CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

0.1-18.6) per 1000 person-years. HIV incidence among BTS placebo recipients in the 2005-2012 trial was 6.8 (95% CI, 4.7-9.6) per 1000 person-years and among tenofovir recipients was 3.5 (95% CI, 2.1-5.6) per 1000 person-years. Conclusions: Bangkok Tenofovir Study open label follow-up has begun and 35% of eligible participants have decided to take daily tenofovir. HIV incidence among participants who have chosen to take daily tenofovir is similar to the incidence in the tenofovir group during the 2005-2012 trial. Only 26% of open label participants are consistently coming to the clinics to take PrEP suggesting additional adherence support is needed. 972 Recent Increases in PrEP Utilization at a Boston Community Health Center Among MenWho Have Sex With Men, 2011-2014: Transition From Research to Clinical Practice Kenneth H. Mayer 1 ; Kenneth Levine 1 ; Chris Grasso 1 ; Douglas S. Krakower 1 ; Matthew Mimiaga 2 1 Fenway Health, Boston, MA, US; 2 Harvard School of Public Health, Boston, MA, US Background: Although pre-exposure prophylaxis (PrEP) has been recommended by the CDC to prevent HIV transmission among men who have sex with men (MSM) and heterosexuals who engage in condomless sex with HIV-infected and/or high risk partners, prior reports have suggested low uptake by key US populations. Methods: Fenway Health (FH), a Boston community health center which has specialized in sexual and gender minority primary care since 1971 has used an electronic medical record (EMR) to document clinical encounters since 1997. EMRs of HIV-uninfected patients who were prescribed Tenofovir/Emtricitabine for more than one month were reviewed. Time trend analyses were calculated to examine the presence of upward trends for: 1) the total number of PrEP prescriptions, annually, from 2011 to 2014, 2) ethnic/racial diversity, and 3) age distributions of PrEP users. Results: Six patients (pts) were prescribed PrEP in 2011; 23 in 2012; 104 in 2013; 326 by 9/20/2014 (upward trend; p<0.05). Although all pts who were prescribed PrEP were White in 2011, by 2014, 8.8% of PrEP users were Black pts and 20.9%were from other racial or ethnic groups (upward trend; p<0.05). In 2011, 50% of PrEP users were < 30 years old (y.o.); in 2014, 40.5% of PrEP users were <30 y.o. Almost all PrEP users were MSM, with only 1 heterosexual man, 2 women and 16 transgender persons being prescribed PrEP at FH since 2011. Over 4/5 (84.1%) of prescriptions were covered by commercial insurance, with 5.0% covered by Medicare and 5.7% by Medicaid. More than 40 providers were involved in the care of at least one PrEP pt, with the largest PrEP census by provider being 52. In EMR review, 36 PrEP pts had been in a prior PrEP study; 61 had a bacterial STD diagnosed within 60 days of initiating PrEP, and 113 had used post-exposure prophylaxis (PEP) previously. Thus far, only one pt prescribed PrEP became HIV-infected; this occurred very soon after initiating PrEP. Conclusions: PrEP uptake has increased among MSM pts in a Boston community health center over the past 3 years, with the greatest increase in recent months. The racial/ethnic diversity of PrEP users has increased, with a large proportion of PrEP pts being < 30 y.o. Although some patients continued using PrEP after being in a research study, more PrEP pts were prescribed PrEP after a recent STD or after having used PEP, without prior PrEP experience. These findings suggest increased FH clinician and MSM pt acceptance of PrEP as part of a comprehensive HIV prevention package. 973 Barriers to Effective Prevention: Applying a PrEP Care Continuum to a US Cohort of Black andWhite MSM Colleen F. Kelley ; Erin M. Kahle; Aaron Siegler; Carlos del Rio;Travis Sanchez; Patrick Sullivan; Eli S. Rosenberg Emory University, Atlanta, GA, US Background: Reductions in HIV incidence with pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) will require significant coverage of those at risk. We propose a simplified framework, similar to the HIV Care Continuum, to achieve protection from HIV with PrEP as follows: 1. At-risk MSM; 2. Aware of and willing to take PrEP; 2. Access to healthcare; 3. Receiving a PrEP prescription; and 4. Adhering to PrEP. We evaluated the PrEP Care Continuum on a cohort of Southern MSM and projected howmany MSM might achieve protection from HIV. Methods: InvolveMENt was an HIV incidence cohort of 562 black and white sexually active, non-monogamous, HIV-negative MSM in Atlanta, Georgia conducted from 2010-2014 with 32 observed HIV seroconversions, and which was used to apply the PrEP Care Continuum under optimistic estimates. Step 1 included all MSM in this at-risk cohort. Step 2 used awareness/willingness estimates. Step 3 used the percent of cohort men with health insurance or ACA eligibility in GA. Step 4 used the percent of cohort men meeting CDC PrEP eligibility guidelines. Step 5 applied the 51% adherence/efficacy estimate from the iPrex OLE study. Proportions with 95% confidence intervals (CI) of MSM in the total cohort and seroconverters projected to reach each step were calculated. We performed sensitivity analyses for a 20% increase at each continuum step individually and for all steps. Results: Awareness/willingness was estimated at 50% for both analyses. Sixty-five percent of MSM in the total cohort, and 43% of seroconverters had health insurance; an additional 20%were ACA eligible in both groups. Sixty-nine percent of MSM in the total cohort and 75% of seroconverters met PrEP eligibility guidelines. The PrEP Care Continuum (figure) resulted in 15% (84/562; CI 12, 18%) of the cohort and 13% (4/32; CI 1, 23%) of seroconverters achieving theoretical protection from HIV. Increases in each step individually by 20% yielded a maximum protection of 21% for the cohort and 16% for seroconverters, while increasing all steps by 20% yielded 44% and 38% protection respectively.

Poster Abstracts

576

CROI 2015