CROI 2017 Abstract e-Book

Abstract eBook

Oral Abstracts

non-current users offered referrals, 47% accepted. The percent of cases reporting already taking PrEP increased from 21% in 2014 to 53% in 2016 among early syphilis and rectal gonorrhea cases (p<.001), from 30% to 58% among other high risk MSM (p=.007), and 15% to 36% among lower risk MSM (p<.001). Among MSM with urethral gonorrhea, PrEP use increased from 17% to 35% (p=.03). Conclusion: PrEP use is rapidly increasing among MSM with bacterial STDs in King County. STD PS can be used to monitor PrEP use in high risk MSM and link these men to PrEP, though additional efforts are needed to increase intervention uptake at each step of the referral process. 90 CHALLENGES OF TRANSLATING PREP INTEREST INTO UPTAKE AMONG YOUNG BLACK MSM IN ATLANTA Charlotte-Paige M. Rolle 1 , Aaron S. Siegler 1 , Travis Sanchez 1 , Nicole Luisi 1 , Scott R. Cutro 2 , Carlos del Rio 1 , Patrick Sullivan 1 , Eli Rosenberg 1 , Colleen F. Kelley 1 1 Emory Univ, Atlanta, GA, USA, 2 Kaiser Permanente, Atlanta, GA, USA Background: The highest HIV incidence rates in the US are among young, black MSM (YBMSM). We hypothesized that structural barriers (e.g. lack of health insurance) could limit PrEP uptake in this group. Here, we describe the implementation of an optional PrEP program as an addition to a standard package of HIV prevention services in a currently enrolling, HIV/STI incidence cohort of YBMSM. Methods: The EleMENt study is an ongoing, observational cohort examining longitudinal interactions between substance use and HIV risk behavior among HIV-negative YBMSM aged 16-29 years in Atlanta, GA. Participants are offered comprehensive HIV risk reduction counseling, condoms and lubricant, and daily oral PrEP as non-incentivized standard of HIV prevention care. After viewing a brief educational video (whatisprep.org), men who express interest in PrEP are scheduled to see a study clinician to initiate PrEP. All costs associated with clinician visits and PrEP lab monitoring are covered by the study; participants use their health insurance and/or manufacturer assistance program to obtain the drug. All PrEP users receive adherence counseling/tools per CDC guidelines. Factors associated with PrEP uptake were assessed with unadjusted odds ratios. Results: Between July 2015 and September 2016, 113 HIV-negative YBMSM enrolled; 3/113 (2.7%) were taking PrEP at study entry. After viewing the video, 17/110 (15%) men reported no interest in PrEP; 31/110 (28%) men wanted to discuss PrEP at the next study visit, and 62/110 (56%) men indicated interest in starting PrEP now. Of 62 interested men, 24 (39%) have not attended a PrEP initiation appointment despite repeated scheduling attempts. Thirty-eight men (38/110; 35%) initiated PrEP; however, 6/38 (16%) subsequently discontinued PrEP. The only evaluated factor associated with PrEP uptake was STI diagnosis in the prior year (OR 3.2 95%CI 1.27, 8.2). Of 54.5 person-years of follow- up to date, 4 HIV seroconversions have occurred in the cohort (annualized incidence rate of 7.3% [95% CI 2.3, 17.7]); 3 occurred in men who initiated PrEP but were not taking it. Conclusion: Despite high levels of interest, uptake and adherence to PrEP appear to be suboptimal among YBMSM in this ongoing cohort even after amelioration of structural barriers that can limit PrEP use. Implementation of PrEP as standard of HIV prevention care in observational studies is feasible. However, further research will be needed to optimize uptake and adherence for YBMSM as we are observing high HIV incidence.

Oral Abstracts

91LB ON DEMAND POST EXPOSURE PROPHYLAXIS WITH DOXYCYCLINE FOR MSM ENROLLED IN A PREP TRIAL Jean-Michel Molina 1 , Isabelle Charreau 2 , Christian Chidiac 3 , Gilles Pialoux 4 , Eric Cua 5 , Constance Delaugerre 1 , Catherine Capitant 2 , Daniela Rojas-Castro 6 , Laurence Meyer 7 , for the ANRS IPERGAY Study Group 1 St. Louis, Hosp, Paris, France, 2 INSERM, Villejuif, France, 3 Univ of Lyon, Lyon, France, 4 Tenon Hosp, Paris, France, 5 CHU de Nice, Nice, France, 6 AIDES, Pantin, France, 7 AP-HP, Le Kremlin-Bicetre, France Background: A high incidence of bacterial sexually transmitted infections (STIs) has been reported in several PrEP trials and demonstration projects among MSM. We wished to assess whether on demand post-exposure prophylaxis (PEP) with doxycycline could reduce STIs incidence in this high risk group. Methods: High risk adult MSM being followed in the open-label phase of the ANRS IPERGAY trial with on demand TDF/FTC for HIV prevention, were enrolled in a prospective randomized open-label sub-study. Participants (pts) were randomized 1:1 to take either two pills of doxycycline (100mg per pill) within 72h after condomless sexual intercourse (without exceeding 6 pills per week) or no PEP. All subjects received risk-reduction counseling and condoms, and were tested every 8 weeks for HIV and STIs with serologic assays

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CROI 2017