CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1015 DISPARITIES IN PrEP UPTAKE AMONG PRIMARY CARE PATIENTS SCREENED FOR HIV/STIs IN SF Hyman Scott 1 , Anne Hirozawa 1 , Miranda Nordell 1 , Monica Gandhi 2 , Catherine James 1 , Hali Hammer 1 , Susan Scheer 1 , Susan P. Buchbinder 1 1 San Francisco Department of Public Health, San Francisco, CA, USA, 2 University of California San Francisco, San Francisco, CA, USA Background: Although pre-exposure prophylaxis (PrEP) across San Francisco is expanding, significant age, gender, and racial/ethnic disparities in uptake persist. Via a data-driven approach, we created a PrEP registry and a high-risk non-PrEP registry to identify patients in primary care who may benefit from targeted outreach. Methods: Starting in January 2016, patients receiving PrEP within the San Francisco Department of Public Health Primary Care (SFPC) clinics were included in a registry if they had received a PrEP prescription from a SFPC medical provider and were confirmed HIV-negative via laboratory and medical chart review. In the absence of structured medical record data on HIV-risk, we used available laboratory data to identify high-risk non-PrEP patients if they were HIV-negative; were not prescribed PrEP; and either were screened for a rectal sexually transmitted infection, were diagnosed with syphilis in the past 12 months, or received ≥3 HIV tests in a 24 month period. This analysis compares PrEP patients to non-PrEP patients as of 5/31/2017. Chi-square tests measure the bivariate association between PrEP initiation, demographics, and active panel status (assigned to a SFPC clinic and primary care provider, with at least one primary care visit in the last 24 months). A multivariate logistic regression model with an outcome of not initiating PrEP was created. Results: Overall, 451 patients were confirmed to have started PrEP and 2,109 patients were identified as high-risk non-PrEP patients. Non-PrEP patients were more likely to be female (45% vs 16%, p<0.01), Black (32% vs 14%, p <0.01), and ≥50 years (24% vs 18%, p=0.02); and less likely to be active on a care panel (52% vs 86%, p<0.01). In a multivariate analysis controlling for active panel status, non-PrEP patients were more likely to be women [adjusted OR (aOR) 5.64; 95%CI:4.22-7.54)], Black (aOR 2.85; 95%CI:2.03-4.00), Latino (aOR 1.38; 95%CI:1.02-1.87), and ≥50 years (aOR 2.18; 95%CI:1.60-2.95) than PrEP patients. Active panel status was a strong negative predictor of being a non-PrEP patient (aOR 0.13; 95%CI:0.09-0.17). Conclusion: Age, gender, and racial/ethnic disparities remain in PrEP uptake across DPH-funded primary care clinics in San Francisco, suggesting that access to care is not sufficient to address these disparities. Additional interventions, informed by this data-driven approach, are needed to help both primary care providers and patients identify risk and, respectively, prescribe and initiate PrEP. 1016 EARLY ADOPTERS OF PrEP AMONG MSM IN INDIA AND DETERMINANTS OF EMERGING DISPARITIES Viraj V. Patel 1 , Alpana Dange 2 , Sarit A. Golub 3 , Shruta Neytra 2 , Yashesh Parekh 1 , Christopher Pina 1 , Julia H. Arnsten 1 , Jack Harrison-Quintana 4 , Kenneth H. Mayer 5 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 Humsafar Trust, Mumbai, India, 3 Hunter HIV/AIDS Research Team, New York, NY, USA, 4 Grindr for Equality, Washington, DC, USA, 5 Fenway Health, Boston, MA, USA Background: The degree of PrEP interest among MSM in India is unknown. We sought to understand the prevalence of PrEP use and characterize unlikely users in a sample of sexually active MSM at high risk of HIV infection. Methods: From Jan-Feb 2017, we recruited sexually active, HIV-negative or unaware MSM (≥ 18 years) across India via multiple social media and MSM mobile dating sites to complete an online survey in Hindi or English, and assessed likelihood of PrEP use. We used multivariable GEE logistic regression, accounting for clustering by state, to identify factors independently associated with unlikely PrEP users (compared to likely users) in MSM at high risk of HIV infection (any condomless anal sex (CAS) or ≥3 anal sex partners in the past 6 months, or stimulant drug use with sex or a STI diagnosis in the past year). Results: The 2,494 MSM completing the survey came from all states and 416 cities, 16% from rural areas; 18% responded in Hindi. Their median age was 26, most (83%) completed college, and 16%were categorized as being in poverty; 52% identified as gay/homosexual, 44% as bisexual, and 4% as heterosexual; 39% had never disclosed their sexual identity to anyone, and most (74%) had never disclosed same-sex behaviors to a doctor. In the past six months, participants had a median of 7 sexual partners, 54% had any CAS, and in the past year, 9% had a STI. Overall, only 16%were aware of PrEP, 1.3% (n=32) had used PrEP, and 37%were unlikely to use PrEP. PrEP users mostly completed the survey in English (90%), were <35 years old (87%), had high income (>₹20,000/

month), college degrees (75%), and lived in urban areas (75%). In multivariable analyses, shown by aOR(95% CI), unlikely users had higher HIV related stigma: 1.2 (1.1,1.3); low risk perception: 2.9 (1.2,6.7)(REF: high risk); easy access to HIV testing 1.4(1.1,1.7)(REF: not easy); more CAS: 1.3 (1, 1.7); ≤4 sex partners/6 months: 1.3 (1,1.7) (REF: >4 partners); no drug use with sex: 1.4 (1.1,2)(REF: any use); ₹40,000/month); rural residence: 1.6 (1.2,2.2) (REF: metropolis); and older age: 1.02 (1,1.03). Conclusion: In this first study of PrEP adoption among MSM in India, PrEP use was low, but interest was high. Implementation efforts targeting unlikely users and focusing on access and affordability may help mitigate emerging socioeconomic and geographic disparities in PrEP uptake.

Poster Abstracts

1017 ACCEPTABILITY OF PrEP AMONG A LARGE COHORT OF YOUNG TRANSGENDER WOMEN IN 2 US CITIES Arjee J. Restar 1 , Lisa Kuhns 2 , Sari Reisner 3 , Robert Garofalo 4 , Matthew J. Mimiaga 1 1 Brown University, Providence, RI, USA, 2 Northwestern University, Chicago, IL, USA, 3 Harvard University, Cambridge, MA, USA, 4 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA Background: Truvada as Pre-exposure prophylaxis (PrEP) is an efficacious biomedical prevention modality for individuals at increased risk of becoming infected with HIV, including young transgender women (YTW). However, no published studies to our knowledge have examined PrEP acceptability and its associated factors among this group. The current study examined the prevalence of PrEP acceptability and related factors among HIV uninfected, YTW in two major urban cities in the US. Methods: Between 2012 to 2015, 300 sexually active YTW (aged 16-29) from Boston and Chicago enrolled in Project LifeSkills, the first behavioral HIV prevention efficacy trial for transgender women in the US. YTWwere asked to complete a baseline assessment of socio- demographics and healthcare utilization characteristics, as well as PrEP acceptability, interest, and awareness. The present analysis was restricted to HIV uninfected YTW (n = 230), who maybe likely candidates for PrEP. Factors associated with PrEP acceptability (continuous scores, sample mean=23.4, range=10.0-30.0) were examined using multiple linear regression procedures. Results: Participants’ mean age was 23 years; the sample was 42% black, 13% Latina, 33%white, and 12% other minority race/ethnicity. In a final model, PrEP interest (β = 3.7, 95% Confidence Interval [95%CI] = 2.2 – 5.2) and having

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