CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

964 TEXT MESSAGING IS ASSOCIATED WITH IMPROVED RETENTION IN A CLINIC-BASED PREP PROGRAM

Christine M. Khosropour 1 , Richard T. Lester 2 , Matthew R. Golden 1 , Julia C. Dombrowski 1 1 Univ of Washington, Seattle, WA, USA, 2 Univ of British Columbia, Vancouver, British Columbia, Canada Background: Text messaging and short message service (SMS) interventions are associated with improved medication adherence among HIV-positive individuals. The impact of SMS on retention in a clinic-based pre-exposure prophylaxis (PrEP) program is unknown. Methods: From September 2015 to June 2016 we invited all patients receiving PrEP through an STD clinic in Seattle, Washington to enroll in an SMS program (provided by WelTel) that included three components: automated weekly “check-in” messages, automated appointment reminders, and bi-directional open communication via SMS with clinic staff. Per routine clinic practice, PrEP patients return to the clinic one month following enrollment and then every three months. Patients cease to receive PrEP from our clinic if they do not return to the clinic and do not respond to multiple phone calls or if they notify the clinic that they are discontinuing PrEP. We used chi-square tests to compare characteristics of patients who did and did not enroll in the SMS program and to examine differences in retention in the PrEP program among those did and did not enroll in SMS. We used log binomial regression to examine the adjusted relative risk (aRR) of the association between enrollment in SMS and dropping from our clinic’s PrEP program. Results: There were 225 patients who received PrEP from our clinic during the study period. Most (95%) were men who have sex with men, 53%were white non-Hispanic and the average age was 31. Of 225 PrEP patients, 159 (71%) opted to enroll in the SMS program; 5 (3.1%) later requested to be withdrawn. Enrollment in SMS was highest for Asian patients (91.3% enrolled) and lowest for black patients (55.6% enrolled). Patients aged 16-24 years were more likely to enroll in SMS compared to those >25 years (82.5% vs. 66.5%, P=0.02). Overall, 70 men stopped receiving PrEP from our clinic during the study period, including 44 (27.7%) of 159 patients enrolled in SMS and 26 (39.9%) of 66 patients not enrolled in SMS (P=0.08). Adjusting for age, race/ethnicity and gender, patients enrolled in SMS were 34% less likely to discontinue PrEP from our clinic compared to those who were not enrolled (aRR=0.66; 95% confidence interval=0.45-0.97). Conclusion: Among PrEP patients in our STD clinic, the majority opted to receive SMS messages and those who did were less likely to discontinue PrEP. These findings suggest that implementing SMS as part of PrEP clinical care is acceptable and may improve retention. 965 BRIEF BEHAVIORAL INTERVENTION INCREASES PREP DRUG LEVELS IN A REAL-WORLD SETTING Sarit A. Golub 1 , Stephanie Pena 2 , Amy Hilley 3 , John Pachankis 4 , Asa Radix 2 1 City Univ of New York, New York, NY, USA, 2 Callen-Lorde Community Hlth Cntr, New York, NY, USA, 3 Hunter HIV/AIDS Rsr Team, New York, NY, USA, 4 Yale Univ, New Haven, CT, USA Background: The effectiveness of pre-exposure prophylaxis (PrEP) depends on optimizing adherence; however, few (if any) brief counseling interventions have demonstrated efficacy improving PrEP adherence in real-world settings. This analysis presents data from SPARK, a PrEP demonstration/implementation project conducted at a community-based health center in New York City. Methods: Participants were 301 men who have sex with men and transgender women (ages 18-63; 49%white) who were patients at the health center and chose to start PrEP. SPARK tested the efficacy of two brief interventions: a sexual health intervention (SHI) designed to frame PrEP use as part of sexual health, and a PrEP adherence intervention (AI) designed to provide detailed information about the rationale for daily dosing and concrete logistical adherence support. Each intervention was tested against an educational control, based on existing clinic protocols (i.e., treatment as usual (TAU)). Participants were randomly assigned to one of four conditions, in which they received SHI only, AI only, both, or neither. Adherence was monitored using dried blood spot testing at 3- and 6-month follow-up visits. Results: Overall adherence in the study was high; almost 93% of participants demonstrated drug levels consistent with >= 4/week dosing (TDF ≥ 700 fmol) at 3M and 90.3% demonstrated these levels at 6M. At 3M, participants who had received one or both of the brief interventions demonstrated significantly higher adherence, compared to those who received neither. Specifically, 96.6% of participants who received at least one brief intervention demonstrated adherence ≥700fmol, compared to only 84% among those who received TAU (p = .002). TAU participants also reported more missed pills, compared to the intervention groups (p = .04). Adherence at 3M did not differ by demographic factors (age, race, income, education, insurance). At 6M there was a trend toward greater adherence in the intervention conditions (92.1% vs. 85.7%), but this difference was not statistically significant. Participants with <700fmol at 6M were more likely to be Black; there were no other demographic factors associated with lower adherence. Conclusion: A brief client-centered counseling intervention can significantly improve PrEP adherence in a real world setting, even among patients who are highly motivated to adhere. Additional “boosters” may be needed at follow-up visits to better support highest priority patients.

Poster and Themed Discussion Abstracts

CROI 2017 418