(P140) Time above 1500 copies/mL: potential for ongoing transmission among patients linked to HIV care from public Sexual Health Clinics

Background: HIV transmission is more likely when HIV viral load (VL) exceeds 1500 copies/mL. We examined HIV transmission potential among New York City (NYC) Sexual Health Clinic (SHC) patients offered the JumpstART program, which provides rapid treatment initiation in SHCs and active linkage to community providers for patients newly diagnosed with HIV.

Methods: The cohort included patients diagnosed (November 2016-September 2018) who either had (n=215, “JumpstART patients”) or had not (n=58, “non-JumpstART patients”) initiated treatment through JumpstART, had ever been virally suppressed (VL< 200 copies/mL) after diagnosis, and had >2 VL tests reported to NYC HIV Surveillance through December 2021. Percentage of person-time spent with VL >1500 copies/mL out of total observation time (PPT >1500) was determined for each person by estimating and summing number of days with VL >1500 copies/mL during consecutive pairs of VL results, and dividing that sum by the interval number of days between first and last VL. We used Poisson regression to estimate person-time rate ratios for JumpstART patients by gender/sexual orientation, race/ethnicity, age at HIV diagnosis, neighborhood poverty level, percent of VL pairs with long interval ( >6 months), and baseline CD4+ count.

Results: Cohort patients had a median follow-up time of 1323 days, median 12 VL records (interquartile range [IQR]: 9-15), and median 98 days between VL pairs (IQR: 50-147). PPT >1500 was lower among JumpstART (9.8%; 95% CI, 7.4%-12.8%) versus non-JumpstART patients (15.3%; 95% CI, 10.8%-21.7%). Among JumpstART patients, PPT >1500 was higher among non-Hispanic Black patients (13.6%, versus 6.2%-9.8% for other race/ethnicity groups). Twenty-three percent of patients had >25% of VL pairs with long interval; PPT >1500 was higher among them (17.4%) than among patients with 10-25% of pairs or < 10% of pairs with long interval (PPT >1500: 8.0% and 5.2%, respectively); rate ratio=3.5 (95% CI, 1.8-6.7) comparing groups with >25% versus < 10% of VL pairs with long interval.

Conclusions: Longitudinal analyses of JumpstART patient-data found a relatively positive program outcome, with an average one-tenth of time spent with VL >1500 copies/mL. HIV transmission potential was higher for some patients, underscoring needs for partnerships with community providers who can assure sustained care and treatment.