896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic

Abstract Background We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results 1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth. Disclosures Ghady Haidar, MD, Karuys (Grant/Research Support)

Session: P-51.HIV: Treatment Background.Telemedicine (TM) has been seldom used for the care of persons with HIV.However, the COVID-19 pandemic has forced HIV clinics to rapidly scale TM resources.With the increase of TM, the impact on HIV patient care remains uncertain.The purpose of this study is to examine the effects of TM on HIV care and retention at a Ryan White-funded clinic.
Methods.This was a retrospective study of patients seen at an academic clinic in Pittsburgh, PA between 1/1/20 -12/31/20.Encounter information was extracted from the clinic electronic health record.Primary outcomes were viral load (VL) suppression (< 200 copies/ml) and retention in care for persons seen via TM (phone, video +/-in person) vs those seen in-person.Secondary outcomes included flu vaccination and STI screening rates.
Results.Amongst 1414 patients, 608 patients had at least one scheduled TM visit, with 97 seen exclusively via TM, and 806 were scheduled for only in-person visits.In those with at least one TM visit, 92.72% had a suppressed VL. 89.69% of those with only TM visits were suppressed.92.43% were suppressed in the in-person group.Average show rate amongst patients who had at least one TM visit was 60.39% (+0.96% from 2019, +1.71% from 2018), vs 64.38% amongst patients who only had in-person visits.Amongst patients who were only scheduled for TM visits, show rate was 83.97%.40.18% of patients who had at least one TM visit received their flu vaccine in 2020 (-37.45% from 2019, -36.72% from 2018) vs 37.62% who were only seen in-person.Amongst patients who had at least one TM visit, syphilis screening rate was 43.09% (-7.64% from 2019, -8.55% from 2018) vs 43.51% for those seen only in-person.Gonorrhea and chlamydia screening rates were both 42.91% (+9.46% from 2019, +15.27% from 2018 for chlamydia screening; +8.36% from 2019, +14.73% from 2018 for gonorrhea screening).Amongst patients who were exclusively seen in-person gonorrhea screening rate was 48.24% and chlamydia screening rate was 47.57%.Background.We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs.
Methods.This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 -12/2020.HIV outpatient visits were identified through HRSA's CareWARE.Visits (in-person, telehealth) only included HIV primary care.HRSA core performance measures were utilized (Table 1).STI positivity rates and descriptive characteristics were calculated.New and refill PrEP prescriptions were tabulated.Chi-square tests compared unmatched non-parametric variables; McNemar's test matched non-parametric variables.Multivariable logistic regression identified variables associated with retention in care and viral suppression.
Results.1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020.The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001).Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002).Overall, 9.7% of patients had detectable VLs at any point.Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075).More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001).Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2,.Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66).There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results.Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively.

Conclusion.
Rates of viral load suppression and retention in care decreased in 2020 compared to 2019.The proportion of clinic visits attended increased after the integration of telemedicine in 2020.These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth.

Trends and Correlation of HIV-1 Reservoir in Acute HIV Infection and Chronic HIV Infection in China
Shuang peng, n/a 1 ; Ming wang, n/a 1 ; 1 The First Hospital of Changsha, Changsha, Hunan, China Session: P-51.HIV: Treatment Background.Among acute HIV infection (AHI)and chronic HIV infection(CHI),the association of HIV-1 DNA and HIV-1 RNA is currently a hot spot of concern.We studied HIV-1 DNA levels in patients with AHI and CHI before initiation of ART to explore the growth characteristics of the HIV reservoir.
Methods.From 2016/10/31 to 2020/11/23, 97 patients were enrolled in the first hospital of Changsha in China.According to the patient's epidemiological history, HIV-1 antibody conversion time, presence of opportunistic infection(OI), to determine whether the patients were in the acute or chronic infection period, and divided into two arms: AHI and CHI.Lleukomonocyte, HIV-1 RNA, and CD4/8 of all patients were collected.The HIV-1 DNA in peripheral blood mononuclear (PBMC) was detected by PCR-Fluorescence Probing.The results were analyzed by SPSS 22.0 and GraphPad Prism 8.0.P-value < 0.05 were statistically significant.
Results.93 of 97 were male and 85 of 97 with sexual transmission.In AHI arm, the mean of HIV-1 RNA was 5.15 log10 copies/ml, and the mean of HIV-1 DNA was 2.83 log10 copies/10 6 PBMCs.In CHI Arm, the mean value of HIV-1 RNA was 4.90 log10 copies/ml, and the mean value of HIV-1 DNA was 3.19 log copies/10 6 PBMCs.The HIV-1 DNA of CHI group was higher than that of AHI group (p = 0.002) , but the HIV-1 RNA of CHI group was lower than that of AHI Group (p = 0.183) .There were no significant differences between AHI and CHI in age, sex, body weight, route of infection, ART, other viral infection, leukomonocyte, CD4+ T cell count, CD4+ T cell percentage, CD8+ T cell count, CD8+ T cell percentage and CD4/CD8 ratio (P > 0.05).In Group AHI, HIV-1 DNA was positively correlated with HIV-1 RNA (r = 0.548, p < 0.001), but not in Group CHI (r = 0.14, p = 0.347).

Table 1 .
Characteristics of Patients Seen in 2020

Table 2 .
Primary and Secondary Outcomes for Patients Seen in 2020 Conclusion.VL suppression rates were similar across both groups, but retention in care was highest in the TM-only group.Flu vaccination rates and STI screening were lower in the groups that included TM.TM is an effective method for maintaining VL suppression and retention in care but has room for improvement with provision of preventative services.Disclosures.All Authors: No reported disclosures 896.

Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic
Michelle Zhang, BS 1 ; Sharlay Butler, MD 2 ; Jason Kennedy, MS 3 ; Molly McKune, MS 3 ; Ghady Haidar, MD 4 ; Deborah McMahon, MD 5 ; 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 2 UPMC, Pittsburgh, Pennsylvania; 3 University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 4 University of Pittsburgh Medical Center, Pittsburgh, PA; 5 University of Pittsburgh, Pittsburgh, Pennsylvania Session: P-51.HIV: Treatment