CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1006 GEOGRAPHIC ACCESS TO PrEP CLINICS AMONG US MSM: DOCUMENTING PrEP DESERTS Kevin Weiss , Anna Bratcher, Patrick S. Sullivan, Aaron J. Siegler Emory University, Atlanta, GA, USA Background: Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy. Using a national database of publicly-listed clinics that prescribe PrEP in the contiguous United States, we explored ‘deserts’ with low access to PrEP as defined by driving time to the closest clinic. Methods: MSM population estimates, county urbanicity, and PrEP provider data were sourced from public data and a national database of publicly listed PrEP providers. Using geographic information systems (GIS), we proportionally allocated county-level MSM estimates and a national PrEP-eligibility estimate to census tracts, areas with a median of 4000 persons. We mapped PrEP providers and calculated travel time, based on ideal traffic conditions, from census tract centroids to the nearest PrEP providers. We classified tracts as being part of a ‘PrEP desert’ based on 30-minute and 60-minute drive travel times to the nearest PrEP-providing clinic. Results: Over one-fifth of MSM (620,150/2,904,089; 21%) lived in census tracts farther than a 30-minute drive away from the nearest PrEP-providing clinic, and 8% (228,391/2,904,089) lived farther than a 60-minute drive. Similar proportions of PrEP-eligible MSM (136,718/607,711; 23%) lived farther than a 30-minute or (49,883/607,711, 8%) 60-minute drive from the nearest PrEP- providing clinic. Using a 60-minute definition of PrEP desert, two-thirds (65.5%) of all deserts were in micropolitan or noncore areas, accounting for 49.2% (28,874) of all PrEP-eligible MSM in deserts. Using the same cutoff, seven of nine geographic census divisions had more than 15,000 MSM living in deserts and six of nine divisions had more than 5,000 PrEP-eligible MSM living in deserts. Conclusion: Substantial geographic areas within the United States do not have nearby, publicly-listed clinics that prescribe PrEP. Large numbers of MSM have limited access to PrEP, living in ‘deserts’ that require substantial driving time to care. Our estimates of the proportion of MSM living in PrEP deserts are conservative, because driving time calculations use ideal traffic conditions. Moreover, many PrEP-eligible MSMmay not have access to a car, which could substantially increase transit times. Given a requisite of four annual visits per year for PrEP care, substantial travel time to care could limit PrEP scale-up. HIV prevention programs must consider travel burden and transportation access as a key part of expansion to more effectively reach both urban and rural MSM in need.

1005 DISTANCE TO CLINIC IS A BARRIER TO PrEP UPTAKE & RETENTION IN UGANDA SEARCH COMMUNITY Christopher Mayer 1 , Asiphas Owaraganise 2 , Jane Kabami 2 , Dalsone Kwarisiima 3 , Catherine A. Koss 4 , Edwin D. Charlebois 4 , Moses R. Kamya 5 , Maya L. Petersen 6 , Diane V. Havlir 4 , Britta Jewell 6 1 Albany Medical College, Albany, NY, USA, 2 Infectious Diseases Research Collaboration, Kampala, Uganda, 3 Makerere University Joint AIDS Program, Kampala, Uganda, 4 University of California San Francisco, San Francisco, CA, USA, 5 Makerere University, Kampala, Uganda, 6 University of California Berkeley, Berkeley, CA, USA Background: Geographic and transportation barriers have previously been associated with poorer HIV-related health outcomes in sub-Saharan Africa, but data on such barriers for prevention are limited. The intervention arm in Phase II of the SEARCH Study (NCT01864603) is investigating a targeted, population- based approach to PrEP in rural communities in East Africa. We estimated the effect of distance to clinic and other transportation-related barriers on PrEP uptake and retention in Ruhoko, an intervention community in southwestern Uganda. Methods: Adult (≥15) participants in Ruhoko were eligible for PrEP based on a risk score, having an HIV-discordant partner, or self-referral at either the community health campaign (CHC) or home visits. We collected data from PrEP- eligible households on GPS-measured distance to clinic, walking time to clinic, and road difficulty. Distance, time to clinic, and road difficulty were measured by walking participant transportation routes to clinic using GPS coordinates for each PrEP-eligible household. A sample of participants was also asked to identify participants’ primary barriers to PrEP use with a semi-quantitative questionnaire. We used multivariable logistic regression to evaluate the association between transportation barriers and i) PrEP uptake among PrEP- eligible individuals and ii) 4-week retention among PrEP initiators, and reported descriptive statistics on named barriers. Results: Of 701 participants eligible for PrEP, 272 (39%) started PrEP within 4 weeks of CHC/home visit; of these, 45 (17%) were retained at 4 weeks. Participants with a distance to clinic of ≥2 kilometers were less likely to start PrEP (aOR 0.35; 95% CI 0.15-0.81, p=0.014) and less likely to be retained on PrEP once initiated (aOR 0.26; 95% CI 0.09-0.76; p=0.013) [Table 1]. Time to clinic (aOR 0.35; 95% CI 0.13-0.96, p=0.42) and road difficulty (aOR 0.27; 95% CI 0.07- 0.97, p=0.044) were also predictive of lower odds of retention. Of participants asked to name barriers to PrEP use (N=98), the most frequently cited were “needing to take PrEP every day” (N=18) and “low/no risk of getting HIV: (N=18). Transportation-related barriers, including “clinic is too far away” (N=6) and “travel away from home” (N=4) were also reported. Conclusion: Distance to clinic is a significant predictor of PrEP uptake and retention in a community in rural Uganda. Interventions that address geographic and transportation barriers may improve PrEP uptake and retention in sub-Saharan Africa.

Poster Abstracts

1007 THE PrEP CASCADE AT NYC SEXUAL HEALTH CLINICS: NAVIGATION IS THE KEY TO UPTAKE Preeti Pathela 1 , Kelly Jamison 1 , Susan Blank 1 , Tarek Mikati 1 , Trevor Hedberg 1 , Sarit A. Golub 2 , Lena Saleh 1 , Christine M. Borges 1 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 City University of New York, New York, NY, USA Background: New York City’s public Sexual Health Clinics reach many people at high risk for HIV acquisition. Staff provide on-site PrEP navigation, and follow up to maximize patient-linkage to ongoing PrEP care. Our aimwas to

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