CROI 2016 Abstract eBook

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Poster Abstracts

from the earliest time point but plateaued after April 2014. Awareness of , willingness to use, and use of PrEP were higher among higher risk MSM, including those recruited from a geospatial sexual networking application, those reporting a bacterial STI, and those with ≥ 10 partners in the last 12 months (See Table). Conclusions: Awareness and use of PrEP are increasing among internet-using MSM in the US. Though it is encouraging that more higher risk MSM are aware of, willing to use, and have used PrEP, there remains a large gap between the number of MSM who report being willing to use PrEP and those who have actually done so.

890 Increasing HIV Suppression, PrEP Use, and STDs in Boston MSM Accessing Primary Care

Kenneth H. Mayer 1 ; Ken Levine 1 ; Kevin M. Maloney 2 ; Shayne Zaslow 3 ; Douglas S. Krakower 2 ; Chris Grasso 1 ; Betsey H. John 4 ; Dawn Fukuda 4 ; Kevin Cranston 4 ; Stephen H. Boswell 3 1 The Fenway Inst, Fenway Hlth, Boston, MA, USA; 2 Beth Israel Deaconess Med Cntr, Boston, MA, USA; 3 Fenway Hlth, Boston, MA, USA; 4 Massachusetts Dept of PH, Boston, MA, USA Background: Recent studies suggest that early HAART initiation and PrEP could decrease HIV incidence, but the measurement of impact in primary care settings has been limited. Methods: Fenway Health (FH), the largest1 0 care center for men who have sex with men (MSM) in Massachusetts (MA) has used an electronic medical record since 1997(Centricity TM ), facilitating analyses of secular trends related to HIV census, HAART use, PrEP initiation and incident STDs. Time trend analyses were performed using Spearman’s rank test for correlation and pairwise comparisons were made with Fisher’s exact chi-square test. Results: Between 2004 and 2014, HIV+ pts in 1 0 care at FH increased from 1083 to 2101 (p<0.001). In 2004, 922 HIV+ pts were newly diagnosed in MA, compared to 698 in 2013 (p<0.001), and the %MA HIV+ diagnosed at FH increased from 6% to 14%. At FH, 58 pts initiated HAART in 2004 and 121 in 2014 (p<0.001). The median CD4 at the time of HAART initiation was 238 cells/mm 3 in 2004, and 464 in 2014 (p<0.001). In 2004, 68% of newly diagnosed pts initiated HAART within the first year of care, compared to 97% in 2014 (p<0.001). During the same period, the % of virologically suppressed pts rose from 57 to 86% (p<0.001) (with 88% suppression among those using HAART). PrEP was first used by 5 pts outside of a clinical trial in 2011, while in 2014, 537 pts initiated PrEP (p<0.001), and in 2015, 589 began PrEP (as of 8/31), with more than 83% of PrEP initiators still using PrEP. Between 2011 and 2015, 5 MSM pts who initiated PrEP became HIV+ (<0.5%) compared to 93 (~2.2%) of more than 4,000 HIV- MSMwho did not use PrEP (p=0.006). In 2005, 162 pts were diagnosed with syphilis or rectal or urethral gonorrhea (GC) or chlamydia (CT), while in 2014, 1145 pts tested + for at least one infection (p<0.001); and as of 8/31/15, it was 918. Since 2005, 1/2 of new syphilis diagnoses were in HIV+ patients, while 80% of incident GC/CT infections were in HIV- MSM. More than one third (36%) of MSM who initiated PrEP in 2014 had a recent bacterial STD. Conclusions: While the HIV+ census at FH has increased over the past decade, earlier treatment initiation has been associated with improved virologic suppression. PrEP use has significantly increased among HIV- MSM, and HIV incidence appears lower in PrEP users than non-users. But, bacterial STD rates significantly increased for HIV+ and - MSM. HIV spread may be slowing among MA MSM, but ongoing screening for bacterial STDs is required, given their significant co-prevalence.

Poster Abstracts

891 Missed Opportunities to Prescribe PrEP by Primary Care Physicians in Saint Louis Rupa Patel 1 ; Philip Chan 2 ; Amy Nunn 2 ; Katherine Goodenberger 1 ; Kenneth H. Mayer 3 ; Leandro Mena 4 ; Enola K. Proctor 1 ;William Powderly 1

1 Washington Univ in St. Louis, St. Louis, MO, USA; 2 Brown Univ, Providence, RI, USA; 3 The Fenway Inst, Fenway Hlth, Boston, MA, USA; 4 Univ of Mississippi, Jackson, MS, USA Background: Current CDC guidelines recommend delivery of HIV pre-exposure prophylaxis (PrEP) by primary care physicians (PCP) for high-risk individuals. We describe barriers to obtaining PrEP from PCPs among individuals who sought PrEP at an infectious diseases specialty clinic. Methods: From July 2014 - September 2015, we conducted an intake survey among 69 patients seeking PrEP from the Washington University in St. Louis (WUSTL) HIV clinic as part of a prospective observational cohort. Survey questions included demographics, sexual behaviors, and whether patients had a PCP. Participants with a PCP were asked why they did not seek or obtain PrEP services from their PCP. Results: Participant median age was 29 years (IQR 26-35), 62%were white, 68%were college graduates, 86%were MSM, 33% had a known HIV+ partner, 74% reported condomless sex in the last 3 months, and 21% reported a sexually transmitted disease in the last 12 months. 71% had a PCP; of these, 46% reported feeling uncomfortable discussing their sexual practices with their PCP. Of those comfortable, 67% asked their provider and were not prescribed PrEP. Overall, 47% asked their PCP for PrEP before coming to WUSTL, but were not prescribed. Commonly cited reasons cited for PCPs not prescribing PrEP included PCPs’ concerns that PrEP was experimental, PCPs not feeling comfortable with the medication, and PCP perceptions that patients did not need PrEP beyond appropriate condom use. As part of provision of PrEP, HIV physicians referred 59% PrEP seekers to a new provider with whom they could feel more comfortable discussing their sexual practices. These referrals were not only for MSM but for heterosexual couples that did not feel comfortable discussing their HIV positive partner’s status with their current providers. Conclusions: In order for successful PrEP implementation in the US, PrEP should be prescribed as part of routine care by PCPs. PCP training needs to go beyond the science of PrEP and include creating an environment where sexual practices can be communicated in a culturally sensitive manner. Unless these discussions can take place, the role for PrEP

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CROI 2016