CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Conclusion: Insurance coverage had a significant and positive impact on PrEP utilization. Disparities in insurance coverage may impede PrEP uptake in non-trial clinical settings and may exacerbate disparities in PrEP access. These findings from three diverse areas suggest state- and local-level PrEP implementation efforts should address barriers to insurance coverage as a critical component to successful programmatic efforts. 973 CONCORDANT POPULATION-LEVEL INCREASES IN PREP FOUND WITH NOVEL PUBLIC HEALTH METHODS Susan Buskin 1 , Julia Hood 1 , Sara N. Glick 2 , Warren Dinges 3 , Matthew R. Golden 2 1 Pub Hlth–Seattle & King County, Seattle, WA, USA, 2 Univ of Washington, Seattle, WA, USA, 3 Seattle Infectious Disease Clinic, Seattle, WA, USA Background: PrEP (pre-exposure prophylaxis) is a highly effective means of HIV prevention yet limited data are available regarding trends in PrEP use. We estimated local PrEP uptake among men who have sex with men (MSM) in King County, WA using data from surveys of medical providers, behavioral surveillance, and community surveys. Methods: Annual provider surveys were conducted in King County 2014-2016. Those surveyed had volunteered to be in state or county PrEP provider lists or had used HIV RNA testing >2 times for HIV testing. Providers estimated their number of patients who were currently taking PrEP, and the percent of MSM using PrEP was calculated assuming 5.7% of King County men aged >14 years were MSM, an estimate from a local probability survey. Annual surveys of MSM were conducted at the 2014-2016 Seattle Pride festivals using convenience sampling. Finally, the Seattle area National HIV Behavioral Surveillance (NHBS) system used venue-based sampling of MSM in the second half of 2014. “High risk” status was defined by any of the following in the past year: a bacterial STI diagnosis, methamphetamine or popper use, condomless intercourse with a sero-discordant partner, or 10 or more MSM partners. Results: Participation in the PrEP provider survey ranged from 82% of 22 providers in 2014 to 76% of 150 providers in 2016. The sum of patients of provider-participants using PrEP increased from 330 in 2014 to 3,347 in 2016 (402 to 4,404 after non-response adjustment). Among providers included in both 2014 and 2016, current PrEP patients increased from 311 to 1,678. The NHBS survey included 424 HIV- MSM and the Seattle Pride data included 371 to 505 seronegative participants each year. Highly consistent findings were present from the disparate methods (see graphic). In 2016, we estimate that 10.6% and 10.2% of MSM were on PrEP based on provider survey and Pride data, respectively. High risk MSM reported more PrEP use than lower risk men: 9% vs. 0-2% from Pride and NHBS in 2014; 34 vs. 3% from Pride in 2015; and 29 vs. 4% from Pride in 2016. Conclusion: Data from both providers and MSM document that PrEP use is rapidly expanding in King County, and increasing more steeply among high risk MSM. While uncertainty in the representativeness of surveyed populations and our estimate of the number of MSM in King County limit the precision of our findings, the consistency of our results supports their validity and demonstrate the utility of our approach to monitoring PrEP uptake at the population-level. 974 RACIAL/ETHNIC DISPARITIES IN PERSISTENCE AMONG PREP USERS IN SAN FRANCISCO Hyman Scott 1 , Miranda Nordell 1 , Anne Hirozawa 1 , Monica Gandhi 2 , Catherine James 1 , Hali Hammer 1 , Susan Buchbinder 1 , Susan Scheer 1 1 San Francisco Dept of Pub Hlth, San Francisco, CA, USA, 2 Univ of California San Francisco, San Francisco, CA, USA Background: Dissemination of Pre-Exposure Prophylaxis (PrEP), a highly effective HIV prevention tool, is a priority for San Francisco’s Getting to Zero campaign to reduce new HIV infections citywide. However, there are limited data available on persistence (staying on PrEP) among those who’ve initiated, an important component of the PrEP cascade. Methods: Patients receiving PrEP within the San Francisco Department of Public Health Primary Care (SFPC) clinics are included in a centralized PrEP registry to monitor metrics such as uptake and persistence. Patients were included in the PrEP registry if they received a PrEP prescription from a SFPC medical provider and were not in the HIV registry, had no HIV positive laboratory tests, and were not on post-exposure prophylaxis. Patients receiving PrEP at any time from 2/1/2015 to 2/29/2016 were included in this analysis, regardless of initiation date, and median time on PrEP was calculated. PrEP persistence, the proportion of patients who remained on PrEP through 4/1/2016, was determined via medical chart abstraction, and stratified by age, race/ethnicity, and clinic. Results: Overall, there were 220 patients who received PrEP over the evaluation period; most (85%) were men. The largest proportion of patients (39%) were 30-39 years old, 9%were 18-24, 20%were 25-29 years, 16%were 40-49, and 17%were >50 years old. Forty-three percent of patients were white, 18% Latino, 9% Black, and 8% Asian/Pacific Islander. At the end of the study period, PrEP persistence was 67% among patients receiving PrEP within SFPC clinics, and the median time on PrEP was 217 days. Persistence was lowest for those aged 25-29 (61%) and 40-49 (60%); and highest for those >50 years old (73%). Black patients had the lowest persistence (50%), followed by Latino patients (57%). Median duration on PrEP was lower for Black patients (115 days, p<0.01), and Latino patients (183 days, p<0.01), compared with White patients (347 days). The primary reason for PrEP discontinuation based on chart review was being lost to clinical follow-up, although discontinuation reason was often missing from the medical record. Conclusion: Age and racial/ethnic disparities in PrEP persistence were identified among patients receiving PrEP in public health clinics in San Francisco. To maximize the preventive impact of PrEP, and reverse HIV-related disparities at a population level, further efforts are needed to understand reasons for PrEP discontinuation and remove barriers to appropriate PrEP persistence. 975 URINE TENOFOVIR TESTING TO MEASURE PREP ADHERENCE AMONG YOUTH IN A REAL WORLD SETTING Linden Lalley-Chareczko 1 , Devon Clark 1 , Ganesh S. Moorthy 2 , Athena Zuppa 3 , Caitlin Conyngham 1 , KaramMounzer 1 , Pablo Tebas 2 , Helen C. Koenig 2 1 Philadelphia FIGHT, Philadephia, PA, USA, 2 Univ of Pennsylvania, Philadephia, PA, USA, 3 Children’s Hosp of Philadelphia, Philadephia, PA, USA Background: Pre-exposure prophylaxis(PrEP) for HIV prevention with daily TDF/FTC is effective when taken consistently. Young men who have sex with men(yMSMc) and transgender women of color(TWc) have the highest risk of new HIV infections. Currently there is no objective way to monitor adherence to PrEP in the clinic. Urine has been shown to be highly correlated with plasma tenofovir(TFV) levels, with urine TFV levels >1000 ng/mL demonstrating recent(last 1-2 days) adherence, levels 10-1000 ng/mL demonstrating adherence within the previous week but not in the last 1-2 days, and levels <10 ng/mL indicative of no TFV in the previous week(Abstr. 975, CROI 2015). Methods: PrEP was administered to 50 yMSMc and TWc at a youth drop-in center using a needs-based dispensation schedule(weekly, biweekly, monthly) over 48 weeks. Primary objectives were retention at 48 weeks (defined as having a study visit at end-of-study and completing ≥50% of medical pick-ups), and adherence as assessed by urine TFV levels. Risk behaviors and STI diagnoses were also collected. Results: Participant mean age was 22.4 years, 10%were transgender women, 64%were African American, and mean time on PrEP prior to study initiation was 35.2 weeks. Retention was 70%(35 subjects) at 48 weeks. 11 withdrew and 4 were lost-to-follow-up. The proportion of subjects with urine TFV concentrations consistent with recent adherence to PrEP was 80% at week 4, 74.4% at week 12, 82.4% at weeks 24 and 36, and 69.7% at week 48. The proportion of subjects with evidence of inconsistent adherence was 15.6% at week 4, 11.6% at week 12, 11.8% at weeks 24 and 36, and 15.2% at week 48. The proportion of subjects who demonstrated nonadherence over the previous 7 days was 4.4% at week 4, 14% at week 12, 5.9% at weeks 24 and 36, and 15% at week 48. 61 STIs were diagnosed over 231 screenings: 6 subjects had rectal gonorrhea/chlamydia at screening; 9 additional subjects tested positive between weeks 2-24, and 12 subjects between weeks 25-48(p=0.43 for change over study period). No subjects seroconverted. At week 48, more than half of subjects endorsed an increase or no change in condom use, an increase in ability to discuss HIV with partners, and no change in number of sexual partners from baseline. Conclusion: PrEP can be successfully delivered to a young high-risk population with high program retention and medication adherence measured through objective urine testing.

Poster and Themed Discussion Abstracts

CROI 2017 422