CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1010 PrEP IMPLEMENTATION AND PERSISTENCE IN A COUNTY HEALTH DEPARTMENT IN ATLANTA, GA Charlotte-Paige M. Rolle 1 , Udodirim Onwubiko 2 , Jennifer Jo 1 , Anandi N. Sheth 1 , Colleen F. Kelley 1 , David P. Holland 2 1 Emory University, Atlanta, GA, USA, 2 Fulton County Board of Health, Atlanta, GA, USA Background: HIV Pre-Exposure Prophylaxis (PrEP) uptake is slower in the Southern US and may be limited by structural barriers such as lack of healthcare access. For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. We implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA and describe early PrEP uptake and persistence estimates. Methods: The Fulton County Board of Health (FCBOH) PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. FCBOH covered all costs associated with provider visits and PrEP lab monitoring; clients used their health insurance and/or manufacturer assistance program to obtain the drug. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as “persistent”, whereas clients with a lapse in follow-up of ≥ 6 months were defined as “not persistent.” Factors associated with PrEP persistence were assessed with unadjusted odds ratios. Results: Between October 2015 and March 2017, 373 clients were screened for PrEP eligibility in accordance with CDC guidelines. Almost all were eligible [367/373 (98%)]; however, 151/367 (41%) did not return to start PrEP after screening. Over half [216/367 (59%)] of PrEP eligible clients attended an enrollment visit, and 201/216 (76%) received a prescription for PrEP. Of 201 clients who started PrEP, 88%were male, 65%were black, 72%were men who have sex with men, 78% reported inconsistent condom use, and 80% had a prior sexually transmitted infection. As of March 2017, only 78/201 (39%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was lack of health insurance (OR 2.68, 95% CI 1.38, 5.36; Table 1). Among persistent clients who have started PrEP, there have been no HIV seroconversions thus far. Conclusion: Implementation of PrEP in the county health department setting is feasible and appears to be an effective strategy to reach key populations in need of HIV prevention services. However, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research

Poster Abstracts

1011 HIV PREEXPOSURE PROPHYLAXIS AS A GATEWAY TO PRIMARY CARE Julia L. Marcus 1 , Kenneth Levine 2 , Chris Grasso 2 , Douglas Krakower 3 , Victoria Powell 2 , Kyle T. Bernstein 4 , Stephen L. Boswell 2 , Kenneth H. Mayer 2 1 Harvard University, Cambridge, MA, USA, 2 Fenway Health, Boston, MA, USA, 3 Beth Israel Deaconess Medical Center, Boston, MA, USA, 4 CDC, Atlanta, GA, USA Background: The HIV-prevention benefits of preexposure prophylaxis (PrEP) have been well-established, but it is unknown whether PrEP is associated with increased utilization of non-HIV-related health care. Methods: We conducted a cross-sectional study of potential PrEP candidates at Fenway Health, a large primary care clinic and PrEP provider in Boston, Massachusetts, during 2012-2016. For each year, we assessed use of PrEP and routine primary care among HIV-uninfected patients tested for rectal gonorrhea or chlamydia. We used multivariable Poisson models with generalized estimating equations to obtain prevalence ratios (PRs) comparing the proportion of PrEP users and non-PrEP users who received influenza vaccination, hemoglobin A1c or glucose testing, tobacco screening, and depression screening. Adjusted models included age, gender, race/ethnicity, and year, and diabetes and hypertension diagnoses were additionally included in the model assessing hemoglobin A1c or glucose testing. Results: We identified 5815 HIV-uninfected individuals with at least one rectal gonorrhea or chlamydia test at Fenway Health during 2012-2016, with 2046 (35%) prescribed PrEP during the study period. Compared with non-PrEP users, PrEP users were more frequently cisgender men (97% vs. 85%, P<0.001) and older at the time of their first rectal test (mean age 34 vs. 33 years, P=0.043). PrEP users more often had hypertension (10% vs. 7.9%, P=0.006), but there was no difference between PrEP users and non-PrEP users in the frequency of diabetes (6.7% vs. 6.1%, P=0.32). After adjustment for demographic characteristics, a higher proportion of PrEP users received influenza vaccination (PR 1.58, 95% confidence interval [CI]: 1.48-1.69; P<0.001), tobacco screening (PR 1.13, 95% CI: 1.10-1.17; P<0.001), and depression screening (PR 1.19, 95% CI: 1.16-1.23; P<0.001) compared with individuals who were not prescribed PrEP. After additional adjustment for diabetes and hypertension diagnoses, PrEP users more frequently received hemoglobin A1c or glucose testing (PR 1.86, 95% CI: 1.77-1.94; P<0.001) compared with individuals who were not prescribed PrEP.

is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.

CROI 2018 387

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