CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

Conclusions: CAB-LA injections are acceptable in subset of ÉCLAIR participants who experienced two to three injections. The pain profile is less focused on the injection itself and more on the post-injection period. While there was significant anxiety around injections, this decreased as participants gained experience with injections. These findings suggest that patient education about CAB-LA should focus on informing patients about the true nature of pain associated with injections, and managing both expectations and anxiety. More research is required to validate these findings on a broader scale. 882LB WITHDRAWN 883LB HPTN 073: PrEP Uptake and Use by Black MenWho Have Sex With Men in 3 US Cities Darrell P. Wheeler 1 ; Sheldon Fields 2 ; LaRon E. Nelson 3 ; LeoWilton 4 ; Lisa Hightow-Weidman 5 ; Steven Shoptaw 6 ; Manya Magnus 7 ; Geetha Beauchamp 8 ; PhaedreaWatkins 9 ; Kenneth H. Mayer 10 1 State Univ of New York at Albany, Albany, NY, USA; 2 Charles R. Drew Univ of Med and Sci, Los Angeles, CA, USA; 3 Univ of Rochester, Rochester, NY, USA; 4 State Univ of New York at Binghamton, Binghamton, NY, USA; 5 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 6 David Geffen School of Medicine at Univ of California Los Angeles, Los Angeles, CA, USA; 7 George Washington Univ, Washington, DC, USA; 8 Statistical Cntr for HIV/AIDS Rsr & Prevention, Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 9 FHI 361, Durham, NC, USA; 10 The Fenway Inst, Fenway Hlth, Boston, MA, USA Background: Among US subgroups, Black men who have sex with men (BMSM) remain at disproportionate risk of HIV acquisition. Comprising less than 0.4% of the U.S. population, they accounted for more than 20% of all new infections in 2013. Identifying effective and innovative methods to deliver effective prevention and halt the epidemic in this key population is an urgent public health priority. HPTN 073 is one of the first studies to evaluate pre-exposure prophylaxis (PrEP) in a US BMSM population. Methods: HIV-uninfected BMSMwere enrolled in three U.S. cities (Washington, DC., Los Angeles CA, & Chapel Hill, NC) All participants were offered once daily oral FTC/TDF combined with client-centered care coordination (C4)–a theory-based counseling approach to promote and support PrEP use, which combined service referral, linkage and follow- up strategies to assist participants in addressing unmet psychosocial needs. Each participant was offered PrEP and followed for a total of 12 months. Results: 226 BMSMmen were recruited; 209 (92%) completed 12 month of follow-up. 40%were <25 years, 27%were unemployed, 31% did not have health insurance. The median number of male partners in the prior 3 months was 3 (IQR 1-4), 33% reported a primary partner and 73% casual male partners. PrEP was accepted by 178 (79%) of study participants (see Figure); 68% remained on PrEP at 26 weeks. Self-reported adherence above 50%was 85% at 4 weeks and 78% at 26 weeks. 23/24 (96%) men reporting an HIV+ primary partner and 104/120 (86%) of men reporting casual partners with unknown or HIV+ status accepted PrEP. Those agreeing to take PrEP utilized a median of 6 C4 sessions (range 3–8) compared to men not accepting PrEP (median 4 range 2-6]). Among the 178 men who ever accepted PrEP, 5 HIV infections occurred in 172 person years (PY) (incidence=2.9 95%CI(0.9-6.8)) compared to 3 in 39 PY (incidence=7.7 95%CI1.6-22.5) in men who never accepted PrEP. Of the 5 seroconverters who ever took PrEP, 2 had discontinued PrEP at 50 and 272 days prior to seroconversion. Conclusions: Providing theory-based culturally tailored programs for BMSM can potentially increase their ability to establish and maintain adherence and prevent HIV in this highly impacted group. HPTN 073 demonstrated high uptake of PrEP in BMSM utilizing a novel coordinated counseling model that was highly acceptable, and led to data that could support a reduced rate of HIV-infection for BMSM on PrEP. These findings help address a vital US public health gap in HIV prevention.

Poster Abstracts

884 HPTN 067/ADAPT: Predictors of Coverage of Sex Events in PrEP Regimens, Thai MSM-TGW Timothy H. Holtz 1 ; Anupong Chitwarakorn 2 ; James P. Hughes 3 ; Marcel Curlin 4 ; AnchaleeVarangrat 5 ; K. R. Amico 6 ;TeeraparpWatanatanyaporn 5 ; Maoji Li 7 ; Philip A. Mock 5 ; Robert Grant 8 1 CDC, Atlanta, GA, USA; 2 Ministry of PH, Muang Nonthaburi, Thailand; 3 Univ of Washington, Seattle, WA, USA; 4 Oregon Hlth and Scis Univ, Portland, OR, USA; 5 Thailand Ministry of PH US CDC Collab, Nonthaburi, Thailand; 6 Univ of Michigan Sch of PH, Ann Arbor, MI, USA; 7 Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA; 8 Univ of California San Francisco, San Francisco, CA, USA Background: We sought to identify baseline predictors of pre-exposure prophylaxis (PrEP) coverage of sex events in HPTN 067, a phase 2, open-label feasibility study of daily and non-daily regimens of FTC/TDF PrEP among Thai men who have sex with men (MSM), and transgender women (TGW), completed in Bangkok, 2012–2014. Methods: We randomly assigned participants to one of three self-administered dosing regimens for 24 weeks: daily, time-driven twice weekly with a post-sex dose, or event- driven before and after sex. Bangkok was one of three study sites, one of which enrolled women. Alcohol (AUDIT score) and substance use were assessed by computer-assisted self-interview. Using sex act as the unit of analysis we defined coverage as taking ≥1 tablet in the four days before sex and ≥1 tablet within 24 hours after sex. We used general estimating equations for clustered data to evaluate predictors associated with coverage. Results: Among 178 MSM and TGW the proportions of sex acts that were covered by PrEP were similar in the daily and time-driven arms (85% vs 84%, p =0.79). Participants reported use of the following substances at baseline: stimulants (e.g. amphetamine type) (8.4%), marijuana (2.8%), opiates (1.7%), and other drugs (23%). AUDIT scores indicated moderate alcohol use in 20.8% and high alcohol use in 6.7%. Proportion of covered sex acts by those reporting stimulant use (coverage: 74%) was similar to those reporting other drug use (non-alcohol) (76%, p =0.80), but lower than those reporting no substance use (85%, p =0.04). In a multivariable model, age 25–35 years (adjusted odds ratio [aOR] 2.34, 95% CI 1.37–3.97, p =0.002), completion of college (aOR 1.74, 95% CI 1.04–2.92, p =0.03), along with moderate (AUDIT Score 7–12: aOR 1.75, 95% CI 1.15–2.66, p <0.01) to high levels (AUDIT Score >13: aOR 2.86, 95% CI 1.19–6.86, p =0.02) of alcohol use, were associated with higher coverage. A higher number of reported sex events (13–80 over three months at baseline: aOR 0.57, 95% CI 0.32–1.00, p =0.05) and use of stimulant drugs (aOR 0.47, 95% CI 0.24–0.93, p =0.03) were significantly associated with lower coverage. Conclusions: Higher coverage of sex acts with PrEP was associated with higher education, and higher AUDIT scores at baseline, after adjusting for age. Use of stimulants and higher sexual frequency in the past 3 months was associated with lower coverage. Regardless of substance use, the majority of Thai MSM/TGW followed the regimen dosing schedules to provide coverage of sexual exposures with PrEP.

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CROI 2016