Keerti Gedela

Four global settings reported on; asymptomatic SARS-CoV-2/Omicron carriage in adults living with HIV (PLWH) in sub-Saharan Africa (US presenter); safety/tolerability for bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for post-exposure prophylaxis (PEP), China; community-based HIV screening, linkage to care, Indonesia and predictors of high HIV viral loads (V/L) among PLWH in care in Zambia.

Jessica Andriesen described a high prevalence of asymptomatic Omicron carriage among PLWH in sub-Saharan Africa from the largest cohort of PLWH in a COVID-19 vaccine trial. Despite the generalised high prevalence, PLWH with CD4 counts <200cells/mm3 had a 2.06 higher-odds of a positive PCR. BIC/FTC/TAF as PEP was deemed well-tolerated and safe following a trial in 112 HIV-negative participants (97.3% male) attending an STD clinic in Beijing. Budi Utomo reported results following the national rollout of a community-based HIV screening/self-testing from late 2021 in Indonesia. 36,616 screening tests were performed by May 2022; 91.9% by men (75.4% MSM), 3.8% were transgender females, 4.6% people who inject drugs, 1.7% female sex workers; 83.2% were first-time HIV testers. Total HIV positivity rate was 3.6% (5.1% among transgender females). 61% with reactive tests initiated ART. Sulani Nyimbili presented cross-sectional data on predictors of high V/L in PLWH receiving care in Zambia (defined as >1,000copies/mL). Adults>15 years, on ART at least 6-months included. Of 531,864 adults (median-age 35); 60% female, and 57% from urban settings. Characteristics associated with high V/L (adjusted) were being male (1.43x higher odds), young (15-19year-age group 2.48 higher odds). Increasing duration on ART reduced the odds of a high V/L.

This session received fascinating large cohort data from Indonesia and Zambia describing programmatic and structural challenges within HIV testing, ART initiation and viral suppression highlighting challenges these settings face in achieving HIV care-cascade goals. The high rates of first-time HIV testing within key populations and poor rate of ART initiation in Indonesia; and factors associated with high V/L on ART in Zambia calls for investment in ART initiation and adherence support in these regions, importantly better understanding of structural barriers behind this data. Data regarding SARS-CoV-2 positivity among immunosuppressed PLWH calls for larger studies to better characterize this relationship.