CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

understand uptake of this intervention and related patient-level factors, which is critical to improving the PrEP cascade. Methods: We analyzed medical record data for HIV-negative men who have sex with men (MSM) with clinic visits during April-June 2017. Hierarchical PrEP priority criteria were: 1) HIV post-exposure (PEP) use (past-year); 2) selected sexually transmitted infections (STI) (past-year); 3) higher-risk (HR) partners (HIV-positive sex/needle-sharing); 4) interest in PrEP. We constructed a PrEP cascade and used multivariable regression to identify factors (priority group, race/ethnicity, age, insurance status) associated with acceptance of PrEP navigation and referral, linkage to PrEP provider (<60 days), and PrEP prescription. Results: Over a 3-month period, 1470 of 4761 MSM were PrEP priority patients: 13% PEP users, 32%with prior STI, 9%with HR partners, 46%with PrEP interest. Of those offered navigation, 62% (890/1437) accepted; prior STI and PEP patients had lowest acceptance (34-37%). 70% of acceptors (627/890) received navigation. Of MSM eligible for referral, 60% (317/526) accepted referral; 45% (143/317) linked to a PrEP provider, and 72% (103/143) were prescribed PrEP; overall 20% (103/526) of referred MSM received PrEP. Compared to MSM with PrEP interest, MSMwith PEP history (OR 0.07, 95% CI 0.05-0.10), prior STI (OR 0.06, 95% CI 0.05-0.09), or HR partners (OR 0.18, 95% CI 0.11-0.28) were much less likely to accept navigation. Black (OR 1.63, 95% CI 1.15-2.30), Hispanic (OR 1.85, 95% CI 1.34-2.57) and MSM of other races (OR 1.64, 95% CI 1.08-2.49) were more likely than white MSM to accept navigation. Once navigated, MSMwith STI or HR partners were twice as likely as those with PrEP interest to accept referrals; referral acceptance did not differ by other factors. Probability of linkage and prescription did not vary by patient factors. Conclusion: Although MSM in key priority groups (e.g., prior STI) showed low navigation uptake, those who accepted navigation had higher referral rates than other groups, suggesting a need for up-front engagement. Clinics offering sexual health services are ideal PrEP implementation settings, reaching racial minority populations likely to accept PrEP, and helping 1 in 5 MSM benefit from these HIV prevention services.

were responsible for after insurance reimbursement, the amount individuals paid, and the debt an individual accrued (i.e., the difference between the total amount a person was responsible for and paid). Medians (IQR) are reported. Logistic regression was performed to assess the relationship between OOP charges, payments, and accrued debt on PrEP utilization. Wilcoxon tests were used to compare costs between race and insurance categories. Results: Of 149 MSM, the median age was 26 years (24, 30), 54%were White, 30%were Black, 4%were Latino, 67%were college graduates, and annual income was $25300; 83% had private, 8% had public, and 9% had no insurance. The median total OOP charge for the initial PrEP office visit was $40 ($20, $79), payment was $20 ($0, $45), and accrued debt was $0 ($0, $25). When adjusting for race and insurance, young adult MSM with any debt (>$0) were less likely to continue PrEP compared to those with no debt (OR:3.65, 95% CI:1.14-11.72); adjusting for the same factors, MSM with debt ≥$25 were less likely to continue PrEP (OR:5.94, 95% CI:1.75-20.19). Among Black and non-Black MSM, OOP payments ($0 and $25; P<0.001, respectively) and accrued debt ($31 and $0; P<0.001) significantly differed. Among the uninsured and insured, OOP charges ($212 and $36; P<0.001, respectively) and accrued debt ($92 and $0; P=0.001) differed. Conclusion: This study quantified amounts (>$0, ≥$25) at which individual out-of-pocket costs impede PrEP utilization among young adult MSM, regardless of insurance coverage, who are accessing care within the US private healthcare system. Black MSMwere disproportionately affected. Public sector financing to cover individual medical costs is needed to reach the population- level benefit of PrEP. 1009 HIGH DISCONTINUATION OF PRE-EXPOSURE PROPHYLAXIS WITHIN SIX MONTHS OF INITIATION Chelsea L. Shover 1 , Marjan Javanbakht 1 , Steven Shoptaw 1 , Robert Bolan 2 , Pamina Gorbach 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Los Angeles LGBT Center, Los Angeles, CA, USA Background: The study was conducted to characterize longitudinal use of HIV pre-exposure prophylaxis (PrEP) at a Federally Qualified Health Center in Los Angeles, CA. We aimed to examine duration of PrEP use, and sociodemographic characteristics associated with discontinuation. We hypothesized that most patients would use PrEP for at least six months, and most of those who discontinued would do so without returning for a first follow-up appointment. Methods: Records were obtained from patients prescribed tenofovir/ emtricitabine as PrEP at the Los Angeles LGBT Center prior to March 1, 2017. “Active” PrEP patients were defined as those who had a PrEP prescription within the past 120 days. Among those not active, last visit with PrEP prescription was a proxy for discontinuation of PrEP use. Patients were followed through the earliest of discontinuation or August 31, 2017. Potential demographic correlates of discontinuation were analyzed using logistic regression. Results: During the study period, 1,764 individuals initiated PrEP. The majority were cisgender men (94%) or transgender women (4%); White (44%), Hispanic (30%), or Black (8%); over 30 (55%). Fifteen percent (n=271) did not return for a follow-up appointment within 120 days of initial visit. By three months, 32% (n=572) discontinued, and 45% (n=802) discontinued by six months. A remaining 55% (n=972) continued attending PrEP follow-up appointments for at least six months. Black race/ethnicity (AOR: 1.6, 95% CI 1.0 2.5) and bisexual orientation (AOR: 1.8, 95% CI 1.2, 2.6) were associated with greater odds of discontinuation at baseline compared to white race/ethnicity or gay sexual orientation, respectively. Discontinuation by six months was associated with age, but not gender, sexual orientation, or race/ethnicity. Compared to those over 50, those between 18-24 (AOR = 2.6, 95% CI 1.6, 4.2); 25-29 (AOR = 1.9, 95% CI 1.3, 2.9), or 30-39 (AOR = 1.5, 95% CI 1.0, 2.3) had higher odds of discontinuing by six months. Conclusion: A substantial proportion of PrEP patients stopped attending follow-up visits within six months of initiation, with differential discontinuation by age, race/ethnicity, and sexual orientation. Further investigation could distinguish between PrEP discontinuation due to changed HIV risk versus barriers to continuation such as health insurance, competing priorities, or medication factors. Such analysis could improve PrEP implementation in community settings.

Poster Abstracts

1008 OUT-OF-POCKET COSTS IMPEDE PrEP USE AMONG YOUNG MSM IN THE PRIVATE HEALTHCARE SYSTEM Rupa R. Patel 1 , Sunidhi Singh 1 , Christian Farag 1 , Kenneth H. Mayer 2 , Philip A. Chan 3 , Amber Salter 1 , Leandro A. Mena 4 , Zachary Feinstein 1 , John Crane 1 , Timothy McBride 1 1 Washington University St Louis, St Louis, MO, USA, 2 Harvard University, Cambridge, MA, USA, 3 Brown University, Providence, RI, USA, 4 University of Mississippi, Jackson, MS, USA Background: The extent that out-of-pocket (OOP) costs (i.e., costs not covered by the insurance company or self-paid) impede PrEP use has not been quantified. We assessed individual OOP costs and its effect on PrEP utilization among young adult MSM. Methods: We reviewed intake demographic, behavioral and billing data among MSM receiving PrEP care at the Washington University in St. Louis Infectious Diseases Clinic from June 2014 to July 2017. MSM 18-35 years who were prescribed PrEP for ≥3 months were included in the study. The primary outcome was PrEP utilization, defined as self-report of continuing PrEP at 3-month follow up. Billing data included office visit charges made to individuals (i.e. copayments, coinsurance) and insurance companies, costs that individuals

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