CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1030 ASSESSING PrEP NEEDS AMONG HETEROSEXUALS AND PEOPLE WHO INJECT DRUGS, WASHINGTON, DC Irene Kuo 1 , Anya Agopian 1 , Jenevieve Opoku 2 , Anthony Rawls 1 , Rudy Patrick 3 , Manya Magnus 1 , Michael Kharfen 2 , Alan Greenberg 1 1 The George Washington University, Washington, DC, USA, 2 District of Columbia Department of Health, Washington, DC, USA, 3 University of California San Diego, La Jolla, CA, USA Background: PrEP is an effective biomedical intervention to prevent HIV transmission; however, uptake among heterosexuals at risk (HET) and people who inject drugs (PWID) recommended for PrEP has not been well-assessed. We used a PrEP continuum to assess the gap in knowledge, access and use of PrEP among HET and PWID in Washington, DC. Methods: We used data from the National HIV Behavioral Surveillance System (NHBS), a community-based cross-sectional survey, collected in 2016 (HET N=503) and 2015 (PWID N=516). Participants were recruited using respondent- driven sampling; weighted percentages are presented. NHBS eligibility for HET included men/women who had sex with an opposite sex partner in the past year; PWID included men/women who reported past year injection drug use. We used CDC criteria to estimate the proportion of HIV-negative/unknown status participants recommended for PrEP use. The PrEP continuum included: ever heard of PrEP, having insurance, ever discussed PrEP with a provider, ever received PrEP or prescription, and ever took PrEP. The number of persons recommended for PrEP was used as the denominator for each continuum step, and the proportion calculated for each step was contingent upon cumulatively meeting all previous steps. Data in the PrEP continuum for both HET and PWID were also examined by gender. Results: Among HET and PWID in NHBS, 20.8% and 35.2% respectively met the CDC criteria for PrEP; of those, 50.3% of HET and 32.0% of PWID were women. Among HET recommended for PrEP (Figure 1a), only 14.3% had ever heard of PrEP; 11.8%were insured, 1.4% had discussed PrEP with a provider; and <1% ever received PrEP and took PrEP. A higher proportion of HET women versus men had heard of PrEP and were currently insured (p=0.05). Among PWID recommended for PrEP (Figure 1b), 7.4% had ever heard of PrEP; 6.5%were insured; 0.8% had discussed PrEP with a provider; <1% had received PrEP; and none had taken PrEP. Similar proportions of male and female PWID were engaged in the PrEP continuum stages. Conclusion: A substantial proportion of HET and PWID met the criteria for PrEP utilization, yet a large gap exists at each stage of the PrEP continuum for both groups. Overall PrEP knowledge and utilization was very low in both groups. While a larger proportion of HET women versus men were aware of PrEP and insured, there was no difference in PrEP uptake by gender in either population. New PrEP implementation programs should focus on increasing knowledge and uptake of PrEP in these populations.

Poster Abstracts

1031 STIMULANT USE AND CONDOMLESS SEX WITH MULTIPLE PARTNERS: EFFECT ON PrEP ADHERENCE David Goodman-Meza 1 , Matthew R. Beymer 1 , Ryan M. Kofron 1 , K. Rivet Amico 2 , Christina Psaros 3 , Lane R. Bushman 4 , Peter L. Anderson 4 , Robert Bolan 5 , Wilbert C. Jordan 6 , James F. Rooney 7 , Amy R. Wohl 8 , Raphael J. Landovitz 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 University of Michigan, Ann Arbor, MI, USA, 3 Massachusetts General Hospital, Boston, MA, USA, 4 University of Colorado Anschutz Medical Campus, Aurora, CO, USA, 5 Los Angeles LGBT Center, Los Angeles, CA, USA, 6 Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA, 7 Gilead Sciences, Inc, Foster City, CA, USA, 8 Los Angeles County Department of Public Health, Los Angeles, CA, USA Background: PrEP with TDF/FTC is highly effective for preventing HIV in diverse populations. Among MSM, stimulant use and condomless anal sex with multiple partners (CAS-MP) are known risk factors for HIV acquisition. CAS-MP has been associated with increased PrEP adherence, but less is known about the association with stimulant use. We hypothesized that stimulant use would modify the effect of CAS-MP, decreasing PrEP adherence. Methods: We performed a secondary analysis of PATH-PrEP, a two-site open label study evaluating PrEP for MSM in Los Angeles, California. TDF/FTC was offered to 296 MSM for 48 weeks between April 2014 and July 2016. Adherence levels to TDF/FTC were assessed via TFV-DP levels in dried blood spots (DBS) and TFV in plasma samples at 4, 8, 12, 24, 36 and 48 weeks. All participants received standardized adherence counseling, which was escalated if TFV plasma levels were below the limit of quantitation (<10 ng/mL). Risk behavior was assessed through a computerized survey instrument at all visits. We modeled an interaction between stimulant use (methamphetamine, ecstasy, or cocaine) and CAS-MP (2 or more partners) over time on protective TFV-DP levels in DBS (>700 fmol/punch). We included individuals with at least one follow-up visit (n=283). We used a generalized linear mixed model, controlling for age, ethnicity, enrollment site, education, income, and sex work. Predicted probabilities were estimated to plot the interaction and 95% CIs (figure). Results: Median age was 33 (IQR 28-42), 51%were White, 28% Latino and 10% Black. At baseline, 61% reported CAS-MP and 34% reported stimulant use in the prior 30 days. Over all observed time points, 80% of samples had protective levels. At week 4, those reporting CAS-MP without stimulant use had higher odds of protective levels (AOR 2.4, 95% CI 1.3-4.6) than non-stimulant and non-CAS-MP (reference). Those with CAS-MP and stimulant use had decreased odds of protective levels (AOR 0.2, 95% CI 0.1-0.7). Over time, those

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