Background: Cognitive impairment is a significant co-morbidity for people aging with HIV/AIDS. Lacking pharmacological treatment, psychosocial group therapies may be best suited to help people aging with HIV and cognitive challenges cope with symptoms. Considering public health threats, rural access, etc., in-person group therapies need online/hybrid adaptation.

Methods: Peer-led focus groups discussed adapting cognitive remediation group therapy (CRGT) hybrid/online, including structure, content, and preferences. CRGT combines mindfulness-based stress reduction and brain training activities. Purposive sampling recruited people aging with HIV (40+) from Ontario and Saskatchewan who all self-identified 5+ cognitive concerns (e.g., memory loss). Participatory content analysis—informed by a “Double Diamond” model of intervention development—was employed on transcripts by 7 independent coders.

Results: Ten, two-hour focus groups were conducted between August and November 2022. Participant (n=45) demographics included age (M=53.22, SD=7.62) gender (20 women, 19 men, 6 trans/non-binary/2-spirit), sexuality (19 gay, 18 heterosexual, 8 bisexual/queer/lesbian/2-spirit), and ethnicity (20 white, 15 Black, 6 Indigenous, 4 mixed-race), province (33 Ontario and 12 Saskatchewan), and employment (15 employed, 30 retired/disability). All were retained in care and taking cART. Overall, participants responded favourably to CRGT’s modalities and preferred hybrid group therapies whereby there could be a blend of in-person and online interactions. Preferred intervention facilitators were peers and mental health professionals, with a few participants strictly requesting a physician. Knowledge of HIV’s impacts on cognitive health, including HIV-associated neurocognitive disorder, was very low despite high reports of cognitive concerns (e.g., trouble remembering, impaired attention, difficulty problem-solving).

Conclusion: Given the aging of the HIV population in Canada, increasing support will be required in addition to medical care to improve quality of life, and proactively address concerns about cognition. This presentation will discuss how CRGT could be adapted and implemented in a hybrid manner, alongside considerations for how COVID-19 has impacted intervention research.

To identify adherence barriers to antiretroviral therapy (ART) in routine HIV care, we created a 7-item patient-reported measure (Interference-Score). It evaluates seven barrier domains: Thoughts/Feelings, Habits/Activities, Social situation, Economic status, Medication, Care, and Health. The instrument has undergone cognitive testing (content validation). To assess the measure’s construct validity, we recruited people with HIV (PHIV) on ART in Canada and France from January to August 2022. Participants completed the measure along with 4 dependent variables (DVs) at baseline (Time 1) and 4 weeks later (Time 2). DVs were dichotomized self-reported measures of adherence (past 7 days, past 4 weeks), intention to adhere, and viral load. Analyses included: 1) inter-item correlations (Spearman’s coefficients) to assess item redundancy (Time 1); 2) logistic regressions, with one model per DV, to assess each item’s (covariate’s) significance; and 3) Receiver operating characteristic (ROC) curve analyses with corresponding areas under curves (AUCs), to evaluate the 7-item models’ predictive capacity. Analyses 2) and 3) were performed using I-Score Time 1 items to predict DVs at Time 1 and Time 2, respectively. AUCs were calculated with 95% bootstrap confidence intervals. Analyses included 265 PHIV at Time 1 and 154 at Time 2. Correlation coefficients ranged from 0.33 to 0.68. The items (covariates) of “Thoughts”, "Habits", "Health" and “Economic status” were significantly and independently associated with from 1 to 3 DVs. AUCs showed the 7-item models’ predictive capacity to be "excellent" to “outstanding” for viral load, correctly classifying >80% of respondents. The models were also “acceptable” for Adherence in the past 4 weeks and past 7 days, correctly classifying ≥72% of respondents. The 7-item I-Score is a simple, valid, and comprehensive tool to evaluate ART adherence barriers in HIV care.

Background: Gay, bisexual and other men who have sex with men (gbMSM) experience high rates of sexually transmitted infections (STIs). Recent studies on the use of the antibiotic doxycycline as pre-exposure prophylaxis (PrEP) have demonstrated efficacy and acceptability in reducing STIs. As interest in clinical implementation grows, there is a need to understand drivers that support use. We aimed to determine the prevalence and correlates of wanting to take STI-PrEP.

Methods: gbMSM aged 15 and older were recruited into the online Sex Now survey through social media advertisements from 11/2019—02/2020. Participants in British Columbia provided demographic details and responded to a module on STI-PrEP, created using the theory of planned behaviour. Binary logistic regression assessed factors associated with wanting to take STI-PrEP.

Results: Among 296 participants, 97 (32.7%) wanted to take STI-PrEP. Participants were mostly white (77.8% [228/293]), with a mean age of 39.1 years. Odds of wanting to take STI-PrEP were elevated for participants who were single (odds ratio [OR] 2.76, 95% CI 1.31, 5.85) or in open relationships (OR 4.23, 95% CI 1.96, 9.13) compared with monogamous participants. Relative to participants with <10 sexual partners in the previous six months, those with 10-25 sexual partners (OR 2.40, 95% CI 1.22, 4.73) and those with >25 sexual partners were more likely to want to take STI-PrEP (OR 4.09 95% CI 1.69, 9.90). Participants with past-year diagnoses of syphilis (OR 7.20, 95% CI 1.47, 35.4) or gonorrhea (OR 2.62, 95% CI 1.25, 5.47) had higher odds of wanting to take STI-PrEP. There were no associations with age, HIV status, or past-year chlamydia diagnosis and wanting to take STI-PrEP.

Conclusion: Individuals with more sexual partners and previous STIs had higher odds of wanting to take STI-PrEP. Understanding STI-PrEP desirability helps inform clinical indications, economic analyses, and health service planning.

Background: Experience of pain is highly prevalent among people living with HIV. Mental health conditions are associated with worse pain outcomes and are common in people living with HIV, many of whom have also had adverse childhood experiences (ACEs) and other forms of adversity and trauma. Our aim was to examine associations between pain and traumatic events and HIV stigma among adults living with HIV in Ontario.

Methods: We conducted a cross-sectional analysis using data from the Ontario HIV Treatment Network Cohort Study (OCS). Adults, age 16 and older, who completed the OCS questionnaire in 2019 were included in the analysis. Associations between pain prevalence in the preceding 3 months, and diagnosis of post-traumatic stress disorder (PTSD), history of intimate partner violence (assessed using an 8-item questionnaire), ACEs (measured using the 10-item ACE questionnaire, scored 0-10), and HIV stigma (measured using the 12-item HIV-stigma scale, scored 12-60) were assessed using chi-squared test and one-way analysis of variance.

Results: A total of 2061 participants, of which majority were men (78%) with a median [interquartile range (IQR)] age of 52 [43, 60] years were included in the analysis. A total of 1367 (66%) reported pain in the past 3 months. Pain was associated with greater prevalence of PTSD (10.5%, compared to 3.1% among those reporting no pain, p<0.0001) but not history of intimate partner violence (p=0.5482). Participants reporting pain had more adverse childhood experiences (mean [IQR] ACE score 3 [3,5]) and higher degree of HIV-related stigma (mean [IQR] HIV-stigma score 35 [28,42]) compared to those without pain (mean [IQR] ACE score 2.3 [2,3], p=0.0156; mean [IQR] HIV-stigma score 32 [33,39], p<0.0001).

Conclusions: Pain appears to be associated with measures of trauma and stigma among this sample of participants living with HIV, suggesting a role for multidisciplinary trauma-informed management approaches in HIV care.

Background: Due to intersecting vulnerabilities and social disparities, people living with HIV (PLWH) have faced many challenges during the COVID-19 pandemic. The preventive behaviour measures advocated through the time of pandemic may have resonated differently with PLWH, as some have difficulty placing trust in the health care system. There is a paucity of PLWH-specific data examining demographic factors that affected preventative behavior practices.

Methods: Using data from Canadian Immunity Task Force questionnaire used in the CIHR Canadian HIV Trials Network prospective observational cohort study (CTN328) of PLWH receiving >1 COVID-19 vaccine, we examined the relationship between participants’ characteristics and behavioural practices intended to prevent COVID-19 infection. Subsets of participants were included in sub-analyses exploring relationships between preventive behaviours and known COVID-19 infection, multimorbidity or symptomatic COVID-19 infection (special look at the Omicron wave).

Results: Among 375 participants, the mean age was 52.0 years (SD 13.3) and median duration of HIV infection 17 years. Forty-nine participants had COVID-19 infection before study enrolment and 78 contracted COVID-19 during the study. The proportion of participants reporting preventative behaviours included 87% masking, 79% physical distancing, 70% limiting social gatherings, 65% limiting contact with at-risk individuals, 33% self-isolating due to symptoms, and 26% self-quarantining due to possible exposure. Participants with known prior COVID-19 infection (n=25) were more likely to self-quarantine when thought to have been exposed to COVID-19 but were asymptomatic (p<0.001). Participants with multimorbidity were more likely to endorse physical distancing (85.7% vs 75.5%, p=0.044) although this was not significant in an adjusted analysis.

Conclusions: Our PLWH cohort reported high rates of preventative behaviour practices, with select differences among those with prior COVID-19 infection and with multimorbidity. Our results suggest some key motivating factors in facilitating preventative behaviours, that can help in tailoring policy and communication strategies directed at PLWH during subsequent pandemic waves.

Background: Questions remain about the potential of the Women-Centered HIV Care (WCHC) Model to serve trans women, who experience disproportionate rates of HIV. Thus, this study critically sought to explore trans women’s insights about the WCHC.

Methods: Semi-structured interviews with 17 trans women were completed in 2022. Participants were recruited through purposive sampling to recruit a sample diverse in gender identity, socioeconomic status, race, and sexuality to elicit perspectives marginalized in research. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

Results: Overall, participants were satisfied with the WCHC Model. They raised unique considerations for the implementation of the model for trans women, exemplified through three overarching themes. First, they identified a lack of knowledge among healthcare providers about trans women’s unique needs with respect to each section of the model. For instance, they recognized that while all women are disproportionately affected by violence, healthcare providers must understand how transphobia intersects with violence. Second, participants spoke to the limitations of the healthcare system—long wait times, increasing out-of-pocket costs, and the compartmentalization of care - by which trans women are disproportionately impacted. They spoke to the need for integration between health and social services and for providers to support trans patients with system navigation. Lastly, participants elucidated the tensions between the community and the individual, highlighting that trans women are not monolithic and emphasizing the importance of person-centered care.

Conclusion: Participants' feedback provides key perspectives on the assumed tension between cis women’s needs and trans women’s needs, which are incorrectly treated as separate in healthcare settings. Their insights advance conceptions of womanhood, community, and self which underpin affirming and inclusive healthcare. This perspective emphasizes the importance of ongoing community involvement in healthcare and has implications for the implementation of the WCHC Model for other groups disproportionately affected by HIV.

Background: Sexual health research among women living with HIV (WLWH) has largely focused on transmission, with scarce work emphasizing positive aspects of sexuality. Low testosterone levels have been previously described among WLWH, however, the consequences on women’s sexuality, including sexual pleasure, are unclear. We compared the frequency of sexual pleasure among WLWH and controls and examined associations with testosterone, controlling for psychosocial variables.

Methods: Cis-gender WLWH and controls were queried regarding socio-demographic variables and one-month history of sexual pleasure (alone or partnered). Plasma total testosterone levels were assayed by ELISA. Groups were compared by Mann-Whitney or Chi-square tests. The relationship between testosterone and sexual pleasure was examined by multivariable logistic regression, controlling for variables listed in Table 1.

Results: Participants (n=194) are described in Table 1. More HIV-negative women (71.2%) were sexually active compared to WLWH (59.0%, p=0.08). Among women with recent sexual experiences (n=128), there was no significant difference in frequency of always/usually experiencing pleasure in WLWH compared to controls (65.3% vs 67.1%, p=0.99). WLWH had lower testosterone levels than controls, however in adjusted analyses, there was no association between total testosterone levels and sexual pleasure (AOR=1.00 [95%CI: 0.99-1.02]; p=0.40). Having children at home was independently associated with lower pleasure (0.17 [0.05-0.51]; p=0.003).

Conclusion: Preliminary results suggest that frequency of sexual pleasure does not differ between WLWH and controls, even after adjusting for potential confounders. Though testosterone levels were lower among WLWH, this was not associated with pleasure, suggesting that psychosocial factors influence sexual pleasure more than biomedical variables.

Background: Accelerated aging has been linked to higher non-communicable disease burden experienced by women living with HIV (WLWH). WLWH are also affected by adverse socio-structural factors that can impact aging. We describe and compare the prevalence of comorbidities and selected social determinants of health among WLWH and HIV-negative controls in BCC3.

Methods: BCC3 is a community-based study of healthy aging enrolling WLWH and controls (trans-inclusive) ≥16y. Socio-demographic characteristics as well as 37 self-reported physical and 13 mental health comorbidities ever diagnosed by a healthcare provider were compared by Chi-Squared or Fisher’s tests. Logistic regression was used to adjust for age, without adjustment for multiple comparisons.

Results: Table 1 describes socio-demographic characteristics of women. After adjusting for age, WLWH were more likely to report osteoporosis (34% vs 16%, p<0.001) , neuropathy (19% vs 10%, p=0.02), insomnia (41% vs 29%, p=0.03), and substance use disorder (36% vs 23%, p<0.01), while controls were more likely to report personality disorder (9% vs 3%, p=0.03). Similarly, high proportions of women reported peptic ulcer disease (28% vs 26%, p=0.99), iron deficiency (44% vs 49%, p=0.46), migraines (28% vs 24%, p=0.47), anxiety (47% vs 52%, p=0.43), depression (47% vs 54%, p=0.15), and post-traumatic stress disorder (PTSD) (40% vs 32%, p=0.12).

Conclusions: Overall, we observed few differences in self-reported prevalence of physical and mental comorbidities between WLWH and controls. These data suggest that the impacts of non-HIV factors, such as psycho-socio-structural stressors on comorbidity burden should be explored as potential confounders for studies on aging in this population.