Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH).Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence.Methods: Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group (n = 8) to assess barriers and facilitators to care adherence. Quantitative data (n = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups.Findings: Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R = 0.534; p < 0.001) and resiliency (R = −0.486; p < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression (p < 0.05)—a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p < 0.05), and among African-Americans, viral suppression was related to increased resiliency (p < 0.04).Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments

Stress, Support, and Length of Diagnosis Among Women Living with HIV/AIDS in the Southern USA, During the COVID-19 Pandemic

Health-related challenges caused and worsened by the global COVID-19 pandemic have proven broad and multifaceted, particularly for racial/ethnic minority women living with HIV (WLWH). The 2020 pandemic has affected the wellbeing and access to care for WLWH in Southeastern Florida, a region that experienced simultaneous high rates of COVID-19 and HIV. WLWH, over a short- or long-term period, likely utilize different coping mechanisms as they face these challenges. This analysis compared pandemic-related stress and support endorsed by participants attending an urban clinic in South Florida, from January through May 2021. Participants completed an adapted version of the Pandemic Stress Index (PSI). The items in the PSI assessed emotional distress, stigma, and support, and were dichotomized, as either "stress" or "support". Mann-Whitney -test assessed differences in distributions of PSI scores (stress and support) comparing long-term survivors (≥10 years with an HIV diagnosis) to those more recently diagnosed (<10 years). The cohort consisted of 63 WLWH, aged 21-71 (Mean = 42 years±12.95). The group of WLWH were almost evenly split, with 50.8% having been diagnosed in the last 10 years (short-term survivors). The high-stress group endorsed lower levels of support, compared to the low-stress group. There was a non-significant trend of higher stress scores for short-term survivors, compared to long-term survivors; and, higher support scores for long-term survivors, compared to short-term survivors. Results suggest a trend in long-term survivor WLWH endorsing lower stress and higher support; the contrary was found for their short-term survivor counterparts. Patterns in COVID-19 related stressors and maladaptive behaviors need further exploration to establish suitable interventions that address disparities within groups of WLWH

Psychometric Properties of a Vaccine Hesitancy Scale Adapted for COVID-19 Vaccination Among People with HIV

We evaluated the psychometric properties of a modified version of the Vaccine Hesitancy Scale (VHS) among people with HIV (PWH) for COVID-19 vaccination in a cross-sectional study in the US. Self-report data from an online questionnaire were collected from a sample of N  = 175 PWH. Participants were surveyed in English or Spanish regarding attitudes towards COVID-19 vaccination using the adapted VHS. Participants were on average 51.55 years of age ( SD  = 13.90) 55% were women. The reliability of the scale was acceptable (α = 0.72). An exploratory factor analysis showed that “Lack of confidence” and “Risks” explained 45.55% and 12.31% of the variance. Related items showed expected associations with these factors, supporting construct validity. Results illustrate that the modified VHS for COVID-19 vaccination has adequate psychometric properties. We replicated the original factor structure of the VHS and demonstrated adequate internal consistency and construct validity. Validated tools are essential to guide vaccination policy and campaigns towards populations at risk

Examining 5-Year Cervical Cytology Progression Among Minority Women Living With HIV and Baseline Negative Cytology

Women living with HIV are at increased risk of developing cervical cancer, in a cohort of minority women living with HIV, human papillomavirus positivity predicted progression to low-grade/high-grade squamous intraepithelial lesions. Women living with HIV (WLWH) have increased risk of human papillomavirus (HPV) infection, precancers, and invasive cervical cancers. This study aims to determine the rate of cervical cytologic progression and related factors in minority WLWH across 5 years

Medical Mistrust and Adherence to Care Among a Heterogeneous Cohort of Women Living with HIV, Followed in a Large, U.S. Safety Net Clinic

To explore the relationship between medical mistrust, as measured by the Group-Based Medical Mistrust (GBMM) scale, and HIV care adherence among a cohort of minority women receiving care in a U.S. safety net clinic. English-, Spanish-, and Haitian Creole (Creole)-speaking patients with a recent history of nonadherence to care were surveyed. English speakers endorsed the highest level of mistrust, followed by Spanish speakers and Creole speakers. Creole speakers endorsed lower mistrust, lower suspicion of providers, and lower levels of "perceived health care disparities." Higher mistrust was associated significantly with lower medication adherence, and lower rates of viral suppression (nonsignificant). Understanding perceptions of medical care and the relationship to HIV care adherence is an important step to addressing negative health outcomes for ethnic minority women with HIV. Clinical Trial Registration Number: NCT03738410

991. Psychosocial Factors and HIV Risk among Transgender Women Living in Miami

Abstract Background Transgender (TG) women are disproportionately affected by HIV infection and have poor health outcomes when compared to cisgender women. This study evaluates psychosocial factors, and HIV risk among transgender women with and without HIV infection living in Miami, the city with the highest incidence of HIV in the US. Methods Adults who identified themselves as TG living in Miami were recruited from the community and local clinics. Self-reported HIV status, sociodemographic, behavioral data (HIV risk behaviors, sexual partners, illicit substance and alcohol use), and psychosocial factors (depression, violence or abuse events, and HIV stigma) were collected with questionnaires into RedCap. Results A total of 22 participants completed assessments. Ten (45.5%) indicated being HIV uninfected (HIV-) and 12 (54.5%) had been diagnosed with HIV (HIV+). A total of 15 (68%) participants reported use of feminizing hormones and 11 (50%) had undergone feminizing surgeries. Median age was 55 (20, 69); 15 (69%) were white and 5 (23%) Black; 15 (69%) were of Hispanic ethnicity; Level of education 11 (12; 1.8) 12(55%) had completed at least high school; 2 (9%) were employed. 16 (73%) reported being sexually active in the previous month; median number of partners in the last month was 1.5 (1; 2.13); only 13 (60%) reported consistent condom use in the last sexual encounter; 14 (64%) engaged in receptive anal sex; 9 (41%) reported ever engaging in sex for money. Violence or abuse events were common, and participants had experienced an average of 3.9 lifetime events (Median = 3; SD = 3.45). Depression measured by the BSI-18 scale revealed low depression scores (Mean = 1.77; SD = 0.82). HIV infected participants were more likely to be black (p=0.05) and unemployed. We did not find significant differences by HIV status in other variables, including depression and violence or abuse. Among HIV+ participants, HIV stigma measured by the ‘Stigma Scale’ was low (Mean = 1.71; SD = 0.41). Conclusion We identified high rates of events of violence or abuse, that did not differ by HIV status. HIV infection was more common among black TG women.Further research is necessary to identify potential targets for HIV prevention and care in the vulnerable population of TG women. Study funded by the Miami CFAR (P30AI073961) Disclosures All Authors: No reported disclosure

A Longitudinal Analysis of SARS-CoV-2 Antibody Responses Among People With HIV

BackgroundThe concentration and duration of antibodies (Ab) to SARS-CoV-2 infection predicts the severity of the disease and the clinical outcomes. Older people and those with HIV have impaired immune responses, worse outcomes after SARS-CoV-2 infection, and lower antibody responses after viral infection and vaccination. This study evaluated an Ab response to SARS-CoV-2 in people with HIV (PWH) and without HIV (HIV-) and its association with age. MethodsA total of 23 COVID+PWH and 21 COVID+HIV- participants were followed longitudinally for 6 months post-mild COVID-19. Immunoglobin G (IgG) and immunoglobin M (IgM) Ab responses were measured by an in-house developed ELISA. Time points and HIV status interaction were analyzed using Poisson generalized estimating equations, and correlations were analyzed using non-parametric tests. ResultsMedian age in PWH was 55 years with 28.6% women, while in the HIV- group was 36 years with 60.9% women. The mean time from COVID-19 diagnosis to study enrollment was 16 days for PWH and 11 days for HIV-. The mean CD4+ T-cell count/mu l for PWH was 772.10 (+/- 365.21). SARS-CoV-2 IgM and IgG were detected at all time points and Ab response levels did not differ by HIV status (p > 0.05). At entry, age showed a weak direct association with IgG responses (rho = 0.44, p < 0.05) in HIV- but did not show any association in PWH. Similar associations between age, IgG, and HIV status emerged at day 14 (T1; rho = 0.50, p < 0.05), 3 months (T3; rho = 0.50, p < 0.05), and 6 months visit (T4; rho = 0.78, p < 0.05) in the HIV- group. ConclusionThe Ab responses in the 6-month post-SARS-CoV-2 infection did not differ by HIV status, though a positive association was found between age and Ab response in older PWH. Results suggest that immune protection and vaccine responses are similar for PWH than for those without HIV infection

482. Impact of COVID-19 Pandemic on Psychosocial and Clinical Factors among people with and without HIV living in Miami

Abstract Background As the COronaVIrus Disease 2019 (COVID-19) continues to unfold, drastic changes in daily life pose significant challenges on mental and clinical health. While public health interventions such as national lockdowns and social distancing are enforced to reduce the spread of COVID-19, the psychosocial and physical consequences have yet to be determined that may disproportionately affect people living with HIV (PLWH). Methods To evaluate the impact of COVID-related stress on mental and clinical health, we conducted a 20-minute questionnaire eliciting sociodemographic information, clinical and psychological factors from people living in Miami, Fl. All individuals >18 years with or without a history of COVID-19 were included. Participating PLWH were recruited from an existing HIV registry and HIV uninfected participants from community flyers and word of mouth. Results A total of 135 participants were recruited from 05/2020-06/2020. The mean age was 50 years old, 73/135 (54%) were female, and 102/135 (75%) were PLWH. Among participating PLWH, 60/102 (58.8%) self-identified as African American, and 9/102 (8.8%) were positive for COVID-19 by a commercially approved test. Among HIV-negative participants, 15/33 (45.5%) self-identified as White and 11/33 (33%) were positive for COVID-19. Both PLWH and HIV-negative participants described significant disruptions in health care access (47%), difficulty paying basic needs (41%), and feelings of anxiety and depression (48%); there was no statistically significant difference by HIV status. However, HIV negative participants were less likely to experience job loss and income disruption compared to PLWH during the pandemic (70% for HIV-negative vs 48% for PLWH; OR 0.40, p=0.03). Conclusion The impact of COVID-19 on emotional and clinical health is significant in both PLWH and HIV-negative groups. These findings highlight the need for providing mental and physical health care during the pandemic, especially for coping with stress and anxiety during these difficult times and ensuring adequate access to health care. Disclosures All Authors: No reported disclosure

549. Clinical Characteristics and Outcomes of Patients with COVID-19 treated with Convalescent Plasma in Miami, Florida

AbstractBackgroundThe Coronavirus disease of 2019 (COVID-19) global health crisis caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in unprecedented mortality, impacted society, and strained healthcare systems, yet sufficient data regarding treatment options are lacking. Convalescent plasma, used since 1895 for infectious disease outbreaks, offers promise as a treatment option for COVID-19.MethodsThis is a retrospective study of patients diagnosed by a nasopharyngeal swab SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR), who received convalescent plasma between April to June 2020 at two large hospitals in Miami, Florida, as part of the US FDA Expanded Access Program for COVID-19 convalescent plasma (CCP).ResultsA total of 23 patients received CCP, 13 (57%) had severe COVID-19 disease, while 8 (35%) had critical or critical with multiorgan dysfunction. Median time of follow up was 26 (range, 7–79) days. Overall, 11 (48%) survived to discharge, 6 (26%) died, while 6 (26%) are currently hospitalized. All deaths reported were due to septic shock from secondary infections. 15 (65%) showed improvement in oxygen requirements 7 days post CCP transfusion. Measured inflammatory markers, c-reactive protein, lactate dehydrogenase, ferritin and d-dimer improved 7 days post transfusion in 13 (57%) patients. No adverse events due to the transfusion were reported. 10 (43.4%) patients had a negative SARS-CoV-2 RT-PCR at a median of 14.5 (range, 4–31) days after receiving convalescent plasma.ConclusionAdministration of convalescent plasma was found to be safe, with favorable outcomes in this small cohort of relatively high acuity patients. Larger studies including control arms are needed to establish the efficacy of convalescent plasma on clinical and virologic outcomes for patients with COVID-19.TableDisclosuresAll Authors: No reported disclosure