Covid Shielding Stories: Co-Produced Research to Understand the Voice of People Living with Arthritis and Auto-Immune Disease

Background/Aims Up to one-third of people with rheumatological conditions were required to 'shield' from COVID-19. This co-produced, qualitative research aimed to understand experiences of the shielding process and the impact of shielding upon people's lives. Methods Adults who shielded due to rheumatological disease participated in audio-recorded interviews and focus groups (FGs). Framework analysis combined inductive and deductive approaches. Creative materials were collected. Two patient contributors proposed the study, are co-investigators, and conducted the research alongside a clinical academic and four-member patient advisory group. COREQ and GRIPP2 guidelines were followed. Full ethical approval was granted by the University of Manchester Research Ethics Committee (2021- 11544-20348). Results Data were generated from 28 interview and 12 FG participants between October 2021-January 2022. 15 people contributed creative materials. Characteristics included 44/48 (85%) female, ages 18-75 years, non-white 10/48 (21%), all UK regions (Table 1). Corbin & Strauss's theory, 'Three lines of work: Managing chronic illness', frames the findings. Shielding increased and shifted the burden of 'illness work' onto patients, e.g., in gaining access to vaccines and navigating risks and uncertainties due to COVID-19. 'Life work' was increased as participants struggled to access food and medicines. Participants' self-identity was re-appraised in the context of their illness. Many feared for their lives because of their diagnosis for the first time, increasing 'biographical work'. Participants' perceived value to society changed over time: feeling equal to the general population at the first UK national lockdown;abandoned by society due to 'freedom day' and formal shielding's end. 'Emotional work' was added to 'Three lines of work'. Shielding notification induced fear, stress, devastation, shock and disbelief, balanced by a feeling of being protected. Emotions experienced include anxiety, guilt, anger and frustration. Mental health problems were experienced, often for the first time. Many continued to shield beyond formal shielding's end. Conclusion This co-produced, qualitative research highlights experiences and impact of shielding including increased illness, life, biographical and emotional work. Clearer, personalised information would help shielders to understand their risk and vaccine response, informing re-integration into society.

HIV care during the SARS-COV-2 pandemic for Black people with HIV in the UK

Background: The COVID-19 pandemic disproportionally affected black communities but the impact on HIV care in this group remains poorly understood. We evaluated measures of HIV care during the COVID-19 pandemic in the GEN-AFRICA cohort of black people with HIV living in the U.K. Method(s): We evaluated interruptions to HIV care during the COVID-19 pandemic (01/2020-09/2022) in the GENAFRICA cohort at nine UK clinics who provided HIV outcomes for >80% of their participants. We ascertained death, transfers of care, loss to follow up for >12 months, the highest HIV viral load and interruptions to antiretroviral therapy (ART). We evaluated factors associated with the composite outcome of HIV viraemia (viral load >200 c/mL) and/or an ART interruption using logistic regression analysis;factors associated (P<0.1) in univariable analysis were included in the multivariable model. We also summarized reasons for ART interruptions where recorded. Result(s): 2321 participants (mean age 51.3 years;55.8% women;pre-pandemic current/nadir CD4 of 500/204 cells/mm3 and HIV RNA <200 c/mL in 92.3%) were in care on 01/01/2020. Thirty (1.3%) subsequently died, 24 (1.0%) transferred care and 48 (2.1%) became lost to follow up. 523 (22.7%) reported an episode of COVID-19 and 1771 (87.1%) having been vaccinated against SARSCoV- 2. The composite outcome could be evaluated in 2130 (91.8%);259 (11.2%) had a documented HIV VL >200 c/mL, 228 (9.8%) an ART interruption and 325 (14%) had HIV viraemia/ART interruption. In multivariable analysis, older age, a pre-pandemic HIV RNA <200 c/mL and being vaccinated against SARS-CoV-2 were associated with reduced odds of HIV viraemia/ART interruption (Table) while sex, CD4 (current/nadir), comorbid status and having had COVID-19 were not associated. Reasons for ART interruption were available for 52 participants;38% cited domestic logistic reasons, 27% issues related to foreign travel, 19% psychological reasons, 12% lockdown or changes to the daily routine and 4% personal choice. Conclusion(s): During the COVID-19 pandemic, one in seven black people with HIV experienced an ART interruption and/or HIV viraemia. Pre-pandemic measures of suboptimal engagement in care, pandemic restrictions, and wider health beliefs as reflected by COVID-vaccination, contributed to these undesirable HIV outcomes. (Table Presented).

Factors associated with severe SARSCOV- 2 infection in people of Black ethnicities living with HIV in the UK

Background: The COVID-19 pandemic has disproportionally affected people of black ethnicities, who have been at greater risk of SARS-CoV-2 acquisition, morbidity and mortality than those of white ethnicity. We describe factors associated with severe COVID-19 infection in the GEN-AFRICA cohort of people of black ethnicities living with HIV in the U.K. Method(s): First reported episodes of COVID-19 up to October 2022 were ascertained by direct questioning and/or medical records review. Pre-pandemic immune-virological and comorbidity status was based on measurements obtained prior to 01/2020 and used to identify risk factors for severe (requiring hospitalisation or resulting in death) COVID-19, using logistic regression Results: COVID-19 status was available for 1806 (72%) of 2503 GEN-AFRICA participants (mean age 49.2 [SD 10.2] years;56% female;80% sub-Saharan African and 14% Caribbean ancestry, median CD4 count 555 [IQR 400-733] cells/mm3;93% undetectable HIV RNA [<200 copies/ mL]);573 (32%) reported a clinical illness consistent with COVID-19;63 (3.5%) experienced severe COVID-19 (hospitalisation 59;death 4). Those who experienced severe COVID-19 were older, more often male, had lower CD4 counts and fewer had undetectable HIV RNA;they more often had prior AIDS, hypertension, diabetes mellitus and chronic kidney disease. Region of ancestry, nadir CD4 count, and obesity were not associated with severe COVID-19. In multivariable analysis, CD4 count <350 cells/mm3, diabetes mellitus and chronic kidney disease were associated with increased odds of severe COVID-19 (Table). Sex and a pre-pandemic HIV RNA were associated with severe disease although this did not reach statistical significance. By October 2022, 1534 (88%) of this sample had received >=1 dose of SARS-CoV-2 vaccine;those who experienced severe COVID-19 were less likely to report vaccination (77% vs. 89%, p=0.01). Conclusion(s): By the end of October 2022, nearly onethird of people of Black ethnicities with HIV in this sample had experienced COVID-19;3.5% had developed severe COVID-19 disease. Pre-pandemic immunovirological and comorbidity status were associated with severe COVID-19. Black populations with less favourable HIV control than observed for GEN-AFRICA participants may have suffered greater COVID-19 morbidity and mortality. (Table Presented).

HIV CARE DURING THE SARS-CoV-2 PANDEMIC IN BLACK PEOPLE WITH HIV IN THE UK

Background: The COVID-19 pandemic disproportionally affected black communities but the impact on HIV care in this group remains poorly understood. We evaluated measures of HIV care during the COVID-19 pandemic in the GEN-AFRICA cohort of black people with HIV living in the United Kingdom. Method(s): We evaluated interruptions to HIV care during the COVID-19 pandemic (01/2020-09/2022) in the GEN-AFRICA cohort at nine UK clinics who provided HIV outcomes for >80% of their participants. We ascertained death, transfers of care, loss to follow up for >12 months, the highest HIV virus load, and interruptions to antiretroviral therapy (ART). We evaluated factors associated with the composite outcome of HIV viraemia (virus load >200 c/mL) and/or an ART interruption using logistic regression analysis;factors associated (P< 0.1) in univariable analysis were included in the multivariable model. We also summarized reasons for ART interruptions where recorded. Result(s): On 01/01/2020, 2321 GEN-AFRICA study participants (mean age 51.3 years;55.8% women;pre-pandemic current/nadir CD4 of 500/204 cells/mm3 and HIV RNA < 200 c/mL in 92.3%) were under active HIV follow up. Thirty (1.3%) subsequently died, 24 (1.0%) transferred care, and 48 (2.1%) became lost to follow up;523 (22.7%) reported an episode of COVID-19 and 1771 (87.1%) having been vaccinated against SARS-CoV-2. The composite outcome could be evaluated in 2130 (91.8%);259 (11.2%) had a documented HIV VL >200 c/mL, 228 (9.8%) an ART interruption, and 325 (14%) had HIV viraemia/ ART interruption. In multivariable analysis, older age, a pre-pandemic HIV RNA < 200 c/mL and being vaccinated against SARS-CoV-2 were associated with reduced odds of HIV viraemia/ART interruption (Table) while sex, CD4 (current/nadir), comorbid status and having had COVID-19 were not or no longer associated. Reasons for ART interruption were available for 52 participants;38% cited domestic logistic reasons, 27% issues related to foreign travel, 19% psychological reasons, 12% lockdown or changes to the daily routine, and 4% personal choice. Conclusion(s): During the COVID-19 pandemic, one in seven black individuals with HIV experienced an ART interruption and/or HIV viraemia. Pre-pandemic measures of suboptimal engagement in care, pandemic restrictions, and wider health beliefs as reflected by SARS-CoV-2 vaccination status, contributed to these undesirable HIV outcomes.

Lung cancer patients' views on screening and experiences of treatment and care - findings from the Global Lung Cancer Coalition's third annual global survey

Introduction: In 2022, the Global Lung Cancer Coalition (GLCC), a partnership of 42 patient organisations across 30 countries, ran its third annual global patient experience survey on the continued impact of COVID-19 on people living with lung cancer. Method(s): A steering group of patients, advocates, and clinicians developed the survey, asking questions around screening, patients' involvement in decision-making, and preferences in speaking to their treatment team. 555 patients from 21 countries responded, including 83 from the UK and Ireland. [Figure presented] Results: The results show that all responding patients in Ireland and 9 in 10 in the UK would attend a screening appointment if it was available and they were invited. Only a small proportion said they would not attend, and a minority were unsure. When asked if they have been involved in decisions about their treatment and care, a large proportion of patients in both countries stated they have not felt fully involved. The majority of patients in the UK and Ireland prefer speaking to their treatment team in person in a range of situations. However, if patients are worried about something, they would be willing to have a telephone conversation with their treatment team. Conclusion(s): The findings on screening are encouraging given the National Screening Committee's recent recommendation to implement a targeted screening programme in the UK. In Ireland, advocacy organisations continue to lobby the Government for a national programme, and it is positive to see high levels of patient support. Treatment teams should be asking and supporting patients to be as involved in decisions around their treatment and care as they wish to be. Finally, it is clear that patients prefer to discuss their treatment and care face-to-face. Treatment teams should seek to understand patients' preferences, and health systems should put in place relevant provisions to offer virtual appointments. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Social Work Education in England and Slovenia

In this article we discuss the nature of service user in-volvement in Higher Education (HE) social work program-mes in both England and Slovenia. This discussion is based on our experiences of supporting such programmes alongsi-de evidence derived from the literature. Firstly, we present a discussion of the effective development of service user involvement in the respective HEIs in our two countries. Se-condly, we explore how the involvement of experts-by -expe-rience in HEIs benefits the learning of social work students. Thirdly, we investigate how the emergence of Covid-19 has influenced the delivery of social work education and the involvement of service users in our respective social work programmes. We conclude by noting that our social work programmes have been forced to adapt to the needs of stu-dents in an online community and have embraced inclusive education. As a result of this, we suggest that the needs of experts-by-experience should inform the development of so-cial work education and that they should be consulted on how they choose to be involved in educational practice.

EXPERIENCES OF SERVICE USER INVOLVEMENT IN SOCIAL WORK EDUCATION IN ENGLAND AND SLOVENIA

In this article we discuss the nature of service user involvement in Higher Education (HE) social work programmes in both England and Slovenia. This discussion is based on our experiences of supporting such programmes alongsi-de evidence derived from the literature. Firstly, we present a discussion of the effective development of service user involvement in the respective HEIs in our two countries. Se-condly, we explore how the involvement of experts-by-expe-rience in HEIs benefits the learning of social work students. Thirdly, we investigate how the emergence of Covid-19 has influenced the delivery of social work education and the involvement of service users in our respective social work programmes. We conclude by noting that our social work programmes have been forced to adapt to the needs of students in an online community and have embraced inclusive education. As a result of this, we suggest that the needs of experts-by-experience should inform the development of social work education and that they should be consulted on how they choose to be involved in educational practice. © 2022, University of Zagreb. All rights reserved.

'Exploring the Effect of Mirror Therapy versus Constraint Induced Movement Therapy in an Older Adult Post Stroke Population'

Introduction: The Covid-19 pandemic resulted in the closure of community therapy services in Ireland. The need for the provision of upper limb rehabilitation for stroke survivors remained. A new method of service provision was developed and evaluated. Aim- To deliver an upper limb rehabilitation programme to older adults post stroke through virtual means and to compare the stroke interventions of mirror therapy (MT) and constraint induced movement therapy (CIMT). Method(s): 21 participants recruited. The investigator recorded 36 upper limb rehabilitation sessions (12 MT, 12 CIMT and 12 control) which were sent electronically to participants- 6 week therapy programme. Participants were assessed pre and post intervention using the DASH, OSA-SF, JAMAR Hand Function Test, 9 Hole Peg Test and Dynamometer. Statistical significance for CIMT group in grip strength and minimal fine motor skills improvement. MT showed significance in both fine and gross motor skills, grip and pinch strength and overall participants self-perceptions of function. Result(s): 21 participants completed upper limb rehabilitation programmes in their own homes successfully. The MT group showed greater significance than CIMT when completed through virtual means. Telehealth may be a means of service delivery going forward and MT has proven effective as virtual intervention. Conclusion(s): Further evaluation of this intervention through virtual means is needed. Implications for practice- The incorporation of telehealth into upper limb stroke rehabilitation practice can alleviate waiting lists through allowing multiple patients access to interventions at once and also can provide a stroke service in a timely manner.

The Online Studio: Cultures, Perceptions and Questions for the Future

We investigated the impact of the transition to online architectural design studios in response to the COVID-19 pandemic at the University of New South Wales in Sydney, Australia. The study focussed specifically on student and tutor perceptions of online design studio before the sudden transition to online delivery, and how those perceptions shifted through the initial months of online delivery. We consider the pedagogical context in which the shift to online teaching took place and the evident successes and failures in the early iterations of online studio. We discuss similar and contrasting perceptions in student and tutor groups and observe the changes in these perceptions prior to and after teaching and learning in online studios. The paper concludes with a series of questions directed to the architectural design studio teaching community regarding the apparent inevitability of a future in which both FTF and online-only studios are surpassed with hybrid design studios. © 2023 The Authors. International Journal of Art & Design Education published by National Society for Education in Art and Design and John Wiley & Sons Ltd.

Social theories and transdisciplinarity: Reflections on the learning potential of three technologically mediated learning spaces

Transdisciplinarity is often a natural response to complex problems that cannot be addressed with the typified and recurrent empirical approaches of a single disciplinary community. Engaging stakeholders with differing worldviews, knowledge, expertise, and experience to address such complex problems increases the potential quality and usefulness of the research. In this chapter, we report on research initiatives that were undertaken in order to enhance the learning of adult, university-bound English for Academic Purposes (EAP) students. The initiatives involved multiple partnerships with other stakeholders (e.g., software engineers/developers, language teachers, educational technologists), and used technology to optimize learning opportunities beyond the temporal and physical constraints of the traditional classroom. In this chapter we describe research regarding the affordances of three technologically mediated online learning spaces: 3D Virtual Learning Environments, ePortfolios, and an HTML Content Creator, first introduced in physical bricks and mortar language classrooms, where teachers were free to use the technologically mediated spaces flexibly in relation to ongoing student needs. In 2020, the COVID-19 pandemic forced the transfer of all language learning online and heightened the importance of teacher flexibility in using these spaces. While acknowledging the challenges of the exclusive shift to online language learning, this chapter highlights what we learned about the affordances and assessment potential of such online language learning. © 2022 Janna Fox and Natasha Artemeva.

Patient Involvement in Decision-Making around Their Treatment and Care: Findings from a Global Patient Experience Survey

Introduction: Two years in, COVID-19 continues to impact healthcare systems and the treatment and care all patients receive, including those living with lung cancer. The Global Lung Cancer Coalition (GLCC) is a partnership of 42 patient organisations across 30 nations dedicated to improving outcomes for lung cancer patients. The GLCC used its third annual global patient experience survey to explore whether the pandemic had affected the extent to which patients are able to be involved in decision-making around their treatment and care. Methods: Among several topics in the survey, the GLCC’s multi-national steering group of patients, advocates, and clinicians included a question to ask about the extent to which patients felt involved in decisions about their treatment and care when talking to their treatment team. The survey received 555 responses from lung cancer patients across 21 countries. Results: Globally, almost half (48%, 258/533) of patients responding to the 2022 survey said they did not feel fully involved in decisions about their treatment and care, with almost one in ten (9%, 48/533) noting that they were not involved but would like to have been. This is a smaller proportion than in the 2021 survey, where 59% (755/1287) of responding patients stated that they did not feel fully involved in decision-making. The national data in Figure 1 highlights variation in the extent to which patients felt involved in decision-making. In both years, the country with the highest proportion of respondents feeling fully involved in decisions was the Netherlands (76% in 2022 and 75% in 2021). Conclusions: The GLCC’s patient charter highlights that every patient should have informed self-determination, which includes involvement in decision-making. This survey highlights the importance of treatment teams asking, and supporting, lung cancer patients to be as involved in decisions around their treatment and care as they wish to be. In all countries, there is scope to increase the extent to which patients feel involved in decision-making. Research is needed to identify best practice from countries where larger proportions of respondents felt fully involved in decision-making. Keywords: patient involvement, decision making, COVID-19 [Formula presented]

Lung Cancer Patients’ Willingness to Attend a Screening Appointment or Lung Health Check: Insights from a Global Patient Experience Survey

Introduction: Lung health checks or screening programmes are a key measure to detecting the disease earlier, when treatment is most likely to be successful, and thus reducing the huge burden currently imposed on the individuals affected, their families, the country, and the healthcare system as a whole. The Global Lung Cancer Coalition (GLCC), a partnership of 42 patient organisations across 30 nations, states in its patient charter that all patients have the right to witness the widespread implementation of well structured, evidence-based programmes of early diagnosis, including screening. With few countries currently offering screening programmes, the GLCC wanted to understand if patients would be willing to attend an appointment if it was available and they were invited. Methods: In the GLCC’s third annual survey, the steering group included questions on the availability of screening in their country, including a question asking patients if they would attend a lung health check or screening programme if invited. The survey received 555 responses from patients across 21 countries. Results: The majority of responding patients (85%, 449/526) said they would attend a screening appointment or lung health check if they were invited. The number of patients willing to attend ranged from 100% in Spain and Ireland to 63% in the USA. One in ten patients (54/526) said they were unsure if they would attend a screening appointment, and almost one in 20 (4%, 23/526) stated that they would not attend. Patients in Italy (17%, 22/129), Taiwan (17%, 12/71) and the USA (37%, 10/27) most frequently selected these options, although the proportions are lower than those stating that they would attend a screening appointment. Figure 1 shows a breakdown of responses by country. Conclusions: Lung health checks or screening programmes are available in very few countries worldwide, despite the increasing number of people being diagnosed every year. The findings from this survey demonstrate that the majority of patients would have been willing to attend a screening appointment to detect their lung cancer earlier if it had been available and they had been invited. As stated in the GLCC patient charter, in countries where lung cancer screening programmes are not available, governments should look to implement pilots as a matter of urgency, as evidence suggests that screening programmes support earlier detection and diagnosis and better patient outcomes. Keywords: advocacy, screening, COVID-19 [Formula presented]

MA08.07 Understanding Lung Cancer Patients’ Preferences in Speaking to Their Treatment Team: Insights from a Global Patient Experience Survey

Introduction: The Global Lung Cancer Coalition (GLCC) is a partnership of 42 patient organisations across 30 nations dedicated to improving outcomes for lung cancer patients. During the COVID-19 pandemic, many lung cancer patients were offered virtual (telephone or video) consultations alongside or instead of face-to-face appointments. Reasons included protecting patients from exposure to the virus, saving travel time, and freeing-up clinical time. As health systems explore the potential of hybrid systems of telemedicine post-COVID-19, the GLCC wanted to understand patients’ preferences for speaking to their treatment team and how they felt about virtual consultations. Methods: In its third annual online patient survey, the GLCC included questions to ask how patients would like to be able to contact their treatment team in different situations. In total, the survey received 555 responses from patients across 21 countries. Results: The findings show that globally, the majority of responding patients would prefer to see their treatment team in person when: finding out their diagnosis (91%, 406/444);having their first consultation (94%, 412/438);having regular check-ups (78%, 349/450);and there is a change to their treatment (84%, 374/444). However, if they are worried about something, many patients would also be willing to have a telephone consultation (32%, 146/452). Figure 1 highlights that patients in almost all countries favoured telephone over video consultations in all situations. However, video consultations were preferred over telephone consultations by patients in the USA for regular check-ups, and in Taiwan if there is a change to treatment. Conclusions: The findings highlight the importance of treatment teams seeking to understand patients’ preferred methods of contact. Support will be needed for treatment teams and for patients if health systems are to successfully transition to a hybrid model of virtual and in-person appointments. This includes treatment teams and patients having appropriate settings and IT in which to conduct virtual consultations. Patients should be asked whether virtual consultations are working for them, since preferences may change with their experience of technology. Keywords: advocacy, virtual consultations, COVID-19 [Formula presented]

Teacher presence through the lens of kindness

In March 2020, one Australian higher education provider, like many others, found itself pivoting into fully online teaching as the nation managed the COVID 19 pandemic and campuses closed. Bespoke professional learning workshops were offered to all staff, many of whom demonstrated the professional willingness to change their practices in order to offer students the highest quality learning experience that was possible in the demanding and unexpected conditions inherent in the pandemic. There were many challenges revealed through ongoing discussions amongst staff as a community of learners. Throughout the discussions, the concept of presence (Garrison, 2007, 2017) was recurring-teacher and student presence in the newly mandated online teaching context. The centrality of kindness was identified as a second concept that mediated academic discussions and emotions. Both concepts form the focus of this paper. The positioning of kindness within Garrison’s framework of inquiry (2017) will be proposed as a proposition that is worthy of further research particularly if higher education in Australia continues to be uncertain and fraught with change. © 2022, Kaplan Singapore. All rights reserved.

REINTEGRATING A GLOBAL HEALTH PROGRAM TO ON-SITE VISITS DURING THE COVID-19 PANDEMIC

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic limited global surgical missions. As a vaccine has been developed and deployed with low-/middle-income countries (LMICs) adjusting to a post-pandemic landscape, the question remains of how and when to restart surgical missions to these locations. This study reports the experience of International Volunteers in Urology (IVUmed) with identifying metrics of “readiness” for return to global health surgical workshops. METHODS: A survey was created and emailed in September 2021 to LMIC international partners where IVUmed has previously performed or is planning surgical workshops. The survey queried if international sites were ready for the return of surgical workshops, the timing of readiness, type workshop requested first, challenges faced including equipment limitations, and vaccination status. Results were tabulated. RESULTS: Of 30 emails sent, there were 12 responses. This represented 11 unique hospitals in 10 unique cities in 9 countries. The majority of respondents were from the continent of Africa (n=9) while the others were from Asia (n=2) and the Caribbean (n=1). Most respondents lived in countries where vaccines were available (75%) with all respondents stating they were vaccinated and are required to wear masks out in public. Most sites (66.7%) responded being ready for IVUmed workshops, with a start date of February 2022 (55.6%). 83% of respondents stated their hospital infrastructure could support a workshop, with 75% stating good access to personal protective equipment;58%, however, noted difficulty obtaining surgical supplies. Two respondents stating their hospitals continue to only perform emergent surgical cases. The most popular first workshops requested were pediatric urology and laparoscopy/endourology (30% each). Themes of the biggest challenge noted since the start of COVID-19 included 7 comments on performing operations, 4 about lack of supplies, and 2 about lost learning opportunities. CONCLUSIONS: It is unclear how and when to restart global health surgical mission programs since the start of the COVID-19 pandemic, which impacted the already critically limited global surgical volumes in LMICs. While LMIC partners queried report a high vaccination status, the vaccination status of the general population in surveyed countries has not been established. While this is an ongoing research project, important considerations for resumption of surgical missions must include careful assessment of timeliness, surgical and anesthetic capacity, facility resources, and safety. Direct communication with local sites is imperative.

ChAdOx1 nCoV-19 VACCINATION in PWH: IMMUNE RESPONSES to SARS-CoV-2, VOCs, and HCoVs

Background: People living with HIV (PWH) may represent a high-risk group for adverse clinical outcomes from SARS-CoV-2. The duration of protection from SARS-CoV-2 and emerging variants of concern (VOC) infection in PWH following vaccination is unclear. Furthermore, the role of preexisting SARS-CoV-2 immune responses, likely acquired from prior exposure to circulating human coronaviruses (HCoVs), on vaccine-mediated immunity remains to be determined. Understanding the kinetics of immune responses to SARS-CoV-2 and VOCs, and the impact of preexisting SARS-CoV-2 immunity on vaccine-mediated immune responses will be critical in informing COVID-19 vaccination policies in PWH. Methods: In this sub-study of the Phase II/III COV002 trial (open-label, non-randomised clinical trial ID: NCT04400838), 54 HIV+ male participants on antiretroviral therapy (undetectable viral loads, CD4+ T cells >350 cells/ul) and 50 HIV-sex and age-matched controls received two doses of ChAdOx1 nCoV-19 (AZD1222) 4-6 weeks apart and were followed for 6 months. Immune responses to vaccination were determined by ELISA (standard and MSD assay), neutralisation, ACE-2 inhibition, IFNγ ELISpot, activation-induced marker (AIM) assay and T cell proliferation assays. Results: 6 months after vaccination, antibody IgG levels to SARS-CoV-2 S and RBD proteins, ACE-2 inhibition and T cell responses to S protein were significantly higher than baseline (Table 1). Both humoral and cell-mediated immunity waned over time, but with no significant difference compared with HIV-individuals vaccinated with the same regimen. T and B cell-mediated immune responses to VOCs α, β, γ, and δ were detectable, although at lower magnitudes than wild type. Prior exposure to circulating β coronavirus HKU1 and OC43 was associated with measurable proliferative SARS-CoV-2 T cell response at baseline and a higher magnitude of post-vaccine T cell responses. Conclusion: Our data demonstrate no significant difference in ChAdOx1 nCoV-19 vaccine-mediated immune responses by HIV status. For all groups, we show waning but detectable immune responses against SARS-CoV-2 and VOCs 6 months after vaccination supporting the on-going policy to vaccinate against SARS-CoV-2 and reinforces the argument for long-term monitoring of responses.

COVID VOICES: CO-PRODUCED RESEARCH TO EXPLORE THE SHIELDING EXPERIENCES OF PEOPLE WITH INFLAMMATORY MUSCULOSKELETAL DISEASE

Background/Aims Up to one-third of people living with inflammatory arthritis or autoimmune disease may have been classified as 'clinically extremely vulnerable' (CEV) to COVID-19 and required to 'shield'. Communication regarding shielding notification and details of how to shield were unclear, causing confusion and uncertainty. Most research into the impact of shielding on people living with musculoskeletal disease has involved either quantitative or survey-based data, with little patient involvement. This project aims to capture patient 'stories' to understand and explore the experiences of people with inflammatory musculoskeletal conditions who shielded, using co-produced, qualitative methodology. Methods The Centre for Epidemiology Versus Arthritis (CfE) is committed to involving patients and the public, convening a COVID-19 Patient and Public Involvement (PPI) group early in the pandemic. Two PPI group members developed the research idea and collaborated with a clinical academic to co-produce a successful grant application to the Versus Arthritis 'New opportunities' fund. The research aims to capture experiences and opinions on the processes for determining and communicating who is identified as CEV, and the impact of shielding upon individuals' lives. We will develop recommendations to improve the process for subsequent pandemics. People who shielded due to inflammatory arthritis / auto-immune disease are invited to discuss their experiences of shielding in semi-structured interviews (n=30) or focus groups (n=12). Up to 50 participants may submit creative materials (artwork, poetry, photographs or written word), to include those unable, or unwilling, to speak about their experiences. A framework approach to thematic analysis of data generated from interviews and focus groups will be employed. Creative materials will be used to illustrate these themes. In addition to the core team, an experienced Patient Advisory Group will contribute to the analysis. Full ethical approval was awarded by the University of Manchester Research Ethics Committee. The 'core team' (two patient/public contributors and a clinical academic) are committed to 'co-production': working together in equal partnership, driven by values such as transparency, sharing power and inclusivity, which we anticipate will improve the relevance and quality of this work. Results Recruitment to interview and focus groups was exceeded within 10 days. Half the creative materials participants were recruited within a month, and recruitment remains open. The team have given invited talks at several national and regional events, discussing the research and methodological approach, demonstrating the significant interest generated by this work. Conclusion Although most funders now mandate some form of PPI in grant applications, research ideas conceived and genuinely co-produced by patient partners are rare. The CfE's commitment to PPI enabled conversations and collaboration, which built on existing relationships, and led to successful grant funding. We look forward to further highlighting and sharing both the model of our collaboration, and the qualitative research findings.