Objectives:This study aims to develop comprehensive computable phenotyping algorithms that integrate multiple domains of electronic health record (EHR) data within the All of Us (AoU) Researcher Workbench to identify sexually transmitted infection (STI) cases and characterize STI patterns. Materials and Methods:We used AoU controlled tier data, version 8, which included participants enrolled from May 6, 2018, to October 1, 2023. Using data across multiple domains of EHRs in AoU, such as diagnostic codes, laboratory results, and medication records, we developed computational phenotyping algorithms to identify 3 leading STIs: chlamydia, gonorrhea, and syphilis. Results:Among 393 596 participants with EHR data in AoU, 2603 had confirmed chlamydia, 1520 had gonorrhea, and 2762 had syphilis. By utilizing information from diagnostic codes and medication records, we identified an additional 4843 individuals with possible/presumed chlamydia and 18 855 individuals with possible/presumed gonorrhea. Among 5784 participants with at least one confirmed STI, 115 (2.0%) had all 3 infections. A notable shift in STI trends occurred in 2019, with the occurrence increasing from 2010 to 2019 before declining through 2023 across different STIs. Discussion:The comprehensive computable phenotype algorithms developed in this study provide an enhanced approach to identifying STI cases that may be missed using traditional lab-based methods. Conclusion:The computable phenotypes developed in this study provide a practical framework for more nuanced STI classification and downstream analysis in All of Us. Our approach may also support clinical and public health efforts by improving case identification beyond laboratory-only methods and informing interventions addressing clinical and social needs.

Limited studies have sought to qualify the extent and trends of racial disparities in viral suppression (VS) among people with HIV(PWH) across the Southern US. This study aims to examine the spatiotemporal trend and structural social determinants of racial disparities of VS. A population-based retrospective cohort study across all counties in South Carolina (SC) from 2013 to 2020. Linear trend test was employed to explore the temporal trend of the disparity indices (Black to White Ratio [BWR], Index of Disparity [ID], Weighted Index of Disparity [Weighted ID], and Gini coefficient). Linear mixed-effect models were further used to assess the association between different contextual factors and these indices. A decrease in racial disparity in VS (p < 0.01) was observed from 2013 to 2020 across all disparity indices. When measured using Weighted ID and Gini coefficient, lower risk of racial disparities in VS was associated with more Ryan White HIV centers (β = -0.92 and β = -0.0046, respectively) and higher disability rates (β = -1.10 and β = -0.0055, respectively). When measured using ID, Weighted ID, and Gini coefficient, counties in PEE DEE region showed less racial disparities in VS (β = -3.89, -1.73, and -0.0086, respectively, p < 0.05) compared with those in Lowcountry region. Although a notable decrease in racial disparities in VS was observed among PWH in SC, attention to addressing related social and structural factors (e.g., fewer Ryan White HIV centers within geographic accessibility) that contribute to poorer HIV outcomes is still needed.

A childhood sexual abuse (CSA) history is more prevalent among people living with HIV and may have lingering effects among older adults living with HIV (OALH). However, studies examining the impact of trauma-informed interventions among OALH are scant. The aim of the study was to determine the preliminary effect of the Coping with Childhood Sexual Abuse, HIV, and Aging (CoSHA) intervention on depressive symptoms, coping and ART adherence among OALH. Data were obtained from 28 OALH recruited from an immunology clinic and an AIDS service organization in South Carolina. Generalized estimating equation (GEE) models were used to determine the preliminary effect of the intervention on depressive symptoms, coping and ART adherence among OALH from baseline to 6-week, 3- and 6- month follow-up using intention-to-treat analysis. The intervention reduced depressive symptoms over the 6-month period (B=-9.13, 95

Mental health diagnoses have been linked to poor HIV treatment outcomes and poorer quality of life among people living with HIV (PLWH). Therefore, this study aimed to investigate the association between sociodemographic and HIV-related characteristics, and common and serious mental health disorders among PLWH in South Carolina (SC). Data were obtained from the integrated system of statewide electronic health record (EHR) data in SC (2006–2019; N = 8,124). Multivariable logistic regression models were used to determine the associations between sociodemographic and HIV-related characteristics, and common mental health disorders and serious mental health disorders. Among the study population, 4

The American Thoracic Society recently released updated community-acquired pneumonia (CAP) guidelines. The Infectious Diseases Society of America (IDSA) agreed with 8 of the 10 recommendations in the guidelines but declined to endorse the guidelines because they include recommendations for use of antibiotics in outpatients with comorbidities and inpatients with nonsevere CAP who test positive for respiratory viruses. It is noted in the guidelines that bacterial coinfections are common and that delaying antibiotics may be harmful. IDSA notes, however, that nondiscriminatory use of antibiotics for patients with CAP and positive viral assays confers more risks than benefits. Most patients do not have bacterial coinfections, and briefly withholding antibiotics for patients with nonsevere illness to clarify the diagnosis is safe. In this era of precision medicine, IDSA instead recommends individualized, dynamic decision-making that takes into account each patient´s evolving trajectory, severity of illness and balance of clinical features for and against coinfection.

OBJECTIVE:This study aims to assess the association between HIV infection and cardiovascular disease (CVD) incidence, with a focus on sex differences and the role of immune status. DESIGN:Retrospective cohort study using electronic health records from the All of Us (AoU) Research Program. We identified people with HIV (PWH) and matched them to people without HIV (PWoH) using propensity score matching (PSM) (1 : 5) by sex, age, and race/ethnicity. The matched cohort was then restricted to participants who were free of CVD before the index date. METHODS:We used Cox proportional hazards models, including an interaction term between sex and HIV status, to assess sex differences in the association between HIV status and incident CVD, adjusting for potential confounders. Subgroup analyses evaluated effect modification by viral suppression (HIV RNA < 50 copies/ml) and preserved immune function (CD4+ cell count >500 cells/μl). RESULTS:After PSM, we identified 4803 PWH without preexisting CVD and matched them with 24 276 PWoH. Compared to their matched PWoH, women with HIV had an elevated adjusted hazard ratio (aHR) for CVD [aHR = 1.933, 95% confidence interval (CI): 1.709-2.188] than men with HIV (aHR = 1.435, 95% CI: 1.313-1.568). In subgroup analyses, compared with women without HIV, women with HIV remained at higher risk of CVD despite viral suppression (aHR = 1.929, 95% CI: 1.565-2.378) or preserved immune function (aHR = 1.813, 95% CI: 1.455-2.259). In contrast, no significant differences were observed between men with HIV and well controlled men without HIV (aHR = 1.133, 95% CI: 0.964-1.332). CONCLUSION:Understanding sex-specific drivers of CVD risk is crucial for developing targeted interventions to prevent CVD in women with HIV and men with HIV.

BACKGROUND:This study aimed to compare the risks of a panel of long COVID (LC) manifestations between people with HIV (PWH) and people without HIV (PWoH). METHODS:Using integrated statewide electronic health record data from the HIV cohort and COVID-19 tester cohort, we identified COVID-19-positive individuals by HIV status between March 02, 2020, and January 15, 2022, in South Carolina. A total of 13 diagnosis groups encompassing 131 potential LC categories were identified. We used inverse probability weighting based on propensity scores to balance covariates between the PWH and PWoH, including age, sex, race, and vaccination status. Cox Proportional Hazard regression models were used to estimate the risk of each diagnosis group examined. RESULTS:Among a total of 838,520 COVID-19-positive individuals, 2662 were with HIV and 835,858 were without HIV. The prevalence of any LC diagnosis was 16.3% and 10.6% for PWH and PWoH, respectively. Compared with PWoH, PWH were found to be at a higher risk of at least one of the LC diagnosis groups (hazard ratio [HR] = 1.29, 95% confidence interval [95% CI]: 1.09 to 1.54) and the highest risk was for diseases of the nervous system (HR = 2.04, 95% CI: 1.42 to 2.92), followed by mental disorders (HR = 1.78, 95% CI: 1.12 to 2.82) and respiratory system (HR = 1.78, 95% CI: 1.18 to 2.69). CONCLUSIONS:Our study highlights the consistent and elevated LC burden in PWH, emphasizing the importance of sustained follow-up for COVID-19 survivors to improve their clinical outcomes and prevent morbidity of LC.

In the United States (US), sexual and gender minority (SGM) people of color (POC) are disproportionately impacted by HIV. Persisting new diagnoses in SGM POC make it unlikely that the US will meet the Ending the HIV Epidemic’s (EHE) goal to reduce new HIV diagnoses by 90% by 2030. Innovative strategies are needed to address this challenge, particularly in the US South, where Black/African American and Latine SGM are disproportionately impacted by HIV. Social network approaches have led to increased HIV testing uptake. Social network interventions that are responsive to SGM POC individuals’ needs could also increase engagement across the HIV prevention and care continuum. This hybrid Type 1 effectiveness-implementation study will evaluate an enhanced Social Network Strategy (eSNS) intervention designed to increase engagement in HIV services (HIV testing, pre-exposure prophylaxis [PrEP] use, and HIV care) among SGM POC. From 2025-2027, eSNS will be delivered in the Charlotte, North Carolina (NC) region, which includes Mecklenburg County, a priority EHE jurisdiction. Phase 1 of the study was a formative period of mixed methods data collection to operationalize enhancements to the Centers for Disease Control and Prevention’s Social Network Strategy (SNS), which will address key facilitators and modifiable barriers to engaging SGM POC in HIV services. In Phase 2, the intervention will be integrated into standard NC Partner Services for people diagnosed with HIV and their sexual and/or social contacts. We will identify network recruiters (Ambassadors) among SGM POC who are either reached by study team members (DIS Coaches) performing Partner Services or referred at community sites. DIS Coaches will guide Ambassadors to identify and refer people in their network (Peers) for HIV services and will support each Ambassador over 2-6 weeks to facilitate Ambassadors’ peer outreach and Peers’ referrals to HIV services. Finally, the study’s Phase 3 will evaluate the eSNS’s effectiveness in increasing HIV services uptake compared to standard-of-care Partner Services in the Raleigh, NC region. This project was funded by the National Institutes of Health and initially approved by the University of North Carolina at Chapel Hill’s Institutional Review Board in 2022. Phase 1 concluded in August 2024. Implementation of eSNS (Phase 2) will launch in January 2025. Evaluation measures (Phase 3) will be assessed at 6-month intervals during and after eSNS implementation. Based on Phase 1 findings, the study was modified to include Latine SGM as Ambassadors and expand identification of Ambassadors through community sites. Substantial reductions in new HIV diagnoses depend on public health approaches that effectively reach people with a higher likelihood of acquiring HIV. Our protocol proposes integrating existing strategies with an innovative intervention (eSNS) to reduce social barriers to increasing SGM POC’s engagement in the full HIV prevention and care continuum.

Objective:We investigated the trends and disparities in cardiovascular disease (CVD) among people with HIV (PWH) in South Carolina (SC). Study design:This is a statewide cohort study. Methods:A comprehensive electronic health records database in SC assessed CVD prevalence trends among PWH overall and within two age groups (<50 and ≥ 50 years) from 2005 to 2020. Additionally, we explored disparities in CVD prevalence across subgroups by sex, race and ethnicity, rurality, and HIV transmission mode. Results:This study included 31,984 PWH aged 18 and older. From 2005 to 2020, the prevalence of CVD among PWH in SC increased from 19.9 % to 24.4 % overall (P-trend<0.001) and from 18.1 % to 22.6 % for those aged <50 years (P-trend<0.001) but remained stable from 41.0 to 40.8 among those aged ≥50 years (P-trend = 0.26). Disparities in CVD prevalence by sex, race and ethnicity, rurality, and HIV transmission mode were observed among PWH across both ages <50 years and ≥50 years. For example, among individuals aged<50 years, the prevalence of CVD increased from 23.1 % to 31.2 % for females (P-trend<0.001) while it increased from 15.8 % to 19.6 % for males (P-trend<0.001) (P-interaction<0.001). The corresponding values for aged ≥50 years were from 48.3 % to 50.4 % for females (P-trend = 0.08) and from 35.6 % to 37.5 % for males (P-trend = 0.02) (P-interaction = 0.003). Conclusion:As PWH experience improved and extended life expectancy, this study revealed the prevalence and associated disparities in CVD prevalence across demographics and HIV transmission mode in SC, emphasizing the need for targeted interventions to enhance cardiovascular health in this vulnerable population.

PURPOSE:Integrase Strand Transfer Inhibitors (INSTIs) are effective and well-tolerated in HIV treatment, but their cardiovascular impact remains uncertain. This study evaluated the association between INSTI-based antiretroviral therapy (ART) and cardiovascular disease (CVD) risk in people with HIV (PWH). METHODS:We conducted a retrospective cohort study using electronic health records and survey data from the All of Us research program. Adults with HIV on continuous ART for ≥ 1 year, free of CVD at baseline and within one year of ART initiation, were included. INSTI exposure was categorized by regimen status. Cox proportional hazards models assessed the association between INSTI use and CVD. A subgroup analysis examined INSTI-naïve individuals who later switched to INSTI-based ART. RESULTS:Among 2175 PWH, 437 (20.09 %) experienced CVD events; 1715 (78.85 %) used INSTIs. INSTI-only (aHR = 0.65, 95 % CI: 0.50-0.83) and partial-INSTI use (aHR = 0.34, 95 % CI: 0.27-0.42) were linked to lower CVD risk. In the INSTI-naïve cohort (N = 1300), switching to INSTIs reduced CVD risk (aHR = 0.32, 95 % CI: 0.25-0.40). Older age (≥ 70) increased CVD risk. CONCLUSIONS:INSTI-based ART may lower CVD risk among PWH. Further research is needed to validate these findings. SUMMARY:INSTI-based ART was associated with reduced cardiovascular disease risk among people with HIV, suggesting potential cardioprotective effects that warrant further investigation.

Introduction Transportation vulnerability is a major barrier to HIV care for many people living with HIV (PLHIV)—especially in the rural southern United States (US), given limited public transportation infrastructure and long travel times to HIV care. Rideshare services have proliferated in recent years, and rideshare interventions are now being used in some HIV clinics to overcome transportation barriers. However, little is known about how PLHIV in the southern US perceive rideshare services and whether they are willing to use them to access HIV care—information that is critical for optimizing the implementation of rideshare interventions. The goal of this mixed-methods study was to examine implementation-related factors relevant to uptake of a concierge rideshare intervention among PLHIV in South Carolina. Methods A total of 160 PLHIV with self-reported transportation vulnerability were enrolled in a randomized clinical trial to test effectiveness of a concierge rideshare intervention. Prior to intervention implementation, all PLHIV completed brief surveys assessing transportation-related barriers to HIV care and implementation-related factors pertaining to rideshare services. Additional semi-structured individual interviews were also completed by a smaller subset of participants ( n = 20) to capture personal experiences and insight into perceptions of rideshare services for accessing HIV care. Results Mean scores indicated favorable perceptions of rideshare interventions across the domains of comfort, ease of use, and safety. However, mean scores also indicated participant concerns with costs associated with rideshare, as well as privacy protections. T-tests showed nonsignificant differences in perceptions of rideshare by gender. Qualitative analysis yielded six key themes—"safety/comfort,” “privacy protections”, “appeal/enjoyment,” “convenience/ease”, “issues encountered”, and “cost”—which aligned with three implementation factors (ie, feasibility, acceptability, adoption) that are relevant for successful implementation of rideshare interventions. Conclusion While the majority of PLHIV had favorable views of using rideshare services to access HIV treatment and care, several obstacles need to be addressed to ensure the success of rideshare interventions, including HIV-related stigma and technological barriers.

This population-based cohort study examines the appropriateness of antibiotic prescribing in South Carolina via aggregated pharmacy claims data matched with diagnosis codes from medical claims. Inappropriate antibiotic prescribing decreased from 30.2% in 2012 to 22.6% in 2017 (P < 0.001) and was more common in adults >40 years old.

Background: This study aims to develop and examine the performance of machine learning (ML) algorithms in predicting viral suppression among statewide people living with HIV (PWH) in South Carolina. Methods: Extracted through the electronic reporting system in South Carolina, the study population was adult PWH who were diagnosed between 2005 and 2021. Viral suppression was defined as viral load <200 copies/mL. The predictors, including sociodemographics, a historical information of viral load indicators (eg, viral rebound), comorbidities, health care utilization, and annual county-level factors (eg, social vulnerability), were measured in each 4-month windows. Using historic information in different lag time windows (1-, 3- or 5-lagged time windows with each 4-month window as a unit), both traditional and ML approaches (eg, Long Short-Term Memory Network) were applied to predict viral suppression. Comparisons of prediction performance between different models were assessed by area under curve (AUC), recall, precision, F1 score, and Youden index. Results: ML approaches outperformed the generalized linear mixed model. In all the 3 lagged analysis of a total of 15,580 PWH, the Long Short-Term Memory Network (Lag 1: AUC = 0.858; Lag 3: AUC = 0.877; Lag 5: AUC = 0.881) algorithm outperformed all the other methods in terms of AUC performance for predicting viral suppression. The top-ranking predictors that were common in different models included historical information of viral suppression, viral rebound, and viral blips in the Lag-1 time window. Inclusion of county-level variables did not improve the model prediction accuracy. Conclusions: Supervised ML algorithms may offer better performance for risk prediction of viral suppression than traditional statistical methods.

Racial disparities have historically existed regarding HIV care outcomes, including linkage to care. This study aims to explore the contribution of contextual features (e.g., socioeconomic and structural environmental factors) to the temporal change of county-level racial disparities in linkage to care. This is a statewide population-based retrospective cohort study. The patient-level variables in the South Carolina HIV registry system were used to calculate the aggregated county-level linkage to care percentage. Then, we used four indices to measure racial disparities in the county-level percentage of timely linkage to care, i.e., the Black-White ratio, index of disparity (ID), weighted ID, and Gini coefficient. Linear mixed-effect models were used to estimate the relationship between a variety of contextual features and disparity indexes. The analysis included data from 2013 to 2020, with 2013 as the start year due to the availability of key contextual features and 2020 as the end year based on the most recent HIV registry data available at the time of this study. Across 46 counties in South Carolina, racial disparity in linkage to care persisted between 2013 and 2020, as indicated by all four indices. When using ID, weighted ID, and Gini as outcomes, counties with lower degrees of racial residential segregation and stronger family structure were at higher risk of racial disparities in linkage to care. For weighted ID only, counties with fewer primary care providers (β = − 4.22; 95

Objectives: We estimated vaccine effectiveness (VE) against SARS-CoV-2 infection among a statewide cohort of people with HIV (PWH) and compared the estimates with a matched cohort of people without HIV (PWoH) in South Carolina (SC), USA. Methods: A population-based cohort was retrieved from statewide electronic health records between January 2, 2021, and April 14, 2022, during which several variants were circulating in SC (i.e., Alpha, Delta, Omicron). We compared the odds of vaccination between test-positive cases and test-negative controls using logistic regression models for both SARS-CoV-2 infection and severe COVID-19 outcomes. The VE was derived as (1 - adjusted odds ratio) x 100%. Results: A total of 7279 test episodes in PWH and 72,790 matched test episodes in PWoH were included for analysis, representing 6561 unique PWH and 67,521 unique PWoH. The peak level of VE against SARSCoV-2 infection occurred 7-59 days after receipt of the second dose of vaccine (PWH: 61.20%; PWoH: 67.09%), followed by a waning protective effect 90-119 days after the second dose in both PWH (35.80%) and PWoH (47.57%), where PWH had a proportionally lower and declined faster VE. Regarding the VE against severe outcomes of SARS-CoV-2 infection, a relatively higher level of protection was maintained in both populations (complete primary series: PWH: 69.06%; PWoH: 60.63%). Conclusions: A complete primary series of COVID-19 vaccines offered significant protection against SARSCoV-2 infection and severe outcomes in both PWH and PWoH populations, although this wanes with time. However, the estimate of VE against SARS-CoV-2 infection appeared lower in PWH than in PWoH and the degree of waning over time was relatively quicker in PWH. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

BACKGROUND:To maintain HIV care during the COVID-19 pandemic, many HIV clinics across the United States adopted telehealth. However, not everyone participated in telehealth equally. This study assessed the use and disparities in telehealth and in-person HIV care at a large academic medical center in North Carolina (NC) relative to the COVID-19 pandemic. METHODS:Data from the Duke University Infectious Disease clinic in NC were extracted from electronic health records (EHR), aggregated across persons with HIV (PWH) by calendar month, visit type (in-person vs. telehealth HIV care), and by key sociodemographic and clinical characteristics. Variation in HIV care over time was analyzed graphically by age, sex, race and ethnicity, county of residence, and viral load (VL) history. RESULTS:EHR data from 2,623 PWH receiving care between January 2019 and March 2023 were included. Telehealth use sharply increased in the first months of the pandemic and decreased thereafter. Telehealth use was higher among non-Hispanic Whites compared to People of Color. Most PWH (93%) had a first post-onset-of-the-pandemic (pop) HIV care visit on March 16, 2020 and thereafter. The proportion of telehealth first pop visits peaked in April 2020 with 88% telehealth visits. CONCLUSIONS:Telehealth bridged the initial COVID-19 pandemic phase with drastically reduced in-person visit availability, yet it was not equally utilized across race and ethnicity groups. To guide the optimal integration of telehealth in HIV care and promote equitable care in the future, HIV care outcomes need to be closely monitored, and strategies designed to promote access for Communities of Color are needed.

Daily oral pre-exposure prophylaxis (PrEP), including emtricitabine/tenofovir disoproxil fumarate (TDF) and emtricitabine/tenofovir alafenamide fumarate (TAF), is a key strategy for HIV prevention. Compared to TDF-based PrEP, TAF may be associated with greater weight gain. This study aims to examine the risk of weight gain among cisgender men and transgender women who were adults and took TAF for HIV prevention using real-world data. This study used data from All of Us, a nationwide research initiative designed to accelerate health and medical discoveries. All PrEP users in All of Us with at least two weight measures, one taken within 180 days prior to and the other between 90 and 365 days after initiating PrEP, were included in analyses. Linear regression was conducted to explore the association between different PrEP regimens and weight gain, adjusting for key sociodemographic characteristics. Among 385 eligible individuals, 284 were TDF-only users, 52 were TAF-only users, and 49 individuals switched from TDF to TAF. The median follow-up time for participants was 312 days. The average weight gain (in kilograms) for TDF-only, TAF-only, and TDF-TAD groups was - 0.68 (standard deviation [SD] = 5.43), 1.80 (SD = 11.60), and 1.74 (SD = 6.35), respectively. TAF-only (β = 2.532, 95%CI 0.708-4.356) and TDF-TAF (β = 2.756, 95%CI 0.890-4.621) were associated with significantly increased weight gain compared to TDF-only use. Closer monitoring of weight gain is recommended for individuals using TAF to prevent HIV.

BACKGROUND:This study aims to estimate the time-varying effects of primary and booster COVID-19 vaccination and past SARS-CoV-2 infection on subsequent SARS-CoV-2 infection (including new infection and re-infection) in people with HIV (PWH). METHODS:A population-based cohort was retrieved from the integrated statewide HIV electronic health record (EHR) dataset, COVID-19 vaccination dataset, and COVID-19 diagnoses dataset between March 2, 2020 and April 14, 2022. The pre-specified outcome was any SARS-CoV-2 infection. We used Cox regression to estimate the time-varying effects of primary and booster vaccination and past infection on the risks of subsequent SARS-CoV-2 infection. RESULTS:A total of 18,509 eligible PWH who had documentation of COVID-19 testing or COVID-19 vaccination records were included for analysis. The effectiveness of primary vaccination against infection, compared with being unvaccinated, was relatively low (26.70 %, 95 % CI: 12.10 %, 38.88 %) at two months, while the effectiveness of a booster dose after two months was high (43.53 %, 95 %CI: 27.54 %, 55.99 %), compared with primary vaccination only (e.g., first two doses of Pfizer or Moderna, or the single dose of Janssen). The effectiveness of past COVID-19 infection during Pre-Delta and Delta dominant periods at one month against reinfection was (67.43 %; 95 %CI: 52.74 %, 77.55 %) and (64.57 %; 95 %CI: 1.39 %, 87.27 %), respectively. CONCLUSION:Natural immunity conferred from past COVID-19 infection in PWH against reinfection appeared to be higher than vaccine-induced immunity. Boosters were more effective than the primary series alone in preventing subsequent infection.

BACKGROUND:People living with HIV (PLHIV) in the southern United States (US) are at high risk for poor outcomes across the HIV care continuum leading to low rates of viral suppression. Understanding structural barriers to care-including transportation vulnerability-is critical to improve HIV outcomes. This study investigated relationships between travel time to HIV care, transportation vulnerability, and HIV care disruptions to inform future transportation interventions for PLHIV residing in South Carolina and other southern US states. METHODS:A total of 160 PLHIV (N = 160) were recruited from a large immunology center in South Carolina. Participants reported on transportation experiences, transportation vulnerabilities, and residence. Differences in sociodemographic characteristics, transportation vulnerabilities, and HIV care disruptions were compared across travel time groups (< 15, 15-30, and > 30 min from residential location to the HIV clinic) using Mantel-Haenszel Chi-Square tests. Multivariable logistic regression tested our a priori hypothesis that travel time would predict HIV care disruptions. RESULTS:A majority of participants were aged 45-64 years old (54.4%), single (77.0%), male (63.8%), and Black (77.5%). Nearly 20% of participants lived < 15 min from their HIV clinic, 59.1% lived 15-30 min, and 21.4% lived > 30 min away. PLHIV who had to travel > 30 min to HIV care were more likely than those living < 15 min away to report transportation vulnerability (73.5% vs. 51.6%, p = 0.048), missed HIV care appointments (64.7% vs. 41.9%, p = 0.049), and transportation challenges that prevented them from seeing HIV care providers (67.7% vs. 39.4%; p = 0.014). Adjusted odds ratios (AOR) show that PLHIV who had to travel > 30 min were more likely to experience transportation-related disruptions to HIV care, including being late to appointments (AOR 5.25, 95% CI:1.06-25.92), missing appointments (AOR 3.85, 95% CI:1.04-15.89), and being unable to see HIV providers (AOR 7.06, 95% CI:0.59-14.89). CONCLUSIONS:In South Carolina-a rural southern state with a disproportionate burden of HIV-long travel time (> 30 min) to HIV care is associated with care disruptions, including more missed visits. Transportation interventions, as well as other efforts to expand rural access to HIV care, are urgently needed to ensure that all PLHIV are able to engage in consistent HIV care in order to reach and maintain viral suppression.