CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Poster and Themed Discussion Abstracts

971 PREP UPTAKE DISPARITIES IN A DIVERSE ON-LINE SAMPLE OF US MEN WHO HAVE SEX WITH MEN Kenneth H. Mayer 1 , Katie Biello 2 , David S. Novak 3 , Douglas Krakower 4 , Matthew J. Mimiaga 2 1 Fenway Hlth, Boston, MA, USA, 2 Brown Univ, Providence, RI, USA, 3 On-Line Buddies, Inc, Cambridge, MA, USA, 4 Beth Israel Deaconess Med Cntr, Boston, MA, USA Background: Although the CDC estimates that >400,000 US men who have sex with men (MSM) are PrEP candidates, uptake initially was slow. Monitoring recent trends is important to ensure wider access to those at greatest HIV risk. Methods: An on-line survey was mounted on 2 popular MSM partner seeking sites during March 2016 to assess PrEP use. Factors independently associated with PrEP use were evaluated using multivariable logistic regression with backward selection. Results: Of 4,698 MSM respondents, 21%were 18 to 24 y.o., 41%were 25 to 39, and 38%were 40 or older. Almost half (47%) identified as White, 25% as Black, 11% as Latino. Almost 12%were born outside the US The largest number of respondents were from the Southeast (26%) or Mid-Atlantic (20%). Nearly 60% had private health insurance; 12% had none. Almost 2/3 reported condomless anal intercourse (C.A.I.) at least once in the prior 3 months. Bacterial STIs were common (8% reporting gonorrhea, 8% chlamydia, and 6% syphilis in the prior year). Almost 8% had used PEP previously. Almost 15% of respondents (N=684) reported using PrEP. PrEP users resided in 45 different states, 491 zipcodes. Factors independently associated with PrEP use in a multivariable model depicted by aOR and (95% CI) were: Age over 25 years: 1.9 (1.3, 2.7) (REF: 18-24 years old) Black race: 0.7 (0.6, 0.9) (REF: White) Born outside US: 0.7 (0.4, 0.9) (REF: native-born) Private insurance: 3.8 (2.4, 6.0) (REF: No insurance) Urban zip code: 1.02 (1.01, 1.02) (REF: non-urban zipcode) 2 or more CAI acts*: 2.9 (2.2, 3.8) (REF: 0 CAI) (*in past 3 months) Bacterial STI**: 3.1 (2.4, 3.9) (REF: no STI) (** in past year) Ever used PEP: 6.5 (4.7, 9.0) (REF: no prior PEP use) Conclusion: In this online MSM sample, those who engaged in condomless anal sex with non-monogamous partners, who had a bacterial STI and/or had used PEP were more likely to report PrEP use. Those who were younger, Black, immigrant and/or uninsured MSM were less likely to report PrEP use, despite frequent condomless anal sex. Programs to address economic and sociodemographic disparities are needed to ensure wider PrEP access to those who might benefit most. 972 IMPACT OF INSURANCE COVERAGE ON PREEXPOSURE PROPHYLAXIS FOR HIV PREVENTION Rupa R. Patel 1 , Leandro Mena 2 , Amy Nunn 3 , Timothy McBride 1 , Laura C. Harrison 1 , Catherine E. Oldenburg 4 , Jingxia Liu 1 , Kenneth H. Mayer 5 , Philip A. Chan 6 1 Washington Univ in St. Louis, St. Louis, MO, USA, 2 Univ of Mississippi, Jackson, MS, USA, 3 Brown Univ, Providence, RI, USA, 4 Univ of California San Francisco, San Francisco, USA, 5 Fenway Hlth, Boston, USA, 6 The Miriam Hosp, Providence, RI, USA Background: Antiretroviral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among high-risk populations in the United States. The effect of insurance coverage on PrEP uptake has not been fully assessed in recent trials where participants often obtained the medications for free. We assessed individual insurance coverage and its effect on PrEP uptake in three diverse clinic settings. Methods: We reviewed demographic, behavioral and insurance data from patients enrolled in an observational PrEP clinical cohort recruited in 3 US cities (Jackson, Mississippi, St. Louis, Missouri and Providence, Rhode Island) from January 2014 to December 2015. Inclusion criteria included patients who were prescribed PrEP for least three months. The primary outcome was PrEP utilization, defined as patients who reported taking PrEP at their three-month follow up evaluation. Multivariable logistic regression analysis was performed to assess the relationship of sociodemographics, including income and insurance coverage, on PrEP utilization. Rhode Island was the only state of the three to have expanded Medicaid during the study period. Results: Of the 201 patients included in the analyses, 34%were from Jackson, 28% from St. Louis, and 38% from Providence. Almost all (91%) were male with a median age of 29 years (IQR 24-37); 51%were White, 34%were African American, and 6%were Latino. Majority (65%) were college graduates with a median income of $25,000 (IQR $7,200- $50,000). Overall, 79%were insured, although this varied by site: 95%were insured in Providence, 49% in Jackson and 95% in St. Louis (P<0.0001). Eighty-two percent of patients reported taking PrEP at three-month follow up. After adjusting for age, race, education, income, and state Medicaid expansion, insured patients had four times the odds of taking PrEP at three months compared to the uninsured (OR: 4.49, 95% CI: 1.68-12.01; P<0.003).

CROI 2017 421