CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Compared to cumulative starts, active PrEP prescriptions serve as a better indicator of persons potentially receiving protective effects of TDF/FTC for PrEP. Both active PrEP prescription prevalence and PrEP-to-need ratios had substantial variation. Females, persons under 25, residents of the Southern region, and residents of non-Medicaid expansion states all received fewer prescriptions per capita and lower levels of prescription in comparison to epidemic need. The PrEP-to-need ratio may be useful for future assessments of health disparities.

Background: Men who have sex with men (MSM) with bacterial STDs are at elevated risk for HIV acquisition. STD partner services (PS) can be used to refer these men to pre-exposure prophylaxis (PrEP), but the effectiveness of these referrals is unknown. Methods: In 2016, Disease Intervention Specialists (DIS) in King County, WA, attempted to provide PS to all early syphilis cases and MSM with gonorrhea and chlamydia as resources allowed. Public Health–Seattle & King County (PHSKC) defined MSM with any of the following as being at high risk for HIV: early syphilis, rectal gonorrhea, methamphetamine or poppers use, sex work, or an HIV-unsuppressed partner. DIS referred high risk MSM to the PHSKC STD clinic to initiate PrEP and all MSM to community PrEP providers. From April-September 2017, we interviewed a random sample of HIV-negative MSMwho were offered PrEP referrals during their PS interview in 2016, stratified by risk and whether they accepted referrals. At follow-up, we assessed PrEP use and, for non-users, assessed current risk and offered new referrals. We compared outcomes across strata using chi-square or Fisher’s exact tests. Results: In 2016, medical providers reported 2633 cases of early syphilis, gonorrhea, or chlamydia in HIV-uninfected MSM in King County, of whom 1126 (43%) received PS. DIS assessed PrEP use in 1067 (95%) PS recipients, of whom 493 (46%) were on PrEP. Among 574 men not using PrEP, 377 (66%) were offered PrEP referrals (Table). Of 189 sampled (50% of eligible), 132 (70%) completed a follow-up interview, of whom 44 (33%) were using PrEP at follow-up and 4 (2%) had initiated PrEP but discontinued it. Of PrEP users, 70%were prescribed PrEP by community providers and 30% at the STD clinic. Men who accepted referrals at initial interview were significantly more likely to be using PrEP at follow-up (32/68=47%) than those who did not (12/64=19%) [p=.0006]. This effect was greater among high risk men (64% v. 19%; p=.0002) than lower risk men (29% v. 18%; p=.28). Of 88 not using PrEP at follow-up, 39 (44%) were interested in starting PrEP, 30 (77%) of whom accepted a referral to a PrEP provider or indicated they would seek PrEP from their own medical provider. Conclusion: Almost half of HIV-negative MSM receiving STD PS in King County, WA, reported using PrEP. Integrating PrEP referrals into PS was associated with approximately one-third of non-users initiating PrEP, and following up with PS recipients to offer additional PrEP navigation services may further increase use.

1023 EFFECT OF ON DEMAND ORAL PrEP WITH TDF/FTC ON HSV-1/2 INCIDENCE AMONG MSM Marie-Laure Chaix Baudier 1 , Isabelle Charreau 2 , Constance Delaugerre 1 , Nadia Mahjoub 1 , Martin Siguier 1 , Catherine Capitant 2 , Cécile Tremblay 3 , François Raffi 4 , Eric Cua 5 , Gilles Pialoux 6 , Laurent Cotte 7 , Armelle Pasquet 8 , Laurence Meyer 9 , Jean-Michel Molina 1 1 Hôpital Saint-Louis, Paris, France, 2 INSERM, Villejuif, France, 3 Université de Montréal, Montreal, QC, Canada, 4 CHU de Nantes, Nantes, France, 5 CHU de Nice, Nice, France, 6 Tenon Hospital, Paris, France, 7 CHU de Lyon, Lyon, France, 8 Centre Hospitalier de Tourcoing, Tourcoing, France, 9 INSERM, Le Kremlin-Bicetre, France Background: The use of topical tenofovir gel for HIV PrEP has been shown to reduce the incidence of HSV-2-infection by 51% in women in the Caprisa 004 Study. Oral tenofovir-based PrEP also reduced HSV-2 acquisition by 28% among heterosexual men and women in the Patrners PrEP study. No reduction of HSV-2 incidence was reported in the Iprex study among MSM with daily TDF/FTC but adherence was low. We wished to assess the impact of on demand TDF/FTC for PrEP on HSV-1/2 incidence in the ANRS IPERGAY PrEP trial among MSM. Methods: Stored serum samples from participants enrolled in the blinded phase (TDF/FTC or placebo) of the ANRS Ipergay trial were tested at baseline and at their last visit for HSV-1 and HSV-2 antibodies using serological tests (BioPlex 2200 HSV-1 & HSV-2 IgG, Biorad). We also studied the shedding of HSV-2 in anal swab from HSV-2 seropositive patients. HSV1/HSV2 (HSV1 HSV2 VZV R-gene™ kit Argene) PCR was performed at baseline, M6 and M12. Results: Of the 400 participants (199 in the TDF/FTC arm and 201 in the placebo arm), 39%were tested HSV-2 sero-positive and 70% HSV-1 sero-positive at baseline. Only 18%were sero-negative for both HSV-1 and HSV-2. Of the 218 HSV-2-seronegative participants with a median follow-up of 10.2 months (IQR: 6.1-23.5), 19 (9%) acquired HSV-2 infection. Overall HSV-2 incidence was 7.6% per 100 person-years; 8.1% (95% CI: 4.0%; 14.5%) in the TDF/FTC arm versus 7.0% (95% CI: 3.0%; 13.7%) in the placebo arm (p=0.75). For HSV-1, 14/108 (13%) seronegative participants acquired HSV-1 infection after a median follow up of 10.2 months. Overal incidence of HSV-1 infection was 11.7% per 100 person-years; 16.2% (95% CI: 7.4%; 30.8%) in the TDF/FTC arm versus 7.8% (95% CI: 2.5%;18.2%) in the placebo arm ( p=0.19). Compared to participants receiving placebo, there was no difference in HSV-2 or HSV-1 sero-incidence among participants using > 15 pills/month of TDF/FTC. HSV-2 shedding was analyzed in 58 participants with available anal samples (28 in the placebo arm and 30 in the TDF/FTC arm), only 3 patients had HSV-2 positive PCR, 1 at baseline (4 900 copies/ml), 1 at M12 (115 500 copies/ml) and 1 at M6 (2 816 000 copies/ ml) and M12 (595 000 copies/ml), the 2 latter being in the TDF/FTC arm. Conclusion: The incidence of HSV-2 and HSV-1 was high in these high risk MSM using PrEP. On demand oral PrEP with TDF/FTC failed to reduce HSV-1/2 incidence in this population. 1024 INTEGRATING PrEP REFERRALS INTO STD PARTNER SERVICES INCREASES PrEP USE AMONG MSM David A. Katz 1 , Michael Barry 2 , Julia C. Dombrowski 1 , Teal Bell 3 , Matthew R. Golden 1 1 University of Washington, Seattle, WA, USA, 2 Public Health–Seattle & King County, Seattle, WA, USA, 3 Washington State Department of Health, Olympia, WA, USA

Poster Abstracts

1025 PARTNERS, NOT CONDOM USE, DRIVE STI RATES AMONG PrEP USERS IN COMMUNITY HEALTH CENTER Sarit A. Golub 1 , Stephanie Pena 2 , Rachel A. Fikslin 3 , Matthew Goldberg 3 , Asa Radix 2 1 Hunter College, CUNY, New York, NY, USA, 2 Callen–Lorde Community Health Center, New York, NY, USA, 3 Hunter HIV/AIDS Research Team, New York, NY, USA Background: The potential association between PrEP use and STI incidence is an important public health issue, and better understanding predictors of STI diagnosis among PrEP users is critical to developing companion behavioral support. This analysis presents data from SPARK, a PrEP demonstration/ implementation project conducted at a community-based health center in New York City. Methods: Participants were 300 MSM and transgender women (ages 18-63; 48% PoC) patients at the health center who chose to start PrEP. SPARK participants were followed for 12-months and tested quarterly for STIs (urethral/rectal gonorrhea/chlamydia and syphilis). Data were also collected on participants presenting to the health center between study visits for STI testing.

CROI 2018 392