CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: PrEP users more often received influenza vaccination, screening for tobacco use and depression, and tests related to diabetes screening and management. Longitudinal studies are warranted to determine if PrEP provides a gateway to primary care, thus extending its benefits to behavioral health, mental health, and prevention and management of other infectious and chronic diseases. 1012 TRENDS IN PrEP UPTAKE, ADHERENCE, AND DISCONTINUATION AMONG YMSM IN CHICAGO Ethan Morgan , Daniel T. Ryan, Kevin Morgan, Richard D’Aquila, Michael E. Newcomb, Brian Mustanski Northwestern University, Chicago, IL, USA Background: Understanding utilization and discontinuation of pre-exposure prophylaxis (PrEP) among young men who have sex with men (YMSM) outside trials and demonstration projects is key in order to inform interventions utilizing PrEP to slow the spread of HIV through this highly impacted population. Methods: Data came from RADAR (N = 1031), an ongoing longitudinal cohort of YMSM (aged 16-29) in Chicago. Trends in PrEP use, adherence, and discontinuation were assessed across five time points of data collection. Poisson regression was utilized to assess trends in PrEP uptake, stratifying by race and ethnicity. Unadjusted and adjusted logistic regression models were utilized to assess the relationship between baseline characteristics and past six-month PrEP use. Results: Across the first three visits in 2015 to 2017, PrEP use in the past six months increased: 6.6% in visit one to 17.5% in visit three. These increases were significant only among white (IRR=1.45; 95% CI: 1.04-2.02) and Hispanic (IRR=1.59; 95% CI: 1.11-2.28) participants; no significant increase was observed among black participants. PrEP use was significantly associated with condomless sex (AOR=2.95; 95% CI: 1.38-6.28), having more sexual partners (AOR = 1.07; 95% CI: 1.03-1.12), and older age (AOR=1.18; 95% CI: 1.07-1.30). Those who used marijuana were also significantly less likely to use PrEP (AOR=0.94; 95% CI: 0.89-0.99). PrEP use was not significantly associated with rectal STIs (AOR=1.34; 95% CI: 0.65-2.75). No significant association was observed between PrEP use and education, alcohol use, or other substance use. We also observed that a majority of individuals reported being at least 90% adherent to their PrEP medication across visits one (77.1%), two (83.3%), and three (81.8%). Sixty-five (33.0%) participants discontinued PrEP use prior to the interview date. Primary reasons for PrEP discontinuation included trouble getting to doctor’s appointments (21.5%) and issues related to insurance coverage or loss (20.0%). Conclusion: We observed an increasing trend of six-month PrEP use among white YMSM in Chicago, and not among those of other race/ethnicity, from 2015 to 2017. Individuals who reported high risk HIV behaviors were also more likely to have used PrEP. Future research should be targeted at understanding longitudinal time- or age-related trends in PrEP uptake as well the drivers of decisions about other prevention strategies following discontinuation of PrEP. 1013 PATTERNS AND CORRELATES OF PARTICIPANT RETENTION IN THE US PrEP DEMO PROJECT Susanne Doblecki-Lewis 1 , Daniel Feaster 1 , Albert Y. Liu 2 , Stephanie E. Cohen 2 , Richard A. Elion 3 , Oliver Bacon 4 , Gabriel Cardenas 1 , Michael Kolber 1 , Megan Coleman 5 1 University of Miami, Miami, FL, USA, 2 San Francisco Department of Public Health, San Francisco, CA, USA, 3 The George Washington University, Washington, DC, USA, 4 University of California San Francisco, San Francisco, CA, USA, 5 Whitman-Walker Health, Washington, DC, USA Background: Safe and effective use of Pre-exposure prophylaxis (PrEP) depends on retention in prevention care after initial engagement. In the U.S. PrEP Demonstration Project, daily oral tenofovir/emtricitabine was offered to eligible men who have sex with men and transgender women for 48 weeks. We assessed patterns of retention among those electing to participate in the project and who received at least one month of medication. Methods: Patterns of retention were assigned to one of three categories: early loss to follow-up (ELTF) within the first 12 weeks of the study, retention throughout the follow-up period, or intermittent retention with missed visits resulting in less than full medication coverage during the study period. For each

retention group, baseline and enrollment survey responses, demographics, and clinical characteristics were tabulated. Predictors were divided into demographic and behavioral domains and a multivariable model for each was created by adding in all variables within the domain in which p<0.05 in the initial models. These two models were combined including those predictors from these two intermediate models with p<.05. Odds Ratios were calculated for each of the variables retained in the final multivariable model. Results: Overall, 366/557 (65.7%) of enrolled participants in the Demo Project were retained for all study visits, 127/557 (22.8%) had intermittent retention, and 64/557 (11.5%) had early loss to follow-up (ELTF). Multivariable analysis of characteristics revealed that Miami site compared to San Francisco site was associated with ELTF rather than full retention (aOR 2.53; CI:1.12-5.71) and also with intermittent rather than full retention (aOR 2.92; CI:1.52-5.59). Decrease in age by 10 years was associated with both ELTF (aOR 1.58; CI:1.14-2.21) and intermittent retention (aOR 1.48; CI:1.17-1.87) compared with full retention. Factors associated with ELTF but not intermittent retention compared with full retention were black race (aOR 4.30; CI:1.26-14.73), higher HIV risk perception (aOR 4.21; CI 1.63-10.87), lack of regular employment (aOR 2.66; CI: 1.36-5.19), and lack of prior awareness of PrEP (aOR 2.36; CI:1.19-4.68). Baseline STI rates were similar across groups when adjusted for reason for visit. Conclusion: Tailored interventions addressing different potential causes and risk factors for loss from PrEP care may improve retention in services and consistency of PrEP use. 1014 INCREASING PrEP UPTAKE, PERSISTENT DISPARITIES IN AT-RISK PATIENTS IN A BOSTON CENTER Kenneth H. Mayer 1 , Chris Grasso 1 , Kenneth Levine 1 , Douglas Krakower 2 , Victoria Powell 2 , Stephen L. Boswell 1 , Julia L. Marcus 3 1 Fenway Health, Boston, MA, USA, 2 Beth Israel Deaconess Medical Center, Boston, MA, USA, 3 Harvard University, Cambridge, MA, USA Background: Although HIV pre-exposure prophylaxis (PrEP) was approved for high-risk persons in 2012, uptake was initially, slow and some groups were underrepresented among PrEP users. Centers caring for large numbers of high- risk people can facilitate monitoring trends and disparities in PrEP use. Methods: A cross-sectional study was conducted in a Boston community health center (CHC) with the most PrEP experience in New England. For each year during 2012-2016, data were analyzed from potential PrEP candidates – i.e., HIV-uninfected patients screened for rectal sexually transmitted infections (STIs). Chi-square tests were used to compare demographic characteristics between patients who were and were not prescribed PrEP each year, and to test for trends over time. Results: In 2012, 2.3% of 681 patients screened for rectal STIs were prescribed PrEP, whereas by 2016, 49% of 3333 were (P<0.001). Among rectally screened patients, PrEP use increased over time for all age, gender, race/ethnicity, and insurance type subgroups, except for cisgender women (P=0.32). PrEP uptake was consistently lower among younger patients screened for rectal STIs, with only 34% aged <25 years prescribed PrEP in 2016 compared with 53% of those aged ≥25 years (P<0.001). PrEP users were mostly White in all years, but PrEP uptake was highest in Hispanic patients in 2014-2016; in 2016, PrEP use was 39% and 41% among Asian and Black patients screened for rectal STIs, compared with 51% and 55% among White and Hispanic patients, respectively (P<0.001). All PrEP users were cisgender males in 2012; by 2016, 2.9%were transgender and 0.1%were cisgender women. Among rectally screened patients in 2016, 53% of cisgender males used PrEP compared with 21% of transgender patients and 1.7% of cisgender women (P<0.001). In 2016, a higher proportion of PrEP users had private insurance (82% vs. 76%) and a lower proportion had Medicaid or other public insurance (6.9% vs. 12%) compared with non-PrEP users (P<0.001). Among rectally screened patients in 2016, PrEP use ranged from 40% among those with Medicaid or other public insurance to 55% among privately insured patients (P<0.001). Conclusion: PrEP uptake increased steeply at a Boston CHC, but in 2016, nearly half of rectally screened patients were not using PrEP, and disparities in uptake persisted. Strategies are needed to mitigate barriers to PrEP use among racial/ethnic minorities, cisgender and transgender women, and younger and underinsured individuals.

Poster Abstracts

CROI 2018 388