CROI 2017 Abstract e-Book

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Oral Abstracts

88 DAPIVIRINE RING USE DOES NOT DIMINISH THE EFFECTIVENESS OF HORMONAL CONTRACEPTION Jennifer Balkus 1 , Thesla Palanee-Phillips 2 , Samantha Siva 3 , Clemensia Nakabiito 4 , Gonasangrie Nair 5 , Samuel Kabwigu 4 , Ishana Harkoo 6 , Catherine Chappell 7 , Lydia Soto-Torres 8 , Jared Baeten 9 1 Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA, 2 Wits Reproductive Hlth and HIV Inst, Johannesburg, South Africa, 3 South African Med Rsr Council, Durban, South Africa, 4 Makerere Univ-Johns Hopkins Univ Rsr Collab, Kampala, Uganda, 5 Emavundleni Rsr Cntr, Cape Town, South Africa, 6 CAPRISA, Durban, South Africa, 7 Magee-Womens Hosp of UPMC, Pittsburgh, PA, USA, 8 NIH, Bethesda, MD, USA, 9 Univ of Washington, Seattle, WA, USA Background: Prevention of HIV-1 and unplanned pregnancy are global public health priorities for reproductive-aged women. HIV-1 treatment with non-nucleoside reverse transcriptase inhibitors (NNRTIs) has been associated with a reduced effectiveness of some hormonal contraceptives for pregnancy prevention, particularly implantable methods. A vaginal ring containing dapivirine, a novel NNRTI, has demonstrated effectiveness for HIV-1 prevention; the potential for a drug-drug interaction between vaginally-delivered dapivirine and contraceptive effectiveness has not been assessed in epidemiologic studies. Methods: MTN-020/ASPIRE was a randomized, double-blind, placebo-controlled phase III safety and effectiveness study of the dapivirine vaginal ring for HIV-1 prevention. Sexually active women aged 18-45 years fromMalawi, South Africa, Uganda, and Zimbabwe were enrolled. Use of a highly effective method of contraception was a criterion for study participation. At monthly visits, current contraceptive method was recorded on a standardized form and urine pregnancy tests were performed. If a participant became pregnant, study product was withheld for the duration of pregnancy and breastfeeding. Pregnancy incidence by armwas calculated separately for each contraceptive method and compared using an Andersen-Gill proportional hazards model stratified by site and censored at HIV-1 infection. Results: Of 2629 women enrolled, 2536 women returned for follow-up and reported using a highly effective contraceptive method during study participation (1263 in the dapivirine arm, 1273 in the placebo arm). Overall pregnancy incidence among women reporting use of injectable depot medroxyprogesterone acetate (DMPA), injectable norethisterone enanthate (NET-EN), hormonal implants, or oral contraceptive pills (OCPs) was: 0.49, 0.58, 0.45, and 30.21 per 100 person-years, respectively. Pregnancy incidence did not differ for those assigned active dapivirine vaginal ring versus placebo ring for any of the hormonal contraceptive methods (Table). Conclusion: Dapivirine vaginal ring use was not associated with diminished hormonal contraceptive effectiveness for pregnancy prevention. Oral contraceptive pill use was associated with high pregnancy incidence, which may be due to poor pill adherence. Injectable and implantable methods were highly effective in preventing pregnancy.

Oral Abstracts

89 STD PARTNER SERVICES TO MONITOR AND PROMOTE PREP USE AMONG MEN WHO HAVE SEX WITH MEN David A. Katz 1 , Julia C. Dombrowski 1 , Teal Bell 2 , Matthew R. Golden 1 1 Univ of Washington, Seattle, WA, USA, 2 Washington State Dept of Hlth, Olympia, WA, USA Background: Men who have sex with men (MSM) with bacterial STDs are at elevated risk for HIV acquisition. We used STD partner services (PS) to monitor pre-exposure

prophylaxis (PrEP) use among MSM and link MSM with bacterial STDs to PrEP. Methods: Disease Intervention Specialists (DIS) in King County, WA, attempt to provide PS to all MSM with early syphilis and to MSM with gonorrhea and chlamydia as resources allow. Public Health–Seattle & King County (PHSKC) defines MSM with any of the following as being at high risk for HIV: early syphilis, rectal gonorrhea, methamphetamine or poppers use, sex work, or an HIV-unsuppressed partner. DIS offer to refer high risk HIV-uninfected MSM to the PHSKC STD clinic to initiate PrEP and offer other MSM referrals to community medical providers. We used chi-square tests to compare PrEP use, acceptance of referrals, and initial PrEP assessment at the STD clinic by HIV risk and to assess temporal trends in current PrEP use. We evaluated trends in PrEP use among MSM with urethral gonorrhea, a largely symptomatic infection, as a measure unbiased by the high level of STD screening among MSM on PrEP. Results: From 8/2014-6/2016, medical providers reported 3936 cases of early syphilis, gonorrhea, or chlamydial infection among HIV-uninfected MSM in King County, including 1105 of early syphilis and rectal gonorrhea (Table). Overall, 1149 (48%) of 2388 PS recipients were defined as high risk and eligible to receive PrEP at the PHSKC Clinic, of whom 956 (83%) had PrEP use assessed. Of those assessed, 407 (43%) reported already using PrEP. Among 549 not currently on PrEP, 338 (62%) were offered a referral, of whom 167 (49%) accepted. Of the 127 who accepted referral to the PHSKC Clinic, 72 (57%) attended a first PrEP assessment visit as of 9/26/16. Among PS recipients not defined as high risk, 28%were already using PrEP; among


CROI 2017

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