ABSTRACT
Background: PWH are disproportionally affected by mpox and at high risk for severe complications. The recent mpox outbreak response included increasing awareness, encouraging behavioral changes and pre- and post-exposure vaccination. We assessed knowledge and perceptions of mpox, adoption of preventive behaviors, and attitudes towards vaccination among PWH in Washington, DC. Method(s): Data from a cross-sectional mpox survey were collected between August and December 2022 from PWH enrolled in a longitudinal HIV cohort, the DC Cohort. We conducted uni- and bivariable analyses comparing participants by vaccination status (vaccinated, plan to vaccinate, no plan to vaccinate) and by HIV risk group (MSM vs. non-MSM). We conducted multinomial regression to identify factors associated with vaccine acceptance. Result(s): Among 178 PWH completing the survey (median age 55;71% male, 81% non-Hispanic Black, 37% MSM), 162 (91%) had heard of mpox. Among 159 PWH who had heard of mpox and answered vaccination questions, 21% (n=33) were vaccinated, 43% (n=69) planned to vaccinate and 36% (n=57) did not plan to vaccinate. Comparing the 3 groups, significant differences were observed by age, gender, education, income, HIV risk group, and level of worry about mpox (all p< 0.01). Viral suppression, prior COVID and influenza vaccination, access to STI services, and STI diagnoses in the last year were not associated with vaccine status. Behaviorally, a higher proportion of vaccinated participants reported limiting their number of sexual partners (p< 0.001) and using more preventive behaviors (e.g., limiting gatherings, increased condom use, avoiding skin-to-skin contact;p=0.034) in response to mpox. A higher proportion of MSM reported limiting their number of sexual partners compared to non-MSM (33% vs 7%, p< 0.0001) and were more likely to be vaccinated or plan to vaccinate vs non-MSM (p< 0.001). In adjusted multinomial regression models comparing vaccinated PWH and those planning to vaccinate to those not planning to vaccinate, age (p= 0.0231) and HIV risk factor/gender (p< 0.0001) were significantly associated with vaccination status with younger PWH and MSM more likely to vaccinate (Figure). Conclusion(s): High levels of mpox awareness were observed among this cohort of PWH in Washington, DC with more MSM employing risk reduction behaviors and vaccination as mpox prevention strategies. Ensuring that all PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.
ABSTRACT
Background: COVID-19 has caused severe disruptions in healthcare access. The impact on persons with HIV (PWH), including their outcomes along the HIV care continuum is still being assessed. Washington, DC is a hotspot for both HIV and COVID-19 infections. We sought to describe the impact of COVID-19 on the care continuum among a cohort of PWH enrolled in a longitudinal HIV study, the DC Cohort. Methods: DC Cohort participants enrolled by 09/1/2018 and active as of 3/1/2020 were included in the analysis (N=8,274). Using cross-sectional and longitudinal approaches, we assessed engagement in care (EIC) (i.e., at least one viral load [VL], CD4 or visit), receipt of cART, and viral suppression (VS)(i.e., VL<200 copies/ml) during the pre-pandemic era (3/1/2019-3/1/2020) versus the recent peri-pandemic era (9/1/2020-9/1/2021) using Cohort data. A subset of participant data was linked to a cross-sectional COVID-19 survey (N=801). Uni-and bivariate analysis were used to describe care continuum outcomes and factors associated with care disruption. Results: Among 8,274 participants, engagement in care during the pre (71.0%) vs peri pandemic (62.5%) era declined significantly (p<.0001). The proportion of participants who were on cART during each era was stable (90.9% vs 90.8% respectively, p=0.1131). 70.3% of participants achieved VS in the pre pandemic era vs 61.2% in the peri-pandemic era (p<.0001). Longitudinally, 9.5% of participants were no longer EIC peri-pandemic;2.4% of participants were no longer on cART peri-pandemic, 6.5% had a loss of VS and 7.3% had no labs in the peri-pandemic era. Among the subset of participants completing the survey, there were no significant differences between those who maintained VS versus those who did not/had no labs in demographics, employment, changes in income, insurance or housing, or self-reported ability to access non-HIV related care or telehealth. Most surveyed participants reported no change in their ability to fill ARV prescriptions (86%) or daily ARV adherence (89%);however, 20% and 13% reported decreased ability to make and keep HIV appointments, respectively, and 15% reported decreased ability to get laboratory examinations completed. Conclusion: Our analysis shows that COVID-19 has disrupted HIV care continuum outcomes including EIC, ART, and loss of viral suppression. As the pandemic continues, efforts to engage PWH through telehealth, multi-month dispensing, and home-based testing, are needed to ensure continued progress towards ending the HIV epidemic.