key: cord-0950893-e9fcjfaj
authors: nan
title: Oral Abstracts from the Fast-Track Cities 2021 Conference Lisbon Portugal October 20-22, 2021
date: 2022-03-03
journal: J Int Assoc Provid AIDS Care
DOI: 10.1177/23259582221075431
sha: d63a319c4f7fcbc02601af416ece7629b7f12137
doc_id: 950893
cord_uid: e9fcjfaj

nan

Introduction: The Austin/Travis County Fast-Track Cities (FTC) Initiative implemented several stakeholder engagement strategies to develop the local Action Plan. The program's partnership framework supports a diverse and robust membership, allowing for substantial Action Plan input and feedback.

Description: With the 90-90-90 goals in mind, four Priority Areas emerged from the Austin/Travis County FTC: Prevention; Testing & Rapid Linkage; Retention, Re-engagement, & Viral Suppression; and Ending Stigma. The Plan was developed and finalized through three key activities: (1) Summer 2019: A SurveyMonkey requesting feedback on current Action Plan components. Plan components requiring further development were identified through survey analysis and evaluation; (2) These areas were addressed through the November 2019 Consortium's interactive activity; (3) December 2019 -May 2020: During monthly meetings, Priority Workgroup Chairs led further analysis and development of their respective Action Plans. The FTC Support Staff provided guidance and transparency through these activities. In

Background: Portugal has set early identification and diagnosis of HIV, HCV, and HBV infections as a priority in 2018. Community pharmacies started performing point-of-care tests for such infections to the public (≥18 years) upon request. Study objective: to characterize the population using this service, their behaviors, and motivations for getting tested at the pharmacy.

• Design: observational, cross-sectional, descriptive study.

• Period: October 8, 2018, to December 31, 2019.

• Data collection instruments: matrix filled by pharmacists (tests performed and results per user); questionnaire to users (self-administered, optional, anonymous, confidential). • Location: community pharmacies in the Municipality of Cascais, members of the ANF, who chose to participate in the Fast-Track Cities initiative, with pharmacists specifically trained to this service. Results: The 21 participating pharmacies (51.2%) performed a total of 1,422 tests (54.9% HIV, 37.9% HCV, 7.2% HB), on 808 individuals (average age 37 years [SD=14], 60% male); 16 tests with reactive result (1.1% total, 1.0% HIV, 1.5% HCV) in 2.0% of users. 70.4% (n=569) of individuals completed the questionnaire. The results showed access to migrant populations (24.8% foreigners), to first-time test users (37.9% HIV, 40.8% HCV, 50.9% HBV) and to younger populations (half of the first-time users are under 30). Main reasons for taking the test: "Unprotected sexual intercourse" (52.6%) and "I never did the test" (23.9%). More than 50% considered the "Reduced waiting time", "Privacy" and "Trust in pharmaceutical counseling and competence" to be extremely important when choosing to do the test at the pharmacy over other testing sites. Instead, "Fear of discrimination in other place", "Lack of willingness to go to other places" and "Ignorance of other place to perform the test" are not differentiating factors.

Conclusion: Performing point-of-care tests in community pharmacies seems to improve the population's access with potential for reducing inequities, as also reported by other countries. Description: Espaço Intendente in Lisbon is a communitybased center of Grupo de Ativistas em Tratamentos (GAT) that focuses on prevention, detection, and linkage to care for trans-people, sexual workers and/or migrants. Espaço Intendente offers counselling; distribution of sexual prevention materials; confidential and anonymous screening for Human Immunodeficiency Virus (HIV), Hepatitis B, Hepatitis C and/ or syphilis; medical care for other Sexual Transmitted Infections (STI's); and support to address people's social needs.

Lessons Learned: In 2019, Espaço Intendente performed 2524 HIV screenings tests, of which 51 (2%) were reactiveone of the reactive tests was performed indoors (in apartments where sex work is carried out). One hundred (100) people with a nonreactive HIV test who reported significant risk situations were referred to Pre-Exposure Prophylaxis (PrEP). One hundred and twenty-eight (128) people with prior knowledge of HIV infection were linked or relinked to HIV care. More than a third of the people screened for HIV did not have the Portuguese National Healthcare beneficiary number.

Recommendations: Espaço Intendente offers a unique contribution for HIV care cascade by adopting a proximity approach in counselling, screening, social support and (re)linkage to care for key populations that otherwise could be missed by the National Health Service.

Introduction: After the first diagnosis of COVID-19 on March 9, 2020, New Orleans, Louisiana had an early, rapid increase in cases, distinguished as the fastest-growing COVID outbreak worldwide. The University Medical Center-New Orleans (UMCNO), a safety net hospital in New Orleans, provided 24-hour access to routine HIV screening throughout the pandemic when many organizations halted screening services.

Description: UMCNO implemented the Frontlines of Communities in the U.S. (FOCUS) grant funded HIV testing program in 2013, which integrated automated electronic medical record (EMR) driven routine HIV testing into normal hospital workflow, with system-wide policy changes to support sustainability. Two full-time navigator positions facilitate linkage to care for patients living with HIV identified through testing.

Lessons Learned: Over 100,000 HIV tests were conducted at UMCNO between 2013 and 2020, with a HIV-seropositivity rate of approximately 0.9%. With implementation of stay-at-home orders, monthly average Emergency Department (ED) visits from April to June 2020 decreased to 65% of the November 2019 -January 2020 pre-pandemic levels, with monthly averages for HIV tests decreasing to 57% compared to the same pre-COVID quarter. Average monthly ED visits later increased, but remained lower than pre-pandemic levels (e.g., 7539 in the November 2019-January 2020 pre-COVID quarter compared to 6264 in the July -September 2020 quarter). Linkage to care rates remained consistently high (Table 1) , proportional to identified positive diagnoses throughout 2020.

Recommendations: UMCNO's FOCUS program integrated HIV screening into hospital workflow. As such, our hospitalmaintained testing, albeit at a reduced rate, during the months the stay-at-home orders were in place in New Orleans. The program maintained routine HIV testing and linkage services through EMR automation (best practice advisories) to ensure all eligible patients are offered testing when appropriate.

Background: Depression can worsen rates of HIV testing and treatment adherence. In urban, generalised epidemic settings, depression prevalence may be high, and a mathematical model linking depression and HIV incidence can give insight into the impact of increasing interventions for depression on HIV incidence.

We used serostatus and questionnaire data from the Manicaland Study (Zimbabwe, 2018-19) for parameterising, calibrating, and validating the model. In addition to demographic, sexual risk and treatment data, the questionnaire incorporated Patient Health Questionnaire-9 questions, allowing assessment of depressive symptom prevalence. Using this data, we developed a deterministic compartmental model describing interactions between depressive symptoms and HIV status (Fig.1) . We estimated depressive symptom prevalence from 2020 to 2025, assessing the impact of a cognitive behavioural therapy-based intervention on HIV incidence.

Results: From study data, depressive symptom prevalence was higher among people living with HIV than HIV-negative people (men:29.8%, 95% confidence interval=24. 8-34.8%, n=331, vs 18.2%, 18.2-20.9%, n=3,544, p<0.001, women:40.8%, 36.9-44.8%, n=605, vs 26.3%, 25.0-27.6%, n=4,834, p<0.001) . We calibrated our model to study data (Fig.2) . Preliminary findings suggested the psychotherapy intervention may reduce HIV incidence by 11.6% over five years, largely driven by changes in mortality and HIV risk behaviour.

Conclusion: This model captures interactions between HIV and depression. While our results on the impact of psychotherapy are initial, they highlight the role that depression interventions could have in the fast-tracked HIV response.

to reduce the co-infection (2013). However, latest TB report shows rates of successful treatment outcomes for co-infected patients still much lower than rates for all TB patients. Data from Carmelo, a reference Hospital in Gaza province, was assessed to identify factors associated with unsuccessful TB treatment outcomes among a cohort of adult TB/HIV patients.

Method: A retrospective study was conducted using 2006-2017 cohort data looking at TB treatment outcomes considering which treatment was initiated before: ATT or ART. The study focused on determinants of unsuccessful TB treatment outcomes, grouping the different outcomes to have a yes/no variable. Probit regression was applied to identify association between binary dependent variables. Variables included ART/ATT start dates; age at ART initiation; gender; baseline CD4; anatomical location of TB; ATT regimens and treatment outcomes.

Results: A total of 6,782 co-infected patients (52.9% males) were included. Of these 69% started ATT first, while 31% started ART first. Among 21.1% of patients with unsuccessful treatment outcomes, those starting ART first were more prevalent. Unsuccessful outcomes were strongly associated with early initiation of secondary treatment: ATT initiation within the first three months of ART and ART initiation while on the intensive phase of TB treatment, especially among patients with low baseline CD4. Being on TB retreatment and age>50 years are risk factors weakly associated (HR>1: 1,075/ 1,492 for ART start first group; and 1,890/ 1,552 for those starting ATT first respectively) with unsuccessful outcomes.

Conclusion: Rapid and more sensitive TB diagnostic tests in PLHIV, better management of elderly and immunosuppressed patients, provision of ART services in all sectors of the facilities are recommended to improve TB outcomes among co-infected patients. Background: The HIV epidemic is a major public health problem in Mozambique. HIV patientśretention in care and treatment is still among the most disturbing challenges. The National Health Service has adopted the differentiated models of service delivery for antiretroviral therapy to adapt the response to the needs of users. Thus, the Ministry of Health in collaboration with its partners established a partnership with public pharmacies outside the health facilities (FARMAC) to dispense antiretroviral drugs to patients in treatment.

Method: Four FARMAC pharmacies in Maputo City were included in the strategy between September 2019 and August 2020. Eleven pharmacists from FARMAC were trained to dispense antiretroviral drugs and in counselling to enforce adherence to antiretroviral treatment. Education sessions and pamphlets were used to disseminate the strategy at health facilities. Patients older than 10, in the first line drugs, with good adherence, undetectable viral load, and without the need to take prophylaxis therapy were invited to participate. Those who consented were referred to the pharmacy of their choice. Patients received monitoring calls to collect their medication and attend clinical consultations timely.

Results: About 2745 patients used FARMAC pharmacies through the intervention. Of those, 99% remained in HIV care and treatment. Adherence to the strategy was higher when associated to three months drugs collection. Only 26 patients interrupted their participation mainly (18 patients) due to repeated absences.

Conclusion: Public pharmacies outside the health facilities are potentially an additional model to differentiated models for HIV service delivery. The strategy reduced the number of visits to the health facilities, demonstrating an appealing option in COVID-19 restrictions context and alike. Moreover, it illustrates patientścentered modelśefficacy in retention improvement.

Patrick Sullivan (presenting) 1 Eric Hall 1 , Chandni Jaggi 1 , Michael Kramer 1 , Nicole Hood 1 1 Emory University, Atlanta, GA, USA Background: Differences in the HIV treatment continuum endpoint (viral suppression) have been demonstrated across several social determinants of health (SDOH). We aimed to evaluate ecologic associations between stages of the HIV treatment continuum and SDOH at the zip code level in 36 US (20 Fast-Track) cities.

Method: Data were obtained by AIDSVu.org. Jurisdictions reported counts of HIV care continuum outcomes (late diagnosis, linked to care for 2014-2018; received care, viral suppression for 2018). SDOH data were obtained from the American Community Survey. Using zip code as the unit of analysis, we used hierarchical linear regression models to estimate the association between each SDOH variable and each HIV care continuum outcome. We present the change in percentage points of each outcome that corresponds to an increase from the first quartile to third quartile of each SDOH.

The zip code level median for percent of new infections with a late diagnosis was 19.7% and linked to care was 72.6%. Among prevalent infections, the median zip-specific values for received care and viral suppression were 71.3% and 59.8%, respectively. Comparing the third to first quartile, median income was associated with 3.2% increase in late diagnosis (95%CI: 2.3%, 4.1%), a 3.1% increase in linkage to care (CI: 2.3%, 3.8%) and a 2.1% increase in viral suppression (CI: 1.6%-2.6%). Zip codes with a higher percentage of Black adults had a lower proportion of late diagnosis (-1.8%, 95% CI: -2.3, -1.4), but lower timely linkage to care (-2.2%, 95% CI: -2.7%, -1.7%) and lower viral suppression (-1.4%, -1.8%, -1.0%).

Conclusion: At the zip code level, social determinants of health are associated with all stages of the HIV care continuum, but the direction and magnitude of that impact differs across stages. Understanding the associations between SDOH and continuum outcomes should inform programmatic planning and resource allocation. Background: Dual tests that can be used at point-of-care for simultaneously detecting HIV and syphilis antibodies have been developed, but there is limited data on their acceptability. CheckpointLX offers 15-minute independent HIV, and syphilis testing for men who have sex with men (MSM) performed by trained peers since 2011. A 1-minute dual test was introduced to scale-up HIV and syphilis testing, but MSM acceptability is a higher priority to tailor the service. Hence an evaluation of the dual test acceptability compared with standard of care at CheckpointLX was performed.

Method: Participants were randomly allocated to receive the 15-minute HIV and syphilis separate testing currently used or receive the 1-minute INSTI® Multiplex HIV-1/HIV-2/ Syphilis Antibody Test, based on the week they visited CheckpointLX. Then they answered an acceptability questionnaire. Data were collected between September 2019 and July 2021, and statistics were performed to describe data and to compare both tests' acceptability. Background: Global efforts aim at tackling human immunodeficiency virus (HIV) and hepatitis C (HCV) infection by stopping its transmission through increased diagnosis and effective linkage to care (LTC). As a Fast-Track City (FTC), Cascais implemented a universal HIV/HCV screening project in the Emergency Department (ED) of its hospital, with an embedded nurse assuring LTC.

Method: For patients 18-65 years of age the Electronic Medical Record (EMR) automatically generates a request for HIV and HCV antibody test provided the patient has a blood test as part of routine ED care; excluded are individuals already known to be infected and those who have on record a test performed in the previous year. Nursing staff in the ED receive a visual warning of patient eligibility and offer the screening; the «opt-out» strategy is applied. All reactive results are referred to the embedded LTC nurse by email who will guarantee assessment, follow-up and LTC when applied.

Results: Between September 2018 and September 2020 a total of 21139 and 27357 patients were screened for HIV and HCV, respectively. 771 reactive results were referred to the LTC nurse, with successful follow-up contact occurring in 759 (98%), of which 266 were HIV and 505 HCV results. 53 and 44 patients were newly diagnosed with HIV and HCV, respectively. LTC (defined by attending a first medical appointment) was achieved in 99.1% of confirmed diagnosis confirmed diagnosis (97/98). 13 people failed to attend their appointment to confirm results despite multiple contacts and scheduled appointments.

Conclusion: Our screening program in the ED was successful in diagnosing new HIV and HCV infections. Effective LTC after diagnosis is crucial to ensure optimal patient outcomes and high LTC rates were achieved because of the crucial role of the LTC nurse. Background: Chemsex is increasing among MSM. Prevalence and incidence estimates change substantially among different cohorts. Aim of our study is to assess prevalence and incidence of chemsex and define factors associated to its use in a community-based PrEP service in Milan.

Method: Data were collected from self-administered questionnaires filled between December 2017 and July 2021. PrEP users completed a questionnaire at each visit providing data on drug and alcohol use, and sexual behaviors. Chemsex practices included use of crystal methamphetamine, mephedrone, MDMA, ketamine, GHB, MDPV and cocaine. Logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with chemsex use.

Results: The analysis included 527 participants with a median age of 44 (31-37) years; 505 (96,2%) were MSM. Overall, 127(24.1%) have reported recreational drug use: 61 (11.6%) continuously and 66 (12.5%) occasionally. Eight participants (1.5%) were female, and none reported chemsex. Among them, 80 (63.0%) participants reported both illicit drugs and alcohol use while 47 (37.0%) only drugs use (p<0.01). Cocaine was the most consumed: it was taken by 77 (14.6%) PrEP users, followed by GHB (7.4%) and MDMA (7.2%). Prevalent cases were 86 at the first visit, while incident cases at follow-up visits were 41 with an incidence of 15.5 per 100 person-years of follow up. Participants who used recreational drugs were more likely to use also erectile dysfunction drugs (aOR 2.77, 95%CI 1.67-4.60, p<0.001) and alcohol during sexual intercourse (aOR 2.54, 95%CI 1.64-3.94, p<0.001), and to have a higher number of unprotected sexual intercourse (aOR 1.04, 95%CI 1.01-1.09, p=0.022), as shown in Table. Conclusion: Chemsex prevalence and incidence proved to be high among PrEP users in Milan. Routine clinical practice should include chemsex screening and counseling for a better risk management. Background: SARS-CoV-2 pandemic had a negative impact not only on diagnostic and therapeutic services but also on prevention, including HIV screening. In this study we evaluated and compared the impact of the pandemic on HIV testing in healthcare and community settings in Milan.

We considered the HIV screening tests performed between 01/01/2019 and 10/06/2021 in two local hospitalbased STIs outpatient clinics and in a community-based HIV testing facility. We then compared the two settings in pre COVID (before Mar2020) and post COVID (Mar2020-Jun2021) period in terms of number of tests performed, test results and age, sex and nationality of the subjects tested.

Results: 4106 HIV screening tests have been performed (30.8% healthcare setting, 69.2% community setting). Globally, the community setting tested younger subjects, more females, and fewer foreigners, with a lower HIV prevalence (Tab1). In the healthcare setting, in the post COVID period there has been a decrease in the number of tests performed (Tab4), with older subjects and fewer females tested (Tab2). HIV prevalence remained quite high (Tab3). In the community setting, in the post COVID period there has been also a decrease in the number of tests performed, mostly due to lockdown (Mar -Jun 2020, Fig1). Indeed, after restricting to the period of Jul 2020 -Jun 2021, the average number of HIV-test/month was similar to pre COVID era. Younger subjects, fewer females and a lower HIV prevalence have been found in post COVID period.

Conclusion: Both settings have reduced their activity due to the pandemic. The prevalence of HIV was high in the healthcare setting, possibly because of subjects attending the service while symptomatic or at higher risk. The differences between the subjects tested in the two settings demonstrate the importance of an integrated approach to ensure greater coverage of HIV screening campaigns. Background: It has been suggested that mass SARS-CoV-2 testing could offer a unique opportunity to screen for viral hepatitis, particularly HCV infection. AIM we design a pilot proof for simultaneous testing of SARS-CoV-2 antigen and anti-HCV antibodies using point of care techniques in the people who wanted to attend the opening of night parties in Sitges.

Method: 350 adult individuals who were tested pre-party were appointed for compulsory second test for SARS-CoV-2 five days after the party. All participants were invited to undergo voluntary screening for anti-HCV the same day that the second appointment in suitably adapted public tent. Anti-HCVs were tested by rapid point of care test (ORAQUICK®) and if it is positive, a dried blood stop test for HCV RNA. Baseline demographic, self-reported previous HCV infection and an a signed inform consent were collected.

Results: 350 participants were preparty negative for SARS-Cov-2 antigens and 337 post-party screening being all negative. 217 (64.39%) of them accepted anti-HCV screening. The majority were male (56%), mean age 37,49 years (18 to 74 years) and three were aware of a previous history of viral hepatitis. Anti-HCV antibodies were negative in 211 cases and in six (2.1%) the result was not interpretable. All the tests were performed simultaneous, and the pilot proof takes a total of six hours. Only 28% were>50 years, ages with the highest prevalence of anti-HCV antibodies in Spain.

Conclusion: Simultaneous point of care screening for anti-HCV and SARSCoV-2 testing is feasible and well accepted at the community level. This strategy should be explored in high-risk groups for hepatitis C, like people who used drugs and men who have sex with men.

Puleng Letsie (presenting) 2 Lion Kahimise 1 , Nevia Mundia 1 , Mary-Anne Kahitu 1 1 City of Windhoek, Windhoek, Namibia 2 UNAIDS, Windhoek, Namibia Introduction: The City of Windhoek (CoW), in partnership with Ministry of Health and Social Services (MoHSS), UNAIDS, and other stakeholders hosted Male Engagement events. The campaign engaged men in dialogue regarding their uptake of health services, gender-based violence, and onsite health services screening, including HIV testing. The events were mainly hosted in informal settlements like the Moses Garoeb Constituency in Windhoek.

Description: The campaign stemmed from the Mayor's commitment to HIV prevention as a Champion of the Paris Declaration on Fast-Track Cities, in Namibia. The Mayor's initiative was fueled by poor access and uptake of health services by men, particularly in the City of Windhoek. The campaign engaged men aged 18 and above in a dialogue regarding their uptake of health services, to recognize the health needs of men and the crucial role of health promotion towards a healthy nation. The campaign provides an open and informative platform for men's health and behaviour change.

Lessons Learned: About 250 men attended the last event and actively participated in the discussions. About 90 men tested for HIV, with most of them testing for the first time. The "Male Engagement Policy Paper" was officially launched by Mayor of City of Windhoek at the event and disseminated to all constituencies. Events such as this increase coverage of HTS and other diseases, and further extends information on sensitive topics such as Gender-Based Violence and Voluntary Medical Male Circumcision (VMMC).

The men made recommendations on how to create male-friendly health facilities which are caring and supportive to all men irrespective of their economic status and social background. Other cities such as Katima Mulilo and Swakopmund were identified for implementing similar campaigns to encourage men to take up health services. These will then be rolled out countrywide.

Raychel Holbert (presenting) 1 1 Southern Nevada Health District, Las Vegas, NV, USA Introduction: This project addressed HIV testing stigma. Due to HIV stigma, people are less likely to get an HIV test in fear of receiving a positive test result thus unknowingly contributing to the transmission of HIV.

Description: To address HIV testing stigma with a new audience, the Southern Nevada Health District asked elected officials in Nevada to participate in a social media campaign to raise awareness of a new at-home HIV testing program (Collect2Protect). The social media campaign was grounded in Social Cognitive Theory through the observational learning construct and aimed to normalize HIV testing. The team hypothesized that after the public had seen the elected officials talking HIV testing, showing the at-home HIV test, they would order one. Multiple recruitment strategies were utilized to gain elected official support. Key messages and sample scripts for HIV testing, stigma, populations impacted, and linkage services were shared with local elected officials. The campaign was launched on National HIV Testing Day June 27th with social media posting starting June 23, 2021, through June 27, 2021.

Lessons Learned: Eleven Nevada elected officials created four videos and shared seven photos during the dates above. The number of video views ranged from 21 to 795, and there were 72 clicks to the Collect2Protect website. Although they were new messengers, the elected officials were glad to be a part of the HIV work in the state and showed interest collaborating on future projects. Housing Fast-Track Nevada within the local health department helped to gain support of elected officials.

Recommendations: For duplication purposes, it is recommended to leverage stakeholders/elected officials who sit on health boards, engage elected officials who have previously supported HIV work, engage elected officials early in the process, and contact social media directors/special assistants of elected officials to coordinate efforts. Background: There are patients with Hepatitis C Virus (HCV) infection previously diagnosed and lost to follow-up (LTFU). Strategies to identify and linkage to care are necessary to achieve HCV elimination. The aims were to evaluate the impact of COVID-19 pandemic on LTFU patients in searching and retrieving HCV-RNA+ve individuals (ReLink-C strategy) and perform a health economic evaluation.

Method: ReLink-C strategy was based on a retrospective search of the microbiology databases of Barcelona north health area (450,000 inhabitants), followed by medical records review to identify and retrieve LTFU of HCV-RNA +ve individuals. Individuals were called (five times) to offer them a medical visit, re-evaluation, and subsequent treatment. The search was done into two periods: pre-COVID, Jan 2019 to Feb 2020 and COVID, Mar 2020 to Dec 2020. The costs of ReLink-C strategy were calculated, and a Markov model was used to estimate lifetime cases of liver complications, liverrelated mortality and costs associated, compared to non-intervention.

Results: Overall 1,415 HCV-RNA+ve individuals were detected, 158 candidates for contact, 99 individuals located and 47 agreed to a visit. 41 individuals attended the visit and 38 started DAA treatment. During COVID period, a higher percentage of individuals were selected for retrieval (65 vs 51%) and a lower percentage were candidates for contact (6 vs 13%) and located (4 vs 8%) comparing to pre-COVID period. A similar percentage of cases started treatment. The cost of ReLink-C strategy was €23.830. During lifetime horizon, for a cohort of 133 viremic patients ReLink-C avoided 10 cases of decompensated cirrhosis, 6 hepatocellular carcinomas and 1 liver transplant, saving €423,372 associated to their management; deaths were reduced by 26%.

Conclusion: Relink-C strategy retrieved and treated a high number of LTFU patients and showed to be cost-effective. COVID had a relevant impact on the linkage to care and treatment of HCV patients.

Method: Adults initiating or using PrEP completed biannual electronic questionnaires for up to two years from 2018-2021, including annual questions about PrEP stigma. We classified participants into trajectories based on patterns of reporting anticipated, enacted, or no stigma over time, using last observation carried forward to impute missing values. We compared demographic characteristics of those reporting never/ever experiencing anticipated/ enacted stigma using pairwise twosample t-/χ2-tests.

Results: Of the 317 participants, the median age was 39.5 (IQR, 30.7-46.1) years, median time on PrEP was 12.8 (IQR, 1.1-19.8) months, and 92.4% identified as gay males. The most common stigma trajectories were: (1) never experiencing stigma (n=223, 70.3%); (2) anticipating but never experiencing stigma (n=31, 9.8%), and initially experiencing stigma but not later (n=23, 7.3%). Three trajectories included enacted stigma: (4) transitioning from none to enacted stigma (n=11, 3.5%); (5) repeatedly reporting enacted stigma (n=9, 2.8%), and (6) transitioning from anticipated to enacted stigma (n=5, 1.6%). Finally, (7) 15 participants (4.7%) transitioned from none to anticipated stigma. Participants with high alcohol consumption were more likely to report ever experiencing anticipated/ enacted stigma (p=0.02), but there were no differences according to age, race, time on PrEP, income, adherence, drug coverage, geography, or depression.

Conclusion: While most PrEP users reported never experiencing stigma or diminishing feelings of stigma over time, enacted stigma was not rare, and patterns fluctuated over time. Future work should acknowledge the dynamic nature of PrEP stigma.

Nicole Hood (presenting) 1 , Chandni Jaggi 1 , Nanette Benbow 2 , Shamaya Whitby 1 , Eric Hall 1 , Patrick Sullivan 1 1 Emory University, Atlanta, GA, USA 2 Northwestern University, Chicago, IL, USA Background: Public health surveillance data are central in measuring progress along the HIV care continuum. Accessible data on progress towards continuum targets can inform local efforts on certain continuum steps, locations, or demographic groups. We report 2019 descriptive statistics for continuum steps for 18 US Fast-Track cities and their progress towards 2020 National HIV/AIDS Strategy (NHAS) goals.

Method: Health departments used standardized code to calculate HIV care continuum indicators (timely diagnosis, linkage to medical care, receipt of care, and viral suppression) from National HIV Surveillance System data to ensure comparability. We report continuous variables for timely diagnoses, linkage to care, receipt of care, viral suppression, and an indicator of progress towards the NHAS goals (i.e., met or surpassed the goal, within 25% of attaining the goal, further than 25% from achieving the goal).

Results: Overall, the median percentages for timely diagnoses, linkages to care, receipt of care, and viral suppression were the following: 81.3%, 77.5%, 78.1%, 59.9%, respectively. Across all cities in the analysis, the highest percentages for linkages to and receipt of care were 83.7% and 87.8%, respectively. The indicator with the most variability among cities was linkages to care (83.7%-64.4%, 19% difference). Across all cities, the most commonly missed goal was viral suppression, and 12 of 18 cities were >25% away from attaining one or more continuum goals. Progress towards the goals for the other indicators was fairly similar, with most cities within 25% of achieving the goal.

Conclusion: Evaluation involving common analytic methods is essential to generating unbiased comparisons of indicators across cities. Cities can benefit from benchmarking against other cities in their region or with similar characteristics that are having success with certain indicators to promote sharing of best practices. Introduction: Thailand has implemented same-day antiretroviral therapy (SDART) initiation in several healthcare facilities. This strategy has proven to be efficient, with increased antiretroviral therapy (ART) uptake, viral load suppression, and retention in care, which led to its incorporation into the 2020 Thai HIV Guidelines. However, linkage to care gaps still exist in community settings in Bangkok, whereby 20% of key populations (KPs), particularly men who have sex with men and transgender women, were lost to follow-up pre-ART. Community-based SDART (CB-SDART) can increase access to and uptake of ART among KPs diagnosed at community-based organizations (CBOs). Here, we present the process of identifying strategies for implementing CB-SDART in this setting.

Description: Proctor's model was used to determine relevant implementation outcomes (IOs): feasibility, fidelity, and sustainability. We held a community consultation with CBO leadership, managers, and key implementers to plan implementation strategies (ISs) to achieve these IOs. Consolidated Framework for Implementation Research (CFIR) was used to assess contextual domains of importance in the implementation of CB-SDART, as well as constructs within those CFIR domains, to identify factors of influence, and potential barriers and facilitators. ISs were formulated to address barriers and utilize facilitators.

Lessons Learned: The CBOs emphasized adaptability of SDART to fit the CBO context, and sustainability, particularly the importance of government financial support. CFIR examination identified relevant domains (intervention, inner setting, outer setting, and process), and five sub-constructs of relevance across these domains. An IS was formulated to optimize implementation success.

Recommendations: The use of CFIR facilitated the formulation of comprehensive ISs to meet relevant Proctor's IOs. This approach will inform how to implement CB-SDART and facilitate the systematic uptake of CB-SDART in CBOs across Thailand in the future.

Pascal Muriset (presenting) 1 , Eleanor Gouws 1 1 NAIDS, Geneva, Switzerland Introduction: To better understand the HIV epidemic and response at city level, UNAIDS in collaboration with city partners developed a set of 15 city epidemic profiles. The profiles help cities to identify data gaps and limitations, to better monitor the response, and can be used for further analysis or city level comparisons.

Description: The joint UNAIDS-IAPAC Fast-Track Cities project supports 15 cities to strengthen their capacity to collect, analyse, and report strategic information on the HIV epidemic and response, and to use this data for policy and programmatic decisions. As part of this work, UNAIDS assisted cities to develop city specific epidemic profiles to provide snapshots of the current status of the HIV epidemic and response, and to help cities better manage their data. The profiles can be updated with newly available data on a regular basis, and can be disseminated at local, national, regional, and global level for monitoring, awareness and advocacy purposes. The profiles include sections on: Epidemiology, Treatment and Care, Prevention, Key Populations, Young People, Intimate Partner Violence, Achievements, Challenges, Solutions and, Priorities.

Lessons Learned: Cities have made good progress towards achieving their 90-90-90 targets since the start of the project. While cities generally have good data on key epidemiological indicators, data on prevention and key populations are limited. The profiles help city stakeholders identify and find solutions to these limitations and other gaps.

• Data collection and analysis need to be reinforced for a comprehensive understanding of the status of city epidemics, to assess the impact of cities responses and to take appropriate measures to reach people being left behind. • Capacity in city-level monitoring and evaluation should be strengthened. These situations posed serious challenges for HIV program implementation to ensure UNAIDS treatment goals of retention in care. It was also compounded due to 53% of PLHIV, being unreachable by phone among those who missed their appointments at ART Centres, with resultant treatment interruptions.

Description: Mumbai Districts AIDS Control Society (MDACS) launched ARTMitr (Mitr meaning friend), the strategy to guide PLHIV for services based on their geo-location during the lockdown. PLHIV who missed appointments received a short SMS vernacular text message from ARTmitr with a helpline number. The patients who responded to SMS and successful SMS beneficiaries received personalized tele-guidance based on their current location and their ability to reach the nearest ART centre. The ARV refills through community refill sites were initiated through training of outreach staff. The mobile web form captured refill data from community sites for real-time updates at ART centre.

Lessons Learned: During April-June 2021, SMS notifications were sent to 9524 PLHIV and were successfully received by 5958 (62%). Tele-guidance was provided to 3242 (54%) patients. ARV medicines in transit were facilitated from nearby treatment centers for 1982 patients and 475 were advised to reach local ART centre. The patient centric services of Community ARV refills and courier services were arranged for continuum of care. Innovative services of e-transfer and e-consultation were launched for PLHIVs using digital technology.

Recommendations: ARTmitr facilitated to reach PLHIVs for accessible ARV services during COVID lockdown through the community ARV refills and e-consultation services. However, in the periods after expansion to 500 cells/mm3 and to UTT, there was a trend of decreasing ART initiations (Fig 1) . During UTT, there was a trend of decreasing numbers of late ART initiations (CD4 count <200 cells/mm3, Fig 2) .

Conclusion: Expansion of ART eligibility criteria was associated with immediate, large increases in ART initiations. With UTT, the number of people initiating ART with CD4 counts<200 cells/mm3 decreased markedly. This supports the rollout of universal ART to achieve 95-95-95 in this high prevalence urban setting.

Sbongile Mzulwini (presenting) 1 1 NACCW, Durban, South Africa

Introduction: The National Association of Child Care Workers (NACCW) has a Youth Forum programme which are platforms to bring young people together to experience themselves as change agents within their lives; and to engage in positive change in communities. The programme is supported by the Adoption centrum and NACCW's membership structures.

Description: Youth Forums serve as 90-90-90 community youth action groups to address stigma and discrimination in relation to HIV/AIDS; and enhance knowledge on HIV prevention, treatment, and care. The Youth Forum is a vehicle for youth participation in matters on HIV/AIDS. Youth Forums address stigma and discrimination through dialogues and awareness-raising activities with other youth and community members. Youth in forums partner with the PLHIV sector (in clinics, DoH, local CBOs or programmes) as community advocates to strengthen community anti-stigma campaigns and activities linked to the 90-90-90 goals.

The forums are made up of the following core elements: a formal governance structure, monthly meetings, community engagement and broader stakeholder engagement through workshops, debates and other activities in community and healthcare settings. There are three Youth Forums in eThekwini where NACCW is currently in partnership with UNAIDS and the Mayor's office deploying child and youth care workers (CYCWs) and Youth Forums in one of the epicentres of the pandemic in South Africa.

Lessons Learned: The youth, including LGBTI peer educators and PLHIV, conduct activities with support from Youth Forum Coordinators who are CYCWs. CYCWs are linked to health facilities to conduct community empowerment sessions with Youth Forum members. There are currently 61 youth in the three Youth Forums working with five clinics and close to 60 other community leaders/stakeholders. The programme aims to reach over 5,000 young people and community members through its various activities. The key purpose of these activities is to promote the 90-90-90 goals and address stigma and discrimination.

Farzana Kapadia (presenting) 1 , Bismark Sarfo 1 1 University of Accra, School of Public Health, Accra, Ghana

Background: Improvements in access and uptake of HIV testing, antiretroviral therapy (ART), and retention in care have increased the life expectancy of persons living with HIV (PLWH). This increase in life expectancy among PLWH parallels an increase in chronic conditions. However, there is limited information on the burden of chronic conditions among PLWH in Accra, Ghana.

Methods: Data on sociodemographic characteristics, physical health, HIV biomarkers, ART adherence and chronic conditions were obtained via medical record abstraction for a sample of n=222 PLWH receiving care at Pantang Hospital in Accra, Ghana.

Results: Among this sample of PLWH (median age=39.2 yrs, IQR=32-58 yrs; 65.3% female; 32.9% WHO Stage III/ IV HIV; 60.4% with CD4 cell count< 350 and 47.3% nonadherent to ART) the overall prevalence of any chronic conditions was 53.6% (95% CI 47.0-61.2%). With regard to specific conditions, the prevalence of chronic respiratory conditions was 17.6% (95% CI: 12.6-22.6), hypertension 12.2% (95% CI 7.9-16.5), CVD 10.8% (95% CI 6.7-14.9), peripheral neuropathy 9.9% (95% CI 6.0-13.8), kidney disease 4.1% (95% CI 1.5-6.6), 2.3% osteoporosis (95% CI 0.3-4.2), 1.4% liver disease (95% CI0.1-2.9), 0.9% diabetes (95% CI 0.1-2.1). The prevalence of chronic conditions was higher among women, among PLWH in WHO Stage III/IV HIV and among those with CD4 cell counts< 350 mm3 .

In low-and middle-income settings such as in Accra, Ghana, the need for comprehensive assessment of chronic conditions among PLWHparticularly women and PLWH in advanced stages of HIV disease, must be integrated with HIV care systems. The integration of such services is necessary to implement effective disease monitoring and management strategies across these chronic conditions and HIV. 

Fast-Track Cities Project is addressing stigma-related challenges faced by PLHIV within healthcare facilities through capacity-building efforts among healthcare professionals.

Method: 141 healthcare workers across 17 primary care facilities in Kyiv were trained onsite using two stigma and discrimination elimination modules covering two domains: Human Rights and Integrating Stigma Elimination into Daily Clinical Practice. To ascertain knowledge improvement, pre-and posttraining assessments were conducted among trainees. Training material was approved by the Ukraine Public Health Center.

Results: 82% of participants were physicians and the remaining 18% included psychologists, social workers, and facility administrators/managers. Results for pre-and post-training assessments showed an important knowledge improvement with an overall average pre-test score at 63% and 79% for post-training, across both modules. Disaggregated, the average baseline score for each module, Human Rights, and Integrating Stigma Elimination in Daily Clinical Practice, was 67% and 59%, respectively. Post-training assessment score for the Human Rights module was 84%, and for the module on how to integrate stigma elimination efforts, post-training score averaged at 74%. Background: People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV) infections and are frequently homeless. To improve HCV case finding in these individuals, we examined the feasibility of rapid HCV RNA testing in homeless services in Amsterdam.

Method: In 2020, we provided a comprehensive service to homeless facilities, which included workshops on HCV for personnel, a "hepatitis ambassador" at each facility, a rapid, onsite HCV RNA fingerstick test service, and assistance with linkage to care. Risk factors for HCV RNA-positive status were examined using Bayesian logistic regression.

Results: Of the 152 participants enrolled, 150 (87% men; median age: 47 years) accepted rapid HCV testing. Seven tested HCV RNA positive (4.7%, 95% CrI= 1.31-8.09; 7/ 150). Of these, five (71%) were linked to care, of whom four (57%, 4/7) initiated treatment and one (14%, 1/7) delayed treatment due to a drug-drug interaction. Of these four people, two completed treatment (50%), of whom one (25%) achieved sustained virologic response after 12 weeks. HCV RNA-positive individuals were more likely to originate from Eastern Europe (posterior-odds ratio (OR)=3.59 (95% credible interval (CrI) =1.27-10.04)) and to inject drugs (ever: posterior-OR=3.89 (95% CrI=1.37-11.09); recent: posterior-OR=3.94 (95% CrI=1.29-11.71)).

We identified HCV RNA-positive individuals and linkage to care was relatively high. Screening in homeless services with rapid testing is feasible and could improve HCV case finding for PWID who do not regularly attend primary care or other harm reduction services for people who use drugs.

Corey Prachniak-Rincón (presenting) 1 , José M. Zuniga 1 1 International Association of Providers of AIDS Care (IAPAC), Washington, DC, USA Background: Stigma and discrimination affect LGBTI+ health and contribute to the HIV-related inequities facing this population. Few studies have examined LGBTI+ issues globally, and little comparable research on LGBTI+ health equity exists between the diverse cities that comprise the Fast-Track Cities initiative.

Method: IAPAC conducted a study of 50 FTCs that included a comprehensive desk review and a survey of 275 key informants. As part of a new analysis for this abstract, cities were divided into unfavorable, moderate, and favorable enabling environments depending on their laws or policies relating to four factors:

• Prohibiting discrimination on the basis of gender identity • Prohibiting discrimination on the basis of sexual orientation • Legal recognition of same-sex marriage • Ability to change one's gender marker without requiring surgery

Results: We found that cities with unfavorable policy environments received the lowest scores with respect to overall quality of life, sexual orientation-based discrimination, and mistreatment by police, cities with moderate environments scored better and cities with favorable environments did best. However, all three categories scored equally with respect to gender identity discrimination. LGBTI+ Wellbeing on a Scale of 1 (Poor) to 4 (Excellent). Conclusion: FTCs that had better policies on LGBTI+ equity had better overall quality of life, less sexual orientation-based discrimination, and less police mistreatment of LGBTI+ people. However, favorable policies were not associated with a decrease in gender identity-based discrimination, demonstrating the limits of policy change without accompanying social change, including decreased stigma and increased awareness on both institutional and individual levels. Results: Among 2,374 respondents, there was a similar gender distribution across both regions with women comprising 47-70%. In WCA, 37-50% reported initiated ART on the same day as HIV diagnosis, with 63-73% reporting initiation within the WHO-recommended seven days. Lagos, Kinshasa, and Yaoundé reported same-day and within seven days of ART initiation ranging from 51% and 68%. In terms of differentiated service delivery, in WCA, 37%-50% reported having initiated ART on the same day, with 63-73% reporting it same day or within less than seven days. In Lusaka and Kigali, respondents reported same-day ART initiation at 34-56%, with 47-65% having received ART on same day or in less than seven days from HIV diagnosis. 37%-53% of respondents reported they were either not virally suppressed or they did not know if that had an undetectable viral load.

Conclusion: A third to a half of respondents reported not initiating ART within the WHO-recommended seven days of HIV diagnosis. In two cities, respondents reported continuation of 1-2 monthly clinic visits despite the WHO recommendation of 3-6 monthly visits. A third to a half reported not being undetectable or not knowing their viral load status. A follow-up survey looking closely at the impact of COVID-19 on HIV services and perceived QoC is recommended to clearly assess impact on WHO recommendations for ART initiation. Background: Mathematical models applied to city level data can be leveraged to examine patterns and trends in treatment coverage and the impact on the HIV epidemic over time in Fast-Track Cities.

Methods: Data on prevalence and ART coverage were extracted from Spectrum and Naomi models for 3 Fast-Track Cities (Nairobi, Maputo, and Lagos) from 1990 to 2020. Further analysis was done to investigate trends in prevalence of people living with HIV, prevalence of PLHIV on treatment, and prevalence of PLHIV not on treatment to assess impact on ART coverage and HIV incidence; as well as identify data quality issues.

Results: In Nairobi and Lagos prevalence of PLHIV on ART is nearly the same as prevalence of PLHIV (5.0% in Nairobi and 1.2% in Lagos). However, large uncertainty bounds in Lagos point to possible data quality issues. In Maputo, prevalence of people on ART is levelling off with only 0.6% increase in the last four years from 13.2% to 13.8% in 2017 and 2020 respectively. Additionally, the prevalence of PLHIV not on ART has not yet reached zero (3.1% currently) indicating continuation of transmission.

The nearly equal prevalence of PLHIV and prevalence of PLHIV on ART suggests that transmission should be very low but if compliance with ART falls significantly below 100% there could still be ongoing residual transmission. The focus for Nairobi must be to keep ART coverage high but also ensure that compliance among those on treatment is maintained to ensure that people live a normal and healthy life, and that transmission is controlled. The focus for Maputo should be on reaching those people who are not yet on treatment and to ensure compliance for those on ART. Issues related to data availability and quality result in large uncertainty bounds suggesting that cities need to do more to invest in solid M&E systems and to collect good quality data over time, which in turn can help to guide an accelerated response towards achieving zero transmission and zero deaths. Methods: Two surveysone targeting the general population (ages 18-55+), the other men who have sex with men (MSM) were fielded in five countries, including the United Kingdom. One of the aims of the surveys was to assess literacy levels regarding HCV screening, testing, and treatment. In the United Kingdom, there were 1,002 respondents for the general population survey and 200 respondents for the MSM survey. Data were further stratified to reflect insights from respondents from seven UK Fast-Track Cities, including Brighton, Cardiff, Edinburgh, Glasgow, Liverpool, London, and Manchester (general population respondents: n = 536; MSM: n = 110).

Results: Across the seven UK cities, only an average 13.2% of general population respondents reported ever having been tested for HCV, while an average 44.5% of MSM respondents reported likewise. When asked if it is possible to cure HCV infection, an average 25.2% of general population respondents across the seven cities said "yes" versus 20.3% who indicated "no" and a majority of 54.7% who did not know or were unsure. Among MSM, those percentages were higher, with 48.2% agreeing that HCV can be cured, 24.5% disagreeing with the statement, and 27.3% saying they did not know or were unsure.

The low level of HCV treatment literacy places untreated HCV-positive individuals at risk of liver-related morbidity and mortality. Increased HCV literacy can promote HCV screening and testing and facilitate linkage to HCV treatment that, if sustainably virally suppressive, can lead to curing chronic HCV infection. Such an effort is needed to close the diagnosis-treatment-cure gap worldwide and further contributes to reducing HCV transmission among key populations, including MSM.

Madeira) were analyzed to inform a targeted approach to Portugal's future TB response. Cases notified on the TB National surveillance database (SVIG TB)

The proportion of MDR TB cases is highest in Lisbon and Tagus Valley, with 10 cases in Lisbon and 10 in Sintra, out of 49 cases in the five-year period. Treatment success is highest in Amadora (84.8%) particularly in migrants (86.1%). LTBI treatment success is also higher (84.8%) in Amadora. In Oporto, determinants for vulnerability included drug use (17.4%) and homelessness (5.1%)

Conclusion: These findings suggest the need for involvement of municipalities and NGOs to reach homeless people and drug users in Oporto while in Lisbon and Tagus Valley the need is shifted towards the engagement of the HIV National Program and the High Commission for Migration. 1340: HIV-Related Stigma Elimination Program for Health Workers in the City of Yaoundé

Anastasia Yenban (presenting) 1 , Serge Billong 2 , Nganhale Francine 3 , Sindhu Ravishankar 1,4 , Imane Sidibé 1 , Chris Duncombe 1 , José M. Zuniga 1,4 1 International Association of Providers of AIDS Care (IAPAC), Washington, DC, USA 2 National AIDS Control Committee, Yaoundé, Cameroon 3 ICWCA, Yaoundé, Cameroon 4 Fast-Track Cities Institute, Washington, DC, USA Background: In sub-Saharan Africa, people living with HIV (PLHIV) face challenges accessing quality health care services, including barriers to care associated with widespread stigma and discrimination in health settings. Here, we present the results and lessons from a training program on stigma elimination rolled out in the city of Yaoundé, Cameroon within the framework of the joint IAPAC-UNAIDS Fast-Track Cities initiative.Method: Trainings were conducted as hybrid on-line and in-person for health workers and paraprofessional navigators employing self-narrated audio-visual training modules approved by the Cameroon National Aids Control Committee (NACC). Pre-and post-training questionnaires were administered to assess knowledge change across two modules: Human Rights and Integrating Stigma Elimination into Daily Practice.Results: A total of 417 health workers across 70 health facilities enrolled for the onsite training, while 671 across 37 health facilities registered for online training. For the onsite training sessions, average pre-and post-test scores for the module covering basics on human rights were 56% and 73%, respectively. Baseline score average for self-administered online trainings on human rights was 83% and 85% for post-training assessments. For the module covering integration of stigma elimination into daily practice, health worker overall knowledge gain in the pre-and post-test assessments was 49% to 69% for onsite trainees, and 85% to 87% for health workers enrolled online.Conclusion: Despite the COVID-19 pandemic, a blend of onsite and online training contributed to knowledge gains, especially among onsite trainees. Gauging the degree of knowledge improvement among self-administered online trainees was limited as health workers could repeat trainings over an extended period when compared to their onsite counterparts. Although the training of health workers is an entry point for stigma elimination, ongoing capacitation and follow up with the facility managers is critical for the attainment of stigma free health facilities.