities with high rates of treatment
interruption were identified as priority sites for
implementing the CMT. One priority site was
BSHC, where on-site mentoring was done on
navigating the tool and utilized different casemanagement interventions to address factors
contributing to clients’ treatment interruption.
Lessons Learned / Results: Using the CMToptimized case management, providers were able
to schedule clients conveniently to reduce missed
appointments, prioritize clients by risk, and allow
for differentiated service delivery methods like

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261

multi-month dispensing and telemedicine forlower-risk clients. As a result, BSHC reduced
monthly client interruption. In over 70 clientinterruptions in September and 106 in October,
BSHC reported 40 and 12 clients interrupting, inNovember and December 2023 respectively.
Conclusion: Standardized monitoring tools canefficiently track clients’ adherence and address risk
factors that contribute to their treatment
interruption. With proper training, the tool canfacilitate efficient case management to reduce
treatment interruption and help clients achieve
U=U status.

E-Poster Abstract236

Bictegravir/emtricitabine/teno
fovir alafenamide (B/F/TAF) in
treatment-naïve (TN) andtreatment-experienced (TE)people with HIV (PWH): 24month outcomes from the
BICSTaR Asia cohort
Yang C1,2, Lu P3, Lee S4, Kim Y5, Choi J6, Cassidy T7,
Marongiu A7, Lee K8, Chang J8, Hung C9,10
Far Eastern Memorial Hospital, New Taipei City, Taiwan,
National Yang Ming Chiao Tung University, Taipei, Taiwan,
3Kaohsiung Medical University, Kaohsiung, Taiwan, 4Pusan
National University School of Medicine and Pusan National
University Hospital, Busan, Republic of Korea, 5Chungnam
National University Hospital, Daejeon, Republic of Korea,
6Yonsei University Hospital, Seoul, Republic of Korea, 7Gilead
Sciences, Uxbridge, United Kingdom, 8Gilead Sciences, , Taiwan,
9National Taiwan University Hospital Yunlin Branch, Yunlin,
Taiwan, 10National Taiwan University Hospital and National
Taiwan University College of Medicine, Taipei, Taiwan
1
2

Background: BICSTaR, an ongoing, multinational,
observational cohort study, evaluates real-world
effectiveness and safety of B/F/TAF in TN and TE
PWH. We present outcomes from the BICSTaR Asia
cohort at 24 months (24M).
Materials and Methods: Retrospective andprospective data were pooled from PWH enrolled
in the Republic of Korea, Singapore, and Taiwan(data cutoff: September 2023). Outcomes included
virologic effectiveness (HIV-1 RNA <50 copies/mL),
CD4 counts, weight/body mass index (BMI)change, treatment discontinuation, and drugrelated adverse events (DRAEs). In prospective
participants, 36-Item Short Form Health Survey
Physical/Mental Component Summary (PCS/MCS)
scores and HIV Treatment Satisfaction
Questionnaire status (HIVTSQs) score (TEparticipants; ranging from 0–60, with higher scoresindicating greater treatment satisfaction) wereassessed.
Results: Overall, 240 participants (78retrospective, 162 prospective) were included (59Republic of Korea, 12 Singapore, 169 Taiwan).
Among TN (n=51) and TE (n=189) participants,
median age was 31.0 and 42.0 years; 96% and 91%

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262

were male at birth, respectively. At baseline, 0 TN
and 91% of TE participants had HIV-1 RNA <50
copies/mL; median HIV-1 viral loads were 4.5 and1.3 log₁₀ copies/mL, respectively. In TN and TE
participants with data at 24M, baseline medianCD4 count was 307.0 and 583.5 cells/µL, median
bodyweight was 71.0 and 67.7 kg, and median BMI
was 23.8 and 23.7 kg/m², respectively. In
prospective TN and TE participants, medianbaseline PCS/MCS scores were 55.5/41.8 and57.7/49.4, respectively.
At 24M, 93% (40/43) of TN and 96% (157/163) of
TE participants had HIV-1 RNA <50 copies/mL by
missing=excluded analysis; 91% (40/44) and 92%(157/171) had HIV-1 RNA <50 copies/mL bydiscontinuation=failure analysis. Median (Q1, Q3)
CD4 count change was +289.0 (186.0, 404.0)
cells/µL in TN (n=34) and +44.5 (-39.0, 153.0)
cells/µL in TE (n=104) participants. No treatmentemergent resistance was reported.
At 24M, median (Q1, Q3) weight change was +3.0
(0.4, 7.0) kg in TN (n=32) and +1.3 (-0.6, 3.9) kg in
TE (n=140) participants; correspondingly, median(Q1, Q3) BMI change was +0.9 (0.2, 2.2) and +0.5 (0.2, 1.4) kg/m².
By 24M, 2% (1/51) of TN and 5% (9/189) of TE
participants discontinued B/F/TAF; the reported
reasons were participant’s decision (n=6), lack ofefficacy (n=1), and adverse events (n=3 [DRAEs,n=2]). DRAEs occurred in 10% (5/51) of TN and 7%(14/189) of TE participants. Weight gain was themost common DRAE (n=8), leading to B/F/TAF
discontinuation in two TE participants.
At 24M, in TN (n=20) and TE (n=129) participants,
median PCS scores remained stable (median [Q1,Q3] change: +0.6 [-5.5, 8.0], P=0.503, and +0.2 [2.4, 2.7], P=0.597, respectively); median MCS
scores showed a small improvement in TN and astatistically significant improvement in TE
participants (median [Q1, Q3] change: +4.5 [-2.1,
12.4], P=0.054, and +1.2 [-3.1, 6.5], P=0.013,
respectively). At 24M, treatment satisfaction washigh in prospective TE (n=130) participants(median [Q1, Q3] HIVTSQs score: 59.0 [54.0,
60.0]).
Conclusions: B/F/TAF demonstrated high levels ofeffectiveness and safety at 24M, with no reported
treatment-emergent resistance, in an
observational cohort of PWH in Asia treated aspart of routine clinical care.

E-Poster Abstract

237

Factors associated with poor
adherence to antiretroviraltherapy in people with HIV in
TaiwanLai H1,2, Yen Y1,2, Wang C3
1
Taipei City Hospital Yang Ming Branch, Taipei, Taiwan, 2School
Of Medicine, College Of Medicine, National Yang Ming Chiao
Tung University, Taipei, Taiwan, 3Taipei City Hospital Linsen,
Chinese Medicine, and Kunming Branch, Taipei, Taiwan

Background: According to UNAIDS statistics, there
are 39 million people with HIV(PWH) globally in
2022. Antiretroviral therapy (ART) has been used
for decades and dramatically improved life quality
and life expectancy of PWH. However, factors
affecting ART adherence are major concerned bycaregivers because poor adherence could cause
poor viral suppression that contributes totreatment failure. Therefore, we conducted thisstudy to find out factors causing poor adherence
to ART.
Methods: This study recruited PWH patients fromone single HIV clinic in northern Taiwan between
December 2018 and December 2020. All
participants who agreed to join this study would
be interviewed face to face by recording charts
and Medication Adherence Report Scale (MARS-5).
MARS-5 was used to evaluate treatment
adherence and score <23 defined as poor
adherence.
Results: 831 participants were enrolled, and 93
patients were considered poor adherence to ART.
The different characteristics between two groups
were that people with low medication adherence
were younger, lower body mass index, shorter ART
treatment duration, lower education level, lower
income level, more history of gonorrhea acquired,more illicit drugs use within 3 months especiallymethamphetamine and sildenafil, living withfriends, more with chronic disease, lower CD4
counts and detectable viral load.(Table 1)
Univariate analysis was conducted which showed
PWH with poor adherence were associated withhaving chronic disease(OR=1.991, p=0.002),
history of gonorrhea acquired (OR=2.101,
p=0.012), taking illicit drugs within 3months(OR=2.976, p=0.002) which

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methamphetamine (OR=2.78, p=<0.001) andsildenafil(OR=2.976, p=0.002) were significant,living with friends (OR=3.39, p=0.004) anddetectable viral load (OR=5.927, p=<0.001). OlderAge (OR=0.944 P<0.001), longer ART treatment
duration (OR=0.951, P=0.02), higher CD4 counts(200-499 OR=0.299, p=0.034; ≥500 OR=0.174,
p=0.003), higher income level (OR=0.466, p=0.027)
and education level above university (OR=0.589,
p=0.026) were prone to good adherence. (Table 2)
Conclusions: Factors of PWH with poor adherencein this study were younger age, shorter ART
treatment duration, with chronic disease, historyof gonorrhea, living with friends, illicit drugs use
within 3 months especially methamphetamine or
sildenafil using, lower CD4 count and detectableviral loads. Therefore, for patients with thesecharacteristics, we need to pay more attention towhether these patients have poor adherence.

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238

ICAROS - An Australianobservational study of clientsand health workers who use
long-acting cabotegravir andrilpivirine injections for HIV
treatment - preliminary
baseline survey results.
Eu B1,2, Lau H3, Roth N1, Ronney J3, Traeger M4,
Stoové M4,8,9, Burnett C5, Russell D2,6,10, Cordon J7
Prahran Market Clinic, Prahran, Australia, 2University of
Melbourne, Melbourne, Australia, 3Alfred Hospital, Melbourne,
Australia, 4Burnet Institute, Melbourne, Australia, 5Living
Positive Victoria, Melbourne, Australia, 6Cairns Sexual HealthCentre, Cairns, Australia, 7NAPWHA, Sydney, Australia, 8Monash
University, Melbourne, Australia, 9Latrobe University,
Melbourne, Australia, 10James Cook University, Cairns, Australia
1

Background: In Australia, long-acting cabotegravir
and rilpivirine injections (LA-CAB/RPV) wereapproved and funded for use as treatment for HIV
in April 2022. HIV treatment in Australia has aunique model of care as 50% of HIV care isprovided by approved primary care providers, thus
it was important to conduct an observational study
using this treatment in Australia. ICAROS (Injectable Cabotegravir and Rilpivirine Observational Study) will help understand theperceptions and barriers, acceptability andappropriateness of this treatment as well as thequality life of people living with HIV over 12months.
Methods: From June 2023 onwards, ICAROS
recruited client and health worker subjects, whohave used or administered this treatment, tocomplete online surveys. Subjects were recruitedfrom primary care centres, tertiary centres and thecommunity. The surveys were done online using a
QR code or website. Surveys included information
about the perceptions and barriers, acceptability
and appropriateness, and quality of life (for clientsonly).
Results: Surveys from the first 35 client subjects
and 33 health workers were reported. All theclients were male and 69.7% received care from a
primary care centre. 57 % were concerned about
continued viral suppression and 54% were

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concerned about injection site pain. The mostcommon reasons for commencing treatment were- interest in new HIV treatments (51%),
convenience for travelling (49%) and not having adaily reminder of HIV (46%). 100% of clients
finding the time taken for this treatment to be
acceptable. For health workers, the concerns were
- staff resourcing (48%), rescheduling missed
appointment (42%) and treatment failures withresistance (39%)
Conclusions: LA-CAB/RPV treatment for HIV ispreferred by people living with HIV for a variety ofreasons but they and health workers haveconcerns about its use. The findings of this study
so far, confirm the common reasons why thistreatment may be preferred by clients but also hassome additional reasons that have not been
described before. Similarly, the survey results fromthe health workers also show some differencesfrom previous studies. The information from thisstudy can help address any concerns or barriers
and also understand the benefits for the clientsand the experience of clients and health workers
in using this treatment. Further data collection isrecommended and further measures can be used
to help reduce the concerns about this treatment
based on the information from this study. This
study is ongoing.

E-Poster Abstract239

Effect of baseline factors on
the efficacy of DTG/3TC in
ART-naive PLHIV: a multicenter
retrospective observational
study
Xin X1, Yin B1, Cao Y1, Yang Z1, Ding H2, Liu B3, Guan
H4, Liu D5, Chen S6The Sixth People's Hospital Of Shenyang, Shen Yang, China,

1

2State Key Laboratory for Diagnosis and Treatment of Infectious

Diseases, Shen Yang, China, 3Anshan Infectious Disease
Hospital, Anshan, China, 4Jinzhou Infectious Disease Hospital,
Jinzhou , China, 5Fushun Infectious Disease Hospital, Fushun,
China, 6Tieling Infectious Disease Hospital, Tieling, China

Background: Dolutegravir/Lamivudine (DTG/3TC)
is approved to be used in ART-Naive people livingwith HIV (PLHIV) with no known resistance to theindividual components and is not recommended
by guidelines for PLHIV with a baseline viral load >500,000 copies/mL and has not been validated for
rapid initiation of ART. Data on the efficacy of
initiating DTG/3TC when baseline resistancetesting or baseline viral load testing results are notavailable or at different time points after diagnosis
are still lacking.
Material and Methods: We conducted a multicenter retrospective observational study in six
clinical centers in Liaoning Province of China toanalyze the effects of baseline drug resistance(BLDR), baseline viral load (BLVL), and ART
initiation time after diagnosis on the virologicalinhibition (VL< 50 copies/mL) rate of DTG/3TC at
48 weeks in PLHIV who initiated ART between May
1, 2020 and December 30, 2022. We used chisquare test and logistic regression to analyze theimpact of different baseline factors on the efficacy
of initial DTG/3TC treatment.
Results: A total of 211 ART-naïve PLHIV without
HBV were enrolled in this study. Overall, 200(94.7%) males, 175 (82.9%) homosexuals, 43(20.3%) aged ≥ 50 years. Median time fromdiagnosis to ART initiation was 40 days, and 143(67.8%) patients initiated ART without baseline
drug resistance testing and 43 (20.4%) patients
initiated ART without baseline viral load testing.
Baseline viral load ≥ 100,000 and < 500,000
copies/mL in 38(19.8%) patients and ≥ 500,000

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copies/mL in 4 (2.1%) patients. The overall
virological inhibition rate is 91% (192/211). The
virologic suppression rates of DTG/3TC weresimilar [OR(95CI): 1.033(0.375-2.847), P=0.949] inpatients with [Ref; 91.1% (62/68)] and without
BLDR [90.9%(130/143)] and were similar inpatients with BLVL<100,000 copies/mL (Ref;
95.0%(114/120) and with ≥ 100,000 and <500,000 copies/mL [86.3%(38/44); OR(95CI):
3.000(0.913-9.858), P=0.07] and with ≥ 500,000
copies/mL [100%(4/4); OR(95CI): 0, P=0.99] andmay be statistically better in patients without BLVL
testing [87.3%(36/43); OR(95CI): 3.694(1.16611.703), P=0.02]. The rate of virologic suppression
was not statistically different in patients who
initiated ART in 0 day [Ref; 90.0%(18/20)] and 7
days [95.3%(61/64); OR(95CI): 0.443(0.069-2.857),
P=0.392] and 14 days [91.1%(51/56); OR(95CI):
0.882(0.157-4.955), P=0.887] and 30 days
[84.6%(33/39); OR(95CI): 1.636(0.299-8.959),
P=0.57] and >30 days [90.6%(29/32); OR(95CI):
0.931(0.142-6.122), P=0.941] after diagnosis.
Conclusion: As recommended in the guidelines,
we suggest that HCPs should order BLDR testing
and BLVL testing before initiating ART. We did not
find that BLDR had an effect on the efficacy of
DTG/3TC in ART- Naive patients, which may berelated to the incidence of transmitted drug
resistance of DTG/3TC being < 1%. We also foundno effect of BLVL on the efficacy of DTG/3TC in
ART- Naive patients, which is consistent with otherreal-world studies. This study demonstrates that
BLDR, BLVL, and different initiation times do notaffect the efficacy of DTG/3TC, indicating that
DTG/3TC can be one of the optional options for
rapid initiation of ART treatment.

E-Poster Abstract240

DTG/3TC improve early renal
dysfunction caused by TDF in
Chinese PLWH
Li J1, Lu X1, Qi Q1, Zhou M1, Chen X1
1The Ninth People’s Hospital of Dongguan, Dongguan, China

Background: Kidney dysfunction is an important
comorbidity in patients live with HIV(PLWH)，
especially in those used TDF containing regimens,
and it is associated with poor outcomes of thesepatients. However, data on kidney dysfunction in
Chinese PLWH is scarce. In this study, weevaluated the improvement in renal dysfunction
after replacement of DTG/3TC in PLWH with renal
dysfunction due to TDF use.
Methods: A single-center, retrospective cohort
study, The Ninth People's Hospital of Dongguan
recruited 54 cases of PLWH with renal dysfunction
who were using TDF regimen and evaluated theimprovement of related indicators of renal
function after 1 year of stable switching to
DTG/3TC. Renal dysfunction was defined asalbumin to creatinine ( UACR )≥ 30 mg/g.
Results: A total of 54 Chinese PLWH were included
and analyzed in this study. The median TDF usetime was 1400 (IQR, 731, 2369.5) days, and the
median duration of use after stable switch to
DTG/3TC was 428.5 (IQR, 398,497) days, with amale predominance of 79.6%, and a median age of
45 (IQR, 34,51.5) . In terms of baselinecharacteristics, 64.81% of patients with renal
dysfunction defined by UACR ≥ 30 mg/g had eGFR
> 90 ml/min . At 12 months after the switch to
DTG/3TC, UACR improved significantly (p=0.000)
compared to baseline, with a median UACR valueof 69.07 (IQR, 45.29,114.32) at baseline and amedian UACR value of 24.76 (IQR, 10.57,40.06) atmonth 12 . However, eGFR calculated using CKDEPI showed a significant decrease from baseline atmonth 12 (P=0.012) , but no statistically different
decrease from month 6 (P=0.099). This may berelated to the physiologic effect of DTG on serum
creatinine.
Conclusion: UACR is an early indicator for theidentification of renal impairment. This study
confirmed that UACR was significantly improved

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266

after stable switching to DTG/3TC in the PLWH ofrenal dysfunction caused by TDF. In PLWH, UACR
may be more sensitive than eGFR, which may help
to recognize renal dysfunction earlier and facilitate
early intervention.

E-Poster Abstract

267

241

significantly higher in EVG/c/FTC/TAF group(p＜0.05).

Efficacy and Safety of
Switching to DTG/3TC from
INI-Based Three-Drug
Regimens in Treated HIV
Patients

At week 24, 140 patients had available follow-up
data, with virological suppression rates of 90.3%(DTG+TAF-free), 96.8% (BIC/FTC/TAF), and 100%
(EVG/c/FTC/TAF). The increase in CD4 counts andthe changes in creatinine, uric acid, eGFR, glucose,
HDL was not statistically significant across thegroups (p＞0.05). After switching to DTG/3TC, theEVG/c/FTC/TAF group showed a decrease in TG,
TC, and LDL from baseline, while the DTG+TAF-freeand BIC/FTC/TAF groups showed an increase, withsignificant differences between the groups(p＜0.05).

Yuan J1, Liu M1, Zhang W1, Chen Y1
1Chongqing Public Health Medical Center, Chongqing, China

Objective: This study assesses the efficacy andmetabolic changes in HIV patients switching fromINI (Integrase Inhibitor)-based regimens without
TAF (Tenofovir Alafenamide), with TAF, and with
TAF plus a booster to DTG/3TC(Dolutegravir/Lamivudine) in a real-world study.
Methods: The retrospective study was conducted
on HIV-1 patients at Chongqing Public Health
Medical Treatment Center from 2021.1 to 2023.1,
who had been on INI-based regimens for at least 6months before switching to DTG/3TC for over 12months. Excluding individuals with pre-existing
metabolic conditions, participants werecategorized based on the prior regimen’s TAF
content into three groups: DTG+TAF-free group,
BIC/TAF/FTC group, and EVG/c/FTC/TAF group.
The study compared virological, immunological,
and metabolic outcomes, including renal function
and lipid and glucose levels at 24- and 48-weeks
after the switch to DTG/3TC.
Results: A total of 214 patients were included withpre-drug resistance testing revealing 3 cases of
3TC resistance among 74 tested (34.6%). The
INI+TAF-free group included 100 patientspreviously treated with DTG+TDF or AZT or
ABC+3TC. BIC/FTC/TAF group include 56 patientsand EVG/c/FTC/TAF group included 58 patients.
Initial virological suppression (defined as HIV-1
RNA＜50 copies/ml) rates before switch were93%, 85.7%, and 91.4%, respectively. At baseline,
there were no significant differences in uric acid,creatinine, or glucose levels among the groups, but
EVG/c/FTC/TAF group had a significantly lower
eGFR compared to the other two groups(p=0.000). Additionally, levels of triglycerides (TG),
total cholesterol (TC), high-density lipoprotein(HDL), and low-density lipoprotein (LDL) were also

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

At week 48, 95 patients had available follow-up
data. The virological suppression rates were 91.3%(DTG+TAF-free), 100% (BIC/FTC/TAF), and 96.0%(EVG/c/FTC/TAF). 3 patients with pre-drug 3TC
resistance all achieved virological suppression. The
increase in CD4 counts and changes in creatinine,uric acid, eGFR, glucose, HDL, and TG was notstatistically significant across the groups (p＞0.05).
Median changes in TC were 0.57 (IQR: -0.19 to0.91), -0.09 (IQR: -0.47 to 0.71), and -0.25 (IQR: 0.99 to 0.33) mmol/L, and median changes in LDL
were 0.23 (IQR: -0.23 to 0.67), -0.15 (IQR: -0.39 to0.01), and -0.18 (IQR: -0.71 to 0.10) mmol/L for the
DTG+TAF-free, BIC/FTC/TAF, and EVG/c/FTC/TAF
groups, respectively, with significant statisticaldifferences observed (p＜0.05).
Conclusion: Switching from INI-based three-drug
regimens to DTG/3TC maintained good virologicaland immunological outcomes. Compared to
DTG+TAF-free group, BIC/FTC/TAF and
EVG/c/FTC/TAF groups showed notable metabolic
benefits after switching to DTG/3TC. The
preliminary findings highlight the potential
advantages of regimen simplification, emphasizing
the need for further studies.

E-Poster Abstract

242
Abstract 242 has been withdrawn.

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268

E-Poster Abstract243

Efficacy and Safety ofIntegrase Inhibitor (INSTI)based ART Regimens B/F/TAF
and DTG/3TC in TreatmentNaive People with AIDS
Wang J1, Sun J1, Yang J1, Zhang R1, Liu L1, Chen J1,Tang Y1, Qi T1, Song W1, Wang Z1, Shen Y1
Department of Infection and Immunity, Shanghai Public Health
Clinical Center, Shanghai, China

1

Background: According to the report from ChineseCenter for Disease Control and Prevention (CDC),
35.5%-37.5% of people with HIV (PWH) are latepresenters with low CD4 cell counts at the time of
HIV diagnosis and/or have been diagnosed withAcquired immunodeficiency syndrome (AIDS),
which may diminish the benefits of antiretroviraltherapy (ART) .
Both Bictegravir/Emtricitabine/Tenofovir
Alafenamide (B/F/TAF) anddolutegravir/lamivudine (DTG/3TC) are efficacious
and well tolerated in clinical studies, while realworld data on the efficacy and safety of these two
regimens in treatment-naïve patients with AIDS
are still insufficient in China. This study is toinvestigate the clinical efficacy and safety ofintegrase inhibitor (INSTI)-based ART regimen
B/F/TAF and DTG/3TC in treatment-naive AIDS
patients in Shanghai.
Methods: This retrospective study enrolled
treatment-naïve PWH initiating ART with coformulated B/F/TAF or DTG/3TC and on stable ART
regimen for ≥6 months from October 2020 to July
2023. Between-regimen differences in viral
suppression (< 50 copies/mL), immunologicalfactors (including CD4 cell count, CD8 cell countand CD4/CD8 ratio) and changes in metabolic,hepatic and renal functions were examined.
Results: We enrolled 189 patients, including 74.6%
on B/F/TAF and 25.4% on DTG/3TC. Participants
with baseline viral load > 500000 copies/mL were20.5% in B/F/TAF group and 8.3% in DTG/3TC
group (p<0.05). 77.3% (109/141) on B/F/TAF
achieved complete virological suppression with novirological failure (plasma HIV-1 RNA≥ 200

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269

copies/mL) at week 24 after initiation, 85.4%(41/48) on DTG/3TC achieved complete virologicalsuppression with 1 virological failure at week 24
after initiation, no statistical significance wasobserved between groups. 92.2% (130/141) on
B/F/TAF and 85.4% (41/48) on DTG/3TC achieved
more than 30% CD4 cell counts increase, nostatistical significance was observed between
groups (p>0.05). Elevated uric acid levels,
creatinine, total cholesterol and low density
lipoprotein from baseline were observed in bothgroups (p<0.05). The proportion of patients withmild and moderate renal impairment (based on
creatinine clearance) increased significantly inboth B/F/TAF regimen and DTG/3TC regimen(p<0.05).
Conclusion: B/F/TAF and DTG/3TC were both
effective in virological suppression andimmunological recovery in treatment-naive people
with AIDS. Both regimens demonstrated goodsafety profile.

E-Poster Abstract244

Efficacy and Metabolic Safetyof Bictegravir/ Emtricitabine/
Tenofovir
Alafenamide（B/F/TAF）in
Treatment-Naive People
Infected with Human
Immunodeficiency Virus(HIV)：A 48-week
Observational Analysis
Zou M1, Zhu X1, Wen X1, Huang Z1, Cao L1, Wang J1,
Wu C1
1Department of Infection, The Third People's Hospital Of

Nantong, Nantong, China

Background: To investigate the efficacy andmetabolic safety of B/F/TAF in the treatment-naïve
people infected with human immunodeficiency
virus (HIV).
Methods: People infected with HIV (PWH) who
used B/F/TAF as their initial antiretroviral therapy(ART) regimen and continued for more than 24
weeks in the third people's hospital of Nantong
from December 2020 to June 2022 wereretrospectively collected. Differences in plasma
HIV RNA viral load, CD4+ T lymphocyte cell count,metabolic indicators including total cholesterol(TC)、 triglyceride (TG)、 high-density lipoprotein(HDL) and Low-density lipoprotein (LDL) were
examined and compared before and after B/F/TAF
treatment.
Results: 168 PWH were enrolled. CD4+cell countwas 176.52±156.47 cells/μL at baseline,
284.86±196.29 cells/μL and 351.60±202.27
cells/μL at 24 and 48 weeks after B/F/TAF
treatment respectively. Significant differenceswere observed among baseline, 24 weeks and 48
weeks (p<0.05）. 85.71% (144/168) on B/F/TAF at
24 weeks and 97.62% (164/168) at 48 weeks
achieved complete virological suppression.
Subgroup analysis showed that in the population
with baseline CD4+ T cell counts <200 cells/μL, thedifferences in TG, CH, HDL, and LDL at 24 weeks
and 48 weeks after treatment were statistically

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270

significant compared with baseline (p<0.05). The
incidence of dyslipidemia was not high, and there
was no significant difference in blood lipid profile
between 24 weeks and 48 weeks after treatment(p>0.05). In the population with a baseline
CD4+cell counts > 200 cells/μL, only HDL wasstatistically increased at 48 weeks after treatmentcompared with baseline (p<0.05).
Conclusion: B/F/TAF has a good virologicalsuppression and immunological reconstitution intreatment-naïve PWH. Elevated lipid profiles wereobserved within 24 weeks after initiation in PWH
with CD4+ <200 cells/μL and then stabilized. There
was no significant difference in the lipid profiles
with CD4+ > 200 cells/μL population, except for asignificant increase in HDL level at 48 weeks.

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245

Safety and Efficacy ofAlbuvirtide plus
Dolutegravir/Lamivudine
compared withBictegravir/Emtricitabine/Tenofovir Alafenamide as initial
therapy for HIV-1 Infected and
ARV-naïve inpatients, 12-weekresults of a preliminary realworld study
He L1, Wang J1, Men Y1, Jiang J1, Chen X1
The 2ND Affiliated Hospital of Chengdu Medical College ·Nuclear Industry 416 Hospital, Chengdu City, China

1

Objective: The study was to evaluate the antiviralefficacy and safety of Albuvirtide (ABT) whencombined with Dolutegravir/Lamivudine(DTG/3TC) compared toBictegravir/Emtricitabine/Tenofovir Alafenamide(BIC/TAF/FTC) as the initial antiretroviral therapy(ART) for treatment-naïve adults with advanced
HIV-1 infection.
Methods: The retrospective study enrolled
participants with advanced HIV-1 infection who
received ABT plus DTG/3TC or BIC/TAF/FTC as
their initial ART at the 2nd Affiliated Hospital ofChengdu Medical College · Nuclear Industry 416
Hospital, a single center. Baseline assessments,
including viral load (VL), CD4+ T cell count, andlaboratory indicators, were conducted. Follow-up
assessments were performed at week 12. The
primary endpoint was the proportion of patientsachieving virological suppression at week 12.
Results: A total of 94 ART-naïve patients with up
to 12-week hospitalization were enrolled, with 49
receiving ABT+DTG/3TC and 45 receiving
BIC/TAF/FTC (2020.4 to 2022.4). At baseline, 29
patients (30.9%) had opportunistic infections (OI),
and 34 (36.2%) had non-AIDS defined chronic
diseases. At week 12, virological success (defined
as HIV-1 RNA < 29 copies/mL) was achieved by 39
out of 49 participants (79.59%) in the
ABT+DTG/3TC group and 31 out of 45 participants

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271

(68.89%) in the BIC/TAF/FTC group (p=0.248). The
increase in CD4+ T cell count was significantly
higher in the BIC/TAF/FTC group (141.73±72.77
cells) compared to the ABT+DTG/3TC group(102.88±48.81 cells) (p=0.003). Both groups
showed a significant increase in the proportion ofpatients with CD4+ T cell counts ≥200 cells/µL.
ABT+DTG/3TC treatment also resulted in asignificant rise in serum creatinine (SCr). No serve
ARV-related adverse events were observed.
Conclusions: This real-world study suggests that
the ABT plus DTG/3TC regimen has similar
virological efficacy to BIC/TAF/FTC as an initial
therapy in hospitalized patients with HIV-1
infection, with fewer potential drug-druginteractions (DDIs). Considering the limitations ofsample size and follow-up duration, further studies
are needed.

E-Poster Abstract

272

246

interactions (33.9%) , dyslipidemia (23.1%) andrenal impairment (23.1%).

Real-world implementation of
dolutegravir plus lamivudine
for rapid initiation-ART ofpeople living with HIV

The proportion of treatment-naïve PLHIV with a VL
<50 copies/mL at 48 weeks was 92.3% (60/65).
One patient achieved virological inhibition at 8
weeks and then HIV VL had increased to 220
copies/mL at 48 weeks. One patient achievedvirological inhibition at 12 weeks and then HIV VL
had increased to 74.9 copies/mL at 48 weeks.
Three patients had a VL >50 copies/mL at 48
weeks due to discontinuing DTG+3TC during thefollow-up. The CD4 count increased significantly by
132 cells/μL (P < 0.001) in the ART-naïve patients,
and the CD4+/CD8+ ratio increased by 0.36 (P<0.001). Serum creatinine (Scr), high-density
lipoprotein cholesterol (HDL-C) increased
significantly (P < 0.001, P < 0.001, respectively),
and the alanine aminotransferase,
aspartate aminotransferase and chronic kidneydisease epidemiology collaboration-based serum
creatinine (CKD-EPI Scr) decreased significantly (P= 0.003, P < 0.001, P < 0.001, respectively ). There
were no significant changes in body weight, bodymass index, total cholesterol, low-density
lipoprotein cholesterol (LDL-C), and triglyceride(TG) from baseline to week 48 (P >0.05).The
estimated rates of drug-related adverse events inthe patients were 13.8%. No adverse effects led tothe discontinuation of DTG+3TC at week 48.

Xie X1, Long H1, Yang X1, Fu Y1, Gan L1, Song C1,
Song Y1
1Guiyang Public Health Clinical Center, Guiyang, China

Real-world implementation of dolutegravir plus
lamivudine for rapid initiation-ART of people livingwith HIV
Background: Dolutegravir/Lamivudine (DTG/3TC)
is indicated for treatment-naïve and treatmentexperienced people living with HIV (PLWH). Longterm outcome data from real-world studies on theimplementation of a two-drug dolutegravir plus
lamivudine (DTG+3TC) regimen for the rapid
antiretroviral therapy of human immunodeficiency
virus (HIV) infection remain limited. This study
evaluated the real-world effectiveness and safetyof DTG+3TC in rapid antiretroviral therapy
initiation (defined as initiating antiviral treatment
within 7 days) patients in Southwestern China.
Method: This was an observational, single-center,retrospective study that enrolled antiretroviraltherapy (ART)-naïve (n = 65) patients with HIV who
initiate antiviral treatment within 7 days between
May 2020 and December 2022. Data on therapy
and virological response were documented.
Treatment success was determined as the
proportion of patients with suppressed viral load
(VL) <50 copies/mL. The primary endpoint was a
VL <50 copies/mL at week 48.
Results: The group was predominantly male
(67.7%), with a age of 57.12±1.82 years, with 31(47.7%) patients aged ≥60 years. In this group, six
patients (9.23%) had a baseline HIV VL >500,000
copies/mL, and 28 patients (43.1%) had a baseline
CD4 count of <200 cells/μL. The prevalence of
cardiovascular disease and AIDS-related
opportunistic infections was 21.5% and 23.1%,
respectively. The main reasons for choosing
DTG+3TC included a low potential for drug-drug

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusion: The results of this study suggest that
DTG+3TC is a safe option to achieve and maintainvirological suppression in rapid antiretroviraltherapy initiation patients. This study also
demonstrated a low prevalence of drug-relatedside effects.
Keywords: dolutegravir plus lamivudine, HIV
infection, rapid initiation-ART, antiretroviraltherapyE-Poster Abstract247

Effectiveness and safety of
Dolutegravir + Lamivudine forlate detection of people
infected with HIV
Yang X1, Long H1, Xie X1, Fu Y1, Gan L1, Song C1,
Song Y1
1Guiyang Public Health Clinical Center, Guiyang, China

Effectiveness and safety of Dolutegravir +Lamivudine for late detection of people infectedwith HIV
Xiaoyan Yang, Hai Long, Xiaoxin Xie, Yanhua Fu, Lin
Gan, Chunli Song, Yebing Song
Guiyang Public Health Clinical Center, Guiyang
550001, China
Background: The efficacy and safety of
dolutegravir+lamivudine (DTG +3TC) have been
demonstrated in clinical trials of treatment-naïve
therapy. However, real-life data are lacking. We
investigated the virological outcomes and safety of
DTG + 3TC for late detection of people living withHIV (PLWH).
Research Design and Methods: We performed a
retrospective cohort analysis of PLWH who werelate identification of human immunodeficiency
virus (HIV) and initiated the antiretroviral regimenof DTG + 3TC from February 2019 to January 2023.
Treatment effectiveness, defined as the capabilityof treatment to achieve viral suppression (viralload < 50 copies/mL), was analyzed. Changes in
immunology, metabolism, liver and renal function
after 48 weeks of treatment were evaluated. Latedetection of people living with HIV defines as: 1)
Surviving HIV infected persons and acquired
immune deficiency syndrome (AIDS) patients with
CD4+T count <200 cells/μL; 2) Surviving AIDS
patients with CD4+T count ranges from 200 to 499
cells/μL.
Results: A total of 111 participants were included.
Most participants were men (77.5%), and the
median age at baseline was 65.0 (IQR: 68.0, 72.0)
years. The viral load was higher than 500,000
copies/mL in 18.9% (21/111) of participants, themedian CD4+T cell count was 123.0 (IQR: 52.5,

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273

168.0) cells/μL, and 44.1% of cases werecomplicated by opportunistic infections. The
prevalence of cardiovascular disease was 53.2%.
At week 48, the proportions of participants with
HIV-1 RNA ＜50 copies/mL were 87.4% (97/111)
for DTG + 3TC. The main reasons for choosing
DTG+3TC included a low potential for drug-druginteractions (53.2%) , Easy to take (15.3%) andrenal impairment (13.5%).
In terms of immunological changes in the
DTG + 3TC, CD4 increased by 122.0 cells/μL, andCD4/CD8 increased by 0.2 (P＜0.001). The changes
in alanine aminotransferase,
aspartate aminotransferase were minimal, and theclinical significance was limited. In terms of renal
function, after 48 weeks of treatment, thecreatinine clearance rate of patients decreased
compared with the baseline (P＜0.001). Serum
creatinine (Scr), high-density lipoproteincholesterol (HDL-C) and total cholesterol (TC)increased significantly (P < 0.001, P < 0.001, P =0.005, respectively). There were no significant
changes in low-density lipoprotein cholesterol(LDL-C), blood sugar and triglyceride (TG) frombaseline to week 48 (P >0.05).
There were 16 (14.4%) adverse events (AEs) and 5(4.5%) drug-related side effects reported in the
study. One patient had SAEs (renal impairment)that required hospitalization, and the SAEs were
non drug-related hospitalizations. During thestudy, none of the participants stopped taking
drugs because of a lack of efficacy or adverse
reactions.
Conclusions: The two drug regimen showed highVirological suppression and tolerability in latedetection of people living with HIV.
Keyword: Dolutegravir plus lamivudine, HIV
infection, late detection, antiretroviral therapy

E-Poster Abstract

248

Outcomes ofbictegravir/emtricitabine/teno
fovir alafenamide versus
Tenofovir/lamivudine/efavirenz in north China: asingle center, real-world
assessment
Xu G, Sun C1
1Qingdao 6th people's Hospital, Qingdao, China

Background: Integrase strand transfer inhibitor(INSTI)-based regimens, have emerged as the
predominant treatment modality worldwide.
Bictegravir/Emtricitabine/Tenofovir (B/F/TAF) has
been endorsed as the preferred choice fortreatment-naive patients by the 2021 edition of
the China Acquired Immune Deficiency Syndrome(AIDS) Diagnosis and Treatment Guidelines.
Nevertheless, the predominant first-line regimen
in China for most patients remains as
Tenofovir/lamivudine/ efavirenz (TLE) which is
free. we conducted a single-center, retrospective
study to provide real-world data for the clinicalART of treatment-naive patients in China.
Method: The data were collected from sixth
Hospital of Qingdao, from January 2022 to Dec
2023. We analyzed viral response rates andchanges of CD4+ counts. Subgroups analyzed inlate presenter defined as baseline CD4+ cell counts<350 cell/μL.
Results: We enrolled 262 treatment naïve people,
including 200(76.4%) on TLE and 62(23.6%) on
B/F/TAF. The Average age was 38y, most are
males, 14.4% people in TLE and 11.3% in B/F/TAF
were married, 55.2% in TLE and 41.9% in B/F/TAF
were on the job (p=0.02), same as the people’s
education level were higher in B/F/TAF than TLE(79% VS 59%, P=0.025). There is no significant
different on baseline viral load and CD4+ counts.
At week 12, Viral response(VR) rate was higher
with B/F/TAF 96.9% than TLE 60.9% (P <0.001),
and there was no difference at week 24 (93.3% vs82.7%, p=0.131) and week 48 (89.1% vs 90.4%, p=0.803). This trend held in subgroup. The CD4+

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counts and CD4+/CD8+ ratio were similar in
B/F/TAF and TLE at week 12, week 24 and 1 year.
Nevertheless, the changes of CD4+ for TLE and
B/F/TAF from baseline to 12week (115 vs 198,
P=0.021 ) and to 1 year(139 vs 234, P=0.025 ) weresignificant different.
In late presenter group, the VR rete weresignificant higher in B/F/TAF group than TLE (100%vs 63%, p=0.001) at week 12. The changes of CD4+
counts were also significant different between TLE
and B/F/TAF from baseline to 12week (median 97
vs 164, p=0.008) and to 1 year(133 vs
159,p=0.043).
At 1 year of treatment, there were 4 people withlower level of viremia and 2 developed resistanceamong 9 people who haven’t got VR in TLE group,in addition, 3 people discontinued treatment. Only
5 people with lower level of viremia in B/F/TAF
group, no resistance and treatment
discontinuation. People were asked to be routinely
monitored viral load at 1 year after treatment
initiated. There were 57.2% of people came backfor viral test at 1 year in TLE group and 74.2% in
B/F/TAF group(p=0.016).
Conclusion: In this real word study, compared to
TLE, the predominant treatment regimen in China,
B/F/TAF led to earlier VR rate, much more CD4+
counts rise at first 3 month and 1 year. The same
results also be found in late presenter group.
There were few people developed LLV but noresistance and treatment discontinuation. And
much more people were well monitored at 1 yearof treatment. B/F/TAF shows a good profile ofefficacy and better follow-up in people live withHIV.

E-Poster Abstract

275

249

virologically suppressed, and maintained on
ABC/3TC/DTG over the same time period.

The efficacy and safety ofswitching todolutegravir/lamivudine
versus continuing on
abacavir/lamivudine/dolutegr
avir in adults withvirologically-suppressed
human immunodeficiency
virus-1 (HIV-1) infection: thefirst report of a real world
experience from Singapore

Results: Between 1 Feb 2022 and 15 Mar 2024, 33
PLHIV were switched from ABC/3TC/DTG to
DTG/3TC, while 51 PLHIV remained on
ABC/3TC/DTG. Baseline characteristics including
age, gender, race, frequencies of comorbidities,
renal function (estimated glomerular filtration rateand serum creatinine) and levels of lipid
biomarkers were similar between the 2 groups.
Specifically, baseline mean low-density lipoprotein(LDL) was 3.01 mmol/L (SD = 0.80) among those
who were subsequently switched to DTG/3TC,
while baseline mean LDL was 3.24 mmol/L (SD =1.15) among those maintained on ABC/3TC/DTG(p=0.324).

Sng E1, Lee W, Lee K1, Tan S1, Cheong H1, Lee W2,
Lim E2, Seah J2, Chien J1
1Department of Infectious Diseases, Changi General Hospital,

Singapore, Singapore, 2Department of Pharmacy, Changi
General Hospital, , Singapore

Background: Randomised controlled trials (RCTs)
such as the TANGO (van Wyk, Ajana et al. 2020)and SALSA (Llibre, Brites et al. 2023) trials havedemonstrated the non-inferiority of
dolutegravir/lamivudine (DTG/3TC) compared witha 3- or 4-drug regimen in HIV-1 treatment.
Observational data (Sabin, Worm et al. 2008)
suggest an increased risk of cardiovascular eventswith abacavir (ABC) exposure. Real world evidence
on the efficacy and safety of switching fromabacavir/lamivudine/dolutegravir (ABC/3TC/DTG)
to DTG/3TC is lacking in Asia. We present thefindings from our cohort of PLHIV who were
switched to DTG/3TC from ABC/3TC/DTG.
Material and Methods: We conducted aretrospective, single-centre observational study
that included all virologically-suppressed PLHIV(defined as HIV RNA < 200 copies/ml) who were
switched to DTG/3TC from ABC/3TC/DTG since 1
Feb 2022, and had at least 1 post-switch HIV-1
RNA by 15 Mar 2024. Those who met inclusion
criteria were assessed clinically, and underwent
monitoring of HIV-1 RNA, renal function and lipid
biomarkers at intervals in accordance withstandard clinical practice. These PHLIV werecompared to a control group who were

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

The mean duration of follow-up from time ofregimen switch was 4.66 months (SD = 1.31) for
those switched to DTG/3TC, and 5.94 months (SD= 2.56) for those maintained on ABC/3TC/DTG. As
of 15 Mar 2024, the proportion of PLHIV who
maintained virologic suppression were similar
between the 2 groups (100.0% of those on
DTG/3TC vs 98.0% of those on ABC/3TC/DTG).
Mean LDL was lower among those switched to
DTG/3TG compared to those maintained on
ABC/3TC/DTG (2.62 mmol/L vs 3.35 mmol/L,
p=0.004). At follow-up, there was no significant
difference in the mean serum creatinine,
triglyceride and high-density lipoprotein between
the 2 groups. After switching to DTG/3TC, 1 PLHIV
developed nausea which resolved spontaneously
without need for regimen change. There was notreatment discontinuation in both groups. One
PLHIV developed stroke 3 months after switch to
DTG/3TC. One PLHIV in the ABC/3TC/DTG groupexperienced virological failure due to medication
non-compliance.
Conclusions: Among virologically-suppressed
PLHIV in our centre, switching from ABC/3TC/DTG
to DTG/3TC was well-tolerated, and virologic
suppression was maintained through a mean of
4.66 months. Continued recruitment and followup are needed to determine if switching from
ABC/3TC/DTG to DTG/3TC is indeed associatedwith a LDL-lowering effect. A longer period of
follow-up would provide useful real-world
evidence on the durability of the virologic
suppression, and the impact of removing ABC on
cardiovascular events incidence.

E-Poster Abstract250

Efficacy and Safety of
dolutegravir plus lamivudine
versus efavirenz plus tenofovir
and lamivudine in HIV-1
infected and ART-naive
patients in West China
Nie J1, Sun W1, Yu Y1, Luo Q1, Wu X1, Mu L1
1People’s Hospital of Chongqing Banan District, Chongqing,

China

Introduction: This retrospective real-world study
evaluated the antiviral efficacy and safety of dual
therapy with dolutegravir plus lamivudine(DTG/3TC) in comparison to the standard regimenof efavirenz plus tenofovir and lamivudine(EFV+TDF+3TC) as initial antiretroviral therapy(ART) in HIV-1 infected patients.
Methods: Antiretroviral-naive HIV-1 patients wereenrolled from the People’s Hospital of Chongqing
Banan District, West China, between January 2022
and April 2023. Participants received either
DTG/3TC (D3 group) or the national free drug
regimen EFV+TDF+3TC (TLE group). Data on viralload (VL), CD4+ T-cell count, and other laboratory
indicators were collected at baseline, week 24, andweek 48. The primary endpoint was the proportionof patients achieving HIV-1 RNA < 50 copies/mL atweek 48, with secondary endpoints including
immune recovery and safety outcomes.
Results: A total of 111 patients were treated with
DTG/3TC, and 121 received EFV+TDF+3TC. By
week 24, 96.6% of the D3 group achieved HIV-1
RNA < 50 copies/mL, compared to 44.3% in the TLE
group. At week 48, 100% of the D3 group achieved
this target, versus 89.8% in the TLE group, withboth differences being statistically significant (p <0.05). Changes in CD4 cell counts from baseline toweeks 24 and 48 were comparable between
groups. The D3 group had significantly higher lowdensity lipoprotein levels at week 24, whereas the
TLE group had significantly higher transaminase
levels at both week 24 and week 48 (p < 0.05).
Conclusions: The DTG/3TC regimen demonstrated
superior efficacy and comparable safety to the

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276

EFV+TDF+3TC regimen at weeks 24 and 48. The
impact of DTG/3TC on lipid profiles warrants
cautious consideration, highlighting the need forfurther research.

E-Poster Abstract

251

Changes in weight and bloodpressure and its association intreatment naive People Livingwith HIV (PLHIV) who initiatedantiretroviral therapy (ART) ina tertiary care hospital in
Malaysia
Tan A1,2, Azwa I1,2, Basri S1,2
1University Of Malaya Medical Centre, Infectious Disease Unit,

Department of Medicine, Kuala Lumpur, Malaysia, 2Universityof Malaya, Center of Excellence for Research in AIDS (CERiA),
Kuala Lumpur, Malaysia

Background: Dolutegravir (DTG) use has increasedin Malaysia due to the rollout of generic DTG in
2023. DTG regimens are found to be associatedwith weight gain and hypertension. We aimed toassess how weight changed and hypertension
developed among Malaysian PLHIV.
Material and Methods: We conducted aretrospective review of adult (≥ 18 years old)
PLHIV who were diagnosed from 1 Jan 2014 to 31
Dec 2021 and initiated on either EFV- or DTGbased ART and remained on their regimen
throughout. PLHIV who have received at least 3
years of care with available baseline weight andblood pressure (bp) data and actively followed up
at the University of Malaya Medical Centre up till
31 July 2023 were included. We evaluated how
weight and bp changed after initiating ART. Weightchange was calculated by comparing their weightat Month (M)6, M12, M24, and M36 with baseline
weight. We identified high bp as systolic bp≥140mmHg and/or diastolic bp ≥90mmHg, andhypertension as two consecutive readings of highbp. We excluded those who were hypertensive atbaseline. Multivariate linear regression andmultivariate logistic regression models wereconducted to identify variables associated withweight gain and hypertension.
Results: Among 283 PLHIV (261 men, 21 women, 1transgender woman), 242 were initiated with EFV
and 41 with DTG. The median age of the study
population was 39 (IQR=35-47). The medianbaseline weight, systolic, and diastolic bp were

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024277

64.2kg (IQR=55.7-71.9), 126mmHG (IQR=116-138),
and 77mmHG (IQR=70-85) respectively. 64 PLHIV
were excluded when assessing hypertension
development. In multivariate analysis, weight gain
at M12 was associated with DTG (β=1.275, p=0.01)
and low baseline CD4 count (<200cells/μL)(β=1.649, p<0.001). Hypertension was associatedwith age (OR:1.059, 95%CI:1.027-1.092) andweight gain at M36 (OR:1.067, 95%CI:1.0191.118). The association between hypertension andART, gender, and low baseline CD4 count were notstatistically significant (p>0.05).
Conclusions: A statistically significant association
was found between DTG and weight gain but not
between DTG and hypertension. Age and weightgain were associated with hypertension. As more
Malaysian PLHIV are being started on DTG andpeople are aging with HIV, close monitoring of
weight, bp, and hypertension in the early stage iscrucial.

E-Poster Abstract

252

Prevalence and influencing
factors of dyslipidemia among
HIV/AIDS patients receiving
antiretroviral therapy in HenanregionDeng M1, Chen z1, Yang X2, Zhao Q2, Zhao S2, Sun Y2
1Clinical Research Center, Affiliated Infectious Disease Hospitalof Zhengzhou University, Zhengzhou , China, 2Department of
Infection, Affiliated Infectious Disease Hospital of Zhengzhou
University, Zhengzhou , China

Prevalence and influencing factors of dyslipidemia
among HIV/AIDS patients receiving antiretroviraltherapy in Henan region
Meng Deng1，Zhaoyun Chen1，Xuan
Yang2，Qingxia Zhao2，Shuxian Zhao2，Yan
Sun2*
1Clinical Research Center, Affiliated Infectious
Disease Hospital of Zhengzhou University ，Zhengzhou 450015, China
2Department of Infection, Affiliated Infectious
Disease Hospital of Zhengzhou University ，Zhengzhou 450015, China；*Corresponding author：Yan Sun，E-mail:sunyan2005@126.com
Background: Antiretroviral therapy (ART) has
significantly reduced AIDS-related deaths andgreatly improved survival rates for people with
HIV/AIDS. However, the metabolic abnormalities
associated with long-term ART therapy havereceived increasing attention. Henan is the earliest
region in China to carry out national free ART, witha long treatment duration, a large cohort, and alarge number of long-term survivors. It is of greatsignificance to explore the prevalence ofdyslipidemia and its risk factors in HIV/AIDS
patients receiving ART in Henan to improve theeffectiveness of ART in patients.
Methods: Adult HIV/AIDS patients who received
ART for more than 1 year in the high prevalencearea of AIDS in Henan Province were enrolled in
the study. Their basic characteristics and clinicaldata were collected to analyze the total
prevalence of dyslipidemia, and the prevalence ofhigh total cholesterol (TC), high triglyceride (TG),high low-density lipoprotein cholesterol (LDL-C)

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278

and low high-density lipoprotein cholesterol (HDLC)in the included subjects. The influencing factorsof dyslipidemia were analyzed using multivariate
Logistic regression model.
Results: A total of 744 patients with HIV/AIDS
were included. The rate of dyslipidemia was
62.76%, among which 80.30% was male and19.70% was female. The ratios of high TC, high TG,
low HDL-C and high LDL-C were 28.6%, 44.8%,
22.8% and 17.7%, respectively. The results ofmultifactor analysis showed that female and age≥60 were independent risk factors for high TC.
Overweight, obesity, ART regimen containing
protease inhibitors and ART treatment time >10
years were independent risk factors for high TG.
Low cluster of differentiation 4 （CD4）cell countand ART regimen containing integrase inhibitors
were risk factors for low HDL-C. ART regiments
containing integrase inhibitors are risk factors forhigh LDL-C.
Conclusion: The prevalence of dyslipidemia in HIV
patients receiving ART in Henan province is high.
Gender, age, BMI, CD4 value, ART regimen and
ART treatment duration are risk factors fordyslipidemia. It is recommended to dynamicallymonitor blood lipid levels in patients receiving ART
for HIV/AIDS, and to intervene in the treatment or
adjust the ART regimen as early as possible forpatients with dyslipidemia.
Keywords: HIV/AIDS; dyslipidemia; antiretroviraltherapy; prevalence; influencing factors

E-Poster Abstract

253

Prevalence and risk factors of
metabolic syndrome among
HIV patients in a medical
center of Northern Taiwan -- across sectional study
Tu C1, Wu A1, Cheng M1
1Mackay Memorial Hospital, Taipei, Taiwan

Background: HIV acquisition has been found to be
associated with increased risk ofcardiometabolic syndrome in the past. In thisstudy, we attempt to delineate the risk
factors of metabolic syndrome among persons
living with HIV in a single medical
institution in Taiwan using mostly integrase
inhibitors as HAART.
Methods: A cross-sectional study involving all HIV
positive patients aged > 18 years
who visited MacKay Memorial Hospital, Taipei,
Taiwan between September 7, 2022
to January 31, 2023 was performed. A modified
National Cholesterol Education
Program ATP III definition of metabolic syndrome
was used to define metabolic
syndrome and body mass index was used assurrogate for waist circumference.
Results: 809 PLWH participated in the study, inwhich 81.3% of patient were on
integrase inhibitor-based HAART regimen. The
prevalence of metabolic syndrome
was 10.0%, which is markedly lower than thosereported previously. Age was asignificant risk factor for metabolic syndrome. HIVrelated factors (CD4, viral load,
HAART regimen) did not affect the presence of
metabolic syndrome.
Conclusions: Prevalence rate of metabolic
syndrome appeared to have declined
among PLWH compared to previous reports,
possibly secondary to widespread use of
integrase inhibitors. Age remains a strong risk
factor for the development of metabolic
syndrome among PLWH.

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279

E-Poster Abstract

254

FEASIBILITY AND OUTCOMES
OF PCI WITH NOVEL TAPEREDCORONARY STENT IN PEOPLE
LIVING WITH HIV: A
PROSPECTIVE, SINGLE-CENTERSTUDY WITH LITERATURE
REVIEW
Natraj Setty H1, Sridhar L1, Rahul P1, Chethan K1,
Srinivas K1, Ravindranath K1
Sri Jayadeva Institute Of Cardiovascular Sciences And ReseachBangalore, Bangalore, India

1

Background and Aims: Patients with chronic
human immunodeficiency virus (HIV) infection
have a high risk of premature coronary
atherosclerosis, which is partly attributed to theirrequirement of a continuous highly active
antiretroviral therapy (HAART) regimen. Their highpredisposition to various opportunistic infections
increases the complexity of percutaneous
coronary intervention (PCI). Importantly, people
living with HIV have thicker, stiffer, more tapered,and highly tortuous coronary vasculature,
stiffness, and tapering compared to non-HIV CAD
patients. Currently, there is no evidence of theclinical outcomes of patients with HIV undergoing
PCI using tapered stents. This study aimed toassess the clinical outcomes of PCI with the novel
tapered Morph sirolimus-eluting coronary stent(SES) system in patients with HIV in a real-world
setting.
Methods: A prospective, single-arm,
nonrandomized study was performed at a tertiary
cardiac care center that included 15 people livingwith HIV and acute coronary syndromes. PCI was
performed in these patients using the study devicefor de novo coronary lesions with significant size
disparity between the reference vessel segments.
The cumulative incidence of major adverse
cardiovascular events (MACE), defined as acomposite of cardiac death, myocardial infarction,and clinically driven target-lesion revascularization(CD-TLR) at the longest available follow-up wasconsidered as the composite safety andeffectiveness endpoint.

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280

Results: Since 2018, a total of 15 people living withHIV with a mean age of 50.67 years underwent PCI
with the study device for the revascularization of
de novo lesions. Despite the patients having
cardiac risk factors and presenting with type B or C
lesions, 100% procedural and device success wasachieved after the index PCI with restoration of
myocardial flow (thrombolysis in myocardial
infarction [TIMI] flow III). Over a median follow-up
period of 40 months, no incidence of MACE orother adverse events was recorded for any of thepatients.
Conclusions: The current study presents fresh
evidence on the use of a long, tapered stent —Morp SES — for treating people living with HIV, inwhom highly occluded vessels were successfully
stented with favorable long-term outcomes. To
the best of our knowledge, this is the first-everreport on obtaining such high success rates of PCI
with long-term outcomes using a long, tapered SES
in people living with HIV.
Keywords: Coronary artery disease, Drug-eluting
stent, Human immunodeficiency virus, Tapered
coronary stents, Percutaneous coronary
intervention.

E-Poster Abstract

255

Quality of Life and Nutritional
Status in HIV-1 Infected
Patients on Maintenance
Hemodialysis
Wang Y1, Cai L1, Xin Y1, Jiang W1
Public Health Clinical Center of Chengdu, Chengdu, China

1

Background: There is limited data on quality of lifeand nutritional status in HIV-1 infected patientswith hemodialysis. The main objective was toinvestigate the quality of life (HIV/AIDSQOL-46
questionnaire) in HIV-1 infected patients withhemodialysis and analysed varied by different
antiretroviral therapy (ART) regimens. We also
evaluated differences of nutritional status
between the patients with integrase strand
transfer inhibitors (INSTIs)-containing ART
regimens and non-INSTIs ART regimens.
Methods: This is a retrospective cohort study
included HIV-1 infected patients with hemodialysis
at the hemodialysis center of the Public Health
Clinic Center of Chengdu, China, between July2010 and October 2020. The primary outcome was
the proportion of patients with HIV/AIDSQOL-46
scores over 161 points, a score of more than 161 isdefined as a satisfactory quality of life. Subjective
Global Assessment（SGA） is an assessment scalefor evaluating the nutritional status of patients.
According to the SGA screening, the nutritional
status was defined as 4 grades: good, mild,moderate and severe respectively.
Results: A total of 94 patients were included in the
study who received maintenance hemodialysis forat least three months, 61 and 33 patients
performed INSTI-containing ART regimens andnon-INSTI ART regimens, respectively. The mean
HIV/AIDSQOL-46 scores was 174
points（IQR，164 to 183）， 78(83.0%) patientswere very satisfied with the current quality of life
evaluation and over 161 points by HIV/AIDSQOL46 scores，50 of 61 and 28 of 33 patients over
161 points with INSTI-containing ART regimens
and non-INSTI ART regimens. Malnutrition wasobserved in patients with mild to moderate ,mild
malnutrition were recorded with SGA, 15(16.0%)
and 5(5.3%) , respectively. 14 (14.9%) versus 6

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281

(6.4%) (χ²＝0.291，P=0.590) patients withmalnutrition in patients had INSTI-containing ART
regimens and non-INSTI ART regimens,
respectively. None of the patients were severely
malnourished.
Conclusions: Our study exhibited that mostpatients reported satisfaction with their quality oflife in maintenance hemodialysis who received
ART. On another hand, the nutritional status ofmaintenance hemodialysis patients still needs tobe improved.

E-Poster Abstract

282

256

Navigating Challenges: PTMC
in People Living with HIV with
Severe Mitral Stenosis
Natraj Setty H , Sridhar L , Rahul P , Chethan K ,Srinivas K1, Ravindranath K1
1

1

1

1

1Sri Jayadeva Institute Of Cardiovascular Sciences And ReseachBangalore, Bangalore, India

Background: Patients with chronic infections andcompromised immune systems are at risk ofdeveloping valvular heart diseases, potentiallyinfluenced by opportunistic infections. Although
the prevalence of rheumatic fever has decreased,
mitral stenosis (MS) remains a significant global
cause of morbidity and mortality. Percutaneous
mitral balloon commissurotomy (PTMC) has
transformed the treatment of MS. This study
explores PTMC as an alternative to open surgicalcommissurotomy for mitral valve stenosis in
People living with HIV.
Material and Methods: The study evaluates theimmediate impact and outcomes of PTMC in 13
people living with HIV with mitral stenosis, utilizing
two-dimensional echocardiography and Doppler
tissue imaging (DTI).
Results: The study, conducted between May 2016
and January 2024, included 13 people living withHIV undergoing PTMC for severe MS. Patient age
ranged from 21 to 43 years, with a mean age of 28± 6 years. Most patients (51.5%) were in the 21-30
age group, and 60.2% were female. Breathlessness
was the predominant symptom (87.1%), and80.2% reported a history of paroxysmal nocturnal
dyspnea. Pre-PTMC, the mean Mitral Valve Orifice
Area (MVOA) was 0.61±0.36, increasing to
1.81±0.17 post-PTMC. Pre-PTMC mean Mitral
Valve Gradient (MVG) was 18.42±3.47, reducing to
5.21±1.1 post-PTMC. The mean Pulmonary Artery
Systolic Pressure (PASP) decreased from47.91±12.04 pre-PTMC to 27.57±7.21 post-PTMC.
The mean Left Atrium (LA) size was 45.2 ± 4.2 mm,with the majority having adequate LV function (EF>50%). The mean Ejection Fraction was 61.0 ±
4.8%. Wilkin's score ranged from 5-9, with a meanscore of 6.7 ± 0.8.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions: This study highlights an association
between valvular heart diseases and clinical stagesof HIV infection. Regular echocardiographic
evaluations are crucial, even for mild disorders.
PTMC, performed by an experienced operator in
carefully selected patients, proves effective andsafe for treating MS in people living with HIV.
Keywords: PTMC, 2D Echocardiography, HIV,
Rheumatic Heart Disease, Mitral Stenosis

E-Poster Abstract257

Hospital Outcomes among
People Living With HIV with
Opportunistic Infections in a
Tertiary Government Hospital
DACURO D1, LIMOS H2
Eastern Visayas Medical Center, Tacloban, Philippines,

1

2Philippine Society for Microbiology and Infectious Diseases, ,Philippines

Background: Human immunodeficiency virus (HIV)causes a decrease in CD4+ cell count levels leading
to profound immunodeficiency and increased
susceptibility to opportunistic infections (OIs), theprimary causes of morbidity and mortality amongpeople living with HIV (PLHIV). This study
determined the association of socio-demographic,clinical and laboratory profiles to the outcomes of
PLHIV with OIs in a tertiary hospital.
Methods: A retrospective cohort study design was
utilized that included 93 newly diagnosed HIV
patients with opportunistic infections duringhospitalization at EVMC from January 1, 2019 to
December 31, 2021. All data collected wereanalyzed descriptively and inferentially using theChi-square test.
Results and Discussion: Majority of the patients
belonged to age group 19-29 years old (60%),
males (95%), homosexual (85%) and unemployed(57%). Bacterial pneumonia (69%), pneumocystis
pneumonia (59%), oral candidiasis (58%) andpulmonary tuberculosis (50%) were mostly
observed opportunistic infections. Almost all (93%)
patients had CD4+ count levels of less than 200
cells/mm3 upon diagnosis. The presence ofpneumocystis pneumonia (p-value 0.013),
bacterial pneumonia (p-value 0.014), and highaspartate aminotransferase (AST) level (p-value
0.050) were significantly associated with inhospital mortality.
Conclusion: Findings of the study were consistent
with the Philippines' data on newly diagnosed HIV
cases in 2023, with majority belonging to younger
population, males and homosexuals. Presence ofbacterial and pneumocystis pneumonia wasassociated with the patient's outcome in terms of
in-hospital mortality. OI is a common cause of HIV-

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related hospitalization, with a significant
percentage of cases occurring in newly diagnosed
HIV-positive patients with low CD4+ cell counts
and not yet on antiretroviral therapy (ART).

E-Poster Abstract

258

A Case Report of Concurrent
Infections in a 17-year-old
male: Acquired
Immunodeficiency Syndrome,
Pulmonary Tuberculosis,
Treatment Failure T/C Multiple
Drug Resistant Tuberculosis,
COVID-19 confirmed severe;
Cerebral Toxoplasmosis,
Paradoxical Immune
Reconstitution Inflammatory
Syndrome
Espino R1, Go G1
San Lazaro Hospital, Manila, Philippines

1

This case report details the clinical course of a 17year-old male Filipino patient admitted to San
Lazaro Hospital in January 2021 with a history ofgeneralized body weakness for one month. The
patient presented with a movable, non-tenderneck mass, high-grade fever, and significant weightloss. Initial treatment from another hospital
included ceftriaxone, clindamycin, andazithromycin, which resulted to slight
improvement. A year ago, patient had engaged in
unprotected sexual activity and had a history of
pulmonary tuberculosis treatment completed for 6
months. However, with development ofneurological symptoms and a reactive HIV
screening prompted transfer to San Lazaro
Hospital. On admission, he exhibited severe
malnutrition, aphasia, and generalized weakness.
The patient was diagnosed with acquired
immunodeficiency syndrome (AIDS) and cerebral
toxoplasmosis by MRI. He was treated with
antiretroviral therapy (ART), co-trimoxazole, andspecific antimicrobials for other infections.
Recurrent healthcare-associated pneumonia,
COVID-19, severe and immune reconstitution
inflammatory syndrome (IRIS) complicated his
hospital stay. Despite these challenges, thepatient's condition improved and was discharged.

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284This case highlights the complexities of diagnosing
and managing opportunistic infections in a young
patient with AIDS. It underscores the importanceof early diagnosis, targeted treatment, and amultidisciplinary approach to optimizing outcomesin complex clinical scenarios.

E-Poster Abstract259
Abstract 259 has been withdrawn.

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E-Poster Abstract

286

260

accept eligible clients even outside theircatchment areas.

Improving coverage of viralload testing through a referral
system led by People Livingwith HIV (PLHIV) in Greater
Metro Manila (GMM),
Philippines

Conclusion: A streamlined referral system anddemand generation optimized facilities to upscaledemand for VL testing, efficiently facilitate accessof PLHIV., and increase VL testing coverage.
Lessons will be used in 2024 to motivate otherfacilities to follow suit.

Rabara M2, Bagasao T1, Castañeda B1, Bagasol E1,
Naldoza R2
1Bacoor Social Hygiene Clinic, Bacoor City Cavite, Philippines,
2Pinoy Plus Advocacy Pilipinas, Inc, Manila, Philippines,

Philippines

Background: Viral Load (VL) testing coverage in
the Philippines stood at 27% by the end of 2022.
The limited number of facilities performing VL
testing and lack of information among eligible
PLHIV about accessing the service contributed tothis. The USAID-supported Meeting Targets andMaintaining Epidemic Control (EpiC) Project in thePhilippines piloted the “VL for ALL” in Greater
Metro Manila (GMM) to increase VL testing
coverage.
Description / Methods: EpiC and Pinoy Plusdeveloped “VL for ALL" pilot, streamlining referrals
using their PLHIV Response Center (PRC); linking
clients to three pilot facilities regardless of theirtreatment hub origin: Tarlac Provincial Hospitaland Social Hygiene Clinics in Caloocan City andGeneral Trias. The referral system was integrated
into EpiC’s online booking platform, Quickres.org,
and promoted in facilities and online from May to
September 2023. Data from the National HIV
information system (OHASIS) and the PRC log
confirmed the results.
Lessons Learned / Results: Pinoy Plus successfully
linked 345 eligible PLHIV to VL testing, contributing
to increasing coverage from 44% in March to 52%
in September in EpiC sites. Results also showedsignificant demand for VL testing among PLHIV
residing outside GMM. This showcased
optimization of Caloocan City SHC’s testing
capacity increasing coverage from 48% in
December 2022 to 69% in September 2023.
Beyond the pilot period, the facilities continued to

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract

261

From bench to bedside:
Elucidating the diagnosis ofacute HIV in complex DADA2
case with serial 4th generation
HIV serology, HIV RNA viralload, and Line Immunoassay
Afeera Zainulabid U1,2, Khee C2, Nawawi M3,
Othman S3, Faisal U3, Ali A4, Periyasamy P2
1Department of Internal Medicine, Kulliyyah of Medicine,International Islamic University Malaysia, Kuantan, Malaysia,
Department of Internal Medicine, Faculty of Medicine,
Universiti Kebangsaan Malaysia, Cheras, Malaysia,
3Department of Medical Microbiology & Immunology, Faculty of
Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia,
4Department of Pediatric, Faculty of Medicine, Universiti
Kebangsaan Malaysia, Cheras, Malaysia
2

Background: Diagnosing acute HIV infection,
especially in complex cases like Deficiency of
Adenosine Deaminase 2 (DADA2), poses significant
challenges due to overlapping symptoms anddiagnostic uncertainties. This study explores thediagnostic utility of serial 4th generation HIV
serology, HIV RNA viral load, and Line
Immunoassay (LIA) in identifying acute HIV
infection in complex DADA2 case.
Materials and Methods: A meticulous analysis was
conducted on a case of DADA2 presenting withfever, sore throat, and rash, complicating thediagnostic process and leading to a dilemma
between acute HIV and full-blown DADA2
manifestations. Despite initial considerations forfull-blown DADA2 and the possibility of a falsepositive HIV result, the culmination of
investigations consistently pointed towards thediagnosis of acute HIV infection. Integrating clinicalevaluations with 4th generation HIV serology, HIV
RNA viral load, and LIA enabled a comprehensive
approach, ultimately leading to the diagnosis ofacute HIV.
Results: Serial 4th Generation HIV serology
unveiled evolving serological patterns indicative ofacute HIV infection. Despite the initial low
reactivity in the screening test detecting bothantigen and antibody, and a negative
supplementary PA test, the assessment of HIV RNA

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287

viral load provided compelling evidence with aviral load of 7.42 x 10^6 million. Additionally, theLine Immunoassay (LIA) revealed positivity for p24
antigen and gp41, while testing negative for
p31.The evaluation is suggestive of Fiebig
laboratory stage V of early HIV-1 infection.
Subsequent repeat testing of 4th generation HIV
serology confirmed positive antigen, antibody, andsupplementary tests. The corroborative results of
HIV serology, HIV RNA viral load, and LIA aid in thetimely diagnosis and management of acute HIV in
a complex DADA2 case.
Conclusion: Serial 4th Generation HIV serology,
HIV RNA viral load, and LIA emerge as
indispensable tools in navigating the diagnosis ofacute HIV infection, particularly in intricate clinicalscenarios like DADA2. Integrating these advanced
diagnostic modalities into clinical algorithms holds
promise for early detection and intervention,
ultimately enhancing patient outcomes.

E-Poster Abstract

262
Abstract 262 has been withdrawn.

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E-Poster Abstract

263

Real World Experience on the
Use of Two-Drug Antiretroviral
Therapy Regimens in Older
People with HIV: ClinicalParameters
Kwong R1, Tang H1, Chan P2, Lam K1, Chan H1, Chu
M1, Lam W1, Lam S1, Leung W3, Ting W1, Wu T1,
Yung S1, Yeung D1, Lee M1
1Department of Medicine, Queen Elizabeth Hospital, Hong Kong

SAR, China, 2Department of Neurology, Yale University School of
Medicine, New Haven, USA, 3Department of Medicine andGeriatrics, Kwong Wah Hospital, Hong Kong SAR, China

Background: Two-drug regimens (2DRs) may
reduce potential long-term drug toxicity and drugdrug interactions for people with HIV (PWH) on
antiretroviral therapy (ART). 2DRs could beparticularly beneficial to older PWH, who usually
have more co-morbidities. However, PWH older
than 50 (PWH>=50) were under-represented in
key 2DR studies. This retrospective study
evaluated the changes in clinical laboratory
outcomes in PWH>=50 who switched fromstandard three-drug ART to 2DRs in real-world
settings.
Material and Methods: PWH>=50 on suppressive
standard ART who switched to 2DRs at the HIVclinic of the Queen Elizabeth Hospital, Hong Kong
SAR, China were identified through electronic
records. Their 2DR formulations, along with theirlast clinical laboratory results before the switch
and the first laboratory results at or after 48-weekpost-switch, were retrieved. Laboratory tests
included blood T-lymphocyte counts, complete
blood count, kidney and liver function tests,
fasting blood glucose and lipid profile. Longitudinaloutcomes were compared using Wilcoxon signedrank tests accordingly.
Results: Between January 2014 and December
2023, 113 PWH>=50 switched to 2Rs; 97 (86%)
were male, with a median age of 59 (IQR 55–66
years). The median duration of ART was 14 (IQR
7.2–18.7 years). All but one received Integrase
strand transfer inhibitors (INSTI)-based 2DRs; 97(86%) combined with a nucleoside reverse
transcriptase inhibitor (NRTI), 10 (9%) with a

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289

protease inhibitor (PI), and 5 (4%) with a nonnucleoside reverse transcriptase inhibitor (NNRTI).
Six of them were unable to maintain the 2DRs for
48 weeks, including two discontinuations due toadverse effects, one due to virologic failure (VF,HIV RNA >200 copies/mL) and three deaths
unrelated to VF. Of the 107 (95%) who maintained
their 2DRs over 48 weeks, their blood CD4+ Tlymphocyte count, CD4/CD8 ratio, haemoglobin,
total white blood cell count, platelet count,creatinine, total bilirubin, alanine transaminase(ALT), alkaline phosphatase (ALP), fasting glucose,high-density lipoprotein (HDL) and low-density
lipoprotein (LDL) cholesterol remained statisticallyunchanged at or after 48 weeks post-switch. The
median triglycerides decreased from 1.6 (IQR 1.2–
2.4) to 1.5 (IQR 1.1–2.1) mmol/L (p=0.02) while themedian total cholesterol from 5.1 (IQR 4.5–5.7) to
4.7 (IQR 3.9–5.6) mmol/L (p=0.04). The decline intriglycerides and total cholesterol was no longer
observed when users of lipid-lowering drugs(n=56, mostly HMG-CoA reductase inhibitors) were
excluded.
Conclusions: In this group of male-predominant,virally suppressed PWH>=50 who switched to
2DRs, the rates of discontinuation and virologic
failure at week 48 post-switch were low, alongwith stable key clinical parameters. The reductions
in blood triglycerides and total cholesterol level at
or after 48-week post-switch might have been due
to lipid-lowering drug use.

E-Poster Abstract

264

Optimization of treatment
outcomes using client
segmentation: Differences
between clients who missed
and adhered to clinicalappointments.
Nguyen V1, Dang H1, Nguyen V1, Bui T1, Vuong T1,
Phan H2, Coley R1, Levitt D1
1FHI 360, , Vietnam, 2Vietnam Administration for HV/AIDS

Control (VAAC), , Vietnam

Background: Missed appointments for
antiretroviral therapy (ART) are associated withnegative consequences among HIV clients. To
gauge ART adherence and continuity, theUSAID/PEPFAR-funded Meeting Targets andMaintaining Epidemic Control (EpiC) project
collaborates with the Vietnam Administration for
HIV/AIDS Control to conduct routine client
tracking. We analyzed client records to determine
the characteristics of ART clients who missed an
appointment in Dong Nai and Tay Ninh provinces
to tailor and optimize strategies to improve ART
adherence and continuation.
Materials and Methods: We analyzed deidentified data for ART clients from October 2022
through September 2023. We defined clients withmissed appointments as those exceeding 28 days
since their expected appointment. Demographic
data and appointment-related variables wereextracted from client records. Univariate andmultivariate logistic regression were used to
calculate odds ratios (OR) reflecting associations
between clients who missed appointments andthose who did not.
Results: Of 8,577 clients, 5.7% were categorized ashaving at least one missed appointment, 80.3% ofwhom were males. Mean age was 33.9 (±10.0),
and mean duration of treatment was 55.7 months(±52.1). For clients reached after missed
appointments (n=280), the primary reason was
relocation for work in another province (30.4%),
followed by no social health insurance or no
validation of social health insurance (12.6%). Age
was directly associated with missed appointments,

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024290

with a 1.3% increase in odds per year of age(OR=1.013, 95% CI: 1.002-1.025, p=0.05). Similarly,
longer ART duration was associated with a 0.6%
increase in missed appointment odds per month(OR=1.006, 95% CI: 1.004-1.008, p<0.05). Notably,
sex was not significantly associated with missed
appointments (OR=0.933, 95% CI: 0.713-1.220,
p=0.613).
Conclusions: In Vietnam, tailored and enhanced
support may be needed for older clients, those on
long-term ART, clients working away from home,
and those lacking valid social health insurance.
Strengthening data systems to address factors
contributing to missed appointments, and putting
greater effort in patient tracking, are crucial for
optimizing adherence and ensuring continued
treatment. In addition, prioritizing the uniqueneeds of each population is essential for improving
healthcare services and overall well-being. The
may involve development of specialized support
services, personalized treatment plans for bettermedication access and management, targetedinterventions to enhance medication adherence,and initial and periodic follow-up client
consultations to ensure continuous healthinsurance coverage.

E-Poster Abstract

265

Concurrent Testing for COVID19 and HIV Infection at Udon
Thani Hospital, Field Hospital,
and Prison Field Hospital forEnding the HIV Epidemic in
Udon Thani Province, Thailand
Watcharasuwanseree S1, Klinphayom P1,
Rattanawongpaibul A1
1Udon Thani Hospital, Udon Thani, Thailand

Concurrent Testing for COVID-19 and HIV Infection at Udon
Thani Hospital, Field Hospital, and Prison Field Hospital forEnding the HIV Epidemic in Udon Thani Province, Thailand

Background: In 2021, access to healthcare services
was difficult due to the early pandemic of COVID19 which caused people with HIV infection to getdelayed diagnoses of opportunistic and HIV
infection. Our team routinely tested the HIV
infection in all COVID-19 cases aiming to detect
the immunocompromised status that was one of
the risk factors of severe COVID-19 and tonormalize HIV testing.
Methods: Anti-HIV testing was routinely done in
all adult patients who were diagnosed with COVID19 in line with COVID-19 diagnosis and treatment
guidance in Thailand. The anti-HIV positive result
consisted of previously diagnosed HIV infection
and newly diagnosed HIV infection. The previously
diagnosed HIV infection individuals were asked
about antiretroviral therapy (ART) compliance, andthe newly HIV-diagnosed individuals received postHIV test counseling and evaluation for early ART
initiation.
Results: COVID-19 cases in Udon Thani Hospitalfrom Jan-Oct 2021 were 11,480 cases with 1,119
cases admitted in Udon Thani Hospital, 5,111 casesin the field hospital, and 5,250 cases in the central
prison of Udon Thani(prison field hospital). These
cases were checked for anti-HIV with the positive
results of 126 cases(1.1%). 46 cases were admitted
to Udon Thani Hospital with 8 of them new HIV
diagnoses, 38 cases in the field hospital with 17 ofthem new HIV diagnoses, and 42 cases in thecentral prison of Udon Thani(prison field hospital)

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024291with 3 of them new HIV diagnoses. Of these 126
cases, 86(68%) were patients who were previously
diagnosed with HIV infection and well-controlled
disease, 12(10%) were patients who werepreviously diagnosed with HIV infection and lost tofollow-up, and 28(22%) were newly diagnosed HIV
infection and 16 of them were initiated ART withinthat admission. 11/126(8.7%) had severe COVID19. Almost all cases(93.6%) received favipiravir as
the COVID-19 antivirus. 5/126(3.9%) who did nottake ARV had pulmonary TB co-infection,
1/126(0.8%) had pneumocystis pneumonia coinfection, 1/126(0.8%) had pulmonary tuberculosis
and pneumocystis pneumonia co-infection. At 1
month after discharge, 87(69%), 19(15%), 19(15%),
and 1(0.8%) of patients were retention in care in
Udon Thani hospital, referred to community
hospitals, lost to follow up, and died, respectively.
At 3 months, the retention rate was 97%.
Conclusion: In the era of the COVID-19 pandemic,
the new HIV diagnosis and identification ofpreviously diagnosed HIV patients are difficult.
Implementation of normalized HIV testing inpatients who have COVID-19 infection shows
benefit in new diagnosis, early starting ART,
continuing ART, and retention in care.

E-Poster Abstract

266

Willingness to receive the 4component meningococcal
serogroup B vaccine forgonorrhoea prevention in atrial setting among men who
have sex with men
Kwan T1,2,3, Chan D2,3, Lee S2,3
1Jockey Club School of Public Health and Primary Care, The

Chinese University of Hong Kong, Shatin, Hong Kong, 2S.H. Ho
Research Centre for Infectious Diseases, The Chinese Universityof Hong Kong, Shatin, Hong Kong, 3Stanley Ho Centre for
Emerging Infectious Diseases, The Chinese University of Hong
Kong, Shatin, Hong Kong

Purpose: The real world effectiveness ofgonorrhoea prevention by using the 4-component
meningococcal serogroup B (4CMenB) vaccine has
yet to be established. A randomised controlled
trial is being conducted on men who have sex withmen (MSM) in Hong Kong. The aim of this analysis
is to determine their willingness to participate.
Methods: A cross-sectional survey was conducted
on MSM from December 2022 to May 2023,
covering demographics, sexual behaviouralpractice, HIV and gonorrhoea risk perception anddiagnosis history, and perception about
vaccination against gonorrhoea. Towards the endof the survey, they were asked about their interestin joining the 4CMenB trial with three options: yes,wishing to know more, and no. Participants
answering yes were regarded as willing toparticipate. Associated factors were assessed using
bivariable analysis.
Results: Of 481 participants, 138 (28.7%)
expressed willingness to join the trial, 104 (21.6%)
wished to know more, and 239 (49.7%) wereuninterested. Those interested in participation in
the trial were more likely to be older (p=0.04),
living with HIV (PLHIV; p=0.048), and using PrEP
(p<0.001). They were more likely to have history oftransactional sex (p=0.03) and group sex(p<0.001). Their odds of condomless sex (p=0.008),
chemsex (p<0.001), and sexually transmitted
infection (STI) diagnosis (p=0.005) in the past 6months were higher. Their perceived risk of STI(p=0.02) but not HIV (p=0.27) was higher. Those

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292

who were not willing to join the trial wereconcerned about the side effects (p=0.006) andprice (p=0.002) when choosing an STI prevention
tool. Efficacy (p=0.15) and drug approval status(p=0.27) did not affect their willingness.
Conclusion: MSM with higher risk of STI werewilling to join the 4CMenB trial probably becauseof the potential advantage of enhancing
prevention of gonorrhoea. Sufficient information
should be provided to the community members,
especially PLHIV, to support making an informed
decision on STI prevention options.

E-Poster Abstract

267

High prevalence of gonorrhea
among Thai adolescent andyoung adult men who haveanal sex: A cross-sectional
study
Tanthawet P1, Padungkiattisak P3, Srithamsiri T3,
Moonwong J3, Songtaweesin W2,3,4,
Anugulruengkitt S2,3, Puthanakit T2,3
1King Chulalongkorn Memorial Hospital, The Thai Red Cross

Society, Bangkok, Thailand, 2Department of Pediatrics, Facultyof Medicine, Chulalongkorn University, Bangkok, Thailand,
3Center of Excellence for Pediatric Infectious Diseases andVaccines, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand, 4School of Global Health, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand

Background: Routine annual testing of N.
gonorrhoeae (NG) and C. trachomatis (CT) bynucleic acid amplification testing (NAAT) is
recommended in guidelines. However, in clinicalpractice, access is limited due to cost andavailability. The objective of this study was to
examine the prevalence of NG and CT among
adolescents and young adults (AYA) at high risk ofsexually transmitted infections (STIs).
Materials and Methods: A cross-sectional studyof AYA aged 15-to 24-years engaging in anal sex
was conducted. Inclusion criteria included (1)presented symptoms of urethritis or proctitis (2) >3 sex partners in preceding 6 months (3) neverbeen screened for NG and CT infections within 6months prior to the study. STI screening was
performed by pooled specimens collected fromurethral, anal and pharyngeal swabs. NAAT testingfor NG and CT were performed using GeneXpert
assays. Prevalence rates were reported with 95%
confidence intervals. Associated factors wereanalyzed with multivariate logistic regression.
Results: From May 2023 to March 2024, 124 Thai
AYA with a median (IQR) age of 22 (20 to 23) years
were enrolled. Median (IQR) age of sexual debut
was 17 (15 to 19) years and 68 (55%) reported >6
sex partners in the preceding 6 months. 116(93.5%) participants were men who have sex withmen. Self-reported sexual roles included 59(47.6%) being both insertive and receptive
partner; 46 (37.1%) receptive only and 19 (15.3%)

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293

insertive only anal partners. 19 (15.3%)
participants were living with HIV and 37 (29.8%)
were HIV pre-exposure prophylaxis users.
Prevalence of NG was 21.8% (95%CI 14.9 to 30.1).
Prevalence of CT was 24.2% (95%CI 17.0 to 32.7). 8(6.5%) had dual infection. Among the 18
participants reporting urethritis symptoms, 7(38.5%) had NG. Among the 45 participants whoreported STIs in the preceding year, 18 (40.0%)
had NG. Among the 59 participants who wereplayed both insertive and receptive anal partner
roles, 19 (32%) had NG. Among the 19 participants
living with HIV, 9 (47.4%) had NG.
Multivariate analysis of factors associated with NG
infection was being both an insertive andreceptive anal partner (adjusted odds ratio (aOR
3.1, 95%CI 1.2 to 8.1) and diagnosis of STI in
preceding year (aOR 4.0, 95%CI 1.4 to 11.1).
Conclusions: One in five AYA were diagnosed withNG, with those reporting both insertive andreceptive anal partner roles and STI in preceding
year being at particular risk of getting NG. In highly
limited resource settings, targeted NAAT testingand prompt treatment for NG should beconsidered in these groups to reduce transmission
and risk of HIV acquisition.

E-Poster Abstract

268

Identifying individuals at highrisk for HIV and sexuallytransmitted infections with anartificial intelligence-based risk
assessment tool
Latt P1,2, Soe N1,2, Xu X2,3, Ong J1,2, Chow E1,2,4,
Fairley C1,2, Zhang L1,2,5
Central Clinical School, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Melbourne, Australia, 2Melbourne
Sexual Health Centre, Alfred Health, Melbourne, Australia,
3School of Public Health, Shanghai University of Traditional
Chinese Medicine, Shanghai, China, 4Centre for Epidemiology
and Biostatistics, Melbourne School of Population and Global
Health, The University of Melbourne, Melbourne, Australia,
5China-Australia Joint Research Center for Infectious Diseases,
School of Public Health, Xi’an Jiaotong University Health Science
Center, Xi’an, China
1Introduction: We have previously developed an
artificial intelligence-based risk assessment tool toidentify the individual risk of HIV and sexuallytransmitted infections (STIs) in a sexual healthclinical setting. Based on this tool, the study aims
to determine the optimal risk score thresholds toidentify individuals at high risk for HIV/STIs.
Methods: Using 2008-2022 data from 216,252 HIV,
227,995 syphilis, 262,599 gonorrhoea, and320,355 chlamydia consultations at a sexual healthcentre, we applied MySTIRisk machine learningmodels to estimate infection risk scores. Optimal
cut-offs for determining high-risk individuals were
determined using Youden’s index.
Results: The HIV risk score cut-off for high risk was
0.56, with 86.0% sensitivity (95% confidence
interval (CI): 82.9-88.7%) and 65.6% specificity(65.4-65.8%). Thirty-five percent of participants
were classified as high-risk, which accounted for
86% of HIV cases. The corresponding cut-offs were0.49 for syphilis (sensitivity 77.6%, 76.2-78.9%;
specificity 78.1%, 77.9-78.3%), 0.52 for gonorrhoea(sensitivity 78.3%, 77.6-78.9%; specificity 71.9%,
71.7-72.0%), and 0.47 for chlamydia (sensitivity
68.8%, 68.3-69.4%; specificity 63.7%, 63.5-63.8%).
High-risk groups identified using these thresholds
accounted for 78% of syphilis, 78% of gonorrhoea,
and 69% of chlamydia cases. The odds of positivity
were significantly higher in the high-risk group

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than otherwise across all infections: 11.4 (9.314.8) times for HIV, 12.3 (11.4-13.3) for syphilis,
9.2 (8.8-9.6) for gonorrhoea, and 3.9 (3.8-4.0) for
chlamydia.
Conclusions: Risk scores generated by the AIbased risk assessment tool MySTIRisk, together
with Youden’s index, are effective in determining
high-risk subgroups for HIV/STIs. The thresholds
can aid targeted HIV/STI screening and prevention.

E-Poster Abstract

269

Significant obstacles to
Women Commercial Sex
Workers' (WCSWs') access to
HIV and STD programs during
the COVID-19 pandemic in
Rajshahi, Bangladesh
Kalam M1
1Quick Health Service Centre (QHSC), Rajsha, Bangladesh

Background: Women Commercial Sex Workers(WCSWs) who engage in hazardous sexual activity
run a much higher risk of contracting HIV andother STDs. Testing and counseling are essential
components of behavior change, treatment
admission, and aftercare. This exploratory study
aimed to record how the nation addressed theneed for people living with HIV/STD andvulnerable to risk during the COVID-19 pandemic,
as well as to look into obstacles that WCSWs facedin accessing, using, and staying in treatment.
Methods: During the peak of the COVID-19
pandemic, the study was conducted in Rajshahi,
Bangladesh, from July 2021 to June 2022. The
study comprised the following: (1) a review ofofficial statements from the Bangladeshi
government (2) in-person interviews with 650
WCSWs (3) in-person interviews with 24 service
providers (4) in-person and telephone interviews
with 14 key informants, and (5) a one-day
negotiation workshop with 40 participants fromthe WCSW and service provider groups.
Results: During the pandemic's peak, WCSWs
reported that they were denied access to medical
facilities for almost 18 months and that they were
not given any tests or treatments. According tonearly 94% of WCSWs, the pandemic made life
more difficult for them and increased the numberof instances in which they were marginalized andunderserved. They also reported facing obstacles
in obtaining social services and health treatment.
However, for those who are currently at
continuous risk of infection, annual HIV/STD
testing is advised. More than 90% of the group asa whole said they had never had an HIV or STD
test. The government's failure to apply a justice

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lens in implementing its response to the nation's
inept healthcare systems was pointed up by the
key informant interviews and service providers.
Conclusions: Public health experts and HIV/STD
service providers need to be aware of how the
COVID-19 pandemic has affected HIV/STD care andbe ready for any rises in HIV/STD-related morbidity
and mortality in the upcoming years. The
government will need to focus on identified policy
and programmatic priorities for urgent HIV/STD
screening, diagnosis, and treatment as well as
educating patients and healthcare providers about
COVID-19's impact on sexual health services.

E-Poster Abstract

270

Impact of humanpapillomavirus vaccination on
anal HPV infection and anal
dysplasia among HIV-positivemen who have sex with men
Lin K1, Huang Y1, Chuang Y1, Liu W1, Hung C
1National Taiwan University Hospital, Taipei, Taiwan

Background: The risk of anal cancer increases
among men who have sex with men (MSM) andpeople with HIV (PWH). Human papillomavirus(HPV) vaccination has recently been expanded tothe male population for the prevention of analcancer, but the impact of HPV vaccination on anal
HPV infection and anal dysplasia is not wellstudied. The study aimed to assess the incidence
and clearance of anal HPV infection and anal
dysplasia following HPV vaccination.
Methods: During February 2021 to December
2023, the prospective study enrolled HIV-positive
MSM aged 20-45 years without a history of HPV
vaccination and suggested that they undergo
three-dose 9-valent HPV vaccination at months 0,
2, and 6. Specimens were collected at the baseline
visit and at months 3, 7, 12 for participantsreceiving HPV vaccination, while for those notreceiving HPV vaccination, specimens werecollected at the baseline visit and at month 12. At
each follow-up visit, anal HPV genotyping,cytology, concurrent sexually transmitted
infections, and microbiome were determined.
Dynamic changes in anal HPV infection and anal
dysplasia were observed.
Results: We enrolled 95 HIV-positive MSM, with
39 receiving HPV vaccination and 56 not receiving.
All vaccinees had completed the third dose of HPV
vaccine and 12-month follow-up, but nonvaccinees had not yet undergone testing at month
12. The participants had a median age of 34 years,
with a median CD4 count of 680 cells/mm3, and98.9% had achieved an HIV RNA viral load of <200
copies/mL. At baseline, 37.9% and 18.9% ofparticipants had prevalent high-risk and low-risk
HPV infections, respectively. While 7 (7.4%)
participants exhibited low-grade squamous
intraepithelial lesion (LSIL) in anal cytology, 4

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(4.2%) showed high-grade squamous
intraepithelial lesion (HSIL). Among vaccinees, theincidence rates of various HPV genotypes ranged
from 2.1 to 6.7 per 1000 person-months, withpersistence rates varying between 21.0 and 76.6
per 1000 person-months, and clearance rates
ranging from 14.4 to 100.0 per 1000 personmonths. The positivity rates for genotypes coveredby the 9-valent HPV vaccine were 41.0%, 35.9%,
33.3%, and 43.6% at the baseline visit, and at
months 3, 7, and 12, respectively. The rates of any
anal cytology abnormalities were 17.9%, 20.5%,
15.4%, and 15.4%, respectively. Four (10.5%)
participants had progression of dysplasia, but novaccinees developed anal cancer during the 12month. The anal microbiome showed a significant
decrease in Corynebacteriaceae,
Peptostreptococcus spp., and Prevotella spp. after
HPV vaccination.
Conclusion: A significant prevalence of HPV
infection and over 10% occurrence of anal
dysplasia were observed among HIV-positive
MSM. Participants experienced clearance of HPV
infection, regression of anal dysplasia, andchanges in anal microbiome following HPV
vaccination. However, the rates should becompared with that in non-vaccinees.

E-Poster Abstract

271

Designing a model of HIV
Community-Based Services toaddress the disruption of HIV
services during Covid-19
Pandemic among MSM
community in South Sulawesi,
Indonesia: An Implementation
Study
Sudirman S1, Ruxrungtham K1, Phanuphak N2,
Nadia Tarmizi S3
1Chulalongkorn University, Bangkok, Thailand, 2Institute of HIV

Research and Innovation, Bangkok, Thailand, 3Ministry of
Health Indonesia, Jakarta, Indonesia

Background: The COVID-19 pandemic disrupts HIV
services and impacts service access by the MSM
community. The innovations in expanding HIV
services reduce clinic visits, and physical contact isrecommended. Community-based HIV service(CBS) is an HIV service conducted outside healthfacilities by trained peers. We intend to design an
HIV CBS model that can overcome barriers toaccessing HIV services, especially by the MSM
community during the COVID-19 pandemic.
Methods: Focus group discussions (FGDs) and indepth interviews (IDIs) were conducted from
December 2022 to January 2023, involving theMSM communities, community-basedorganization members, health workers,
stakeholders, and academicians. The participants
were purposely selected and located in South
Sulawesi, Jakarta, Yogyakarta, and Bali Province.
We collected the informants' perceptions
regarding preparing and designing an HIV CBS byadopting the KPLHS (Key Population Led HealthServices) model in Bangkok, Thailand, with someadjustments to the Indonesian national HIV
program and local context. FGDs and interviews
were audio-recorded, transcribed verbatim, andanalyzed deductively following the thematic
framework approach.
Results: Sixty-three informants (49 men and 14
women) aged 21-57 participated in eight FGDs and
22 IDIs. The HIV CBS design included training for

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community health workers, competency testing,internship, CBS implementation, and evaluation.
The duration of training was set to 24 hours (threedays), consisting of theory and practice with the
Basic Level training (HIV and STI Screening)
curriculum. Training materials are divided into
three categories: core training materials,
compulsory training materials, and additional
training materials. The core training material
consists of two modules: basic information on HIV
and related infections and HIV counselling. The
compulsory training material consists of only one
module, namely HIV and STI screening and testing.
The additional training material contains one
module: promoting HIV STI services and clientreferral to health facilities. The trainees must pass
the theoretical knowledge and practice skills test
and score 80% or higher to be competent and geta certificate. After passing the assessment, all thetrainees should join a one-week internship in
Puskesmas (public health care). The services in HIV
CBS will include screening and testing for HIV andsyphilis, treatment, referral, and prevention
programs by implementing static and mobile
services. The HIV CBS will also perform
management and supervision functions to ensure
the quality of the services. Monthly evaluations
will be conducted to monitor progress andconstraints during service implementation.
Conclusion: The HIV CBS model will be
implemented through several processes. By
providing more flexible services in time and place,
CBS is expected to overcome barriers to HIV
services during Covid 19 and possible pandemics inthe future. Government involvement is urgently
needed, especially related to the regulation ofblood-based HIV testing by non-health workers.

E-Poster Abstract

272

Cracking the Code to Boost HIV
Testing Uptake: A
Comprehensive Model
Integrating E-commerce
Accessibility and Treatment
Referral.
Mai Q1
1WeCare Social Enterprise, Dong Da District, Việt Nam

Presenter:
Quang Anh Mai, MSW (Master of Social Work - Flinders
University - South Australia)
Institutions:
WeCare Social Enterprise
Sexual Health Promotion Clinic - Hanoi Medical University
Hospital
Center for Training and Research on Substance Abuse and HIV
Vietnam CBO network

Background: The rate of new HIV infections in
Vietnam is concentrated mainly in key high-risk
populations and ranges from 7% to 15% in men
who have sex with men and drug users.
Meanwhile, ensuring successful referrals in highrisk groups still poses significant barriers.
Furthermore, community members are starting toprefer self-testing modalities in the privacy of theirown homes. To address this, WeCare Social
Enterprise, in collaboration with the Sexual Health
Promotion Clinic (SHP) at Hanoi Medical University
Hospital and the Community-Based Organizations(CBOs) network, introduces an innovative model
leveraging e-commerce for self-testing accessibility
and seamless referral to PrEP services and HIV
treatment.
Methods: WeCare has made our rapid HIV test kitsavailable on popular e-commerce platforms,
Shopee and Lazada. Through collaborations with
Community-Based Organizations (CBOs) and the
Sexual Health Promotion Clinic, we have devised a
strategic approach to ensuring these kitseffectively reach high-risk communities.
Utilizing the extensive networks of 24 CBOs, weshare purchase links for the test kits on their
online platforms, ensuring broad access among
vulnerable populations. Our communication

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experts play a crucial role in enhancing outreachefforts, leveraging trust built through priorinteractions with hotspot owners, community
leaders, and CBOs.
Each kit includes brochures supporting
confirmatory testing and free HIV treatment
information for positive cases. It also includes a listof facilities offering free PrEP medication and a
support hotline from the SHP clinic. For clients
who initiate PrEP through our test kits at the SHP,
we offer a refund for the test kit purchase andfacilitate seamless referral to the SHP at Hanoi
Medical University Hospital. This integrated
approach ensures that individuals not only haveaccess to testing but also receive the necessary
support and follow-up care.
Results: Since the model’s launch in May 2023,
685 self-test kits have been sold, connecting
approximately 13.44% (92 individuals) to PrEP
services, identifying approximately 6.72% (46cases) of new HIV-positive cases, and successfullyreferring approximately 5.54% (38 individuals) to
ARV treatment. Additionally, 5 cases (6.25%)
returned to their provinces for treatment due totheir insurance registration, with only 3 cases(3.75%) lost to follow-up.
Conclusion: The success of our model underscores
the effectiveness of collaborative efforts between
a social enterprise, a medical institution, andcommunity organizations in bolstering HIV testing,prevention, and treatment. A key aspect of ourmodel is expert outreach, which plays a significant
role in providing detailed insights to inspire andguide others in implementing similar programs attheir respective institutions. Moving forward, we
will explore the continuation and adaptability ofthis model to other social enterprises andcommunity-based organizations.

E-Poster Abstract

273

Acceptability, Feasibility, andEffectiveness of HIV
Community-Based Services
among MSM Community inIndonesia: An Implementation
Research
Sudirman S1, Ruxrungtham K1, Phanuphak N2,
Nadia Tarmizi S3
1Chulalongkorn University, Bangkok, Thailand, 2Institute of HIV

Research and Innovation, Bangkok, Thailand, 3Ministry of
Health Indonesia, Jakarta, Indonesia

Background: As one of the most rapidly growing
HIV epidemics in Asia, Indonesia has failed toachieve the UNAIDS targets, even though it hasvarious services and programs. The World HealthOrganization (WHO) has recommended to expand
HIV testing outside the clinical setting.
Community-based HIV service (CBS) is one
approach recommended. Adopting the KPLHS (KeyPopulation-Led Health Services) model in Thailand,
we implemented an HIV CBS pilot project. We
aimed to determine this approach's acceptability,
feasibility, and effectiveness among the MSM
community in Indonesia.
Methods: A cross-sectional study using aconcurrent mixed-method design was conductedfrom Mei to November 2023 in South Sulawesi,
Indonesia. We collected quantitative data using
questionnaires among the MSM population andqualitative data with focus group discussions(FGDs) and in-depth interviews (IDIs) to gather
information from HIV service beneficiaries,
community health workers, health workers, andstakeholders to assess the acceptability, feasibility,
effectiveness, and evaluation of the HIV CBS
model. We analyzed quantitative data
descriptively and qualitative data deductively
following the thematic framework approach.
Results: A total of 423 MSM participated andaccessed the HIV CBS during the implementation
phase. 2.8% (12) of the total were screened for
HIV reactive and 1.9% (8) Syphilis reactive. All HIV
and Syphilis reactive were successfully referred for
confirmatory tests in health facilities. 100% of

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participants expressed that community members
were acceptable to perform HIV and Syphilis rapid
tests in the community, 98.8% preferred rapid
testing in the community rather than in healthfacilities, 99.3% were willing to support HIV CBS,
79.2% were willing to recommend the CBS, 67.4%
had willingness to pay if CBS was not free, and68.3% were very satisfactory about the CBS. All
group informants in qualitative data collection
stated that the CBS was acceptable, possible, andnecessary to develop in other areas, community
members were worthy of conducting HIV services
in CBS, and the CBS has a significant impact on the
HIV program and the community.
Conclusion: The HIV community-based service is
acceptable and feasible to implement, and it iseffectively supporting the HIV program.
Multisector support, regulations from thegovernment related to capillary-based HIV testingby non-health workers, and relevant pilot projects
in other areas are needed to escalate this service
model as a national program in Indonesia.

E-Poster Abstract274

Boosting HIV Self-Testing Kit
Uptake: Leveraging Mpox
Vaccination Opportunities in
TaiwanHuang H1, Chiu C1, Lai Y1, Liang Y1, Lai P1, Chan P1,
Lee C1
1Taiwan Centers For Diseases Control, Taipei, Taiwan

Since 2016, Taiwan has initiated an pilot HIV selftesting program. Initially, it involved traditional
face-to-face manual distribution and the setup of
self-service machines in health units, LGBT-friendly
centers, and pharmacies,etc. In 2017, the program
expanded to include online ordering and 24-hour
convenience store pickup services to increase
service capacity. By 2023, there were 575
execution points, 79 self-service machines, andover 10,600 convenience stores providing services.
In both 2021 and 2022, an average of over 50,000
self-screening test kits were distributed,
equivalent to 217 self-screening tests per 100,000
individuals. The initial HIV testing self-reported
positive rate was around 1% in 2017 and has
ranged between 0.4% and 0.5% in 2021 and 2022.
In February 2023, Taiwan began to reportdomestic cases of Mpox. Epidemiologicalinvestigations found that over 60% of these cases
were HIV-infected individuals. This indicates asignificant overlap between high-risk groups for
Mpox and HIV infections. Therefore, shortly after
the domestic outbreak in February 2023, during
planning of vaccination services, HIV self-testing
kits were planned to distribute alongside with
Mpox vaccination opportunities.
A total of 141 vaccination sites cooperated in thiseffort, and distributing work was done to facilitate
the public, with a limit of one kit per person per
vaccination. The process of obtaining the kits was
integrated into the vaccination workflow of Mpox
vaccination hospitals, clinics or health stations,with providing a testing kit directly, and recorded
the number of testing kit at the top right of theconsent form or registered in the list foraccounting process, to reduce the extra effort
from service sites for Mpox vaccination.

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Distribution began on June 1, 2023. By December
31, 2023, a total of 18,274 self-screening test kits
were distributed through Mpox vaccination sites,
reaching 79,851 individuals in total. This
represented an increase of 25,413 individuals, or a
47% increase compared to 2022. The initial
screening positive rate recorded at Mpox
vaccination sites was 0.7%, higher than the
average HIV positive rate in 2021 and 2022.

E-Poster Abstract

275

Rapid Development of
Neurological Infection in an
HIV Patient Following
Schistosomiasis
liu y1, kong x, zhou gFirst Hospital Of Changsha, Changsha, China

1

Background: HIV-1 and schistosomiasis infections
pose significant challenges to global public health.
The neurological infection caused by these twopathogens is easily misdiagnosed due to its rarity.
Thus, accumulating experience to manage suchcases is crucial.
Case presentation: We present a case of a 36year-old AIDS patient who was initially diagnosed
with HIV-1 infection four years ago without
antiretroviral therapy (ART). Approximately one
year ago, the patient was hospitalized due to thediagnosis of tuberculosis and subsequently
initiated ART. After one year of treatment, thepatient achieved virological suppression of HIV-1.
However, he was readmitted to the hospital,presenting with high fever and headache.
Although tuberculosis was considered based onclinical performance and brain imaging features,
his symptoms did not improve after
antituberculosis therapy. Further investigation
confirmed an intracranial infection caused byschistosomiasis. Following anti-schistosomiasis
treatment and optimized ART, the patient
experienced complete recovery and was
subsequently discharged.
Conclusions: we reported the first case in Asia of apatient afflicted with HIV who rapidly developed
neurological infection subsequent toschistosomiasis acquisition. Thorough medical
history inquiries, comprehensive analyses, and theprovision of timely and accurate treatment cansignificantly benefit patients.

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E-Poster Abstract

276

Outcomes of rapid initiation of
antiretroviral therapy among
HIV-positive patients: realworld experience from asingle-center retrospective
cohortXu G, Sun C1
1Qingdao 6th people's Hospital, Qingdao, China

Objectives: Rapid initiation of antiretroviraltherapy (ART) engenders faster viral suppression
as reported by clinical trials. But real-world
experience with rapid ART initiation remains
limited China as different medical policies andvarious known about the benefit of it.
Main outcome measures: This is a retrospective
study enrolled patients from 2022 Jan to Dec in
Medical records, Qingdao 6th Hospital. Rapid ART
initiation was defined as starting ART within 7 days
after HIV diagnosis confirmation. HIV diagnosis,
ART initiation and viral suppression dates andclinical outcome data were collected by reviewing
medical records. The time for viral suppression
started counting from the day treatment
initiation.
Results: There were 432 treatment naive people
with HIV (PWH) enrolled, the average age was 39y,
93.5% were male, 81.7% were homosexualtransmission. 50.2% PWH initiated TDF+LAM+EFV(TLE) treatment, and 15.5% were under B/F/TAF,
14% were under DTG/3TC. All of those patients,
only 44.2% PWH initiated ART within 7 days.
Compared with PWH those without rapid ART
initiation, there were no significant difference inage, sexual, marriage status, ART regimens, waysof transmission , education status. There weremuch more people detected HIV infected throughpassive checking (66.2% vs 48%, p=0.003), andmore be workers(57.3% vs 41.9%, p=0.01) in rapid
initiation group.
There was no significant difference for vroligicalresults at 90 days between those two groups,evennumerical lower in rapid initiation group(66.7% vs
82.7%). The logistic regression for 90 days viral

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suppression rate showed that only ART regiments
were significant risk (P<0.001). The viral
suppression rate was 93.3% for B/F/TAF, 83.3% for
DTG/3TC, and 50% for TLE, separately, in rapid
initiation group and significant different (P=0.043).
Similar results for adherence rate at 1 year, nodifference found between people with or without
rapid initiation. The logistic regression showedthat only ART regiments were significant risks(P=0.001). The adherence rate was 74.2% for
B/F/TAF, 60.7% for DTG/3TC, and 57.2% for TLE,
with significant different (P=0.006).
Discussion:
1.Nearly half of PWH initiate with 7 days, weshould do more to have them known the benefitof rapid initiation. Especially for those PWH who
are unemployed, and active come to clinic.
2.It is reasonable to find no significant differenceof viral suppression between PWH with ART rapid
initiation or not, as the time counting form the day
ART started. And as the high resistance barrier andefficacy, B/F/TAF shows the highest viral
suppression rate than others. Learned that theregimen also plays an important role in rapid
initiation.
3. 1 year adherence rate is another importantresult for treatment and also only related totreatment regiments. It shows B/F/TAF has thehighest rate of adherence rate, the regimens
choice should be taken into consideration for rapid
initiation for a better treatment result andadherence.

E-Poster Abstract

277

The clinical prognostic risk
stratification system for HIV
infected hepatocellular
carcinoma
Chen Y1,2, Zhao H3, Wang Y2, Liu B3, Chen Z3, Tao Y1,
Xun Y4, Yang H4, Liu R1, Feng L3, Liu X3, Li H3, Wang
S3, Zhao D5, He H3, You H1,2
1Children's Hospital Of Chongqing Medical University,

Chongqing, China, 2Affiliated Cancer Hospital & Institute ofGuangzhou Medical University, Guangzhou, China, 3Guangzhou
Eighth People's Hospital, Guangzhou, China, 4Foshan University,
Foshan, China, 5Shenzhen Third People’s Hospital, Shenzhen,
China

Background: Patients with humanimmunodeficiency virus (HIV) are more susceptible
to liver cancer because of their compromised
immune system. There is no specific prognostic
model for HIV-infected hepatocellular carcinoma(HCC) patients.
Methods: Clinical data of 85 patients with HIVinfected HCC was divided into a 7:3 ratio fortraining and internal validation sets, while the dataof 23 patients with HIV-infected HCC was served as
the external validation set. Data of 275 HIVnegative HCC patients was considered as external
HIV-negative validation set. Variables associatedwith overall survival (OS) in the training set wereused to develop the HIV-infected HCC prognosis(HIHP) model. The model was tested in theinternal and external validation sets. The
predictive accuracy of the model was assessedwith conventional HIV-negative HCC prognostic
scoring systems.
Results: The HIHP model demonstrated asignificant association with OS in the training set,with a median OS of 13 months for low risk, 7months for medium risk, and 3 months for highrisk (p < 0.001). The HIHP model showed asignificant association with OS, and exhibited
greater discriminative abilities compared toconventional HIV-negative HCC prognostic models
both in the internal and external validation sets. In
the external HIV-negative validation set, the HIHP
model did not show better discrimination thanconventional HIV-negative HCC scores.

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Conclusion: The new model presented in the work
provided a more accurate prognostic prediction of
OS in HIV-infected HCC patients. However, themodel is not applicable to patients with HIVnegative HCC.

E-Poster Abstract

278

Enhancing private sector’s rolein providing comprehensive
person-centered care and HIV
treatment services to people inneed.
Green K1, Tran T1, Nguyen V1, Khanh A1, Ngoc B1,
Phuong P1, Khanh L1, Quang K2, Minh T3, Nguyen
D4, Ngo T4, Doan A4
1PATH, Hanoi, Viet Nam, 2Galant Clinic, Ho Chi Minh City, Viet

Nam, 3Glink Clinic, Ho Chi Minh City, Viet Nam, 4United States
Agency for International Development (USAID), Hanoi, Viet
Nam

Background: With strong understanding of theirclients, private clinics play a vital role in delivering
HIV services to key populations (KPs) by offering awide range of HIV-related services inaccommodative ways, including confidentiality,
flexible working hours, and continuously
improving to meet the needs of targeted clients.
To strengthen private sector engagement inproviding comprehensive person-centered careand HIV treatment services, the USAID/PATH
Support for Technical Excellence and Private
Sector Sustainability in Vietnam (STEPS) projectdelivered a complete package of technical training
and continuous quality improvement (CQI) to two
private clinics, named Glink and Galant in Ho Chi
Minh City, Vietnam.
Description: Since 2022, STEPS has been providing
technical assistance to private clinics in delivering
comprehensive healthcare for ART clients
including same day antiretroviral therapy (ART),
HIV viral load testing, prophylaxis and treatment
for opportunistic infections; as well as providing
other client centered services such as screening
and linkage to mental health, non-communicablediseases such as dyslipidemia, diabetes,
hypertension etc. In addition, STEPS provides
training and tools for CQI to clinics by regularlycollecting client feedback on service delivery, andoffering solutions to address areas that need
improvement.
Lessons learned: From October 2022 toSeptember 2023, 1,518 clients received ART at

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304

Glink and Galant clinics (commercial clients: 731;
clients with Social Health Insurance (SHI): 787) out
of which 509 were new clients. Most clients weremen who have sex with me (MSM) (94.5%) with anaverage age of 27 years. In terms of socioeconomic status, the majority of clients had acollege or higher education level (57%), werecurrently employed (82.2%) and were office
workers (44.2%). As of 2023, treatment
effectiveness was very high with viral suppressionof 99.8%, much higher than the national rate of
96%, and the treatment retention rate of ARVclients is at 85.3%.
Conclusions/Next steps: Private clinic
participation in providing comprehensive ART
services contributes an important role to diversify
choices to meet the needs of clients. Besides
ensuring treatment according to standard care,holistic health care needs are comprehensively
being taken care of as an integral part for such
populations.

E-Poster Abstract

305

279

coverage among FSWs and MSMs increased tomore than 95%, among IDUs to 72%.

Reaching the unreachedvulnerable population with
HIV prevention and careservices: Learning from
National AIDS Control
Programme in India

Lessons learnt: The adoption of differentiatedprevention model (DPM) and segmenting KPs not
only contributed in expanding the coverage andimproved behavioural outcomes among vulnerable
groups but also increased the number ofindividuals linked to HIV treatment. These
achievements highlight the effectiveness oftargeted, peer-led interventions and differentiatedcare models in managing concentrated HIV
epidemics.

Badgujar S1Conclusions: With changing dynamics of HIV anddecline in financial resources, it's become very
important that HIV prevention and care services,
are continuously modified to to respond tochanging context. The learnings from successful
implementation and scale-up of DifferentiatedPrevention Model (DPM) in India, can help othercountries too.

1Network of Asian People who use Drugs (NAPUD), Pune, India

Background: India's National AIDS Control
Programme (NACP), has been pivotal in addressing
the country's significant HIV epidemic, particularly
among key populations (KPs) including men who
have sex with men, female sex workers, andpeople who inject drugs. Despite substantial
progress, the program faced challenges due tochanging practices among key population and gaps
in linkages to antiretroviral therapy (ART). In 2018,with the support of the World Bank, the NACP
underwent strategic revisions to enhance its
effectiveness.
Methods: The revised strategy introduced theDifferentiated Prevention Model (DPM),
segmenting KPs into five risk groups to prioritize
services for those with higher risk andvulnerability, including new KPs. A Peer Navigation
initiative was implemented, wherein role model
peers assisted KPs through the processes of HIV
diagnosis, treatment, and care. Additionally, theDifferentiated Care Model was adopted tocustomize patient treatment services, reducing
hospital visit frequency and waiting times.
Results: These strategic changes led to substantial
improvements in coverage and behavior among
KPs. Condom use increased significantly from 2013
to 2020: among female sex workers (FSW) from
80% to 96%, and among men who have sex withmen (MSM) from 45% to 85%. Safe drug injection
practices increased from 45% to 88% amongpeople who injected drugs. The strategy alsoenhanced the linkage of HIV-positive individuals totreatment, increasing the number of people
receiving HIV treatment in India from 1.05 million
in 2017 to 1.38 million in 2020. Further, by 2023,

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E-Poster Abstract

280

Development and delivery ofan online HIV pre-exposure
prophylaxis (PrEP) training forcommunity pharmacists forthe implementation ofpharmacy-based PrEP service
in the Klang Valley, Malaysia.
Gan Y1,2, Hafidzar S3, Koh K4, Nizaruddin M5, Mohd
Nor R6, Khalid K7, Yap A8, Ahmad Zaki R1,9, Lim S1,3,
Altice F3,10,11,12, Azwa I3,13
1Department of Social & Preventive Medicine, Universiti

Malaya, Kuala Lumpur, Malaysia, 2Malaysian HealthTechnology Assessment Section, Ministry of Health, Putrajaya,
Malaysia, 3Centre of Excellence for Research in AIDS (CERiA),
Universiti Malaya, Kuala Lumpur, Malaysia, 4Department ofInternal Medicine, School of Medicine, International Medical
University, Kuala Lumpur, Malaysia, 5Department of Community& Pharmacy Practice, Faculty of Pharmacy, University ofCyberjaya, Cyberjaya, Malaysia, 6Department of Medicine,
Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh,
Malaysia, 7Department of Medicine, Hospital Kuala Lumpur,
Kuala Lumpur, Malaysia, 8The Red Clinic, Petaling Jaya,
Malaysia, 9Centre for Epidemiology and Evidence-based
Practice (CEBP), Universiti Malaya, Kuala Lumpur, Malaysia,
10Section of Infectious Diseases, Department of Internal
Medicine, Yale School of Medicine, New Haven, United States,
11Department of Epidemiology of Microbial Diseases, Yale
School of Public Health, New Haven, United States, 12Center forInterdisciplinary Research on AIDS (CIRA), Yale University, New
Haven, United States, 13Infectious Diseases Unit, Department ofMedicine, Universiti Malaya, Kuala Lumpur, Malaysia

Background: Study has shown that some key
population members prefer to access HIV preexposure prophylaxis (PrEP) through pharmacies.
As community pharmacists are recognized as
widely accessible and trusted healthcare
professionals, there is potential to expand PrEP
access through a demedicalised, differentiatedservice delivery model in the community
pharmacy setting. In preparation to pilot a
pharmacy-based PrEP service delivery in Malaysia,
an online self-paced PrEP training program forcommunity pharmacists was developed andevaluated for its effectiveness.
Methods: This study was conducted between May
and June 2023. A PrEP training committee
consisting of 5 experts from professional medical
and pharmacy societies, and academia developed

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an online self-paced training program covering thefundamentals of PrEP. This included efficacy,
safety, eligibility criteria, initial assessment, HIV
testing and other baseline tests, prescribing PrEP,
and special situations. The training modules wereadapted from the HIV Connect training programfor general practitioners, based on current best
evidence, and tailored to the needs of community
pharmacists. Program effectiveness was evaluatedthrough pre- and post-training knowledge tests,
followed by post-training feedback form. Bothtests comprised of 20 questions each, with correct
answers scoring 5 points with a maximum score of
100 points. The tests were pilot tested with 5
pharmacists and the passing mark was determinedas 55% based on pre-test median score. Paired ttest was performed to determine the difference
between pre- and post-training knowledge scores(significance level of p<0.05).
Results: A total of 18 community pharmacists
completed the online training via the Edpuzzle
platform over 2 weeks. The mean age of theparticipants was 32 years, with a male-to-female
ratio of 1:3 and an average of 7.9 years of work
experience. All participants surpassed the 55%
passing mark for the post-test. The mean
(standard deviation (SD)) scores for pre- and posttraining knowledge scores were 64.72% (9.77) and
78.89% (7.96), respectively. The mean difference
was 23.61% and statistically significant (p<0.001).
Majority of the pharmacists agreed that thetraining covered the expected content; thecontent was organized, easy to follow and easy tounderstand; the duration of training wasappropriate; the additional resources were
helpful; overall they were satisfied with thetraining; the training will be useful for their work;and they would recommend to others.
Conclusions: The novel approach of using an
online self-paced training program to train
community pharmacists for PrEP service delivery isan effective tool to increase the community
pharmacists’ knowledge of PrEP. This approach
can be expanded to train community pharmacists
nationwide to provide greater access to PrEP in
Malaysia.

E-Poster Abstract

281

PrEPPY Spaces: Community-led
initiation of PrEP using selftesting kits among men who
have sex with men using
online social networks in
Metro Manila, Philippines
Cruz D1,2, Rosadiño J1,2, Aspiras G1, Pe Benito J1,
Dela Cruz J1, Pagtakhan R1
1LoveYourself Inc., Mandaluyong, Philippines, 2Faculty ofManagement and Development Studies, University of thePhilippines - Open University, Los Baños, Philippines

Background: The Philippines has been identified ashaving the fastest-growing HIV epidemic in theWestern Pacific region, diagnosing 48 cases per
day as of May 2023. To ease testing access foreveryone, collaborations with community-basedorganizations were strengthened to expand HIV
testing services. Increased HIV-specific programs,
especially PrEP initiation, are needed forcommunities to become more aware and produce
better engagement. Capacitating providers fortelemedicine and tapping other social networks
are possible steps to increase PrEP utilization evenin rural areas. This project made use of online
dating apps to provide differentiated testing
services and demedicalized PrEP distribution
through individual meet-ups with PrEPPY Spaces
volunteers.
Description: PrEPPY Spaces started in May 2023
upon the release of the simplified WHO guidelines
on PrEP initiation. The project was piloted in thegreater Metro Manila area where the majority ofthe volunteers of the project are residing. The
volunteers used location-based online dating apps
to initiate contact with potential participants. The
volunteers were trained in the use of HIV selftesting kits and key messages for PrEP. An
algorithm was created for the assessment of PrEP
eligibility and enrollment.
Lessons learned: In total, 610 self-testing kits were
distributed with instructions on how to reporttheir results and linkage to care should theychoose to do testing alone. A total of 104 men
who have sex with men were enrolled in the

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project and all participants were PrEP naïve. Out of
the 106 that were enrolled in the program, 21
participants were able to have their on-site refill ata facility convenient for them to visit. On-site visitswere scheduled for an STI workup and a creatinine
test.
Conclusions: Tapping transgender volunteers in
the next phase of the project might also increase
HIV testing access and PrEP enrollment among the
population. Other location-based social networks
may also be explored especially when targeting
different key populations. Monitoring theparticipants' preferred dosing is also important totrack adherence and refills for programmatic
implications. Alternative ways of follow-up andrefills should also be explored (use of couriers fordeliveries, or partnerships with other facilities for
STI workups).

E-Poster Abstract

282

A Comparative Analysis of theWillingness to Access PrEP
Among Cisgender and Other
Gender-diverse Individuals of
Iloilo Province
Labiano R1,2, Leonor E3, Banico W3, Buencuchillo
A3, Depasupil S3, Laurilla M3, Parreño L3, Yap K3,
Macalalag A3, Olete R4
1Team Dugong Bughaw, Iloilo City, Philippines, 2Mother Candide
Center, St. Paul’s Hospital of Iloilo, Inc., Iloilo City, Philippines,
3Iloilo Doctors’ College – College of Nursing, Iloilo City,
Philippines, 4National Cheng Kung University – Department of
Public Health, Tainan City, Taiwan

Introduction: Pre-Exposure Prophylaxis (PrEP) is ahighly effective method of preventing HIV
acquisition and was made available in thePhilippines in 2017. Despite its availability,transmission continues due to a lack of knowledge,
gender stigma, financial limitations, andinadequacies in the healthcare system. This study
sought to understand Ilonggos' willingness toutilize PrEP in light of their varied gender identities
in order to increase accessibility and provide
gender-sensitive interventions with the goal oflowering HIV transmission and improving healthoutcomes in the locality.
Method: A cross-sectional survey was conducted
between January and February 2024 among 178
sexually active individuals in Iloilo Province. The
survey used a 10-point Likert scale to assess thewillingness of cisgender and other gender-diverse
individuals to access PrEP. Descriptive statistics
were used to analyze the data.
Results: In this study, results showed that othergenders are more inclined to take daily HIV
prevention medications (38.8%, 19 out of 49),
utilize Pre-Exposure Prophylaxis (PrEP) if it is free
(61.2%, 30 out of 49), and adopt PrEP when it
becomes available (40.8%, 20 out of 49). On theother hand, cisgender people indicate that they
are willing to take PrEP (36.4%, 47 out of 129),
continue taking pills consistently to prevent HIV(38%, 49 out of 129), and continue using PrEP in
spite of its side effects (32.6%, 42 out of 129).
Comparable willingness to participate in PrEP is

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308

shown by both groups (37.2% or 48 cisgender,
36.7% or 18 other genders). Comparably, theyboth exhibit low willingness to take PrEP if it is nota hundred percent effective (27.9% or 36
cisgenders; 34.7% or 17 in other genders). Overall,
48.8% of cisgenders showed high willingness,
43.4% showed low willingness, and 7.8% showedno willingness, while 59.2% of other genderdiverse individuals showed high willingness, 36.7%
showed low willingness, and only 4.1% showed nowillingness.
Conclusion: This study revealed the diverse
willingness levels toward HIV prevention among
genders, thus emphasizing the need for gendersensitive and gender-transformative interventions.
While other genders exhibit a higher overall
willingness compared to cisgender individuals,
customized strategies are essential to meet arange of needs and guarantee that Pre-Exposure
Prophylaxis (PrEP) has equitable access and uptake
for people of all gender identities.

E-Poster Abstract

283

Stakeholder insights on
implementing pharmacy-based
HIV pre-exposure prophylaxis(PrEP) service delivery modelin the Klang Valley, Malaysia
Gan Y1,2, Ahmad Zaki R1,3, Syed Razif S4, Ahmad
Nizaruddin M5, Rajasuriar R4,6, Basri S4,7, Yap A8,
Lim S1,4, Altice F4,9,10,11, Azwa I4,7
1Department of Social & Preventive Medicine, Universiti

Malaya, Kuala Lumpur, Malaysia, 2Malaysian HealthTechnology Assessment Section, Ministry of Health, Putrajaya,
Malaysia, 3Centre for Epidemiology and Evidence-based
Practice (CEBP), Universiti Malaya, Kuala Lumpur, Malaysia,
4Centre of Excellence for Research in AIDS (CERiA), Universiti
Malaya, Kuala Lumpur, Malaysia, 5Department of Community &Pharmacy Practice, Faculty of Pharmacy, University ofCyberjaya, Cyberjaya, Malaysia, 6Department of Medicine,
Universiti Malaya, Kuala Lumpur, Malaysia, 7Infectious Diseases
Unit, Department of Medicine, Universiti Malaya, Kuala
Lumpur, Malaysia, 8The Red Clinic, Petaling Jaya, Malaysia,
9Section of Infectious Diseases, Department of Internal
Medicine, Yale School of Medicine, New Haven, United States,
10Department of Epidemiology of Microbial Diseases, Yale
School of Public Health, New Haven, United States, 11Center forInterdisciplinary Research on AIDS (CIRA), Yale University, New
Haven, United States

Background: Despite the evidence supporting preexposure prophylaxis (PrEP) to prevent HIV andthe high unmet need, <5000 people in Malaysia
have accessed free medication available ingovernment health clinics in 2023. To address this
implementation gap, we explored the feasibility ofleveraging the private community pharmacies toprovide demedicalised and differentiated PrEP
service delivery through a collaborative
stakeholder consultation.
Description: In April 2023, a one-day meeting washeld in Kuala Lumpur with 31 stakeholders from
community pharmacies, professional medical andpharmacy societies, telemedicine provider, nongovernmental organisations (NGOs), and HIV
implementation science researchers. Stakeholders
first reviewed the barriers and facilitators statedby key populations, PrEP prescribers, andcommunity pharmacists in the Klang Valley (anurban region including the state of Selangor andfederal territories of Kuala Lumpur and Putrajaya)
from a recently completed qualitative study.
Stakeholders considered how the pharmacy-based

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PrEP service might fill the implementation gap andidentified ways to overcome barriers related tocore components of pharmacy-based PrEP service(promotional activities, HIV testing, pharmacist
assessment and counselling, physician prescribing,
PrEP dispensing, and follow-up). Attendees also
reviewed a proposed implementation protocol,
care pathway, workflow, assessment tool, training
needs and competencies for community
pharmacists as well as implementation site
selection and preparation needs. Key discussion
points were summarized.
Lessons learned: Community stakeholders
suggested ensuring privacy during consultation;
ensuring affordable PrEP pricing; establishing afeasible workflow for pharmacy-based PrEP
service; implementing digitalised checklist-based
assessments to reduce opportunities for stigma,
streamline workflow and facilitate documentation;
incorporating the use of HIV self-testing;
simplifying laboratory testing requirements;
ensuring collaboration with NGOs, PrEP
prescribers, and laboratory providers; andensuring strict confidentiality of client information.
Stakeholders perceived that pharmacists would
need additional training including adequate
education about PrEP, how to reduce stigma
during eligibility screening, PrEP initiation andfollow-up visits, strategies to optimize referrals for
supplemental clinical services (e.g., HIV care,sexually transmitted infection (STI) services,
Hepatitis B virus (HBV) care, etc.) and effective
communication skills addressing culturalcompetency when communicating with key
populations who are socially stigmatized in
Malaysia. Necessary competencies included
knowledge on HIV and STI; risk behaviourassessment; professional, stigma-free and nonjudgmental behaviour; and using person-centredlanguage. Six implementation sites were selectedbased on availability of a private consultation
room, willingness of pharmacists to provide PrEP
service, availability of telemedicine, location in the
Klang Valley, and proximity to PrEP clinics.
Preparation needs included ensuring theavailability of HIV self-test kits, PrEP medication,
PrEP leaflets, trained pharmacists, and partnering
PrEP clinics within 10km for referrals andlaboratory testing needs. Findings were used torefine and finalise the implementation plan.
Conclusion: Stakeholders were supportive andenthusiastic about the pharmacy-based PrEP
service delivery model as an alternative access to
PrEP in the Klang Valley, Malaysia. Future research

E-Poster Abstract

is essential to evaluate the sustainability of thisnovel implementation strategy to increase PrEP
uptake in Malaysia and other similar settings.
Streamlining the approach to be simplified,person-centred, and demedicalised will be pivotal
for successful implementation.

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310

E-Poster Abstract284

Knowledge, perception, andwillingness to access PrEP
among individuals in Iloilo,
Philippines
Leonor E1, Buencuchillo A1, Depasupil S1, Laurilla
M1, Banico W1, Parreño L1, Yap K1, Macalalag A1,
Olete R2
1Iloilo Doctors' College, Iloilo City, Philippines, 2National Cheng

Kung University , Tainan City, Taiwan

Introduction: The human immunodeficiency virus(HIV) in Iloilo, Philippines, is a health threat thatascends among individuals in Iloilo, Philippines,
hence, alarms for an urgent need to address theescalating rates of HIV transmission. As the region
grapples with rising HIV cases, particularly among
the mentioned key populations, the exploration ofeffective preventive measures becomesparamount. Among these strategies, Pre-Exposure
Prophylaxis (PrEP) represents a pivotal
advancement, offering a proactive approach
towards HIV prevention. However, the extent ofawareness, perceptions, and willingness of
individuals to access PrEP remain a significant gap
in current understanding. Grounded in the HealthBelief Modell, this research delves into theintricacies surrounding the PrEP utilization, aiming
to uncover valuable insights and understanding
among individuals in Iloilo, Philippines. The
insights derived from this inquiry bear a potential
lead to enhance the interventions aimed at
augmenting the PrEP accessibility, ultimately
paving the way to reduce HIV transmission rates
and an improvement in health outcomes among
the individuals in Iloilo, Philippines.
Method: In this study, a descriptive cross-sectional
survey was conducted between January 08, 2024
and February 10, 2024 among 178 individuals
residing in Iloilo, Philippines. The survey useddichotomous questions answerable by “True” or“False” and Likert scales to assess the level ofknowledge, perception, willingness of theindividuals towards accessing HIV Pre-Exposure
Prophylaxis (PrEP). Inferential statistics were used
to analyze the data.

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311

Results: In this study, there are 178 respondents
which majorly consists of 50.56% adults (22-36
years old) and 44.49% young respondents (18-21
years old). More than half of the respondents or
55.62% have a high level of knowledge about PreExposure Prophylaxis (PrEP) when they areclassified according to age, sex, gender , sexual
orientation, place of residence, educational
attainment, employment status, and monthly
income. Majority of the respondents (80.34%)
strongly agreed that they might be infected with
HIV if their sex partner is having unsafe sex withothers and 55.62% of the respondents strongly
agreed that PrEP will provide the option to getearly prevention from acquiring HIV. For thecorrelation between knowledge, perception, andwillingness of the respondents there is no
significant correlation. However, respondents(22.47%) have shown to strongly disagree thatthey are concerned about separation from theirfriends and families if they access PrEP due to thestigma associated with it. Majority of respondents(68.5%) are more willing to use PrEP if they havemore information. But, some of the respondents(41%) are less willing to use PrEP even if it wasmade available in the Philippines.
Conclusion: Understanding the correlation ofknowledge, perception, and willingness to access
Pre-Exposure Prophylaxis (PrEP) among individuals
in Iloilo, Philippines, is crucial for designing
targeted interventions and improving public healthoutcomes. The findings underscore theimportance of tailored education programs,
destigmatization efforts, and enhanced
accessibility to PrEP services to effectively address
HIV prevention in these communities.

E-Poster Abstract

285

Overcoming Barriers andHarnessing Opportunities:
Lessons from Mongolia's PrEP
Demonstration Project for
MSM Populations
Chansiri M1, Zayasaikhan S2
1Health Equity Matters , Asok, Thailand , 2Youth for HealthCenter NGO, Bayangol District , Mongolia

The introduction of Pre-exposure Prophylaxis(PrEP) in Ulaanbaatar, Mongolia among men who
have sex with men (MSM), was led by the National
Center for Communicable Disease (NCCD) and theMinistry of Health (MOH), in collaboration with
the Youth for Health Center (YFHC) and Health
Equity Matters. This demonstration project,conducted between 2021 and 2022, aimed toassess the feasibility of PrEP to prevent HIV
transmission in high-risk populations andcontribute to the national goal of 95-95-95 for HIV
prevention and treatment. The project's success
was evidenced by notable participation andcompletion rates among MSM, leading to theintegration of PrEP into the revised National STI,
HIV, and AIDS Diagnosis and Treatment Guideline
in April 2023.
The global health community recognizes PrEP as a
critical tool in HIV prevention strategies,
particularly for populations at substantial risk ofinfection. Mongolia's demonstration project, led
by the NCCD and YFHC, aimed to address the highHIV and syphilis prevalence among MSM and TGW
populations, as well as tackle issues related tostigma, discrimination, and low condom use. The
project's findings underscore the urgent need forcomprehensive HIV prevention strategies,
including PrEP, to mitigate the risk of new HIV
transmission networks.
Despite the project's positive outcomes, which
included high acceptability, engagement, and noreports of HIV seroconversions or serious adverse
effects, the implementation revealed significant
barriers to PrEP accessibility. The primary barrier isthe lack of PrEP medication registration as well as
inclusion in the list of Essential Medicines with theMedicine and Medical Device Regulatory Agency

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312

(MMRA), coupled with challenges in the private
healthcare market and the absence of PrEP in the
Health Insurance General Officer (HIGO) scheme,
Mongolia's healthcare reimbursement system.
HIGO scheme is a recent reform in health sector
financing of Mongolia. In addition, the law of
medicine is under revision.
The pilot indicated a pressing need for urgent,comprehensive HIV prevention strategies that
include PrEP, especially given the higher rates of
HIV infection among MSM and transgenderwomen (TGW), as opposed to the general
population. However, due to the lack ofregistration, as well as inclusion in the essential
medicines’ list, and unstable policy environment,
an anticipated delay in PrEP registration poses a
strategic challenge that demands immediate
attention. Therefore, the main objective now is tofind the right strategy to secure registration for
PrEP and inclusion in the list of Essential Medicines
beyond the regulatory obstacles due to thesechallenges.
In conclusion, for PrEP to be effectively integrated
into Mongolia's HIV prevention strategy, efforts
must now focus on expediting its registration as an
essential medication. Simultaneously, there must
be an increase in community awareness anddemand, improved healthcare services that areclient-centered, and an enhanced supportive
environment that assures safety andconfidentiality for potential PrEP users, especiallywithin hidden networks such as MSM.

E-Poster Abstract

286

Dysbiosis of Gut Microbia andChanges of Immune Markers in
HIV Pre-Exposure Prophylaxis(PrEP) Users
Chiang C1, Yen-Hung L1, Pei Lun H2, Ya-Hui W1, HuiMei S1, *Hsiu-Wen C1
1Cardinal Tien Hospital, New Taipei City, Taiwan, 2National

Taiwan University Hospital, Taipei, Taiwan

Background: PrEP, the daily or event-driven use
with the fixed-dose agents, consisting of tenofovir
disoproxil fumarate (TDF) and emtricitbine (FTC),
has been regarded as a method to reduce the riskof HIV acquisition. Gut microbial dysbiosis andsubsequently chronic immune activation, inducedby TDF and FTC, in HIV-infected patients has been
widely explored. However, the impact of TDF andFTC on gut microbiota and immune markers in
HIV-uninfected individuals has not been clarified .
Thus, we conducted a prospective observational
study to investigate the effects of PrEP on the gut
microbiota and immune markers.
Method: Participants aged 18 years or older, whowere HIV-uninfected, were recruited in Cardinal
Tien Hospital in Taiwan from June 2023 to August2023. These participants were divided into the
PrEP group and the Non-PrEP group, respectively,
according to the use of PrEP (daily or event-driven,≥ 8 pills in the previous month) or not. Individuals
who had taken antibiotics or probiotics, or
experienced digestive symptoms within the pastmonth were excluded. Serum immune makers,
including interleukin(IL)-1β, 6, 8, 10, 17A, andoxidized LDL(oxLDL) were measured. Stool samples
were collected and DNA extraction was performedfor 16S rRNA gene amplicon sequencing to analyze
the gut microbiota.
Result: 17 participants were enrolled, with 6 in the
PrEP group and 11 in the Non-PrEP group. The
alpha diversity of the gut microbiota wassignificantly higher in the PrEP group. Regarding
the bacterial composition profiles, the results of
PCoA analysis showed that the distribution
between the PrEP and Non-PrEP groups was
significantly different. The PrEP group revealed
expansion of Prevotella genus and a drop in the

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313

proportions of Bacteroides genus, implying
mucosal inflammation. The mean values of the
pro-inflammatory makers, including IL-1β, 6, 8,
17A, and the anti-inflammatory IL-10 were higher
in the PrEP group, though only the level of IL-10
reached the statistical significance. The mean levelof oxLDL is also statistically higher in the PrEP
group, suggesting increased risk of cardiovasculardiseases and metabolic syndrome for individuals in
the PrEP group.
Limitation: There were some limitations in thisstudy. First, only 17 participants were included.
Second, other factors that affect gut microbiota,
such as sexual preference and diet, were notconsidered.
Conclusion: We showed the gut microbial
dysbiosis and changes of immune markers in PrEP
users so that further studies to evaluate theinflammation-driven complications in PrEP users isneeded.
Keywords: gut microbiota, inflammation, preexposure prophylaxis, tenofovir disoproxil
fumarate, and emtricitbine

E-Poster Abstract

287
Abstract 287 has been withdrawn.

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314

E-Poster Abstract

288

The Hidden Crisis: The Causes
and Consequences of
Sexualised Drug Use(‘Chemsex’) amongst Key
Populations in Pakistan
Khan A1
1Dareecha Male Health Society, Rawalpindi, Pakistan, 2Dostana

Male Health Society, Lahore, Pakistan

With the aim of developing a first national level
evidence base study on the effects of Chemsex inPakistan where it remains unspoken. Those
working in HIV sector with key populations andtransgender community demanded for evidencebased research in Pakistan.
Because of the sensitive nature of the topic, it was
important to practice discretion and caution whenreaching out to respondents. For this purpose, 100interviews were conducted at National level inperson through a structured questionnaire. Usinga snowball sampling, relied mostly upon
community-based organizations (CBOs) in 05
major cities and community networks in the other
cities where such CBOs do not exist in order toaccess research participants. Written consent was
taken from all participants and anonymity was
ensured. Respondents were selected based onwhether they were currently engaging or had
previously engaged in the practice of chemsex.
Duration July 2021-February 2022.
Respondents were between the ages of 17 and 54
with the largest number of respondents between
the ages of 20 and 30. Out of which 65% identified
as Key Population (MSM) and 35% Transgenders.
90% reported currently practicing chemsex while
10% said that they previously practiced chemsex.
Considering 90% of the people involved in the
study were still engaged in chemsex and those
who stopped never reported doing so as a result offear or punishment, clearly the punitive approachis ineffective.
Study demonstrate a clear link between thepractice of chemsex and a variety of negative
mental and physical health consequences. Because
crystal meth is known to reduce sexual inhibitions,

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024315

high levels of group sex and unprotected sex werereported by the respondents thus raising the riskof contracting STIs including HIV. Apart from this,those who practiced chemsex reported higher
rates of mental health issues including anxiety,depression, and suicidal tendencies. Thisbehavioral issue is increasing unsafe practices andincrease in HIV positive cases.
The findings of the report clearly demonstrate
there are no formal structures developed forcommunity-based rehab and support, there is aneed for urgent action on the part ofpolicymakers, donors, families, peers and civilsociety organizations to support transgendercommunity and key populations in accessing
support for physical and mental health services inorder to reduce the harm being caused by thepractice of chemsex. Unfortunately, HIV sector at
the moment in Pakistan is unable to take any
formal initiative/action for this behaviour and thus
causing higher risk for spreading HIV and STIs.

E-Poster Abstract

289

Client and Provider
Perspectives on Mental Health
Screening and Linkage to Carein Key Population HIV and
Sexual Services in Thailand: A
Pre-Implementation
Qualitative Study
Sitikornvorakul K1, Janamnuaysook R1, Sinchai K1,
Ramautarsing R1, Ross J2, Mootz J3, Wainberg M3
Institute of HIV Research and Innovation, Bangkok, Thailand,
TREAT Asia, amfAR, Bangkok, Thailand, 3Department of
Psychiatry, New York State Psychiatric Institute and Columbia
University, New York, United States

1
2

Background: Mental health (MH) disorders arehighly prevalent among people with HIV and key
populations in Thailand. However, MH screening
within HIV and sexual health services, and linkages
to MH specialists are limited. The Pribta Tangerine
Clinic, a sexual health clinic in Bangkok, Thailand,
currently offers depression screening, psychosocial
counseling and referral services. Other MH
services (e.g. anxiety, substance use, suicide,psychosis) are not yet available.
Method: Fourteen semi-structured interviews withpeople with HIV (n=8) and healthcare providers(n=6), were conducted between June-December
2023. People with HIV were a quota sample whileproviders, including clinicians, psychologist,
nurses, and counsellors, were enrolled based onroles involved in MH service provision. Guided by
the Consolidated Framework for Implementation
Research (CFIR) and using thematic analysis,
interviews were audio-recorded, transcribed,translated and analyzed in Dedoose.
Results: All study participants agreed that acomprehensive MH screening and linkage to careintervention was essential in increasing access to
MH care for people with HIV. Providers and people
with HIV concurred that offering screening at HIV
diagnosis could reduce risks of severe MH
symptoms and treatment interruption amongpeople with HIV. People with HIV aged 18-25 years
showed stronger interest in receiving thescreening than people with HIV aged 60+ years.

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316

Key inner setting facilitators included clients’
confidence in the clinic’s confidentiality policy(culture) and professional services in a welcoming
environment (recipient-centeredness). People
with HIV also suggested online availability ofscreening tools and extending services to parentsof youth with HIV (domain innovation, construct
adaptability). Key potential Outer Setting barriers
included perceived stigma towards mental healthand HIV-positive status (local attitudes) andassociated costs (local conditions). Providers
anticipated barriers in the Outer Setting, includinglack of specialists with HIV expertise (local
conditions), and in the Innovation domain,
including sensitivity of screening tools to be usedat the clinic (evidence base).
Conclusion: Both clients and healthcare providers
emphasized the need to integrate acomprehensive mental health screening andlinkage to care intervention for people with HIV.
Whilst this integration might be supported by theclinic’s policy and environment, several barriers
were identified, including stigma towards mental
health and HIV-positive status, and associatedcosts.

E-Poster Abstract

290

Young Trans People First:
Youth-inclusive genderaffirming services facilitate
access to HIV and sexual
health services among youngtransgender women in
Bangkok, Thailand
Samitpol K1,2, Janamnuaysook R1,2, Getwongsa P1,
Amatsombat T1, Chancham A1, Sripoonbun V1,
Suttanan K1, Mingkwanrungruang P1, Arunmanakul
A3, Mills S3, Phanuphak N1,2
1Institute of HIV Research and Innovation, Bangkok, Thailand,
2Center of Excellence in Transgender Health, Chulalongkorn

University, Bangkok, Thailand, 3USAID EpiC Thailand, FHI 360,
Asia Pacific Regional Office, Bangkok, Thailand

Background: Globally, young key populations are
disproportionately affected by HIV. In order toaddress the gaps, the Tangerine Clinic, atransgender-led gender-affirming sexual healthclinic in Bangkok, integrated youth-inclusive
gender-affirming care into HIV services. Thisapproach aims to minimize the harms of selfmedicated hormone treatment, as genderaffirming care had yet to be covered under theThailand’s Universal Health Coverage, and to
facilitate access to HIV and sexual health services
among young transgender populations. We
conducted an observational cohort examining
access to HIV and other sexual health services
among young transgender clients of the Tangerine
Clinic.
Methods: We analyzed data collected from clientsof the Tangerine Clinic during November 2015September 2023. Data on HIV and sexuallytransmitted infections (STI) services accessed bytransgender women aged ≤24 years, who used
gender-affirming care as a service entry point, andservice outcomes were reported. Gender-affirmingcare at the Tangerine Clinic included genderaffirming care counseling, hormone treatment andhormone level monitoring.
Results: Of 6,280 transgender women clients of
the Tangerine Clinic, 2,839 (45.2%) aged ≤24.
Among them, 2,012 (70.9%) reported gender-

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affirming hormone treatment as their primaryreason for a clinic visit. Of those, 1,924 (95.6%)
received HIV testing and 39 (2%) who tested HIVpositive, 35 (89.7%) initiated same-day
antiretroviral treatment and 28 (71.8%) achievedvirologic suppression. Pre-exposure prophylaxis
was prescribed to 390 (20.7%) and post-exposure
prophylaxis to 65 (3.4%) individuals who tested
HIV-negative. Psychoactive substance use wasreported by 7 (0.3%) and 188 (9.3%) engaged in
sex work. Syphilis testing by TPHA was conducted
in 1,665 (82.8% of 2,012), 23 (1.4%) wereconfirmed by VDRL to have active syphilis, and 21(91.3%) received treatment. Of 256 (12.7% of
2,012) who tested for chlamydia/gonorrhea by
nucleic acid amplification testing, 59 (23%) tested
positive and 52 (88.1%) received treatment.
Conclusions: Integration of youth-inclusive
gender-affirming care into sexual health services
successfully facilitated access to HIV prevention
and treatment, STI testing and treatment, and safe
hormone treatment among young transgenderwomen. It is crucial to nationally scale up theyouth-inclusive gender-affirming HIV service
intervention for young transgender populations inThailand in order to accelerate an ending AIDS goalby 2030.

E-Poster Abstract

291

Strengthening integrated
HIV/STD testing services
among MSM in China:
Qualitative findings from cocreation groups
Zhang L1, Luo D1, Li K2, Marley G1, Tan R3, Zhu Z1,
Liu Y1, Wang T1, Tang Q1, Sun M1, van Duin D4, Wu
D5, Sylvia S4, Gray K4, Wang C6, Yang L6, Zheng H6,
Ramaswamy R7, Tang W4, Tucker J4,8
1UNC Project-China, Guangzhou, China, 2University of California,

Los Angeles, Los Angeles, United States, 3National University ofSingapore, , Singapore, 4University of North Carolina at Chapel
Hill, North Carolina, United States, 5Nanjing Medical University,
Nanjing, China, 6Dermatology Hospital, Southern Medical
University, Guangzhou, China, 7Cincinnati Children’s Hospital
Medical Center, , United States, 8London School of Hygiene &Tropical Medicine, London, United Kingdom

Background: Despite the need for integrated HIV
and other sexually transmitted disease (STD)
testing services, many clinical services remainsiloed. Co-creation is a participatory researchmethod that brings community perspectives into
public health research. We used co-creation
involving different stakeholders involved in sexual
health and HIV prevention of men who have sex
with men (MSM) to promote integrated chlamydia(CT) and gonorrhea (NG) testing services within
existing HIV testing services at community-basedorganizations (CBOs) in Guangdong Province,
China.
Methods: We conducted formative research for acluster randomized trial to promote STD testing
among MSM. From August 2021 to August 2023,
we held 10 one-hour co-creation sessions involving
2 doctors and 15 MSM community members,
including 5 CBO representatives. The purposes of
FGDs were to (1) understand their experiences ofintegrating CT/NG testing within existing HIV
testing services and (2) explore barriers andfacilitators of HIV/STD integrated service delivery.
All co-creation sessions were conducted in
Mandarin and documented through audio
recordings or written meeting notes. Qualitative
data were analyzed through rapid inductive
thematic analysis.

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Results: The co-creation sessions elicited three
key themes related to integrated services: lack ofintegrated testing, limited knowledge of STDs
other than HIV, and the need for policy advocacy.
1.
The limited availability of CT/NG selftesting options complicates HIV/STD services
integration. Co-creation participants iterated that
decentralized testing options like HIV/syphilis selftesting and CT/NG self-sampling could facilitate
service integration.
2.
Most MSM presenting for testing had
limited knowledge of CT/NG compared to HIV.
CBO representatives highlighted the need fordeveloping educational materials that emphasize
the relationship between CT/NG acquisition andHIV risk to promote HIV/STD awareness.
3.
Without research funding, CBOs and thegovernment lacked CT/NG testing funds as it is nota national priority area. It was suggested that
researchers should advocate for including CT/NG
in the national STD screening guidelines for MSM.
Conclusions: Our study revealed through cocreation that lack of access, education, promotion,and policy advocacy hampered the developmentof integrated HIV/STD testing. Further researchand development of interventions to addressthese areas are warranted.

E-Poster Abstract

319

292

disclosure is a concern for them, 10 of them preferperiodic counseling for psychosocial support.

The fourth 90: Qualitative
study on improving quality oflife of young PWH men who
have sex with men living in
Metro Manila, Philippines

Conclusions: Upon diagnosis, an interview by asocial worker or trained staff could be done toassess the psychosocial needs of newly diagnosed
PWH. Among treatment facilities in limited
resource settings, linkage to social services should
be readily available. Counseling and other mental
health interventions should also be easily
accessible even for virally suppressed PWH. Family
dynamics should also be included during
discussions with PWH, especially among the youth,
to help in formulating interventions and disclosure
should they decide to.

Cruz D1,2, Rosadiño J1,2, Alvarez R1, Pagtakhan R1
1LoveYourself Inc., Mandaluyong, Philippines, 2Faculty ofManagement and Development Studies, University of thePhilippines - Open University, Los Baños, Philippines

Background: In the Philippines, there are arecorded 48 cases of people being diagnosed withHIV daily. This translated from wider access to HIV
testing services, from local government units tocommunity-based organizations. Linkage to care is
an important aspect of the HIV cascade of care,
where people diagnosed with HIV are linked totreatment with the goal of viral suppression.
However, should viral suppression be the end goal
for both PWH and the providers? Here, qualitative
data were gathered from 15 young PWH forinterventions in improving quality of life after viral
suppression.
Description: A qualitative interview of 15 young
men who have sex with men aged 18-24,
diagnosed with HIV in the past 12 months, andvirally suppressed at the time of the interview wasdone. The interviews included family relations,school/work life, romantic/sexual relations, HIVdiagnosis, financial capacity, and assistance theywould potentially need to have an optimal qualityof life.
Lessons: All participants grew up in
unconventional family dynamics: separated
parents (8), parents were migrant laborers (1), or
one or both parents were already deceased (6). 13of the 15 participants were not comfortabledisclosing HIV status among family members citinglack of awareness about HIV, and since dynamics
at home was not well established, they would
rather not disclose at all. They were highly reliant
on friends or significant others in terms of social
support. Financial support is the primary concernof the 12 out of the 15 who are still studying.
Expenses to support their education andtreatment were identified challenges. Since

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract

293

Navigating facilitators andbarriers to establishingchemsex services in Thailand:
Qualitative findings from the
CLYMAX study
Hiransuthikul A1,2, Phongsinghwithaya C1, Siriphan
J3, Chayaananchot T1, Tangmunkongvorakul A4,
Sripitathanasakul T1, Khomshuk P1, Hongchookiat
P1, Nonenoy S1, Boonruang J1, Phanuphak N1
1Institute of HIV Research and Innovation (IHRI), Bangkok,

Thailand, 2Department of Preventive and Social Medicine,
Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand, 3Foundation for AIDS Rights (FAR), Bangkok, Thailand,
4Research Institute for Health Sciences, Chiang Mai University,
Chiang Mai, Thailand

Background: Despite the growing prevalence ofchemsex, there remains a lack of dedicatedservices for people who use chemsex and those
involved in chemsex use in Thailand. We exploredfacilitators and barriers to establishing andaccessing comprehensive chemsex services
encompassing physical, mental, and social healthaspects for men who have sex with men (MSM) in
Thailand.
Material and Methods: Semi-structured, in-depth
interviews were conducted with 60 key
informants, comprising 40 MSM aged 16-35 who
use chemsex, 10 peers/family members, and 10
healthcare providers. Interviews were conductedin person, recorded, and transcribed verbatim. A
codebook was developed integrating a priori
themes from the interview guide and emergent
themes identified from transcripts. Analyses wereconducted using Dedoose software.
Results: All informants highlighted stigmatization,
discrimination, and the uncertainty of law
enforcement practices related to chemsex as key
barriers to establishing or accessing
comprehensive chemsex services. The feeling ofintersectional stigma – being a person who use
drug, a gender minority, and, for some, living withHIV – along with anticipated discrimination in
healthcare settings, legal uncertainties, and fear ofarrest were reasons why people who use chemsex
may hesitate to access chemsex services. For
healthcare providers, barriers included a lack of

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320

knowledge and confidence in providing care,particularly due to the variety of substances used
and multifaceted chemsex-related harms, andcompeting priorities within health centers.
Disparities in views on harm reduction between
informants and the country’s policy, which focuseson abstinence, were another crucial barrier.
Facilitators included integrating technology for
online-based services and public campaigns todestigmatize chemsex. People who use chemsex
and peers/family members emphasized thebenefits of including former users in consulting
sessions and the importance of legal services andprotection to make clients feel safe accessing
services. Healthcare providers expressed a strong
willingness to move forward with the services,highlighting the need for well-established training
and specialist consultation to build confidence inproviding chemsex services to their clients.
Conclusions: Establishing comprehensive chemsex
services presents a challenging yet crucial task to
improve the health of people who use chemsex.
Addressing identified barriers is essential toenhance and expand chemsex services tailored to
the needs of this population.

E-Poster Abstract

294

Transcending healthcare:
Exploring tailored service
packages to boost transgender
key-populations’ access andreturn rate to HIV service
deliveries.
Rebalde J1, Laguing T1, Rosadiño J1, Ruanto J1,
Pagtakhan R1
1LoveYourself Inc., Pasig City, Philippines

Background: The transgender key-populations’access to HIV services is among the top challenges
faced in the Philippines. Amidst the Philippines’
fastest-growing HIV epidemic globally, transgenderpeople are placed in worse vulnerabilities with anestimated 49 times more prevalence to HIV
compared to the general adult population. This is
the motivator of the two first-ever transgenderspecific HIV hubs in the Philippines, Victoria and
Lily, initiated by the transgender community of
LoveYourself.
Description: Exploring the behavior of transgenderpeople towards accessing HIV services, we havefound out that among their barriers is the neglectof service deliveries for their primary healthcare
priority which is the realization of their gender
identities through gender-affirming hormone
therapy (GAHT). Even upon this recognition, there
is a lack of funding for transgender-specificprograms in the Philippines prompting Victoria and
Lily to be limited on employing the service package
available to its current resources; free GAHT
consultation, free laboratory tests, free HIV testing
and combination prevention. Both clinics operate
on both onsite and telemedicine modes of delivery(MOD) in response to the geographic barriers. The
service delivery process involves setting an
appointment online, conduct of consultation on
both MOD, onsite HIV testing or delivery of selftesting kits, conduct of laboratory tests,prescription of GAHT, enrollment to freehormones and HIV treatment if applicable.
Lessons Learned: Currently, the program has atotal of 320 enrollees for its service packages,
67.5% coming from transgender women and

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321

32.5% from transgender men. From this data, 82(25.6%) are enrolled in free pre-exposure
prophylaxis (PrEP) which, due to current policy
implementations in the Philippines, aretransgender women alone. These service packages
boosted the data of transgender key-populations
accessing HIV services in LoveYourself Inc. with amore than 50% return rate. This also contributed
in streamlining visibility and targeted-response fortransgender peers in the Philippine HIV service
delivery.
Conclusion/Next Steps: Gender-affirming service
packages equipped with demand generation
campaigns are effective generators of transgenderdemand in accessing HIV services. The program
also contributed in mapping the transgender keypopulation which could provide more insights to
support future data that could help in advancing
transgender-specific healthcare landscape of thecountry.

E-Poster Abstract

322

295

Navigating pathways towards
Thailand's Universal Health
Coverage on transgender
health: the importance of
catalytic funding, concerted
community-led efforts, andpolitical advocacy.
Samitpol K , Janamnuaysook R , Getwongsa P ,Amatsombat T1, Chancham A1, Sripoonbun V1,Janyam S3, Taesombat R4, Rattakitvijun Na Nakorn
P5, Arunmanakul A6, Mills S6, Phanuphak N1,2
1,2

1,2

1

1Institute of HIV Research and Innovation, Bangkok, Thailand,
2Center of Excellence in Transgender Health, Chulalongkorn

University, Bangkok, Thailand, 3Service Workers in Group
Foundation, Bangkok, Thailand, 4The Foundation ofTransgender Alliance for Human Rights, Bangkok, Thailand,
5USAID Regional Development Mission Asia, Bangkok, Thailand,
6
USAID EpiC Thailand, FHI 360, Asia Pacific Regional Office,Bangkok, Thailand

Background: The Tangerine Clinic as the firsttransgender-led health clinic in Thailand has
proven that the integration of gender-affirmingcare into sexual health services increased access to
HIV services among transgender populations.
However, despite HIV testing, treatment, and preexposure prophylaxis being covered under
Thailand's Universal Health Coverage (UHC),
gender-affirming care is not included. We describe
community-driven efforts to advocate for the
inclusion of gender-affirming care under UHC byusing data to inform policy change discussions.
Description: Established in 2015, Tangerine Clinic
provides gender-affirming care and HIV services totransgender population where data were collected
as part of a prospective cohort study, and positive
outcomes were published in the Lancet HIV, JIAS,
and Transgender Health. The Tangerine Clinic
partnered with Chulalongkorn University inestablishing the Center of Excellence inTransgender Health and developed the Thai
Handbook of Transgender Healthcare Services
as a tool to guide the development and expansionof transgender-competent care service models in
Thailand and the region.
In 2020, Tangerine Clinic and a sex worker-led
SWING Foundation proposed the inclusion of

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

gender-affirming care under Thailand’s UHC using
these community-collected data. The proposal was
selected and proceeded to a two-year effective
coverage study being conducted in 2023. Together
with persistent advocacy from rights-based civilsociety organizations and the Foundation ofTransgender Alliance for Human Rights to allpolitical parties for transgender-inclusive policies,
following the General Election in 2023, thegovernment announced to support genderaffirming care as their priority and anticipated toinclude it as part of UHC within 2024, in parallelwith the effective coverage study.
Lessons learned: International funding was vitalfor the entire policy change process, including theestablishment of a transgender-led health service
model, data collection, feasibility demonstration,and evidence-based advocacy for sustained andscalable programs. Concerted stakeholder efforts
were crucial for amplifying the needs and requiringchanges. Engaging with political bodies wasimportant as they played a decision-making role.
Conclusions/Next steps: Community-driven,
evidence-informed policy change processes canenhance health equity towards an ending HIV goal.
Countries receiving international funding must use
them in a catalytic way from demonstrating
feasibility of innovative models to advocate forsustainability/domestic
financing.

E-Poster Abstract

296

The Unassisted HIV SelfTesting Tag-o-war: A review on
Philippines' health system
response to community-led
HIVST implementation among
key populations.
Maynes J1, Pagtakhan R1, Ruanto J1, Manahan R1,
Flores M2
1Loveyourself Inc., Mandaluyong City, Philippines, 2Pilipinas
Shell Foundation Inc., Taguig City, Philippines

Background: Getting HIV testing in your own
convenient space and time has encounteredbarriers in implementation, and crossing theconventional HIV testing approaches in thePhilippines had been seen as a peak to climb. This
review gears towards showing different levels of
approaches and partnership exploration to reach
responsiveness and acceptance of the unassisted
HIV self-testing in the Philippines.
Description: By demonstrating the feasibility of
HIV self-testing during the peak of COVID-19
Pandemic, LoveYourself's (LY) 2020 formative
study paved the way for the implementation of acommunity-led unassisted HIV self-testing
program in the Metro Manila. With the study's
promising results, the Department of Health (DOH)
created a TWG to establish an interim guideline for
HIVST. With reasonable but conventional issues
and concerns of most health facilities and offices,
Philippines have been behind in taking advantageof this testing modality. During the fourth quarterof 2021 of the Global Fund PROTECTS Project,
Pilipinas Shell Foundation Inc., (PSFI) and LY
mobilized four sites to pilot community-led HIVST
implementation and collect their experiences for
scaling up. Community-based organizations (CBOs)
played a crucial role in proving the good receptionof the key populations (KPs) they cater towards
this new HIV testing modality.
Initially, there were 4 pilot sites, divided among
the three major island group, Luzon, Visayas,
Mindanao, and Metro Manila; but towards the
middle of 2022, an evident clamor among regional
health offices of DOH and other local government

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323

units, who were initially nonchalant about HIVST,
were then seeking for orientations and trainings
about HIVST. This clamor pushed PSFI and LY, andin collaboration with DOH Central’s Disease
Prevention and Control Bureau (DPCB), in creating
series of trainings and orientations across all
project sites.
Lessons learned: By the end of 2023, all 11 regions
under the PROTECTS Project are already
implementing Unassisted HIV Self-testing. This
demonstrated the potent combination of aformative study, community demand generation,pilot implementation, and multi-sectoralcollaboration which brought about inclusion andacceptance of the HIVST in Philippine's healthsystem.
Conclusions/Next steps: The review establishedthe efficacy, further, the KPs and the healthsystem as a whole benefit in more community-led
and multi-sectoral approaches to upscaling
innovations.

E-Poster Abstract

297

Examining participantsatisfaction in service-based
research: Prevalence and risk
factors of cervical dysplasiaand HPV transmission in
women living with HIV in Bali,
Indonesia
Astuti N1, Somia I1, Pratiwi N1, Purwanta M1,
Sawitri A1, Dwija I1, Pidari D1, Winarti N1, Gayatri
A1, Budiana I1, Merati K1, Pinatih K1
1Faculty Of Medicine, Udayana University, Denpasar, Indonesia

Cervical cancer is frequently detected in women
living with HIV and classified as an AIDS-relateddisease. Women with HIV have a sixfold higher riskof developing cervical cancer than those without
HIV, attributed to their compromised immune
system making them susceptible to HPV, thereby
increasing the risk of cervical dysplasia. Cervicalcancer screening is crucial to avoid complications.
Hence, the Faculty of Medicine at Udayana
University conducted a service-based research toprovide services and delve into risk factors and theneeds of participants in cervical cancer screening
for women with HIV.
To ensure the program's sustainability, aparticipant satisfaction study was conducted.
User’s satisfaction was explored from fivedimensions of healthcare quality including
tangible, reliability, responsiveness, assurance andempathy. Data was analyzed using measurement
followed Kaplan and Norton's theory, andparticipant data were calculated using specificformulas to obtain average satisfaction values.
Data collection utilized a Likert scale questionnairethat underwent validity and reliability tests. The
accessible population comprised women livingwith HIV participating in the service-based
research organized by the Faculty of Medicine at
Udayana University. Sampling was done
consecutively (non-probability technique),enrolling all samples meeting the inclusion andexclusion criteria, with a sample size of 168
subjects. The research analysis results showed

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324

tangible variables at 4.48 very satisfied), reliability
at 4.36 (very satisfied), responsiveness at 4.33
(very satisfied), assurance at 4.41 (very satisfied),and empathy at 4.51 (very satisfied). The
percentage of participants willing to attend theprogram again was 98.81%. Based on the
conducted research, the variable with the highest
satisfaction level was empathy, while the lowest
was responsiveness.
In conclusion, participants were highly satisfied
with the service-based research program across all
dimensions. Almost all participants expressed awillingness to participate in future cervical cancer
screening programs. These research findings are
expected to serve as a foundation for thegovernment in developing cervical cancer
prevention programs, especially for the more
vulnerable population which is women with HIV.

E-Poster Abstract298

Low incidence of directly
observed stigmatizing
behaviors but high prevalenceof attitudes that contribute to
stigma, an analysis of nationwide stigma survey inhealthcare settings inIndonesia.
Januraga P1, Harjana N1, Kartika K1, Wardhani B2,Octaviana B2, Darmawan K2, Sudastri N2
1Center for Public Health Innovation, Udayana University,

Denpasar, Indonesia, 2Pusat Inovasi Kesehatan (HealthInnovation Institute), Denpasar, Indonesia

Indonesia ranks among the nations in the AsiaPacific region where the incidence of new HIV
infections among key populations, especiallyamong Men who have Sex with Men (MSM),
remains alarmingly high. The country's HIV care
continuum is characterized by a notable
percentage of individuals living with HIV (PLHIV)
who are unaware of their HIV status, alongside a
pronounced decrease in the number of PLHIV who
initiate treatment and achieve viral suppression.
Stigma and discrimination stand as significant
obstacles, severely hampering efforts to combat
HIV by hindering effective prevention strategies
and the management of the condition. This study
is dedicated to examining the extent of HIVrelated stigma and discrimination within
healthcare environments.
This research examines quantitative data obtained
from a pioneering mixed-methods study ofnational scope, carried out at the close of 2023.
Garnering insights from 2,198 participants, which
included a mix of individuals working in
healthcare, the study deployed comprehensive
surveys across twelve districts/cities spanning six
provinces, executed by trained enumerators. The
survey instrument was derived from Thailand's
stigma and discrimination survey, which is rooted
in the foundational Health Stigma andDiscrimination Framework.

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The investigation revealed a modest yet consistent
incidence of stigmatizing behavior among
healthcare providers towards PLHIV and key
populations, with a prevalence below 5%.
Transgender women, closely followed by MSM,
have been identified as the groups encountering
the most severe forms of stigma. Notably, such
behaviors were more prevalent among healthprofessionals than their non-professionalcounterparts and among personnel working inHIV-related services. Although the frequency ofobserved stigmatization was low, the adoption of
unnecessary safety measures was significantly
higher, reaching 35.5%, particularly in services notdirectly related to HIV. In terms of attitudes, asubstantial number of respondents exhibited afear of contracting HIV, with this concern markedly
more pronounced (59.2%) among staff in non-HIVrelated services than those engaged in direct care
(36.7%).
Furthermore, a considerable segment of thesurvey participants harbored stigmatizing views
towards PLHIV, with 59.2% of non-professionals
and 56.6% of health professionals agreeing with
one or more of the following statements: PLHIV
are indifferent about transmitting the virus toothers, they should feel ashamed of their status,
or HIV infection results from irresponsible orimmoral actions. When addressing workplace
health policies, it was found that only 59.8% of
respondents were aware of their employer's
written policies aimed at safeguarding clients fromstigma and discrimination. Additionally, around
11.8% expressed disagreement with the policythat HIV testing should only be conducted with theclient's informed consent.
The study's findings highlight that, despite therelatively low incidence of directly observed
stigmatizing behaviors, the prevalence of attitudes
that contribute to stigma remains significantly
elevated. These outcomes underscore thenecessity for a comprehensive strategy,necessitating the engagement of not just medical
personnel but also a wider societal mobilization.
This includes educational initiatives on HIV,gender, and sexuality, alongside the active
participation of religious and community leaders
to transform societal attitudes and norms. To
support such measures, the pivotal importance oforganizational policies, and leadership cannot be
overstated.

E-Poster Abstract

299

Fear of progression amongpeople living with HIV waspositively associated with anegative medical coping
strategy: a cross-sectionalstudy
Li B1, Lin X1, Chen S1, Qian Z2, Wu H1, Liao G1, Chen
H1, Kang Z1, Peng J1, Liang G1
1Southern Medical University Nanfang Hospital, Guangzhou,

China, 2Guangdong Provincial People's Hospital, Guangzhou,
China

Background: Due to the chronic nature of HIV,their mental health has become a critical concern.
However, little knowledge exists about the fear of
progression (FoP) in people living with HIV(PLWHIV) in China.
Methods: PLWHIV were consecutively enrolled infrom February to June, 2022. A total of 303
PLWHIV were included and their demographic,clinical and psychological information wascollected. The Fear of Progression QuestionnaireShort Form (FoP-Q-SF), Social Support Rating Scale(SSRS), Internalized HIV Stigma Scale (IHSS) and
Medical Coping Modes Questionnaire were
utilized.
Results: Of the participants, 215 PLWHIV wereclassified into the low-level FoP group, and 88
were grouped into the high-level FoP group basedon their FoP-Q-SF scores, according to the criteria
for the classification of dysfunctional FoP in cancer
patients. The high-level group had a higher
proportion of acquired immunodeficiency
syndrome (AIDS) stage (P=0.005), lower educationlevels (P=0.027) and lower income levels(P=0.031). Additionally, the high-level group had
lower scores in social support (P<0.001) and its
three dimensions, with total SSRS scores showing anegative correlation with two dimensions of FoPQ-SF, namely physical health (r²= 0.0409, P<0.001)
and social family (r²= 0.0422, P<0.001). Further,
the high-level group had higher scores in four
dimensions of internalized HIV stigma, and apositive relationship was found to exist between
IHSS scores and FoP-Q-SF scores for physical

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326

health (r²=0.0960, P<0.001) and social family(r²=0.0719, P<0.001). Social support (OR=0.929,
P=0.001) was identified as an independent
protective factor for FoP, while AIDS stage(OR=3.795, P=0.001) and internalized HIV stigma(OR=1.028, P<0.001) were independent risk factors
for FoP. Furthermore, intended medical coping
modes (MCMs) were evaluated. The high-levelgroup preferred a negative avoidance mode
(P<0.001). FoP were positively correlated withavoidance scores (r²=0.0886, P<0.001) and wasvalidated as the only factor for the mode ofconfrontation (OR=0.944, P=0.001) and avoidance(OR=1.059, P=0.001) in multivariate analysis.
Conclusion: The incidence of dysfunctional FoP in
our study population was relatively high. Highlevel FoP was associated with poor social supportand high-level internalized HIV stigma andpredicted a negative MCM among PLWHIV.

E-Poster Abstract

300

Lived Experiences of Young
Professionals Living with
Human Immunodeficiency
Virus (HIV)Reyes R1
De La Salle Medical And Health Sciences Institute, Dasmariñas,
Philippines

1

The Philippines is one country with the fastestgrowing number of HIV infections and majority of
the newly infected individuals are young adults
who can still make valuable contributions in thesociety as most of them are young professionals
who are just about to establish their career.
The purpose of this phenomenological study was
to explore the life experiences of young
professionals living with HIV. Descriptive
phenomenology was used in this study to vividly
illustrate the life experiences of the participants.
The study participants were selected using
purposive and snowball sampling and they arecomposed of eight (8) male HIV infectedindividuals aged 21-35 years old, who has abachelor’s degree of any profession and are
currently employed full-time in any institution. The
researcher conducted series of in-depth interviews
with all the participants using an online platform.
Limited observation of nonverbal cues was alsodone during the interview session.
The analysis of data was guided by Colaizzi’s 7-step
descriptive phenomenological method. After
analyzing the data gathered, four (4) interrelated
themes and nine (9) sub themes emerged to givemeaning to the life experiences of the participants.
The main storylines include: (1) Chain of
Limitations and Uncertainties ([a] Receiving the
Bad news, [b] Carrying the Heavy Burden, [c]Feeling Lost in Career Path) that they haveencountered which eventually affected how they
fought their (2) Battles in the World of Work ([a]Dealing with Issues in the Workplace, [b] Adapting
to Changes in their Professional Career, [c] Driving
their Own Career Growth). In those battlefields,
they have developed (3) A Warrior’s Mindset ([a]Embracing the New Normal, [b] Positive Career

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Mindset, [c] Developing Personal Advocacy) thatencouraged them to take the first step towards (4)Breaking the Chains of Stigma and Discriminationin the Workplace. The study findings conclude that
(1) HIV significantly affects the psychosocial aspectof young professionals as they enter the world ofwork, (2) young professionals living with HIV
encounter many challenges, problems, andhindrances in the workplace in spite of the existinglaws, policies, and programs on HIV/AIDS, (3)strong support system in the workplace, sharedlife stories of other successful PLHIV, and theirhealthcare providers help young professionals
living with HIV to overcome different obstacles
and develop a positive career mindset, and (4) lackof standard policies and programs on HIV in theworkplace leads to growing stigma anddiscrimination among young professionals livingwith HIV.
In this regard, this study recommends that the (1)government revisit and update the existing laws,
regulations and programs concerning the PLHIV;(2) employers should implement standard policies
and programs on HIV in the workplace to ensure
and maintain a healthy and safe working
environment; (3) nurse practitioners should rendera more holistic approach in the care andmanagement of patients with HIV; and (4) future
researchers to explore other aspects of PLHIV,
increase sample size, include a more diverse set ofparticipants, and utilize other research designs
that will further explore more impactful ways oferadicating this social problem.

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301

Lessons learnt: Challenges ofsetting up a PrEP clinic in a
tertiary hospital in Singapore
Sng E1, Lee A1, Lee W2
1Department of Infectious Diseases, Changi General Hospital,

Singapore, Singapore, 2Department of Pharmacy, Changi
General Hospital, Singapore, Singapore

HIV pre-exposure prophylaxis (PrEP) is an effective
strategy against HIV infection. A clinic, run by aninfectious diseases physician, was set up in
February 2023 in Changi General Hospital for the
management of sexually-transmitted infections(STIs) and the provision of HIV PrEP. Educationaltalks targeting healthcare providers (HCPs) within
the hospital and general practitioners (GPs) wereconducted to promote the new service. Details of
the clinic were included on the hospital’s website.
Over a period of 14 months between February
2023 and Mar 2024, only 19 clients were seen at
the clinic. The mean age was 50.2 years old (SD =19). All were male. 15 out of 19 identified asheterosexual, 3 as homosexual and 1 as bisexual.
Almost all (17 out of 19) were referred following
the diagnosis of a STI. Two clients were referred
for non-occupational post-exposure prophylaxis
against HIV. There was no self-referral. No HIV coinfection was detected on screening. All 20 clientswere assessed for PrEP. Only 2 out of 19 (10.5%)
were initiated on PrEP (1 daily PrEP, 1 on-demand
PrEP). The main reasons cited by the clients for
declining PrEP, apart from no longer being sexuallyactive(n=8) are high cost of medication (n= 6), andopting for sexual behaviour modification (n=4).
Both clients who were on PrEP discontinued PrEP
use subsequently.
The low clinic load is due to both low referral
numbers from HCPs and low self-referrals. Referral
to a new centre is a unfamiliar process for many
HCPs. Furthermore, promotion of the service isalso limited to educational talks to HCPs, listing on
a complicated hospital website and occasional
public health campaigns. Lack of awareness ofofficial PrEP services has resulted in clientsobtaining their PrEP supply through unregulated
websites.

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Among those in whom HIV PrEP is indicated, thehigh cost of the medication (around 400 SGD or
300 USD for 1 month’s supply) is a huge barrier to
PrEP uptake and PrEP persistence. This is incontrast to other countries, including in Asia,
where PrEP is heavily subsidised or even free ofcharge. Several clients turned to purchasing PrEP
online or through buyer’s clubs, which retails PrEP
at less than 20% of the hospital’s price. This results
in a lack of a HCP's oversight, leading to improper
PrEP use and delayed or missed diagnoses of HIV
infection and other STIs.
While there have been efforts at de-stigmatising
HIV in Singapore, the limited marketing avenues
available to the HCP and the lack of government
subsidy for PrEP may be partly attributed to thestill-present stigma against HIV. PrEP should not beseen as encouraging promiscuity, but rather as aneffective risk mitigation strategy against HIV
transmission. It would be a missed opportunity for
Singapore if those who are at risk are unable toaccess PrEP services. Greater effort at combating
HIV stigma at the societal level, including more
open public health messaging on PrEP and more
subsidies for the medication, would be crucial
steps towards improving PrEP access andultimately, HIV elimination.

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302

Three decades growing up
together with HIV in Thailand:Lessons learned
Saisaengjan C1
1Center Of Excellence In Pediatric Infectious Diseases And

Vaccines, Faculty Of Medicine, Chulalongkorn University.,
Bangkok, Thailand

The Thai Youth Living with HIV Group is made up
of approximately 400 young people living withperinatally acquired HIV who have received care at
Chulalongkorn University, Thailand. To date, 150
youth from the clinic are now aged >25 years. In
March 2024, 8 representatives aged between 2734 years came together to share their wisdomfrom a lifetime living with HIV with healthcare
providers, carers, and fellow youth on how to livewith HIV and thrive.
In 1988, Thailand reported infants being born with
HIV. WE were those infants. Most of our families
didn’t know we had HIV, until our parents diedfrom AIDS, or we got sick.
Childhood
We just weren’t like other kids. They called usorphans. Kids weren’t allowed to play with us. We
got ill a lot but didn’t know why. After recovering,
we STILL had to take huge and bitter tablets. To
stop us dying like our parents they said. By the endof primary school, we learned what HIV/AIDS was.
We were afraid. Sad. But relieved to finally knowwhat was wrong.
Teenage years
Having HIV didn’t mean having AIDS anymore. We
learned more about HIV/AIDS, the medication wewere taking, and met others who also had HIV. The
fear and isolation reduced. Some got tired oftaking tablets. Some suffered side effects so
stopped taking them. And got sick again.
Adulthood
U=U. Life is more stable. Some of us have even
disclosed to loved ones without fear. It broke
down the fearful silence. Our partners andchildren are free from HIV. But discrimination
persists. Some workplaces don’t take people with
HIV. Some career dreams are still not possible.

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We thank our carers who took us to see doctors
and helped us take our medication. Thank you to
our doctors who made the medications easier totake, were not quick to judge why we weren’t
taking our medications, but listened and helped us
to find a way through. Thankyou medical team, foryour care from childhood to adulthood – youlooked after us, counseled us, never discriminatedagainst us. Some of us had no family, but you were
beside us. We don’t expect you to understandeverything. Having just one person who will listen
and create a safe zone for us is all that we need.
We thank ourselves for loving ourselves, setting
our own life goals, and our own tenacity.
Our lives started with curiosity, illness, andhelplessness. We were helped to understand andestablish our lives, set goals, and go forward. As
you stayed beside us, we became stronger andmore self-sufficient.
For future generations of kids with HIV: You’ll befine. We’ve lived with HIV for over 30 years. If you
don’t want to tell anyone, you don’t need to. If
your life is not ok and you’re fed up of medication,it’s okay – there’s a way through. Have patience
with your family. Sometimes it seems like they’re
not helping, but look closely, they may be helping
in their own way.

E-Poster Abstract

330

303

a medical officer in charge of HIV Unit in the state
health office.

Learning from the expansionof HIV-Related Stigma andDiscrimination (S+D) Reduction
Quality Improvement (QI)
Project in Government Primary
Health Clinics Malaysia

Strengths-based learning in which change
champions from Phase 1 were invited to share
their experience to be emulated accordingly by theclinics in Phase 2. A scalability assessment tool
explored input from the successful examples andperception of clinics in Phase 2 to identify thefacilitators and the barriers to be overcome in the
expansion preparation.

Mohamed N1, Awang S1, Mohd Ujang I1, Nair
Narayanan D1, Hamidi N1, Mohamad Yadzir Z2,
Mohamad M1, Ramly M2, Suleiman A3
1Institute for Health Systems Research, Shah Alam, Malaysia,
2HIV/STI/Hep C Sector, Disease Control Division, Ministry of

Health Malaysia, Federal Government Administrative Centre, ,Putrajaya, Malaysia, 3Disease Control Director Office, Ministryof Health Malaysia, Federal Government Administrative
Centre,, Putrajaya, Malaysia

HIV-Related S+D Reduction QI Project in Malaysia
started as a tripartite collaboration between thenational HIV technical advisor (HIV/STI/Hep C
Sector, Ministry of Health (Sector)), the ministry’s
research institute leading the QI training (Institutefor Health Systems Research (IHSR) and the
Malaysian AIDS Council (MAC) as the nongovernmental advisor in 2020 to reduce S+Damong HCW using QI approach in government
health facilities. The project was expanded to 55
clinics in Phase 2, representing 14 states andfederal territories from only 10 MOH healthcare
facilities in Phase 1. Here are some of the lessons
learned from the process.
An established governance is paramount indelineating roles between the parties for proper
project management. The Sector set the directionand ensured regular updates to the top managers
through Special Meetings between the DirectorGeneral of Health, Head of programmes and state
directors, fostering support from early adopter
state directors. The IHSR provided QI training andlearning tools like a locally developed QA
workbook and a template guide slide forpresentation; the MAC facilitated the engagementof caseworkers with PLHIV in the clinics. The core
implementation team in clinics consisted of but
was not limited to the family medicine specialist, a
staff nurse, and an assistant medical officer, withthe state AIDS Officer serving as a crucial link
between the states and the Sector. AIDS officer is

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Establishing a national centralized data collection
system for the indicators monitoring since Phase 1
improved the data collection efficiency, and wascontinued in Phase 2. Baseline assessment wasrolled out virtually before the first training with astandardized tool to assess knowledge, attitude,
and practice previously used in Phase 1.
As the total facility approach was adopted, teamcoordination was improved as staff of all services
available in the clinics was required to answer thesurvey, observe their work process to identify
potential S+D pitfalls and be involved in designingand implementing the remedial measures. Thisleverages an understanding of the different
procedures that exist across the various services.
Staggered regional implementation in Phase 2enhanced organizational learning via targetedfacilitation through training sessions, progresspresentations at specified milestones, and ongoing
virtual QI coaching; all aligned with the regional
timeline. Concurrently, inter-clinic learning was
fostered either in understanding analysis orintervention designing. A Compendium of bestpractices published from Phase 1 experience also
guided the facilitation.
However, the sustainability of response in thesurvey and intervention involvement of PLHIV andstaff needs improvement. The possibility of using
community-led monitoring for the survey should
be explored.

E-Poster Abstract

304

Perspectives from Thailand’s
National Stakeholders on
implementation of key
population-led hepatitis C
virus test and treat: A
qualitative preimplementation study
Sinchai K1, Wongsa A1, Janamnuaysook R1,
Saiwaew S2, Janyam S3, Phanuphak P1, Phanuphak
N1, Ramautarsing R1
1Institute Of Hiv Research And Innovation, Bangkok, Thailand,
2Rainbow Sky Association of Thailand, Bangkok, Thailand,
3Service Worker in Group Foundation, Bangkok, Thailand

Background: Due to high Hepatitis C virus (HCV)
prevalence and low linkage to treatment withdirect acting antivirals (DAAs) among key
populations in Thailand, we plan on implementing
HCV test and treat services in two community-led
clinics in Bangkok. HCV testing and DAA treatment
will be conducted and delivered by key population
lay providers experienced in providing HIV andrelated health services. We explored perspectives
from national HCV stakeholders to inform
implementation strategies.
Methods: From September-November 2023, we
conducted in-depth interviews with national HCV
stakeholders from the Ministry of Public Health’s
Department of Disease Control (DDC), National
Health Security Office (NHSO), Bangkok
Metropolitan Administration (BMA), and the Thai
Association for the Study of the Liver (THASL).
Semi-structured interviews were audio recorded,transcribed and analyzed using selected thematic
analysis guided by the Consolidated Framework
for Implementation Research. Data were coded in
Dedoose program.
Results: All (n=10) stakeholders agreed that
implementing key population-led HCV test andtreat at community-led clinics was feasible. All
noted key facilitators within the construct Culturein the domain Inner Setting: the subconstructs
human equality-centeredness and recipientcenteredness (proven track records of communityled clinics of providing stigma-free HIV and sexual

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331

health services and of identifying and recruiting
members of key populations). Identified barriers
were: 1. Outer Setting domain, construct Policies
and laws (legal challenges in keeping DAA stocks incommunity-led clinics), 2. Inner Setting Domain,
construct Structural Characteristics, subconstruct
Work Infrastructure (lack of standard operatingprocedures - SOPs), and 3. Individuals domain,
Characteristics subdomain (capability of lay
providers to conduct physical examinations).
Conclusions: Thailand’s national HCV stakeholders
showed support and confidence in implementing
key population-led HCV test and treat at two
community-led clinics. Community-led clinics canplay instrumental roles in providing stigma-free
health services beyond HIV and have the capacity
to integrate HCV as part of comprehensive service
package. Identified barriers will inform the designof multi-level implementation strategies, including
capacity-building interventions and certification
for lay providers, SOP-development, arranging
teleconsultations with physicians, and advocating
for policy changes related to DAA stock, to support
successful implementation of the key populationled HCV test and treat service.

E-Poster Abstract

305

Collaborative Surveillance
Strategies against Alarming
HIV Prevalence among TGs and
MSM in Multan, Pakistan
Ilyas M1
1
Wasaib Sanwaro, Multan, Pakistan
Author: Ilyas Muhammad (Last Name, First Name)

Institution:
1Wasaib Sanwaro, 2Global Funds, 3National AIDS Control
Program, 4Green Star, 5UNDP

Background: Since 2018, Wasaib Sanwaro has
partnered with key organizations such as Global
Funds, National AIDS Control Program, Green Star,and UNDP, securing vital funding support. The
collaborative effort targets the pressing issue ofsoaring HIV prevalence rates among youngtransgender individuals (TGs) and men who havesex with men (MSM) in Multan, Pakistan. Facing a
staggering 12% prevalence rate for TGs and aconcerning 5.7% for MSM, significantly surpassing
general population rates, pervasive stigma, legal
obstacles, and a lack of tailored prevention andtreatment strategies pose substantial challenges.
With financial support from these collaborative
organizations, Wasaib Sanwaro strives toimplement targeted interventions, aiming for a
substantial reduction in HIV prevalence rates
among young TGs and MSM in Multan.
Description: Collaborating with Global Funds andother partners, Wasaib Sanwaro has executed acomprehensive project since 2018 to combat highHIV prevalence rates among young TGs and MSM
in Multan. Conducting targeted community
outreach programs in busy bazaars, backward
areas, and tea cafe, the project focuses on raisingawareness about HIV prevention, testing, andtreatment. Peer education initiatives are
established in diverse settings, and stigma
reduction campaigns span locations such as
religious institutes, beauty salons, parks, bus
stands, roadsides and trans hostels. Utilizing
technological solutions, including mobile apps,social media accounts, Wasaib Sanwaro ensures
accessible information and virtual counselingservices, overcoming geographical barriers.

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332

Lessons Learned: Over the years, collaborative
efforts between Wasaib Sanwaro and Global
Funds, along with other partners, havesignificantly enhanced HIV prevention andtreatment for young TGs and MSM in Multan.
From 2018 to 2023, tailored interventions,
including community outreach and stigma
reduction, led to an 80% increase in TGs'
registration and a 60% boost in testing. Positive
cases among TGs decreased by 15% from 2018 to2023. For MSM, registration and testing rates
surged by 65% and 45%, respectively, from 2018
to 2023, resulting in a 10% decline in positive
cases. Linkage to care saw marked improvements,
with a 58% increase for TGs and a 40% rise for
MSM during the same period. These achievements
underscore the successful reduction in HIV
prevalence rates and improved healthcare
accessibility for TGs and MSM in the Multan city.
Conclusions/Next Steps: In conclusion, Wasaib
Sanwaro's journey in addressing the challenges ofhigh HIV prevalence rates among young TGs and
MSM in Multan has been marked by resilience,
adaptation, and continuous improvement.
Evolving strategies through data analysis, theorganization has achieved significant increases in
TGs' and MSM's registration and testing rates,
coupled with reductions in positive cases. As
Wasaib Sanwaro looks ahead, enhancing thelinkage of HIV individuals to antiretroviral therapy(ART) centers emerges as a crucial next step,further strengthening the organization's impact
and ensuring continued progress in reducing HIV
prevalence rates and enhancing healthcare
accessibility for TGs and MSM in Multan.

E-Poster Abstract

306

HIV/AIDS prevention
initiatives by rural/tribal
community basedorganizations in rural/tribal
Asia
Pal S1, patil V
1Sfccp, Meerut , India

Purpose: In resource-poor-nations specialized HIV
care-services are non-existent. Hence maximum
efforts for HIV prevention are advocated by WHO.
Primary-Health-Care is backbone of rural/tribal
India. Community based organizations [CBOs]
cater to this vast gap in urgent and rural/tribal
areas. CBOs have limited resources/training.
Rural/tribal communities are potentiallyvulnerable to HIV-risk. Vulnerability of youth
results from lack of literacy and knowledge,
inadequate protection by adults at
home/school/workplace as well as peer/social/early-marriage pressures in risky sexual
encounters. Our CBO devised model of peereducation-pattern since 2013. Especially thosevulnerable young-people who make choices out oflack of parental-support and ignorance of UNSAFE
SEX.
Method: CBO-workers reduce burden of existing
healthcare-system. Youth oriented programs
achieve more effective results. Lack of skillbuilding services for youth is reflected in numberof youths dianosed as HIV +ve. This is a policy
paper on HIV prevention by our CBO. Our teamhas 2 nurses, one
physician, one psychologists and five traditional
faith healers. We covered 23 villages with 41
schools for peer education in HIV prevention, 58
truck drivers, 12 young commercial sex workers.
Results: after 18 months of prevention efforts ourteam found that 70% participants changed highrisk sexual behavior. Launching youth's Peer
program with training from CBO's increases
awareness on HIV-control. Establishing counselingcenters and handing over peer-educationprograms to local communities is best suited toresource-poor-developing nations. Our modelgraphically & pictorially shown to participants

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333

through DVDs . Our approach provides
opportunities for reaching youth population byawareness/prevention campaign programs.
Conclusions: Challenge of distance/isolation/poorinfrastructure can be overcome throughcommitted/trained CBO-Peer-Education-Model.
BUT we need to provide regular hands-on training
at field level to CBO staff.
Recommendations: APACC needs to support/train
such CBO-Initiatives in rural/tribal Asian nations.
skills and knowledge gained by me by my APACC
participation will provide us contacts/tools to
make impact on future HIV control projects

E-Poster Abstract

307

Using chatbot for creatingawareness on Sexual andReproductive Health andRights (SRHR) and HIV among
adolescent from marginalized
communities – Learnings froma field project in India
Badgujar S1
1Network of Asian People who use Drugs (NAPUD), Pune, India

Introduction: In several world parts of the world,
new HIV cases are primarily being detected among
key population and young people. While there areseveral interventions focusing on key population,
has been In several parts of the world, Creatingawareness on sexual and reproductive health(SRH) and HIV among adolescents is a challenge
across most of the developing countries.
Adolescents from marginalized communities andadolescents girls face increased challenges inaccessing information related to SRH and HIV,
specially in country like India where several taboos
are associated with SRH, HIV and Comprehensive
Sexuality Education (CSE). While there arechallenges in reaching out to adolescents andyoung people, in in-person mode, withinformation on SRH and HIV, rapid advancement intechnology and increasing penetration of mobile
and internet presents new opportunities.
Method: In Madhya Pradesh (India's
geographically largest state and one of the poorest
states), an initiative was undertaken to reach out
to adolescents using technology. Discussions were
held with adolescents to understand their needs,
concerns, and expectations from the technology
based solution. A chatbot was developed based on
the discussions, and it was hosted on the Facebook
Messenger platform. The chatbot was initially field
tested with a smaller group of 100 adolescents (50boys and 50 girls), and further improvements were
made, adding more than 12,000 question andanswer pairs, including audio and video materials.
The chatbot was rolled out primarily foradolescents aged 15-19 in January 2022.

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Findings: A survey was conducted in January 2023
with 3,286 adolescents to understand theirperspective on the chatbot. The chatbot wasappreciated by 92% of the respondents, who
preferred it to face to face conversations. 88% of
the respondents found it easily accessible, 85%
found it to have comprehensive information, and
84% found the content as appropriate.
Conclusion: The finding from the assessmentsshows that chatbot can be a powerful tool toaddress adolescents' queries on sensitive issues,
including SRH and HIV, as it is easily accessible andmakes adolescents feel more comfortable. It canbe adopted in other parts of the world too.

E-Poster Abstract

308

Association of digital media
use for information about sex
with comprehensive HIV
knowledge and awareness ofanti-retroviral treatment
among adolescents and young
adults: Evidence from a
middle-income country
Bilon X1
1University of the Philippines Diliman, Quezon City, Philippines

Background: Central to addressing the HIV
epidemic is ramping up HIV testing and reducing
stigma against people living with HIV. Previous
research has shown that enhancing
comprehensive HIV knowledge and awareness ofanti-retroviral treatment (ART) correlates withmore accepting attitudes toward people living withHIV and increased likelihood to undergo HIV
testing. While factors influencing HIV knowledge
and ART awareness are well-understood in lowincome countries, there remains a gap in
understanding in middle-income countries where
access to the Internet and digital media use for
information are more widespread.
Methods: In this study, I measured theassociation of use of two types of digital media—
Internet media and social media—as information
sources about sex with comprehensive HIV
knowledge and ART awareness among youth aged
15–24. I used a nationally representative
probability sample from the 2021 Young Adult
Fertility and Sexuality Study in the Philippines (n =10,949) and adopted the Health Literacy Skills
Framework to obtain a parsimonious weighted
logistic regression model that controlled for otherrelevant factors.
Results: Findings show that only a low percentageof adolescents and young adults in the Philippines
had comprehensive knowledge about HIV (P =14.3%, 95% CI = [13.4%, 15.2%]) and were awareof anti-retroviral treatment (P = 8.5%, 95% CI =[7.7%, 9.3%]). Several factors under various
components of the Health Literacy Skills

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335

Framework such as demographic characteristics,
individual resources, and prior knowledge andexperiences were found to be associated withcomprehensive HIV knowledge and ART
awareness. Regarding different types of media,
youth who used print media such as books andnewspapers for information about sex were more
likely to have awareness of ART (adjusted OR[aOR] = 1.432, p = .046). On the other hand, those
who used broadcast media such as TV and radio
for sex-related information were less likely to beaware of ART (aOR = .709, p = .049). With a highpercentage of youth having access to the Internet(P = 89.5%, 95% CI = [88.2%, 90.7%]), a substantial
percentage used Internet media such as on-line
news and articles (P = 17.9%, 95% CI = [16.5%,
19.2%]) and social media (P = 28.3%, 95% CI =[26.6%, 30.0%]) for information about sex. Despite
this, usage of social media for sex-related
information was only associated with improved
comprehensive HIV knowledge (aOR = 1.265, p =.002), but not ART awareness (aOR = 1.244, p =.063). Meanwhile, usage of Internet media such as
on-line news and articles were not associated withimproved comprehensive HIV knowledge (aOR =1.105, p = .335) nor ART awareness (aOR = 1.025, p= .832).
Conclusion: Given the prevalent use of theInternet among young people in middle-income
countries, public health initiatives aiming toincrease HIV testing and combat HIV-related
stigma should leverage digital media, includingInternet and social media, to enhance HIVawareness. This can be done by ensuring thatcomplete and correct information about HIV isavailable and accessible on-line. Alongside otherHIV-related content, information about ART
should also be included and emphasized.

E-Poster Abstract

309

Community-led Research forEnhancing Pre-Exposure
Prophylaxis (PrEP) Uptake
Among Sex Workers in
Thailand
Sumalu S1, Sukthongsa S1, Somwaeng A1,
Phaengnongyang C1, Janyam S1, Manopaiboon C2,
Girault P2, Clarke D2, Vannakit R2
1Service Workers In Group (SWING) Foundation, Bangrak,

Thailand, 2BIRD (Bangkok Interdisciplinary Research andDevelopment), Phayathai, Thailand

Background: SWING Foundation, a sex worker-led
community-based organization (CBO), led thisresearch in collaboration with BIRD (Bangkok
Interdisciplinary Research and Development) toinvestigate low levels of PrEP engagement among
SW – female (FSW), male (MSW) and transgenderfemale (TGSW) despite government policy of free
PrEP for anyone who wants it.
Description: From April-December 2023, SWING
conducted the largest cross-sectional study of SW
in Thailand to assess demand for PrEP and
decision-making factors in PrEP engagement. We
enrolled 621 FSW, 452 MSW and 438 TGSW
(n=1,511) in 7 provinces - Bangkok, Pattaya,
Chiang Mai, Kanchanaburi, Phuket, Sakaew andUdonthani. SWING engaged in protocol
development and defense with the Ethics
Committee. We collaborated with provincial publichealth offices to obtain permission. National
government and other key stakeholders served in
the study advisory group. We used ourconnections and our database to promote thestudy and facilitate SW participation in face-toface data collection. We were able to identify
hotspots for sex work and recruit SW of all
genders. We contributed to questionnairedevelopment and implementation ensuring
sensitivity to SW culture.
Lessons learned: The study reveals important
findings that can be used to inform advocacy
activities, improve SWING interventions for SW
and influence Thailand policy on PrEP in line with
the SWING strategic plan, 2023-2027. We foundevidence of high-risk behaviors, including group

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sex (21% of respondents) with 95% of thesereporting no use of condoms, low levels of HIV
testing with 43% not having been tested in thepast 12 months, low levels of PrEP knowledge, but
relatively high level of interest in PrEP use.
Gender-based violence was found to be pervasive
among all sub-populations, particularly fromclients but also from strangers.
Conclusions/next steps: Community leadership in
policy-relevant research is not only feasible, butalso essential to engage successfully with thedifferent and hard to reach SW populations. We
will use the findings to drive the development andexpansion of PrEP services to cover the needs of
SW of all genders and geographical areas. We will
advocate for the inclusion of community-led
research in the national strategic plan to end AIDS.

E-Poster Abstract

310

Transcending the Virus:
Understanding the Societal
Dynamics Shaping the
HIV/AIDS Crisis through a Lens
of Social Inequality
Li W1
1Peking University, Beijing, China

Since its emergence in the 1980s, AIDS has
persistently challenged global health efforts.
Despite incremental strides, AIDS remains aformidable public health concern, particularly
among marginalized demographics. Confronting
AIDS demands more than medical intervention; it
necessitates an understanding of how various
social determinants shape the transmission andimpact of HIV on individuals and communities.
This research delves into the influence of social
factors on HIV infection across 37 countries,
including Vietnam, Haiti, South Africa, andTanzania, drawing from the expansive dataset of
929,005 samples gathered from the Demographicand Health Surveys (DHS). Employing logistic
regression and fixed-effects models, the analysis
operates on three tiers: national, community, andindividual levels.
The findings underscore the profound impact ofgender, education, asset ownership, female
empowerment, discrimination, urban-rural
dynamics, and sexual attitudes on HIV
transmission. Notably, gender assumes contrastingroles in HIV susceptibility across regions: whilefemales serve as protective factors in Asia-Pacificnations like Vietnam and India, males play a similarrole in African contexts such as Tanzania andAngola. These disparities are attributed to diverse
cultural and structural influences, elucidated
through frameworks like "structural violence" and"internalized violence."
In the end, we make the policy recommendations
encompassing systemic reforms in education,family planning, cultural adaptation, healthcare
infrastructure, gender parity promotion, and social
network fortification. This endeavor aims to

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337

combat HIV infection by transcending the virus
and addressing entrenched social inequalities.

E-Poster Abstract

311'KISARA is my second school':
A Phenomenological
Exploration of Volunteer
Motivations, Challenges, andBenefits in KISARA's Sexualand Reproductive Health
Advocacy Program in Bali,
Indonesia
Nario J1, Daquinan G1, Swe J1, Jiang R1, Mara G1
1University Of Groningen, Groningen, Netherlands

Young people aged 10-24 are particularly
vulnerable to poor sexual and reproductive health(SRH) outcomes. In Indonesia, peer education has
emerged as a significant youth-centered SRH
intervention and the study focuses on KISARA, a
non-profit organization in Bali, Indonesia that
focuses on sexual and reproductive healthadvocacy.
The study presents an in-depth exploration of the
motivations, challenges, and benefits associatedwith volunteering at KISARA. It seeks tounderstand how these factors influence
volunteerism in youth health advocacy inIndonesia. A qualitative research was utilized,
centering on in-depth remote interviews. It
employed Schultz's phenomenological sociology
and Attride - Stirling's thematic network analysis.
These methodologies were used to systematically
explore and interpret the experiences of thevolunteers at KISARA.
The study identifies three key themes inmotivation, namely: access to opportunities,
network expansion, and altruistic endeavors; twothemes in challenges, namely: organizational
challenges and personal challenges; and four
themes in benefits, namely: application ofacademic knowledge to community work,
enhancement of soft skills like communication andleadership, broadening personal perspectives on
sexual reproductive health (SRH), and personalfulfillment.

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The study contributes to the broader
understanding of volunteerism in non-profit
organizations. It offers insights for improving
volunteer management and engagement
strategies in similar contexts, emphasizing theimportance of addressing the challenges andleveraging the benefits experienced by volunteers.

E-Poster Abstract

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312

CI=[-4.20, -0.32]) and PrEP stigma (C=-2.08, CI [3.35, -0.81]) decreased compared to baseline.

HIV PrEP initiation leads toreduced HIV and PrEP stigma
and depression severity among
GBMSM in Singapore: A
prospective cohort study andmixed-methods analysis

Participants highlighted in interviews that being on
PrEP helped them feel less worried and fearful ofacquiring HIV and significantly improved theirmental health. They also articulated how initiating
PrEP gave them more confidence andopportunities to have sex with people living with
HIV, and positively shaped their views towards
both HIV and PrEP use in the community.

Naidu K1, Ong C1, Tan R1, Le T2, Chia S2, Chia T2,
Archuleta S2, Olszyna D2
1National University Of Singapore, Singapore, Singapore,
2National University Hospital, Singapore , Singapore

Background: PrEP initiation may be beneficial for
emotional well-being among gay, bisexual, andother men who have sex with men (GBMSM)
through empowerment as well as reduced fears ofacquiring HIV. However, no prior study has
explored the impact of PrEP initiation on themental well-being of GBMSM in Singapore.
Methods: A concurrent mixed-methods study
design was employed. Quantitative data werecollected at baseline, 6 and 12 months following
PrEP initiation at a clinical setting. Outcomes ofinterest including HIV risk perception, internalised
homophobia, depression, HIV stigma and PrEP
stigma were measured as thecomposite score of several Likert scale questions.
A longitudinal mixed effect linear model
incorporating indicator variables for each time
point and controlling for key sociodemographic
variables. Participants were purposively sampled
to participate in in-depth interviews about their
PrEP experience at the end of thestudy, which were analyzed through inductive
thematic analysis.
Results: The baseline cohort consisted of 53
participants, with 40 individuals remaining in the
study at the 6-month follow-up and 36
participants at the 12-month follow-up. A total of
13 participants participated in in-depth interviews.
At the 6-month mark, HIV stigma (C=-2.13, CI=[4.00, -0.26]) and PrEP stigma(C=-1.36, CI=[-2.59, -0.14]) decreased compared tobaseline. At the 12-month mark, HIV risk
perception (C=-1.07, CI=[-1.87, -0.32]), depression(C=-1.55, CI=[-2.81, -0.29]), HIV stigma (C=-2.26,

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions: PrEP initiation has a significant
positive impact on the mental well-being of
GBMSM and has the potential to help indestigmatizing both PrEP use and having HIV in thecommunity. Further research is needed to explore
the use of PrEP as a platform for addressing HIVrelated stigma.

E-Poster Abstract

313

Decoding U=U: A Comparative
Study on Knowledge andPerceptions toward
Undetectable=Untransmittable, and Willingness to HIV testing
among Heterosexual and NonHeterosexual Populations in
the Philippines
Olete R1,2, Belvis A3, Strong C1
1Department of Public Health, National Cheng Kung University(NCKU), Tainan, Taiwan, 2Sustained Health Initiatives of thePhilippines (SHIP), Mandaluyong City, Philippines, 3College ofNursing, Iloilo Doctors' College, Iloilo City, Philippines

Background: The rate of new HIV cases in thePhilippines surged by 418% from 2010 to 2022 due
to intensified nationwide HIV testing efforts. The
global Undetectable=Untransmittable (U=U)
campaign has improved HIV awareness andtesting, particularly among non-heterosexual
populations (LGBTQIA+). Yet, understanding of
U=U and HIV perceptions remains limited among
heterosexuals. This study aims to compare
knowledge, perception, and willingness to undergo
HIV testing between heterosexual and nonheterosexual populations in the Philippines.
Methods: A nationwide online cross-sectional
survey, conducted from January 6 to 17, 2024,
employed a self-made, validated questionnaire.
The survey encompassed demographic aspects,
including sex at birth (male, female, intersex) andsexual orientation (heterosexual, nonheterosexual). It also gauged knowledge on U=U(10-item, true/false), perceptions regarding U=U
and HIV (susceptibility, severity, benefits, barriers;
1-strongly disagree, 5-strongly agree), andwillingness to undergo HIV testing (0-not
willing,9=very willing). The inclusion criteria
include Filipino residing in the Philippines, at least
18 years old. Data analysis utilized descriptive
statistics, composite scoring for knowledge andperception, and multivariable regression analysis.

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Results: A total of 334 Filipinos participated in thesurvey (mean age=28.3 years, SD=7.2). The
majority identified as male at birth (84.1%), nonheterosexual (82.6%), and cisgender (60.8%).
Respondents scored an average of 7.6 on the 10point willingness scale (SD=2.5) and 6.9 on the 10item knowledge questionnaire (SD=1.6). Highproportions of the respondents got incorrect
answers to the following knowledge-basedquestions: “When a person achieves undetectableviral load, this means a person living with HIV canstop using condoms when having sex and still
protect their sexual partners from HIV
transmission” (72.8% answered incorrectly);“Undetectable viral load in the body can stop HIVfrom spreading through sharing needles during
drug use” (40% incorrect); and “U=U is only
applicable for behaviors that involve sexualintercourse” (39.8% incorrect). Compared toheterosexuals, non-heterosexual individuals
showed higher knowledge on U=U/HIV (91.5% vs8.46%, p=0.001) and greater willingness toundergo HIV testing (90.8% vs 9.2%, p<0.001).
Compared to non-heterosexuals, heterosexual
respondents had higher proportion of never beentested for HIV (93.1% vs 27.9%, p<0.001).
Composite scores indicated favorable perceptions:very good for HIV susceptibility (mean=3.54,
SD=0.71), excellent for HIV severity (mean=4.27,
SD=0.71) and benefits of HIV testing (mean=4.59,
SD=0.66), and good for barriers to HIV testing(mean=2.84, SD=1.04). Multivariable regression
analysis revealed willingness to undergo HIV
testing to be positively associated with sex at birthand perceived benefits (aOR=7.91; p=0.012 andaOR=3.28; p=0.03, respectively).
Conclusion: In conclusion, findings from thissurvey provide insights on the disparity of U=U
campaign among Filipino heterosexuals.
Community efforts should be aimed atmainstreaming the U=U campaign and widen its
reach to the general population. Moreover,normalizing HIV testing among the heterosexual
populations is necessary to improve theirknowledge and perceptions—emphasizing thatHIV prevention is a responsibility of all Filipinos.

E-Poster Abstract

314

Internet-based self-sampled
testing for Chlamydia
trachomatis (CT), Neisseria
gonorrhoeae (NG) and HPV asa tool for expanding testing
coverage
Chung S1,2, Lee K3, Wong N1,2,4, Kwan T1,2,4, Lee S1,2
1Stanley Ho Centre for Emerging Infectious Diseases, The

Chinese University Of Hong Kong, Hong Kong, Hong Kong, 2S.H.
Ho Research Centre for Infectious Diseases, The Chinese
University of Hong Kong, Hong Kong, Hong Kong, 3Departmentof Psychiatry, The University of Hong Kong, Hong Kong, Hong
Kong, Hong Kong, 4JC School of Public Health and Primary Care,
The Chinese University of Hong Kong, Hong Kong, Hong Kong

Background: Testing for sexually transmitted
infection (STI) facilitates early identification andtimely treatment, which potentially reduces
ongoing undiagnosed asymptomatic STItransmissions. Internet-based self-sampling for STI
test could be an effective means to boost testing
coverage. This qualitative study, as a part of a
population study, aimed to understand attitudes,concerns and motivations regarding users’ STI selfsampling experience.
Material and Methods: Sexually experienced Hong
Kong residents aged 18 years or above wereinvited to join a population study in 2022 byrandom sampling. Participants could request free
self-sampling kits from the online survey platform,
including urine specimens, vaginal swab forfemales and penile swab for heterosexual males
and men who have sex with men (MSM),
pharyngeal and rectal swabs for MSM, for
Chlamydia trachomatis, Neisseria gonorrhoeae
and human papillomavirus laboratory tests. After
submitting the samples, they were invited forsemi-structured individual in-depth interviews,
enquiring about their self-sampling experience,
concerns and reasons for using self-sampling, andcomparison with on-site sampling performed byhealthcare workers. All interviews were audiorecorded, transcribed verbatim, and analysedusing an inductive approach in NVIVO 12.

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Results: Some 21 participants (8 heterosexual
female, 7 heterosexual male, 6 self-reportedMSM) were interviewed. All participants had apositive attitude towards self-sampling.
Minimizing physical discomfort and psychologicalburden, ensuring privacy, avoiding
embarrassment, and perceiving self-sampling
procedures simple and convenient were the main
advantages of self-sampling over on-site sampling
performed by healthcare workers. Participants
expected a consultation for follow-up if tested
positive once the service is implemented in a realworld setting. Despite concerns about the validityof samples due to unprofessional self-samplingskills and storage conditions during sample
delivery reported in less than 30% of the subjects,
the majority of the participants were confident in
the accuracy of laboratory test results using theirself-collected samples. The primary motivation forusing self-sampling for STI test was concerns of STI
risk while asymptomatic. The acceptable cost
range was between 100-1000HKD (~13-130USD).
Conclusions: Our findings suggest that internetbased self-sampling for STI is an acceptable meansof testing for asymptomatic individuals. While thevalidity of samples remains a concern, clear
instructions and promising delivery methods mayhelp increasing users’ confidence. The
development of effective and accessible selfsampling programs would be important forenhancing STI testing coverage.

E-Poster Abstract

315“Flourishing like the forest andclear like the sky”: a
Photovoice exploration ofchallenges experienced andresilience resources employedby key populations and people
with HIV in Malaysia
Chong N1,2, Mousavi M3, Wong P1,2, Ng R1,2, Saifi
R1,2, Azwa I1,2, Amir Hassan A1, Collier Z5, Walters
S6,7, Syed Omar S1,2, Haddad M8, Altice F1,9,10,
Kamarulzaman A1,2,11
1Center of Excellence for Research In AIDS (CERiA), Kuala

Lumpur, Malaysia, 2Department of Medicine, Faculty of
Medicine, Universiti Malaya, Kuala Lumpur, Malaysia,
3University of Delaware, Department of Human Development
and Family Sciences, Newark, United States, 4Department of Art
and Design, University of Delaware, Newark, United States,
5
University of Connecticut, Department of Educational
Psychology, Connecticut, United States, 6Department ofPopulation Health Epidemiology, New York University Grossman
School of Medicine, New York, United States, 7Center for Drug
Use and HIV/HCV Research, New York University, New York,
United States, 8Community Health Center, Inc., Center for Key
Populations, Middletown Connecticut, United States, 9Yale
University, Yale School of Public Health, New Haven, UnitedStates, 10Yale School of Medicine, Yale University, Department
of Internal Medicine, New Haven, United States, 11Monash
University Malaysia, Bandar Sunway, Malaysia

Background: Key populations and people livingwith HIV in Malaysia experience adversities,
including pathologization, stigmatization ofintersectional identities, and resource restriction,
resulting in deleterious well-being outcomes.
While people living with and affected by HIV
employ varying strategies in response to stressors,research exploring factors contributing to theirresilience is scarce. Resilience is the process ofovercoming traumatic events and mitigating theharmful consequences of these experiences.
Resilience necessitates two essential components:
the presence of adversity(-ies) and promotive
moderators that either strengthen positive
outcomes or mitigate negative outcomes. Using
Photovoice, a qualitative research method thatempowers individuals to represent theircommunities through imagery narratives, we
explored the challenges key populations andpeople living with HIV in Malaysia experience andthe repertoire of resilience resources they employ.

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Material & Methods: From October to November
2021, individuals across Malaysia aged 18 andabove who self-identified as members of key
populations, i.e., men who have sex with men,transgender women, female sex workers, people
who inject drugs, and people with HIV,participated in an online Photovoice project. A
website, available in Malay and English, facilitatedthe Photovoice data collection, wherein
participants were introduced to the project andtaught photography skills. Participants submitted
photographs with captions responding to thefollowing prompts: (1) what challenges do you
face? (2) What makes you happy? (3) What makes
you sad? (4) What is important to you? We
employed Rapid Qualitative Inquiry to identify
themes across the data.
Results: Thirty-four participants took part,
including 12 (35.3%) men who have sex with men,
7 (20.6%) transgender women, 7 (20.6%) female
sex workers, 6 (17.6%) people who inject drugs,
and 8 (23.5%) people with HIV. We grouped theemerging challenges from the data into threedomains: (1) Intrapersonal: management ofconcealable stigmatized identities; perceived
stigma, i.e., assessment of beliefs about prejudice,stereotypes, and discrimination among others;
securing subsistence resources (e.g., food, safety,
access to transportation, and employment); anddeath-related cognitions and grief; (2)Interpersonal: enacted stigma, i.e., experiences ofstereotypes, prejudice, and discrimination; andnavigating complexities of relationships withfriends, family, and partners; and lastly (3)structural stigma (e.g., absence of legal protection
and restriction of resources).
The resilience resources that emerged werecreative expression and celebration of selfidentities; engaging in prosocial actions (e.g.,
volunteering, making someone smile, donation);spirituality, religious values, and drawing strengthfrom nature; social support; self-care (e.g.,
exercise, good food, practicing gratitude); and therole of time as a promotive factor in developing
resilience, i.e., quality time dedicated to healthpromotion and relationships as a buffer against
stress and illness.
Conclusion: The study identified stressors
experienced by key populations and people with
HIV in Malaysia and the resilience resources
employed. Taken together, findings suggest thatthe local and regional HIV response would benefit
from examining the protective roles of resilienceE-Poster Abstract

resources in the relationship between stressors
and well-being outcomes, offering insights into theneed for empowerment-based approaches tobolster access to HIV care, guide social justicerelated programs and policies as well as cultivating
stigma-resistant communities.

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E-Poster Abstract

316

The Positive Perspectives
Wave 3 study protocol: codeveloping a patient
experience study with
community to assess unmet
needs, engagement in care,and quality of life in people
living with HIV
Patel R1, Allan B2, Brough G3, Cascio M4,
Castellanos E5, Cingolani A6, García-Morcillo D7,
Hardy W8, Han J9, Richman B10, Appiah A1, Fox D11,
Mayer M12, Mehta S1, Mellors S1, Vega V11,
Nwokolo N1, Iwahashi K *Presenting on behalf of
the authors13
1ViiV Healthcare, London, United Kingdom, 2National

Association of People Living with HIV Australia, Newtown,
Australia, 3Transformation Partners in Health and Care, London,
UK, 4European AIDS Treatment Group (EATG), Bruxelles,
Belgium, 5Global Action for Trans Equality (GATE), ,Netherlands, 6Fondazione Policlinico A. Gemelli, IRCCS, Catholic
University of the Sacred Heart, Roma, Italy, 7Adhara, Seville,
Spain, 8USC Rand Schrader (HIV) Clinic, Keck School of Medicine
of USC, Johns Hopkins University School of Medicine, Baltimore,
USA, 9Home of Red Ribbon, Beijing, China, 10Prevention AccessCampaign, Brooklyn, USA, 11ViiV Healthcare , Durham, USA,
12ViiV Healthcare , Rueil-Malmaison, France , 13Akta, Tokyo,
Japan

Background: The Positive Perspectives studies areglobal, cross-sectional surveys of people living withHIV co-designed by community advocates, people
living with HIV, healthcare providers and industry
representatives. Previous research Waves havecontributed to literature on unmet treatment
needs, engagement in care, and barriers tocommunication with healthcare providers and how
these impact self-reported health outcomes. Data
have helped advance critical initiatives, improving
HIV care at country and global levels.
Description: The Third Wave of the study expands
on previous research, broadening the population
to include adolescents, trans and gender-diverse
people and older individuals, increasing the
proportion of women (to 50%) and participating
countries, and delving further into unmet needs
and experiences. Three components are included(Figure).

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344

Patient experience data are important for personcentred healthcare. To increase research utility
and applicability, a diverse 16-member steeringcommittee of advocates, people living with HIV,patient organisation representatives andhealthcare professionals engaged in HIV care
globally co-created study objectives, surveys, andstudy protocol.
Lessons learnt: We learned the value of engaging
broad and diverse groups; demographic
differences in culture and experience among
committee members enabled creation of surveys
with broad relevance and acceptability. The
steering committee modified previous objectives
to reflect priorities relevant to people living withHIV around the world.
Our interactions enabled identification of several
additional areas of research and analysis to better
understand experiences of people living with HIVthat we would have been unaware of had we notengaged in this way.
Conclusions/next steps: Meaningful engagementwith affected communities in research, working insynergy with healthcare providers, has been
identified as key to good health and researchoutcomes. The Positive Perspectives studies havedemonstrated that continuous, authentic patientengagement is best able to identify and address
unmet needs among people living with HIV.
Positive Perspectives Wave 3 enrols through 2024.
Figure:PART A: Adult Survey; Quantitative
Target recruitment: 2,890 people living with HIV
aged 18+ across 29 countries
Research objectives include capturing perspectiveson:- Unmet Needs- Treatment Challenges & Aspirations- Engagement in care
- Impact of quality of care on health outcomes- Challenges of growing older with HIV- Belief in and impact of U=U on behaviourchange- Impact of COVID on access to care
PART B: Personnel in HIV Patient Organisation
survey; Mixed mode (qualitative & quantitative)
Target Recruitment: 435 people across 29
countries
Research objectives include capturing information
on support provided in relation to:- HIV stigma prevention- Barriers to accessing support- Facilitators for sharing U=U

E-Poster Abstract- Community needs around care, support andeducation
PART C: Youth Survey; Quantitative
Target Recruitment: 50 people living with HIV aged
13-17 years in South Africa
Research objectives include capturing perspectiveson:- Challenges and barriers to care
- Level of understanding of HIV and U=U- Self-reported health

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E-Poster Abstract

317

Understanding impact of
COVID19 on Sex Workers:
Findings from a study in
Madhya Pradesh, India
Badgujar S1
Network of Asian People who use Drugs (NAPUD), Pune, India

1

Introduction: Like all humanitarian crises, COVID19 affected different people differently,
highlighting structural inequalities, exacerbating
gender inequality and disproportionately
impacting the marginalized and dispossessed. Sex
workers all over the world were among thehardest hit communities at the start of the COVID19 pandemic and in India also, COVID-19 pandemic
had severe impact on sex workers, intensifying
their existing vulnerabilities and challenges.
Method: In order to understand the challenges
faced by sex workers during COVID19, a study wasdone among 156 female sex workers in two
districts of Madhya Pradesh.
Findings - Findings from the study show that sex
workers have to face increased vulnerabilities andchallenges during the COVID19. 83% of
respondents reported a decrease in their income
and 71% experienced increased mental stress andhardship during the COVID-19 period. 48% of
respondents faced challenges in accessing HIV
prevention services, and 41% of respondents
experienced increased violence in the last two
years. 24% of respondents did not receive any
support from the government or other agencies
during the COVID-19 pandemic. Lack of
information, identity documents and proof ofaddress compounded their difficulties.
Furthermore, 31% of respondents reported anincrease in stigma and discrimination towards sex
workers.
Lessons learnt: COVID19 pandemic exacerbatedthe challenges and struggles of female sex
workers, leading to increased violence, decline inincome, and difficulties in accessing healthcare,particularly for HIV prevention and treatment
services.

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Conclusion: The study reveals the multifaceted
impact of COVID-19 on sex workers, underscoring
the need for inclusive, rights-based responses andsupport systems. This includes need of addressing
violence and discrimination, and integrating sex
workers into social protection and humanitarianefforts to foster resilience against future crises.
Further, it is also critical to strengthen community
systems and social capital to protect against future
crises.

E-Poster Abstract318

Chemsex as lines of flight?
Critical Deleuzean perspectives
on chemical intimacies
Tan Q2, Tan R1
1Saw Swee Hock School Of Public Health, National University Of

Singapore, Singapore, Singapore, 2Asia Research Institute,
National University of Singapore, Singapore, Singapore

Background: Set against a dominant public healthand biomedicalist approach, sex among men
compounded by illegal drug use, has generated
moral panic scripts. Public health scholars have, in
their ‘rush to risk’, over-emphasised the
problematic aspects of chemsex, while glossing
over how it may be transformative. In a bid toresist a medical-moralist paradigm dominating
public health ideologies, critical scholars havebeen partial to the emancipatory potential ofchemical-sexual intimacies. Taking this view as apoint of departure, we make a case forunderstanding chemsex among men in Singapore
vis-à-vis Deleuzean lines of flight.
Methods: Semi-structured in-depth interviews
were conducted with 33 purposively sampledsexual minority men seeking treatment forchemsex in Singapore. Interview topics included
participants’ experiences and life histories ofchemsex, substance use, incarceration, trauma,
and ongoing recovery from chemsex. Interviews
were audio-recorded and transcribed verbatim.
Data were and analyzed via inductive thematic
analysis.
Results: Drawing on in-depth qualitativeinterviews, we illustrate how chemically inflected
sexual encounters can offer deterritorialisingflights of fantasy and freedom from aheteronormative social structure that stigmatises
gay sex, among other normative regimes.
Nevertheless, we argue that these flight lines are
not static, neither do they extend indefinitely inspace-time. Accordingly, we show how flights of
freedom can evolve into lines of fright (or nonflight) when chemsex practitioners are met withcritical thresholds that reveal the less-thandesirable aspects of being intoxicated.
Consequently, they may eventually consider thereterritorialisation of their lives (i.e. abstinence

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347

and recovery) as a more constructive option.
Regardless of their choices to ride on chemicallyinduced flight lines or to take a step back fromsuch deterritorialising pathways, they haveasserted their agency and troubled stereotypicalperspectives of drug users as passive automatons.
Conclusions: This paper enriches the chemsex
scholarship by presenting a robust and nuanced
Deleuzean conceptualisation of chemical-sexualintimacies without romantacising and/or
overstating the ‘escape’/‘freedom’ that chemsex
can facilitate. Future research in this arena could
potentially investigate the complicated, conflicted
and protracted intimate relationships that users
may have with their drug(s) of choice, as well as
the varied lines of (non-)flight that these chemicals
can endow over a longitudinal study.

E-Poster Abstract

319

Primary care providers’knowledge, attitudes, andpractice of recommending HPV
vaccination to adolescentmales in mainland China: across-sectional study
Li M1, Cai W2, Chandrasekhar A3, Hu H4, Chow E5,
Wu D6
1School of Public Health, Nanjing Medical University, Nanjing,

China, 2General Practice, Mishixiang Street Community HealthService Center, Gongshu District, Hangzhou, China, 3School of
Medicine, , United States of America, 4Nanjing Medical
University Drum Tower Clinical Medical College, Nanjing, China,
5Melbourne Sexual Health Centre, Melbourne, Australia, 6Schoolof Public Health, Nanjing Medical University, Nanjing, China

Background: HPV vaccination for boys is effective
in preventing HPV-related diseases such as
oropharyngeal and anal cancers among adult men
and has peripheral benefits for women. The
Chinese government has not yet prioritized malepopulation for HPV vaccination but there are
increasingly more discussions about including
them in HPV vaccination services. It is therefore
important to prepare health providers for future
inclusion of men in HPV vaccination services in
China. This study aimed to understand primarycare providers’ knowledge, attitudes, and practicesof recommending HPV vaccination for adolescentmales, and associated factors.
Methods: Between December 2023 and February
2024, we conducted an online questionnaire
survey with primary care providers in, including
general practitioners, nurses, public healthpractitioners in community health settings. We
used the socio-ecological model to guide thesurvey instrument design and data on individuallevel (e.g., knowledge of HPV and the HPV vaccine,
perceived safety of vaccination in adolescentmales), interpersonal-level (e.g., embarrassment
when discussing HPV with parents of boys),community-level (e.g., focus population formarketing), organizational-level (e.g., vaccine
supply and availability), and policy-level factors(e.g., lack of policy or clinical guidelines) werecollected. We used a stepwise regression approach
to identify factors associated with their previous

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348

recommendation experiences and willingness torecommend HPV vaccines to adolescent males.
Gender, age, occupation, professional specialty,
job title, years of practice, education, and income
were adjusted as potential confounders.
Results: A total of 605 primary care providers
completed the survey, including 349 (57.7%)
primary care physicians and 256 (42.3%) nurses,
with a mean age of 36.3 years (SD=8.0).
Participants possessed a relatively goodknowledge of HPV and HPV vaccines, with a
median score of 8 out of 10 (10 suggests the best
knowledge level). Ninety-nine (16.4%) had
recommended the vaccine to adolescent males in
the past year, and 92.7% reported willingness torecommend in future. Factors associated withrecommending vaccination to adolescent males in
the past year were: colleagues encouragement(aOR=2.52, 95%CI: 1.52-4.18), supportive
organizational policies (aOR=5.11, 95%CI: 2.938.90), having incentives for HPV vaccine promotioni (aOR=2.36, 95%CI: 1.37-4.06), community
discussion that HPV-related diseases areuncommon (aOR=0.53, 95%CI: 0.34-0.83),
community perception that HPV vaccine is only forfemales (aOR=0.33, 95%CI: 0.21- 0.53). Factors
associated with willingness to recommend
vaccination for adolescent males were: the belief
that the vaccine was safe (aOR=14.32, 95%CI:
4.16-49.33), willingness to explain the benefits ofvaccination to parents (aOR=11.68, 95%CI: 4.4730.50), existence of vaccination campaigns in nonprofessional settings (aOR=5.09, 95%CI: 2.5010.33), personal endorsement of including HPV
vaccination in the National Immunization Program(aOR=5.97, 95%CI: 2.81-12.66), the belief thatadolescent males were too young (aOR=0.15,
95%CI: 0.07-0.31), and fear of offending parents bydiscussing HPV-related diseases (aOR=0.25, 95%CI:
0.13-0.48).
Conclusion: Primary care providers’ willingness torecommend HPV vaccine is high, but actual
recommendation rates for HPV vaccination ofadolescent males were low. We identified various
associated factors, and these can be used to
inform future interventions targeting primary careproviders to increase HPV vaccination among
adolescent males.

E-Poster Abstract

320

HIV, hepatitis, and syphilis
self-testing among adolescentsand young people: A
systematic review and metaanalysis
Zhang Y1,2, Tapa J1,2, Johnson C3, Baggaley R3,
Fairley C1,2,4, Ong J1,2,5
Central Clinical School, Monash University, Melbourne,
Australia, 2Melbourne Sexual Health Centre, The Alfred
Hospital, Melbourne, Australia, 3Global HIV, Hepatitis and STI
Programmes, World Health Organization, , Switzerland,
4
University of Melbourne, Melbourne, Australia, 5Faculty of
Infectious and Tropical Diseases, London School of Hygiene andTropical Medicine, , United Kingdom
1

Background: Adolescents and young people makeup a disproportionate share of the world’s HIV andsexually transmitted infections (STI). Self-testing
can increase testing coverage and strengthen the
uptake of HIV/STI prevention and treatment
services. We aimed to critically appraise theliterature regarding HIV, hepatitis, and syphilis
self-testing among adolescents and young people(age 10–24 years, based on definition from theWorld Health Organization), and assess its
acceptability, feasibility, usability, and costeffectiveness.
Methods: We conducted a systematic review andmeta-analysis, searching six databases between
January 2010 and October 2023. We included all
studies on HIV, hepatitis and syphilis self-testing inadolescents and young people. A random-effects
meta-analysis was used to summarise the uptake,proportion of first-time testers and linkage to care.
Qualitative data were narratively synthesised.
Results: We identified 104 relevant studies, ofwhich 98 were on HIV, four on hepatitis and two
on syphilis self-testing. Among these, six studies
focused on adolescents aged 10–14, 96 studies
included adolescents aged 15–19, and 96 studies
involved young people aged 20–24. A total of 46
studies were included in the meta-analysis. Most
studies were conducted in the African region (n=33/46, 72%) and lower-middle-income countries(n= 17/46, 37%). Approximately 90% (95%
confidence interval (CI): 82–96%, I²=99%) ofadolescents who were offered any of the three

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types of self-test completed the test. Around 78%(95% CI: 26–100%, I²=98%) of adolescent selftesters reporting reactive result subsequently
linked to further testing and onward care asneeded. In general, there was high acceptability
and usability among adolescents and young people
towards self-testing. Adolescents aged 10–14
preferred receiving a self-test kit with pre-test
counselling or assisted video/audio instructions
from a healthcare worker to guide them on how to
self-test. Most individuals aged 15–24 liked theconfidentiality, convenience and non-invasivenessof self-testing compared to conventional facilitybased testing. They also found self-testing easy to
perform without assistance and were confident ininterpreting the results by themselves.
Conclusions: Self-testing is a safe, effective andaccessible way to increase HIV, hepatitis andsyphilis testing and treatment in adolescents andyoung people. Efforts to ensure access to selftesting for this population should be prioritized
across disease areas to maximise public healthimpact.
*Numbers may not add up due to studies withparticipants from >1 age group.

E-Poster Abstract

321

A secondary data analysis of
HIV testing service databasefrom 2021-2024: Preliminary
assessment of risk profiles
among clients in fourcommunity-based HIV carefacilities in Greater Metro
Manila, Philippines
Olete R1,2, Leyritana K1, Gonzales J1, Daclison J1
1Sustained Health Initiatives of the Philippines (SHIP),

Mandaluyong City, Philippines, 2Department of Public Health,National Cheng Kung University (NCKU), Tainan, Taiwan

Introduction: Factors associated with HIV infection
vary according to country and community
contexts. In the Philippines, condomless sex
among men who have sex with men (MSM)
remains the most prevalent risk of HIV infection.
However, other risk factors remain unexplored at
the community-level. Save And Improve Lives(SAIL), a key population (KP)-led, foreign aid-local
NGO collaborative model, established one-stop
shop HIV care facilities in high HIV-burden areas of
the Philippines. To effectively plan for sustainabledifferentiated and KP-centered HIV service
provision, this study was conducted to assess thefactors associated with HIV among clients of SAIL
clinics.
Method: A secondary data analysis was conductedusing the entire HIV Testing Service (HTS) databaseof four SAIL clinics—two located in Metro Manila(Makati City and Caloocan City) and two in
CaLaBarZon Region (Calamba and Cavite).
Descriptive statistics and multivariable logistic
regression were used to analyze the association
between an HIV-positive status and specific risk
behaviors. The association between HIV result andbehavior risks were adjusted for age, sex at birth,education level, civil status, and employment, withlevel of significance set at p=0.05.
Results: From January 5, 2021 to February 6, 2024,
a total of 24244 HTS data entries were recorded,showing a mean age of 19.4 years old (sd=7.79),
male at birth as a majority (94.3%), unemployed

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status (49.5%), and 13.7% were current students.
Facility-based testing was the most common
modality conducted (40.3%) with a highly
urbanized, central business district-adjacent clinic(Makati) having the highest proportion of HTS
uptake (44%). HIV reactivity, on the average, was
4.9% (1196/24244), with the highest rate
demonstrated by a provincial clinic near hot spring
resorts and short term vacation houses (Calamba,
5.5%). The highest proportions of risk behavior
recorded was sex with males (86.6%), sex withfemales (16%), paying for sex (3%), and receiving
payment for sex (2.9%). Adjusted odds ratios
revealed that an HIV-positive result was more
likely associated with male sex (aOR=2.04,
p<0.001), paying for sex (aOR=1.74, p<0.001), andreceiving payment for sex (aOR=1.8, p<0.001).
Conclusion: The secondary data analysis from four
SAIL clinics suggests that targeted outreach andeducation efforts should focus on reaching young
males, particularly those who may be out of schoolor unemployed. The identified factors associatedwith HIV-positive results, such as male sex, paying
for sex, and receiving payment for sex, provide
valuable insights for designing combination
prevention strategies for people who engage insex work, receive gifts in exchange for sex. This
may include increasing uptake of Pre-Exposure
Prophylaxis (PrEP) with a comprehensive STI
testing package while addressing unemployment
and education support as social determinants ofHIV.

E-Poster Abstract322

The impact of COVID-19
pandemic on the clinicalcharacteristics of new HIV
diagnoses- a retrospective
single-centre observational
study in Sabah, Malaysia
Ng E1, Lee H1
1Queen Elizabeth Hospital, Kota Kinabalu, Malaysia

Background: The COVID-19 pandemic has had asignificant impact on healthcare delivery globally.
Disruption of HIV care services and restrictive
measures implemented during the pandemic could
have altered the disease dynamics of HIV
infection. Data on the impact of the COVID-19
pandemic on new HIV diagnoses in Malaysia arelacking. This is a retrospective, single-centre
observational study at a tertiary hospital in Sabah,
Malaysia, comparing the clinical characteristics of
new HIV diagnoses pre- and post-COVID-19
pandemic.
Methods: All adult patients who presented to the
Infectious Diseases Clinic at Queen Elizabeth
Hospital with newly diagnosed HIV infection in thefollowing 2 time frames were included in the
study: from 1st May to 30th November 2019 (preCOVID-19 period) and from 1st May to 30th
November 2022 (post-COVID-19 period). Clinicaland laboratory results and demographic data werecollected from medical records.
Results: A total of 121 patients were included in
the analysis: 66 (54.5%) in the pre-COVID-19 groupand 55 (45.5%) in the post-COVID-19 group. The
median ages were 31 years for the pre-COVID-19
group and 32 years for the post-COVID-19 group.
Male sex was predominant in both groups ofpatients. There was no difference in terms of risk
factors for HIV acquisition in the 2 groups (preand post-COVID-19), with men who have sex withmen (MSM) being the predominant risk factor. In
terms of the median CD4 cell count at diagnosis,
there was no statistically significant difference
between patients in the pre- and post-COVID-19
groups (median: 285 vs 243 cells/mm3; p = 0.555).

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The number of cases of syphilis infection was
significantly higher in the post-COVID-19 group(16/55; 29.1%) than in the pre-COVID-19 group(6/66; 9.1%) (p=0.005). Fever was the mostcommon symptom at HIV diagnosis in both groupsof patients. Significantly more patients in the postCOVID-19 group (7/55; 12.7%) reported weightloss at HIV diagnosis than those in the pre-COVID19 group (1/66; 1.5%) (p= 0.023). Hypertension
was the most common comorbidity and wasobserved more in patients in the pre-COVID-19
group (10/66; 15.2%) than those in the postCOVID-19 group (2/55; 3.6%) (p=0.035).
Conclusion: In conclusion, the clinicalcharacteristics of new HIV diagnoses were affectedby the COVID-19 pandemic, although larger
multicentric studies are needed to examine thereal impact. The transmission dynamics of otherdiseases, such as syphilis, might also be influenced
by the pandemic.
Keywords: HIV, COVID-19, Syphilis

E-Poster Abstract

323

Correlation between High-Risk
HPV and Cervical
Abnormalities in Women
Living with HIV in Bali,
Indonesia
Somia I1, SOMIA I2, Winarti N2, Dwija I2, Pidari D3,
Sawitri A2, Gayatri A1, Budiana I2, Pinatih K2, Merati
K1
1Prof dr IGNG Ngoerah Hospital – Faculty of Medicine Udayana
University , Denpasar, Indonesia, 2Faculty of Medicine Udayana
University , Denpasar, Indonesia, 3Kerti Praja HIV Foundation
Clinic , Denpasar, Indonesia

Background: Women living with HIV face a higher
risk of developing cervical cancer compared tothose without HIV. However, comprehensive
cervical cancer screening programs for thispopulation are still lacking in Indonesia. This has
resulted in many cases of late-stage cervical cancer
being diagnosed, especially in Bali, which has
experienced an increase in cases of HIV andcervical cancer. This study aimed to determine theprevalence of and risk factors for cervicalabnormalities/dysplasia in women living with HIV
in Bali and to explore their relationship with highrisk HPV (HPV-HR) types.
Material and methods: An observational crosssectional design was used, with eligible women
recruited from outpatient HIV clinics in Bali who
provided consent to participate. Between July to
December 2023, participants were interviewed tocollect demographic and historical medical
information, followed by a physical examination
including a pelvic examination with sample
collection and phlebotomy. Pap smear samples
and cervical swabs were processed using ThinPrep(Hologic, Inc., USA) for cytology and HPV DNA
testing. PCR for detection and genotyping was
performed using the Veriti ThermoCycler (Applied
Biosystems). HPV-HR types included HPV 16, 18,
31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.
Blood samples were analyzed for CD4 and CD8 cellcounts.
Results: A total of 245 women with HIV wereenrolled (median age 38 years old (IQR 33-44
years)), their median time on antiretroviral

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352

therapy was 7 years (IQR 3-11); 239 (98%) had
valid initial results and were included in theanalysis. Overall, 26 (11%) of samples showedabnormal cytology: 9 (3.8%) ASC-US, 6 (2.5%) ASCH, 7 (2.9%) LSIL, and 4 (1.7%) HSIL. Of the 58 (24%)
that tested positive for HPV DNA, 18 (31%) had
abnormal cytology. HPV 18 was the most common
high-risk genotype detected 16 (28%). Bivariate
analysis showed a significant association between
positive HPV DNA and abnormal cytology, withthose testing HPV-positive having a 9.7 times
higher risk of ASC-US or greater (OR=9.73;
95%CI=3.95-23.96; p=0.000). Multivariate
regression analyses identified having HPV 18
infection as an independent risk factor for
abnormal cytology (OR=9.02; 95%CI=1.84 - 44.4;
p=0.007).
Conclusion: In our study,11% of women living withHIV had abnormal cytology and 24% had positive
HPV DNA tests. HPV 18 was associated with agreater risk of abnormal cytology compared toother HPV-HR strains, but our sample size wassmall. These results underscore the need forincreased vaccination of younger women andscreening of all women living with HIV in Indonesia
in order to improve their health outcomes andprevent cervical cancer.

E-Poster Abstract

324

Diversity of HIV-1 CRF01 AE
cluster 4 and its impact on
immune recovery during
combination antiretroviraltherapy
Ge Y1, Liu Y1, Fu G2, Wei P1, Yang D2, Qiu T2, Xu X2,
Guan W2Southeast University, Nanjing, China, 2Jiangsu Provincial Center
for Diseases Control and Prevention, Nanjing, China

1

Background: HIV-1 CRF01_AE cluster 4 has thehighest diversity among multiple phylogenetic
lineages. We aim to explore the impact of cluster 4
diversity on immune recovery during combination
antiretroviral therapy (cART).
Methods: This retrospective longitudinal study
enrolled patients newly diagnosed with HIV-1
infection in Jiangsu Province from 2017 to 2018.
The pol sequences of CRF01_AE strain were
subjected to cluster identification. The patients
who have received cART for at least 2 years andmaintained virological suppression at all follow-up
visits were selected. The immune recovery analysis
included CD4+ T cell counts increase rate, risk of
immunological non-response (INR), and theprogression of immune reconstitution (IR). We
used generalized additive mixed model to assess
the CD4+ T cell counts increase rate. Univariable
and multivariable Logistic regression models wereused to determine the association of cluster 4
diversity with the risk of INR. Kaplan-Meieranalysis and multivariable Cox proportional
hazards models were employed to compare theprogression of achieving IR among different
CRF01_AE clusters.
Results: A total of 1364 CRF01_AE patients weresuccessfully identified, mainly comprised of cluster
4 (64.74%, 883) and cluster 5 (20.38%, 278).
Cluster 4 further diversified into cluster 4a(35.79%, 316), cluster 4b (30.24%, 267) and two
novel subclusters named cluster 4c (16.53%, 146)
and cluster 4d (17.44%, 154). Among 767 patientswith sustained virological suppression, cluster 4apatients showed a slower CD4 increase rate (vscluster 4b, coefficient: 8.60, 95% CI: 0.05 ~ 17.14, P= 0.049; vs cluster 4c, coefficient: 7.69, 95% CI: -Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024353

2.45 ~ 17.83, P = 0.138; vs cluster 4d, coefficient:20.30, 95% CI: 10.46 ~ 30.14, P < 0.001; vs cluster
5, coefficient: 15.72, 95% CI: 7.15 ~ 24.28, P <0.001), higher risk of INR (vs cluster 4b, adjusted
OR: 0.77, 95% CI: 0.46 ~ 1.29; vs cluster 4c,
adjusted OR: 0.89, 95% CI: 0.48 ~ 1.67; vs cluster
4d, adjusted OR: 0.42, 95% CI: 0.23 ~ 0.76; vscluster 5, adjusted OR: 0.58, 95% CI: 0.34 ~ 0.98),
and longer progression of IR (vs cluster 4b,
adjusted HR: 1.37, 95% CI: 1.00 ~ 1.88; vs cluster
4c, adjusted HR: 1.18, 95% CI: 0.80 ~1.73; vscluster 4d, adjusted HR: 2.10, 95% CI: 1.46 ~ 3.02;
vs cluster 5, adjusted HR: 1.83, 95% CI: 1.34 ~2.49). In the subgroup analyses of patients withbaseline CD4+ T cell counts less than 500 cells/µl,
the results that cluster 4a associated with poorer
immune recovery remained salient. The
proportion of CXCR4 tropism (X4) in cluster 4a wassignificantly higher than other clusters (cluster 4a:29.17%, cluster 4b: 18.10%, cluster 4c: 14.71%,
cluster 4d: 10.00%, cluster 5: 9.68%; P = 0.001).
Conclusions: The cluster 4 diversity was evolving
and was associated with immune recovery. Cluster
4a was associated with poorer immune recovery
than other subclusters of cluster 4, which might bedue to the high proportion of CXCR4 tropism. Early
initiation of cART after diagnosis and clinicalmonitoring for patients with cluster 4a should behighly emphasized.

E-Poster Abstract

325

Clinical characteristics, clinicaloutcome and mortality amongpeople living with HIV in Siriraj
Hospital, Thailand.
Navanukroh O1, Curlin M2, Sirijatuphat R1
Faculty of Medicine Siriraj Hospital, Bangkoknoi, Thailand,

12Oregon Health and Science University, Portland, United Statesof America

Background: Combination antiretroviral therapy(cART) scale-up have been implemented in
Thailand since 2002 and significantly decreased
HIV-related mortality. We conducted aretrospective cohort study to describe clinicalcharacteristics and clinical outcomes of people
living with HIV(PLWH) who had been treatedbetween 2006 and 2015 in Siriraj Hospital,
Thailand. We evaluated 5-year mortality andcauses of death of PLWH.
Methods: Men and non-pregnant women livingwith HIV aged > 15 years who were diagnosed andtreated at Siriraj Hospital were included in the
study. Data were retrospectively reviewed frommedical records and death registration.
Results: A total of 869 patients, 602(69.3%) weremale and the median age at diagnosis was 38.4
(IQR 29.4-47.4) years. At the time of HIV diagnosis,
60% were in WHO clinical stage 3 and 4, median
CD4 was 262 cells/mm3(IQR 150-405). Prevalenceof HBV, HCV co-infection, and any stage of syphilis
were 98(16.8%), 49(6.1%), and 86(10.2%),
respectively. Most common opportunistic
infections(OIs) and malignancies were tuberculosis(209; 24.1%) with two-thirds were extrapulmonary involvement, followed by
Pneumocystis jirovecii pneumonia(PJP) (153;
17.6%), and disseminated cryptococcosis(46;5.2%), and hematologic malignancies(37; 4.6%).
785(90.3%) received cART and 688(93.2%) werevirologic-suppressed at 6 months after cART
initiation. During 5-year follow-up period, 87
patients developed virologic failure, 48(5.5%) werereferred-out, 40(4.6%) were lost to follow-up,
144(16.5%) died from AIDS-related illnesses, and37(4.2%) died from non-AIDS-related causes or
unknown. Mortality rate was 0.14 (95%CI 0.12,0.16) per 1000 person-years.

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354

Common causes of AIDS-related death weretuberculosis(22%), hematologic
malignancies(mostly lymphoma)(16%), andcryptococcosis(7.7%), respectively. Mortality wasstatistically significant associated with malesex(aHR 1.36), aged > 55 years(aHR 1.44), andWHO clinical stage 3 and 4(aHR 3.94) with p<0.05.
Conclusion: Early diagnosis and early cART
initiation are associated with favorable clinicaloutcomes among PLWH. Common causes of deathamong PLWH were who were elderly and werediagnosed at late stage, especially presence withtuberculosis, cryptococccosis and hematologic
malignancies. Early HIV diagnosis, appropriate OIs
management, timely initiation of cART are key
strategies to improve clinical outcomes among
PLWH. Nevertheless, the study has limitations due
to retrospective study, single center, and missingdata.

E-Poster Abstract

326

Molecular epidemiologicalcharacteristics and dynamic
molecular network analysis of
HIV-1 in Nanjing from 2016 to2018
Liu Y1, Ge Y1, Wei P1
1Southeast University, Nanjing, China

Objective: In order to monitor the dynamicchanges of key populations in the HIV-1 molecular
network in Nanjing and the influencing factors that
promote transmission, the intervention strategy
was adjusted in time.
Methods: The plasma of newly reported HIV-1
infected patients in 2016~2019 was collected toamplify the genes in the Pol region. Taking the2016 sequence as the baseline, the sequence wasincreased year by year to construct a dynamic
molecular network, and multivariate analysis wasused to find the influencing factors that may drive
the dynamic change of the molecular network.
Results: In 2016~2018, the genotypes of newly
reported infections in Nanjing were mainly CRF
01_AE (46.57%) and CRF 07_BC (32.73%). The
median mean age of the infected patients at thetime of diagnosis was 28 [23, 29] years, and themain ones were males (94.75%), unmarried(66.26%), 60.20% with college or bachelor's degree
or above, non-students (83.43%), and sexuallytransmitted by men (78.69%). A total of 489
sequences entered the dynamic molecular
network, of which 136 sequences had beenpresent in the network, and univariate analysis
showed that there were significant differences inage, sexual history, CD4+ T cell count at diagnosis,
and whether they were high-risk transmitters(P<0.05), and multivariate analysis showed thatsexual history, CD4+ T cell count at diagnosis, andwhether they were high-risk transmitters were thefactors affecting the dynamic molecular network.
Conclusion: The dynamic molecular network
reveals the characteristics of a certain propagation
relationship, and it is found that there is an active
network in Nanjing. A variety of factors may affectthe network structure, and prevention and control

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355

efforts such as "early detection and rapid testing"are needed to reduce the complexity of thetransmission network to a certain extent andprevent the spread of the epidemic.
Keywords: HIV-1; phylogenetic analysis; dynamic
molecular networks; Influencing factors

E-Poster Abstract

327

Meeting 95-95-95 targets in
Vietnam: An analysis ofdecreasing HIV prevalence inQuang Ninh Province over thelast decade
Dang H1, Bui H2, Nguyen V1, Nguyen V1, Nguyen T2,
Vu T2, Luu H2, Vuong T1, Phan H3, Coley R1, Levitt
D1
1FHI 360 Vietnam, Hanoi, Viet Nam, 2Quang Ninh provincial
Center for Diseases Control, Quang Ninh, Viet Nam, 3Vietnam
Administration for HIV/AIDS Control, Hanoi, Viet Nam

Background: Provincial HIV prevalence andincidence vary considerably in Vietnam, withevidence of emerging and decreasing subepidemics. Quang Ninh, a province with previously
high HIV prevalence, has made significant progressagainst 95-95-95 targets. Incidence dropped from
0.7 per 1,000 population in 2006 to 0.1 per 1,000
population in 2022, and prevalence decreased
from 0.67% in 2006 to 0.42% in 2022. At the endof 2023, 88.3% of people living with HIV knew
their HIV-positive status; among those who knew
their status, 89.8% were on treatment; and 99.4%of those on treatment had achieved viral
suppression. We focused on trends in HIV testing,new HIV diagnoses, and enrollment in care andtreatment over the past 10 years in Quang Ninh tohelp characterize the province’s progress inepidemic control.
Materials and Methods: We reviewed deidentified data for newly diagnosed HIV clientsfrom 2013 through 2023 from the provincial casereporting system and data from HIV testing andcare and treatment programs. Linear regression
analysis was used to assess temporal trends andChi-square to identify significant differences.
Results: From 2013 to 2023, 2,465 individuals
were newly diagnosed with HIV, of whom 90.6%(2,233/2,465) started treatment. The number of
new cases decreased significantly over time, withan annual average change (AAC) of -12.7% (95% CI:-22.0% to -3.4%; p<0.05). Statistically significant
decreases were found among most subpopulation
analyses, with the largest changes among people
who inject drugs (AAC -19.3%, 95% CI: -35.7% to -Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

356

3.1%; p<0.05), individuals 35–44 years (AAC 15.2%, 95% CI: -31.4% to 1.0%; p<0.05), and thosecategorized as other key populations (AAC -8.8%,
95% CI: -25.9% to 8.3%; p<0.05). Overall, the total
number of people with permanent residency inthe province who were newly diagnosed with HIV
decreased as well (AAC -11.8%, 95% CI: -22.8% to 0.8%; p<0.05). The number of HIV tests conducted
and number of HIV patients on antiretroviraltherapy (ART) increased, with AACs of 3.7% and2.4%, respectively. ART patients maintained a highrate of viral load suppression (five-year average of
98.3%).
Conclusions: The decrease in newly diagnosed
individuals from 2013 to 2023, coupled withincreased coverage of HIV testing and treatment
uptake in Quang Ninh province, reflect a
potentially positive trend toward epidemic control.
Recent advancements in HIV programming may be
more effectively identifying and targeting
populations at higher risk. As an example, while
Quang Ninh experienced high HIV incidence andprevalence among PWID, national efforts to scale
methadone treatment, and sociological shifts in
drug in Vietnam have led to overall reduction in
HIV infection among this population.
Concomitantly, programming has shifted towards
MSM and transgender woman, amongproportionate infections are increasing in several
provinces in Vietnam. Ongoing efforts in Quang
Ninh should concentrate on community-led
outreach to determine if risk networks remain
untapped, transition to provincially funded
community-to-facility models, promotion of
biomedical prevention (pre-exposure prophylaxis),
and data-driven resource planning.

E-Poster Abstract

328

Knowledge and awareness on
sexually transmitted diseases(STDs) among Women in
KeralaKatpattil S1
Mes Dental College And Hospital, MALAPPURAM, India

1

Background: Knowledge and awarenessconcerning sexually transmitted diseases (STDs)
has become the burning issue of the day. Although
STDs pose serious risks to health security, there isvery little literature quantifying the knowledge andawareness of these diseases and their principal
socioeconomic determinants. The aim of this study
is to determine the effect of different socioeconomic and demographic factors on knowledge
and awareness about STDs among women in India.
Methods: This is a cross-sectional study using datafrom the Demographic and Health Survey (DHS)
2020. It involves 945 women in six districts of
Kerala, India . In this study, the percentage
distribution and logistic regression model are used
to identify which factors are associated withknowledge and awareness among women in kerala
about STDs.
Results: There is a significant association between
geographic division (District 1 : OR = 1.669, 95%
CI = 0.89-2.10, District 2: OR = 2.234, 95% CI = 1.23.2); places of residence (Rural: OR = 0.363, 95%
CI = 0.20-1.08), respondent’s age (20-29 years:
OR = 1.331; 95% CI = 0.98-2.31); education(Primary: OR = 2.366, 95% CI = 1.98-3.1, secondary:
OR = 10.089, 95% CI = 8.98-12.77, higher:
OR = 20.241, 95% CI = 18.33-22.65); listening toradio (OR = 1.189, 95% CI = 1.29-3.12) andwatching TV (OR = 2.498, 95% CI = 2.22-4.09) withknowledge and awareness among women in kerala, India about STDs.
Conclusion: There is a need to improve theeducation in India about STDs particularly among
those in the rural areas and older ages of women(30-49 years). Formal, informal and special
educational knowledge and awarenessprogrammes may be implemented to educate
people concerning STDs. Campaigns and mass

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357

media can be used to increase the knowledge andawareness among the community, especiallyamong women. Policies concerning the issue of
STDs need to be improved and can be emphasizedin collaboration with government agencies toensure the success of these campaigns.

E-Poster Abstract

358

329

PNPLA3 rs738409 may increase the risk of NAFLD
in HIV/AIDS populations.

The correlation between
NAFLD and PNPLA3 rs738409
gene polymorphism in naïve
patients with HIV/AIDS in
Nanjing from 2022 to 2023

Keywords: ART naïve，HIV/AIDS，NAFLD，PNPLA3

Yu N1, Peng J1, Xia Z1, Di X1, Li M2, Guan H2, Chen
C1, Cai R1, Wei H1,2
Department of Infectious Disease, The Second Hospital of
Nanjing, Affiliated to Nanjing University of Chinese Medicine,
China, Nanjing, China, 2Department of Infectious Disease, The
School of Public Health of Nanjing Medical University, The
Second Hospital of Nanjing, China, Nanjing, China
1

Objective: To investigate the correlation between
PNPLA3 rs738409 gene polymorphism and NAFLD
genetic susceptibility in HIV/AIDS patients.
Methods: The peripheral venous blood of
HIV/AIDS patients who were followed up in theoutpatient clinic from June 1, 2022 to September
30, 2023 were collected, and nucleic acidextraction and PNPLA3 rs738409 genotyping were
performed to explore the relationship between
the polymorphism of this gene and the genetic
susceptibility of NAFLD.
Results: A total of 249 patients were included in
the analysis, and PNPLA3 rs738409 was sequenced
with three genotypes: C/C, C/G, and G/G.
Compared with the NAFLD group, there wassignificant difference in genotype frequency andallele frequency distribution of PNPLA3 rs738409
between the two groups (all P<0.05). The resultsof logistic regression model analysis showed thatcompared with C/C carriers, G/G carriers at
PNPLA3 rs738409 had an increased risk of NAFLD(OR=3.334, 95%CI 1.527-7.281, P=0.003); andthere was no significant difference in the risk of
NAFLD among C/G carriers at NPLA3 rs738409
compared with C/C carriers (OR=1.322, 95%CI
0.754-2.320，P=0.330）. Carrying the G allele
remained a risk factor for NAFLD in HIV/AIDS
populations (OR=1.740, 95%CI 1.201-2.521,
P=0.003).
Conclusion: In HIV/AIDS patients, G/G carriers withPNPLA3 rs738409 have an increased risk of NAFLD
compared with C/C carriers, and the G allele at

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

E-Poster Abstract

330

Quality of Life of patientsliving with Human
Immunodeficiency Virus
Infection – Evidence fromSouth India
Sha A1
1Al Iqbal Hospital, Kerlala, India

Introduction: With anti-retroviral therapy (ART)for human immunodeficiency virus infection (HIV)coming into picture, quality of life (QOL) has
gained importance. Knowledge on the factors
affecting QOL would be helpful in making
important policy decisions and health careinterventions.
Aims: The aim of this study is to assess the qualityof life of people living with HIV (PLWH) and to
identify the factors influencing their QOL.
Materials and Methods: The study was done
among 50 PLWH attending a tertiary care hospital,
and three Non-Governmental Organizations at
Calicut, Kerala, India, from June 2022 to May 2023.
QOL was assessed using HIV specific World HealthOrganization Quality Of Life scale (WHOQOL-HIV) –BREF questionnaire which has six domains(physical, psychological, level of independence,social relationships, environment andspirituality/religiousness/personal belief). Social
support and stigma were measured using“Multidimensional Scale of Perceived Social
Support” and “HIV Stigma Scale,” respectively,
using Likert Scale. Factors influencing QOL wereidentified using backward stepwise multiple linear
regression with the six domain scores as thedependent variables.
Results: Male: Female ratio was 1:1 and 58% werein early stage of the disease (stage I/II).
Psychological and SRPB (Spirituality Religiousness
and Personal Beliefs) domains were the mostaffected domains. All the regression models were
statistically significant (P<0.05). The determination
coefficient was highest for the social relationshipdomain (57%) followed by the psychologicaldomain (51%). Disease stage and perceived social
support significantly influenced all the domains of

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WHOQOL. Younger age, female gender, ruralbackground, shorter duration of HIV, non-intake of
ART and greater HIV related stigma were the highrisk factors of poor QOL.
Conclusion: Interventions such as ART, family,
vocational and peer counselling would addressthese modifiable factors influencing QOL, thereby
improving the QOL of PLWH.
Keywords: Human immunodeficiency virus, HIVrelated stigma, India, people living with HIV,quality of life social support WHOQOL-HIV

E-Poster Abstract

331

Strengthening systems formeaningful engagement ofcommunities to address HIV
Response in India.
Das U1, Agrawal S1, Pandey S1, Jangid N1
Hindustan Latex Family Planning Promotion Trust, Noida, India

1

Background: Since the initiation of the National
AIDS Control Programme (NACP), the community
has been playing a centre role in progressing HIV
response in India. Community Systems
Strengthening (CSS) is an integral part under thecurrent NACP Phase V (2021-2026) and aimed atdeveloping an informed, capable and coordinatedstructures within communities to address
challenges and needs effectively. It aims to create
an enabling environment, generating demand forprevention and testing, providing care and support
for those on ART, and ensuring effective program
delivery through community monitoring.
Description: CSS is dedicated towards contributing
to strategic outcomes of the National AIDS Control
Programme through strengthening andestablishing National and subnational pool ofcommunity resources, strengthening thecapacities of community based organizations andamplifying their participation in the national
HIV/AIDS response. Master Trainers from
communities and over 5000 Community
Champions (CC), representing various typologies(FSW, MSM, H/TG, PWID, PLHIV, and KP-Youth),have completed a capacity building programmethat included six thematic modules to ensure theircomprehensive skill development. Relevant
stakeholders and partners have been briefed on
this initiative, ensuring their active involvement in
implementing CSS activities. The State Community
Resource Groups (SRGs) have been established inall 35 States, and over 110 district community
resource groups have been constituted and iscurrently underway nationwide.
Lessons Learnt: Amplifying the involvement of thecommunities in the HIV response is critical. The
unique ability of the Community Champions ininteracting and engaging with their peers, reacting
to the needs and issues, contributed into improved

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uptake of services, health outcomes and reductionof stigma and discrimination. The roles andresponsibilities have been delineated for State andDistrict Community Resource Groups (S-CRG and
D-CRG), emphasizing on regular meetings,
community representation, coordination,
documentation, and monitoring of progress. The
active involvement and participation ofcommunities has resulted into rapid formation of
D-CRGs across the nation.
Conclusions/Next Steps: To optimize CSS, ongoing
efforts involve the institutionalization andimplementation of Community Led Monitoring(CLM) at the district and State levels. The CLM
process ensures issue compilation, facilitation ofsolutions through work plans, and regular review
of "action taken" reports. Continuous support andcollaboration with relevant stakeholders, including
NACO, are crucial for the success and sustainabilityof CSS initiatives, which is ultimately focused on
expanding the reach of prevention, treatment, andcare services and goal of reducing stigma anddiscrimination.

E-Poster Abstract

332

Assessing the private healthsector’s readiness: PrivateSector Engagement (PSE)
benchmarking for HIV services
in Vietnam.
Khanh L1, Green K1, Ngoc B1, Tran T1, Castillo G2, Vu
Y1, Nguyen G3, Nguyen T4, Ngo T5, Nguyen D5,
Doan A5, Duong A3, Phan H3
1PATH, Hanoi, Viet Nam, 2PATH, Seattle, United States ofAmerica, 3Vietnam Administration of HIV/AIDS (VAAC), Hanoi,
Viet Nam, 4Health Strategy and Policy Institute (HSPI), Hanoi,
Viet Nam, 5United States Agency for International Development(USAID), Hanoi, Viet Nam

Background: Despite achieving over 90% universal
health coverage through social health insurance,
Vietnam’s private healthcare spending makes up
55% of total consumer health expenses.
Acknowledging this, Vietnam’s Ministry of Health(MOH), with support from USAID/PATH Support
for Technical Excellence and Private-Sector
Sustainability (STEPS) project, approved a national
plan for private-sector engagement (PSE) in HIV
services in December 2021. However, there islimited information on the level of PSE, and anational landscape analysis is needed for
implementation of a National HIV PSE Plan.
Methods: The PSE benchmark assessment follows
the World Health Organization and World Bank
PSE framework and was adopted to Vietnam’s
unique context through multiple revisions forrelevance and accuracy. From May to September
2023, STEPS conducted a cross-sectional study,
encompassing an online survey across all 63
provinces in the country to gather data fromprovincial Centers for Disease Control (CDC) and
Departments of Health (DOH). A qualitative survey
in 12 selected provinces was also conducted togain deeper insights into provincial PSE.
Results: The PSE benchmark tool tailored for
Vietnam encompasses six domains: (1) Policies andplanning supporting PSE; (2) Public-private
information exchange; (3) Private Healthcare
Service Coverage; (4) Provision of public goods andservices to the private sector; (5) Financing
initiatives for PSE; and (6) Regulations promoting

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PSE. With a 92% response rate (58 out of 63
provinces), the average national PSE score was
19.7 out of 43, indicating an overall low level of
PSE in Vietnam's HIV prevention program. PSE
readiness varied by province, where provinceswith robust community organizations, larger
populations, and more private facilities scoredhigher. Regional differences were noted, with theSoutheast region, particularly Ho Chi Minh Cityand Dong Nai, having the highest readiness scores.
Weaknesses identified include financing structures
heavily relying on external funding, stringent
regulations for private health facilities, and a lackof official recognition for PSE in HIV prevention.
Conclusions: The inaugural national HIV PSE
benchmark assesses strengths and identifies
provinces with high demand for PSE, and provinceswith moderate/low readiness. Annual
benchmarking will track changes over time,
contributing to a sustainable national HIV
response by 2030.

E-Poster Abstract

333

Community-led Testing among
People Who Inject Drugs:
Exploring new cases of HIV and
Hepatitis C in urban Nepal
Pokhrel K, Gaulee Pokhrel K
Develop and Research Service International Nepal, Lalitpur,
Nepal

1

Background: People who inject drugs (PWIDs)
endure sub-optimal HIV and HCV testing Nepal.
We hypothesized and examined a model of testingby Lay Service Providers (LSP), who had similar
backgrounds to those of PWIDs in urban Nepal.
We assessed the prevalence of HIV and HCV within
this study population and the associated risk
factors of HCV positivity among PWIDs.
Method: A cross-sectional study was conductedamong 1029 PWIDs in urban areas of Nepal from
July 2021 to February 2022. Trained LSPs
performed the screening for HIV and HCV using
Rapid Diagnostic Test (RDT) kits. We assessed theprevalence of HIV, HIV/HCV co-infection and theinjecting and noninjecting risk characteristics that
influence HCV infection. The association of risk andprevention characteristics with HCV positivity wasassessed using multiple logistic regression.
Results: Of total PWIDs (n=1,029), 20.6% were
HCV-positive and 0.2% were HIV-positive. HCV
positivity was associated with needle sharing(AOR: 1.83, 95% CI: 1.27,2.64; p=0.001) and reuseof syringe/needle (AOR: 2.26; 95% CI: 1.34, 3.79;
p=0.002). In addition, PWIDs were more likely to
be HCV-positive who started opioid substitution
therapy (OST) (AOR: 1.88, 95% CI: 1.26, 2.80,
p=0.002) and attended the rehabilitation center(AOR: 1.66, 95% CI: 1.10, 2.53, p=0.017).

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Conclusions: This LSP led test in the urban
community was able to screen high percentage ofhidden cases of HCV about 20% of hidden HCV and
0.2% of HIV in Nepal and showed the highprevalence of HCV and its association with
injecting-related risk behaviors and being users of
OST and rehabilitation. The findings highlight theneed of LSP led testing in hotspots, OST settings,
and rehabilitation centers to screen new HIV and
HCV infections.

E-Poster Abstract

334

Advancing Private Sector
Engagement (PSE) in Vietnam's
HIV Response: Driving
sustainable change in PSE
through a National PSE
Technical Working Group(TWG).
Vu Y1, Duong T2, Tran T1, Green K1, Ngo T3, Doan
A3, Nguyen D3, Phuong T1, Nguyen V4, Minh H4,
Nguyen Q4, Vu C4
1PATH, Hanoi, Viet Nam, 2Vietnam Administration of HIV/AIDS(VAAC), Hanoi, Viet Nam, 3United States Agency forInternational Development (USAID), Hanoi, Viet Nam, 4Center
for Disease Control (CDC) of Dong Nai Province, Dong Nai, Viet
Nam

Background: Vietnam’s private sector plays acritical role in providing HIV goods and services,
especially among key population and othercommunities who prefer to receive services
outside of traditional, public-sector facilities. As
willingness-to-pay for health-related goods anduse of private sector services increase, driven by
Vietnam’s strong economic growth, theUSAID/PATH Support for Technical Excellence andPrivate Sector Sustainability in Vietnam (STEPS)
project has been supporting the Government ofVietnam (GVN) to intentionally increase PSE todevelop a more sustainable HIV response.
Description: In December 2021, the Ministry of
Health (MOH) issued a five-year National PSE Plan
to guide strengthened private-sector engagement
and investment in the HIV response and provisionof HIV-related goods and services through 2025.
USAID/PATH STEPS supported the Vietnam
Administration of HIV/AIDS Control (VAAC) and inJune 2023, the National PSE Technical Working
Group (TWG) was formed, functioning as acoordination platform to exchange information,
propose solutions, and serve as an advocacy bodyto recommend policy initiatives and drive forward
key initiatives/activities of the national PSE plan.
Lessons learned: The TWG was a critical avenue
for formulating and recommending required policy
revisions favorable to enhance PSE and

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363

investment; these recommendations wereabsorbed by the MOH. As a result, a new Decree
detailing some articles of the Law on Medical
Examination and Treatment, particularly
regulations on telemedicine and HIV clinic
licensing that was newly approved by the GVN in
December 2023. In addition, a PSE data
management platform for tracking, exchanging
and updating HIV PSE was developed andcoordinated by VAAC. In September 2023, theDong Nai provinces Department of Health (DOH)
promulgated a PSE Plan for 2021-2025 and is in
the process of functioning and coordinating
provincial PSE TWG with members from DOH,
Centre for Disease Control (CDCs) and private
sector partners implementing HIV activities in theprovince.
Conclusions/Next steps: Vietnam’s
groundbreaking HIV PSE plan codifies theimportant role of the private sector in Vietnam’s
HIV response. Moving forward, it will be importantto provide continued GVN leadership for publicprivate partnerships and investment in HIV goods
and services to increase domestic resources tomeet HIV/AIDS prevention efforts across thecountry.

E-Poster Abstract

335

Lesson Learned from HIV
Control Program for Dealing
with COVID-19 Crisis, 20192023, I.R.Iran
Tayeri K1, Karimi S3, Jamaaati H2, Janbabaei G5,
Mokhtari M4, Reisi A10 , Tabarsi P2,
Mardani M7, Gouya M8, Arshi S10, Namdari Tabar H9 ,Mohraz M6
1
Ministry of health and Medical education, Iran, National
HIV/AIDS care and treatment advisor, Tehran, I.R.Iran,
2Clinical Tuberculosis and Epidemiology Research Center,

NRITLD, Shahid Beheshti University of Medical Science,
Tehran, I.R.Iran, Tehran, I.R.Iran, 3Ophthalmic ResearchCenter, Research Institute for Ophthalmology and
Vision Science, Shahid Beheshti University of Medical
Sciences, Tehran, I.R.Iran, Tehran, Iran, 4Loghman
Hakim Hospital, Shahid Beheshti University of Medical Sciences,
Tehran, Iran., Tehran, Iran, 5Department of Hematology
Oncology, Tehran University of Medical Sciences, Tehran,
I.R.Iran., Tehran, Iran, 6Full professor of Infectious Diseases at
the Tehran University of of Medical Sciences, Tehran, Iran.
Researcher and AIDS specialist, Tehran, Iran, 7Infectious
diseases research center, Shahid Beheshti University of Medical
Sciences, Tehran, Iran., Tehran, Iran, 8professor of Infectious
Diseases at the Iran University of of Medical Sciences, Tehran,
Iran., Tehran, Iran, 9M& E senior Officer, Ministry of Health andMedical Education, AIDS/STI Control Dep. Ministry of Healthand Medical Education, Tehran, Iran., Tehran, Iran, 10Professorof Infectious Diseases, Shahid Beheshti University of Medical
Science, Tehran, I.R.Iran, Tehran, Iran364

The characteristics of the committee members
included scientific flexibility, continuous studies,
knowledge of health care capacities of thecountry, familiarity with internationalorganizations such as UNAIDS and WHO, and theskill of adapting the latest information to healthneeds, which was needed for finding the necessary
solutions to deal with the COVID-19. By the orderof the Minister of Health, five days after theidentification of the first COVID-19 case in the
country, national COVID-19 committee wasformed with the membership of some members of
the national HIV/AIDS committee and relevantscientific associations with the aim of developing anational guideline for diagnosis, care andtreatment of COVID-19 and unifying the service
delivery throughout the country.
On February 27, 2020 (8 days after identificationof the first case of COVID-19 in the country), thefirst guideline of diagnosis and treatment of
COVID-19 in outpatients and inpatients settings
was published which had a diagnostic flow chart toseparate outpatient cases from inpatients, withspecial attention to high-risk groups and proposed
treatment regimen for outpatient and inpatients.
During 23 days after the formation of thetreatment committee, four version of the COVID19 care and treatment guide were updated, the12th edition is available now.

As a global disaster, COVID-19 has affected thehealth system in the world with successive shocks
to the health system of the countries. The global
health system was confused, the priorities andneeds changed, the health system was worried
and inefficient about the control of the new
epidemic without access to effective treatments.

Registry system of cases, disaggregated by theservices, was designed and included in the national
Health System as electronic health records ofindividuals. All services were available for Key
population, including PLWH and prisoners.
During that time, along with national programs,international organizations such as UNAIDS playeda very important role in providing personal
protective equipment for at risk groups and AntiRetroviral medication to PLHIV to avoid HIV
treatment services interruption.

At the beginning, each country dealt with theepidemic based on its capabilities and capacities.
The faster planning and necessary measures weretaken, the more lives would be saved, and what
could help was the experiences of dealing withprevious epidemics and programs related todisease control.

Development of guidelines with practical and most
up-to-date information, efforts to provide
necessary items for prevention and treatment
based on national guideline, played an importantrole in reducing treatment chaos and outlined
legal responsibilities for providing appropriate careand treatment services to the patients.

Since 20 years ego, Iran's national HIV control
strategic plan has been developed with thecooperation of 23 organizations. One of the main
pillars of the program is the scientific committee
for HIV/AIDS care and treatment, which is
responsible for compiling and updating all national
HIV guidelines.

Development of a coherent scientific team withthe experience of developing national HIV/AIDS
guidelines, continuous monitoring and presence ofvarious specialities and related disciplines at fieldlevel played very important role in accelerating theactions taken.

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E-Poster Abstract

336

Increasing PrEP uptake among
Transgender Women (TGW):
Development Journey of Ruby
Clinic, a TGW-Led social
enterprise in Vietnam.
Tran T1, Green K1, Nguyen H1, Ngo T2, Nguyen D2,
Doan A2, Ngoc B1, Canagasabey D3PATH, Hanoi, Viet Nam, 2United States Agency forInternational Development (USAID), Hanoi, Viet Nam, 3PATH,
Seattle, United States of America
1

Background: Despite the recent emergence ofclinics providing gender-affirming healthcare to
the transgender community in Vietnam,transgender individuals continue to encounterbarriers and stigma when seeking healthcare,leading to growing health disparities, increased
vulnerability to HIV and other sexually transmitted
infections, and low uptake of pre-exposure
prophylaxis (PrEP). Ruby Social Enterprise (SE), a
key-population (KP)-led clinic in Hanoi, with
USAID/PATH STEPS and Healthy Markets projects,
passionate healthcare professionals, andcommunity members/influencers collaborated to
improve access to gender-affirming andtransgender-competent healthcare and increase
PrEP uptake among TGW.
Description: Ruby was established in 2009 as acommunity based organization with the aim ofactively engaging HIV related service delivery andreferrals for TGW. Ruby registered as a SE in 2016,
and launched its own clinic in Hanoi in 2023,
marking a milestone in its efforts to provide
comprehensive, transgender-competent
healthcare services for TGW. As a result ofcapacity building efforts and assistance from
USAID/PATH STEPS and Healthy Markets
throughout their development journey, Ruby SE
has: (1) Engaged and directed TGW towards HIV
testing, treatment, and PrEP; (2) Distributed HIVrelated informative leaflets and products(condoms, lubricants); and (3) co-created and co
implemented marketing and awareness-raising
campaigns to promote HIV1related services
among KPs.

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365

Lessons learned: Due to capacity strengthening
initiatives and PrEP promotional efforts incollaboration with community
networks/influencers, Ruby SE has increased
awareness and uptake of PrEP services among
TGW, from three TGW enrolled on PrEP at STEPSsupported facilities in December 2017 to 1,013
TGW enrolled on PrEP as of December 2023. In
2021, Ruby SE also implemented the month-long
PrEP Ambassador campaign, collaborating with 10
KP influencers to post 60 TikTok videos to raiseawareness of and address concerns and questions
related to PrEP use. The campaign had 10,000
followers, with more than 8,000 interactions and80,000 views.
Conclusions/Next steps: By recognizing andunderstanding the unique challenges faced by
TGW, healthcare systems can implement targeted
strategies to enhance access, quality, andoutcomes of HIV care services. This approach aims
to leverage the skills and abilities of KP-led clinics
to provide care for TGW and promote theavailability of comprehensive care for TGW.

E-Poster Abstract

337

Influencing factor of HIV
positive on anonymous HIV
testing in a medical center(2017 to 2023)
Tang Y1, Mao L1, Chen Y2, Ko W1, Ko N3
National Cheng Kung University Hospital, Tainan, TAIWAN,

1

2National Sun Yat-sen University, Kaohsiung, TAIWAN, 3National

Cheng Kung University, Tainan, TAIWAN

Background: To combat the increasing number of
new human immunodeficiency virus (HIV)infections and achieve a consensus goal of "three95s". A medical center in southern Taiwan has
been conducting anonymous HIV tests since 1994
and implemented a serious of HIV prevention
activities including pre-exposure prophylaxis (PrEP)
program in 2017, a comprehensive one-stop HIV
screening service for individuals at high risk of HIV
infection in 2019, and same-day initiation of
antiretroviral therapy (ART) for all persons
diagnosed with HIV in 2020.
Purposes: This study aimed to evaluate the trendof anonymous HIV testing at the medical center,and to analyze the influencing factors correlated to
HIV positive among HIV test takers.
Methods: A retrospective study design was
employed. Given the nature of anonymous HIV
testing, the HIV positivity rate per 100 tests wascalculated, as repeat tests could not be
distinguished. A multiple logistic regression model
was used to identify factors influencing HIV
positivity among high-risk individuals who
underwent anonymous HIV testing.
Results: A total of 15,639 HIV screening tests wereconducted at medical center between 2017 and2023. The proportion of anonymous testing
increased from 1,966 tests in 2017 to 2,630 tests
in 2020. A slight decreased to 2027 tests in 2023
due to COVID-19 pandemic. While the number of
HIV tests sustained around 2000 tests, thepercentage of anonymous HIV-positive test resultsfrom 1.7% in 2017 to 0.7% in 2023. Overall, HIV
positivity rate was 1.04% (164/15,639). Persons
with confirmed HIV infection were predominantly
men who sex with men, primarily aged mostly
between 20-29 years and with a college/university

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366

education. Being over 30 years old, having a lower
education level, identifying as homosexual andbisexual, having a history of sexual transmitted
diseases (STDs), and recent use of amphetamines,
particularly through injection were significant
factors for developing HIV infection.
Conclusions: Our findings revealed that thesustained provision of anonymous HIV testing
resulted in a low HIV positivity rate, even during
the challenging period of the COVID-19 pandemic.
The success in maintaining a low HIV infection rate
may be attributed to numerous prevention efforts.
Future outreach HIV testing efforts should
prioritize high-risk groups, including young adults
and above, individuals with lower education levels,
those who identify as homosexual or bisexual,
individuals with a history of STDs, and those who
engage in amphetamine use.
Keywords: anonymous, HIV test, HIV

E-Poster Abstract

338

Project High Five: Effectivenessof Peer-To-Peer Education on
HIV Awareness in Iloilo City,
Philippines, a Cross-Sectional
Study
De Los Santos K2,4, Amon A1,4, Labiano R3,4, Vijar J4,
Bordon J4, Estrella A4,5, Eufracio R4
Ajou University, Suwon, South Korea, 2University of thePhilippines Visayas, Miagao, Philippines, 3Mother Candide
Center, St. Paul’s Hospital of Iloilo, Inc., Iloilo City, Philippines,
4Team Dugong Bughaw, Inc., Iloilo City, Philippines, 5Universityof Sussex, Brighton, United Kingdom
1

Introduction: As of 2023, almost half of the people
living with Human Immunodeficiency Virus (HIV) in
the Philippines are 15-24 years old (AIDS Epidemic
Model-Spectrum, 2023). This trend is evident in
Iloilo City, Philippines, where 39% of newly
diagnosed with HIV come from the same agegroup (Western Visayas Center of Health
Development, 2023). In line with the 7th AIDS
Medium Term Plan, the Philippines aims toprevent new HIV diagnoses and have 95% of young
people know about HIV transmission andprevention (Philippine National AIDS Council,
2022). According to a meta-analysis by Restar et al.
(2018), HIV knowledge, attitude, and behaviors
can improve through HIV prevention programs. A
more specific social intervention, peer-to-peer
education, has increased HIV knowledge indeveloping countries (Medley et al., 2009). With
this, Team Dugong Bughaw implemented ProjectHigh Five, a peer-to-peer awareness campaign
formulated specifically for the youth in Iloilo City.
This study aimed to assess the effectiveness ofpeer-to-peer HIV awareness education among
young people in Iloilo City, Philippines.
Method: Students (n=428) from 10 Higher
Education Institutions (HEIs) in Iloilo City
participated in this cross-sectional study. Thesestudents belonged to the youth sector of thePhilippines (<17 to 25 years old) and haveparticipated in Project High Five. The pre- andpost-test questionnaires measured the knowledgeof participants on HIV such as statistics,
transmission, usage of condoms, and HIV policies.
Additionally, these evaluated their awareness andAbstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

367

practices in relation to HIV. Nonparametric
Wilcoxon Paired t-test was employed in analyzing
the test results of the participants in this study.
Results: In this awareness intervention, there has
been a significant increase (p<0.001) in theknowledge, awareness, and practices at 18.97%.
The results were disaggregated across age and sex.
Specifically, males saw an increase of 20.47% whilefemales were 18.27%. The age group 17 and below
saw the highest increase in test scores at 27.48%
while the age group 18-21 was the lowest at
18.63%. However, no significant difference has
been observed across sex (male-female) and age
groups (<17, 18-21, and 22-25). The results suggestthat the intervention was nondiscriminatory inincreasing the pre- and post-tests scores of theparticipants regardless of sex or age group
included in the study.
Conclusion: Overall, peer-to-peer education has
been effective in increasing the HIV awareness ofthe youth in Iloilo City, Philippines. This study
showed that overall peer-to-peer education has
been effective in increasing HIV awareness among
the youth in Iloilo, City Philippines. It is, therefore,
important to innovate learning methods for target
age groups so as preventive programs can be
optimized.

E-Poster Abstract

368

339

interpret the data. This research was approved by
the Alfred Hospital Ethics Committee.

Education providers’ roles inproviding sexual andreproductive health education
to international students in
Victoria, Australia: A
qualitative study

Results: Staff participants worked in student
administration including student support, auniversity medical clinic, and student counselling
services. Most of student participants were
postgraduate students and came from the Asia
Pacific region. We found that nearly allparticipants felt that education providers should
provide SRH education specific to international
students, especially when SRH education was notprovided in their countries of origin. Staff
expressed some barriers, such as limited resourcesand government funding, personal discomfort
talking about SRH to international students, and alack of SRH knowledge. Staff and students
proposed several initiatives to improve SRH
knowledge. These include: SRH peer-to-peer
education; information session during the predeparture and orientation program; SRH training
for staff and students; a health and wellbeing
outreach team that embed SRH; and a dedicated
SRH website that can be linked to education
providers' websites and student portal as part ofinternational students' health and wellbeing page.

Sudarto B1, Chow E1,2,3, Phillips T1,2, Ong J1,2,4
1School of Translational Medicine, Monash University,

Melbourne, Australia, 2Melbourne Sexual Health Centre, Alfred
Health, Melbourne, Australia, 3School of Population and Global
Health, The University of Melbourne, Melbourne, Australia,
4Faculty of Infectious and Tropical Diseases, London School ofHygiene and Tropical Medicine, London, United Kingdom

Background: International education is Australia's
4th largest export, attracting more than 780,000
students in 2023 with a significant proportion
camel from the Asia Pacific region, such as China,
India, Thailand and the Philippines. Maintaining
their overall health and wellbeing during theirstudy is mandated under the Australian Education
Services for Overseas Students (ESOS) framework.
While there are programs relating to international
students' physical and mental health, to date,sexual and reproductive health (SRH) is an
overlooked area even though it is an integral partof individuals' health. Previous studies haveinvestigated international students' perspectives
on SRH program specific to them. However, there
has been no study that specifically focused on
tertiary education providers' views on SRH
education for international students. We
conducted this research to investigate staff
perspectives on the issue, and to contrast theiropinions with international students' views. We
also asked participants of future opportunities toprovide international students with SRH
education.
Material and Methods: Between August 2022 andJuly 2023, we conducted online in-depth
qualitative interviews with 15 staff working at
tertiary education providers (university, Technicaland Further Education (TAFE), and English
language college), and two focus groups involving
9 international students based in Victoria,
Australia. We used a reflexive thematic analysis to

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Participants would like to see information onconsent, respectful relationships, and SRH
prevention strategies to be delivered in plain
English and easily accessible to students. All
participants believed that a sustainable
government funding is needed to support thiscomprehensive SRH program. Potential benefits tostudents include reducing SRH-related stigma,
increasing SRH knowledge to make informed
decisions, and for students to maintain theiroverall health and wellbeing which would
positively contribute to their study outcomes andlived experiences in Australia.
Conclusions: A sustainable government funding isneeded to support education providers indeveloping and delivering a comprehensive SRH
program for international students. This program
must involve a collaboration between education
providers, health organisations, and international
student bodies to ensure SRH information isrelevant to their cultural norms, practices, andlived experiences.

E-Poster Abstract

340

A thematic analysis on theawareness and experiences ofIlonggo GBMSM towards theimportance of AntiDiscrimination Ordinance(ICADO) in improving sexual
health and HIV services in
Iloilo City, Philippines
Olete R1,2, Martinez F3, Strong C1
1Department of Public Health, National Cheng Kung University(NCKU), Tainan, Taiwan, 2Sustained Health Initiatives of thePhilippines (SHIP), Mandaluyong City, Philippines, 3College ofNursing, Iloilo Doctors' College, Iloilo City, Philippines

Background: The Iloilo City Anti-Discrimination
Ordinance (ICADO) safeguards Ilonggos fromdiscrimination based on sex, gender identity, andsexual orientation. Yet, there's limited knowledge
about how gays, bisexuals and other men who
have sex with men (GBMSM) perceive ICADO's
impact on sexual health and HIV services quality in
Iloilo City. This study explores GBMSM awarenessand experiences regarding ICADO's role inenhancing these services.
Methods: Using a qualitative descriptive design,
key informant interviews(KIIs) between February
15 and March 2, 2023. The inclusion criteria were
GBMSM accessing sexual health services in Iloilo
City. Transcripts were thematically analyzed using
Braun and Clarke’s approach.
Results: A total of 20 participants were included in
the KIIs with age ranging from 18-45 years old.
There were four three themes identified during
analysis: (1) ICADO’s role in accessing services—
generating mix responses where some GBMSM
believed that the ordinance would improve theirsense of safety in accessing sexual health services
while others claimed that there is much workneeded on a city-wide discussion to make surethat GBMSM are fully aware of the ordinance; (2)stigma and discrimination—while all of the
respondents reported favorable experiences with
their health facilities, some GBMSM experienced
discrimination in public venues, workplaces, andAbstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

369

educational institutions but had little idea how to
use ICADO for their legal protection; (3) self-careabilities—most GBMSM claimed that theirperceived risk and experiencing some symptomsof HIV/STIs are the main factor for them seeking
health services while some verbalized
embarrassment and self-stigma while accessing
sexual health services.
Conclusion: The study reveals diverse perspectives
among GBMSM regarding ICADO's impact onaccessing services. While some anticipate
increased safety, others emphasize the need forwidespread awareness. Positive experiences werereported in health facilities but instances of
discrimination in public spaces indicate theimportance of strengthening legal knowledge
among GBMSM. Moreover, the influence of selfcare abilities on health-seeking behavior
emphasizes the significance of tailoring services toaddress perceived risks and mitigate self-stigma.
These insights have implications for refining ICADO
implementation, emphasizing education, andfostering an inclusive environment to promotebetter health outcomes among GBMSM in Iloilo
City.

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341

implement effective digital campaigns andincreasing visibility among target populations.

Driving peer-to-peer learningand strengthening
collaborative key population(KP) organizational networks
in Vietnam through Business
Innovation Talks and DigitalMarketing Forums.

Lessons learned: Glink Academy has hosted over
10 BITs since March 2022, with 60 participants
attending each session on average, and conducted
8 DMFs since July 2022 on topics including social
media trends, video- or TikTok-based marketing,marketing with limited resources, gamification,
and Canva. Glink Academy’s BITs and DMFs are
excellent demonstrations of unique KP-led effort
to expand impact and innovation within the KP
community.

Tran T , Tran T , Phan T , Nguyen H , Vu P , Le T ,Tran T2, Green K1, Ngo T3, Nguyen D3, Doan A3,
Udugama M1
1

1

1

1

1

2

1PATH, Hanoi, Viet Nam, 2Glink Academy, Ho Chi Minh City, Viet

Nam, 3United States Agency for International Development(USAID), , Viet Nam

Background: Empowering community-led services
is essential for the sustainability of HIV programsand to ensure the provision of high-quality andacceptable HIV services for KPs in Vietnam. Glink, a
KP-led social enterprise (SE) and clinic network,
has been a cornerstone of Vietnam’s HIV response
since 2009. In 2021, Glink established Glink
Academy to enhance organizational capacities andsustainability of nascent LGBTIQ+ SEs/clinics in
Vietnam. PATH, through USAID/PATH STEPS,
supported Glink Academy to introduce Business
Innovation Talks (BITs) and Digital Marketing
Forums (DMFs) as peer learning resources that
foster a vibrant and supportive community of KPled entities.
Description: Glink Academy offers a multi-modal
capacity strengthening platform to support theorganizational development of community-basedorganizations and KP-led entities in Vietnam; thisplatform provides online and offline trainings,
mentoring sessions, e-learning platform, and abusiness incubation program. In 2022, PATH andGlink Academy introduced BITs and DMFs as
mechanisms to foster greater connectivity andbuild a supportive network among nascent KP-ledentities working to strengthen their organizational
capabilities and sustainability. BITs are interactive
dialogues that offer opportunities for KP-ledentities to engage and network with experts acrossvariety of topic areas to turn their ideas into
reality, whereas DMFs focus on enhancing KP-ledpartners’ marketing knowledge and skills to

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

Conclusions/Next steps: BITs and DMFs provide
avenues for KP-led businesses to equip themselveswith knowledge and skills to identify suitable
solutions for business-related challenges oradvance start-up ideas. Mechanisms that promotea collaborative network of KP-led entities engaged
in HIV and other healthcare service provision for
KPs is critical to enhancing HIV awareness andservice uptake while supporting Vietnam achievesustainable epidemic control.

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342

Growth of Glink Academy:First key-population (KP) led
peer to-peer capacity building
program in Vietnam for HIV
awareness and service uptake.
Tran T1, Tran T1, Phan T1, Nguyen H1, Vu P1, Le T2,
Tran T2, Green K1, Ngo T3, Nguyen D3, Doan A3,
Udugama M1
1PATH, Hanoi, Viet Nam, 2Glink Academy, Ho Chi Minh City, Viet

Nam, 3United States Agency for International Development(USAID), Hanoi, Viet Nam

Background: Business start-up and growth,
especially in the field of HIV, is a challenge forearly-stage LGBTQI+ led organizations in Vietnam.
Glink Academy, initiated by Glink key population(KP)-led social enterprise (SE), with 12 years ofoperating experience in the HIV KP-led clinic chain
and community, and USAID/PATH STEPS project,provides a comprehensive peer-to-peer capacity
building program to support the establishment
and sustainable growth of KP-led SEs and clinics.
Description: Since its inception in 2022, Glink
Academy, with support from USAID/PATH STEPS,
has grown as an incubator for social enterprises by
providing a comprehensive and need-based peerto-peer capacity-building program. The program
offers diverse activities which includes: thematictraining; individual mentoring and coaching;
resources and tools for start-up development; ane-learning platform; Business Innovation Talks(BITs); Digital Marketing Forums (DMF); and an
innovation grant for KP-led SEs and clinics. Glink
Academy’s capacity building program takes ahuman centered approach, through selection of
innovative, useful, and practical topics requestedby the community, unique case studies, andlessons learned from the HIV field.
Lessons learned: Glink Academy continues to drive
the growth of a sustainable network of KP-ledbusinesses that provide high-quality HIV services,and have successfully delivered series of activities
that expand impact and innovation within the KP
community including but not limited to: 3 trainings
on business development, demand generation,and marketing and communications; 10 BITs

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371

connecting social impact businesses with speakers
and experts; 8 DMFs on digital campaigns toeffectively reach target populations; incubated 3
SEs with innovative business models in HIV, ofwhich, one is TG-led clinic and working towards its
mission of healthcare promotion for TG
communities; and developed an e-learning
platform with learning material on social
entrepreneurship, legal matters, health service
delivery, organizational management, sustainablegrowth; and a mentoring and coaching program.
Conclusions/Next steps: Glink Academy
exemplifies a transformative LGBTQI+ led model
for peer learning and incubation. Further
advancement of its peer-to-peer capacity building
efforts will help diversify and expand a network ofcommunity-friendly health social enterprises inVietnam that are positioned to deliver highquality, inclusive health services for the LGTBQI+
community creating greater HIV awareness andservice uptake.

E-Poster Abstract

343

Impact of Health Education
Intervention on Self-Efficacy
among Men who have Sex
with Men
Hsu S1, Yen W4, Chao Y3
National Taipei University of Nursing and Health Sciences,
Taipei, Taiwan, 2Mental Health Association in Taiwan, , Taiwan,
3Yuanpei University of Medical Technology, Hsinchu, Taiwan,
4Taipei City Hospital, Taipei, Taiwan
1This study examines the impact of healtheducation intervention on AIDS prevention selfefficacy among men who have sex with men(MSM).
A single-group pre/post-test design was utilized,
employing structured questionnaires for datacollection. Participants consisted of MSM from
Taiwan. The intervention involved thedissemination of curated information on preexposure prophylaxis through Google Meet during
the COVID-19 pandemic. Measurement tools
included the Chinese Adaptation of the HIV
Prevention Self-Efficacy Scale. Recruitment took
place from July 21, 2021, to October 31, 2021, witha total sample size of 158 individuals. This study
was approved by the Institutional Review Board of
National Taiwan University.
Following prophylactic intervention and healtheducation, there was a significant improvement in
AIDS prevention self-efficacy among MSM.
Additionally, condom usage frequency increased
with non-steady partners. Moreover, postintervention health education heightened MSM's
attention to sexual history and HIV testing statusof partners.
After prophylactic administration intervention,
health education significantly increased thewillingness to use preventive drugs among MSM.
This study demonstrates that health educationintervention can enhance AIDS prevention selfefficacy among MSM.

Abstract Book | Asia-Pacific AIDS & Co-Infections Conference (APACC) 2024

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E-Poster Abstract

344

Aspirations and Sustainabilityof Youth HIV Civil Society
Organizations in thePhilippines
Amon A1,2
Team Dugong Bughaw, Inc., Iloilo City, Philippines, 2Ajou
University, Suwon, South Korea

1Introduction: The global HIV response aims to end
AIDS by 2030. However, cases continue to rise incountries like the Philippines. Various stakeholders
have acknowledged the work of community andkey population-led organizations, including youth
groups, in effectively delivering programs andservices to key populations. From January to
December 2022, young people account for 65% of
people living with HIV in the Philippines. With
global and local partners highlighting youth
participation as an asset, this study explores theroles, aspirations, and sustainability strategies ofyouth civil society organizations (CSOs) in the HIV
response.
Method: This study took on a qualitative approachin data gathering in order to explore andunderstand the situation of the participants. Given
the lack of an established directory of HIV
organizations in the Philippines, much less youth
organizations working on HIV, data gathering via
semistructured interviews was intentionally broad.
Eleven outh HIV civil society organizations acrossthe Philippines were asked to participate insemistructured interviews to collect qualitative
data for the study.
Results: Youth HIV CSOs do aspire forsustainability and they have existing strategies
towards it, amidst internal and external barriers.
Alongside this, stakeholders were identified by theparticipants: donors, national and local
government, development agencies, UN agencies,
fellow civil society organizations, the private
sector, international organizations, and of course,
key populations.
What are the roles of youth HIV CSOs in civilsociety? Youth HIV CSOs work in (1) education andawareness, (2) humanitarian relief, (3) advocacy

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373

and lobbying, (4) monitoring, and (5) service
delivery, (6) service referral, (7) shelter, (8)economic empowerment, and (9) educational
assistance.
How do youth HIV CSOs define sustainability?
Youth HIV CSOs vie for internal capacity, externalreach, and community empowerment. These
answers align with the financial, programmatic,
epidemiological, and political tenets ofsustainability in the HIV response Oberth (2016).
Do youth HIV CSOs aspire for sustainability? If yes,
what are the strategies of youth HIV CSOs towards
sustainability? To meet these aspirations, CSOs
have taken initiatives towards sustainability. Their
strategies based on the interviews are diverse, butthese have been categorized by the researcher
into accreditation, continuous partnerships,
revenue diversification, program expansion, andsocial contracting.
What are the enablers and barriers towards
sustainability that youth HIV CSOs face? External
enablers include government support,
partnerships and networking, and operational
funding. Meanwhile CSOs consider the following
as barriers to their sustainability: weak community
mobilization, unstable or limited funding, multiple
intersecting stigma, and political relations.
Stakeholders in the work of youth in HIV include
donors, national government, people living with
HIV, local government, UN agencies, CSOs, key
populations, private sector, and internationalorganizations.
Conclusion: Youth HIV CSOs want to keep going.
Hence, they employ a variety of strategies in order
to be more sustainable in the work they do.
However, they will not be able to achieve their
aspirations for internal capacity, external reach,and community empowerment without external
support, primarily that of the government andfunders.