CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

reporting CAS-MP without stimulant use did not have a significant change in odds of protective levels (AOR 1.00, 95% CI 0.96-1.03), while those who reported CAS-MP and stimulant use had increased odds of protective levels (AOR 1.07 per week, 95% CI 1.01-1.13). Conclusion: Stimulant use moderated the effect of CAS-MP on adherence over time, increasing the odds of protective levels of PrEP, contrary to our initial hypothesis. Stimulant use should not be a deterrent to prescribe PrEP to high- risk individuals engaging in CAS-MP.

1033 HIV INCIDENCE AMONG MSM GIVEN PEP STARTER PACKS IN NYC SEXUAL HEALTH CLINICS, 2014-16 Christine M. Borges 1 , Addie Crawley 1 , Michael A. Castro 1 , Susan Blank 2 , Sarah L. Braunstein 1 , Preeti Pathela 1 1 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 2 CDC, Atlanta, GA, USA Background: Patients receiving starter packs of PEP may not complete the full course and non-completers may have a disproportionately high risk of acquiring HIV. This analysis examined factors associated with medication-completion and HIV incidence in patients receiving HIV PEP starter packs. Methods: We analyzed data on HIV-negative men who have sex with men (MSM) who received PEP starter packs at NYC sexual health clinics from April 2014-December 2015. PEP criteria were: anal/vaginal sex with an HIV-positive partner, condomless receptive anal sex (RAI) with a person of unknown HIV status, shared injected drugs with an HIV-positive person, or sexual assault <36 hours prior to clinic visit. Patients received 3 days of PEP on-site and were referred out for the remaining medication. We gathered follow-up information from both patients and providers to ascertain completion. All demographic, risk and completion information was recorded in the electronic medical record. We used multivariable regression to identify patient demographic and risk-related correlates of completion. We measured HIV incidence among patients with PEP completion information via a match with NYC HIV surveillance data through December 2016. Results: 421 MSM received PEP starter packs; the majority were Black or Hispanic (56%) and <30 years (58%). Most reported either sex with an HIV- positive partner (47%) or condomless RAI with a partner of unknown status (47%.) Of patients for whomwe had completion information (80%); 77% (257/335) reported completing the PEP course. Completion was not significantly associated with age, race, PEP criteria category, or STI diagnosis on day of clinic visit. There were 13 new HIV diagnoses for an overall HIV incidence of 2.1 per 100 person-years (PY), with higher incidence among non-Hispanic black MSM (3.5/100 PY; 95% CI: 1.3-7.8) and MSM under 30 (2.5/100 PY, 95% CI: 1.2-4.6). HIV incidence was lower among completers (1.7/100 PY, 95% CI: 0.8-3.2) than among non-completers (3.4/100 PY, 95% CI: 1.3-7.6), however, this was not a statistically significant difference. Conclusion: Most patients who received starter packs completed full course PEP. HIV incidence was lower but not significantly different for completers versus non-completers. PEP starter packs are a viable option for those with a high risk of HIV acquisition who may also face barriers to accessing medication elsewhere. Because of continued HIV risk behavior, linkage to PrEP or other prevention is a key intervention following PEP. 1034 COVERAGE OF SEX EVENTS WITH ON DEMAND PrEP: A MEMS SUB-STUDY OF THE IPERGAY TRIAL Rebecca Bauer 1 , Emmanuelle Netzer 1 , Claire Pintado 2 , Catherine Capitant 1 , Eric Cua 3 , Nicolas Etien 4 , Gilles Pialoux 2 , Christian Chidiac 5 , Cedric Etienne 3 , François Raffi 6 , Armelle Pasquet 7 , Veronique Dore 4 , Laurence Meyer 8 , Jean-Michel Molina 2 1 INSERM, Villejuif, France, 2 AP–HP, Paris, France, 3 Nice University Hospital, Nice, France, 4 INSERM, Paris, France, 5 CHU de Lyon, Lyon, France, 6 CHU de Nantes, Nantes, France, 7 CHU de Lille, Lille, France, 8 INSERM, Le Kremlin-Bicetre, France

1032 USE OF HIV PEP BY US COMMERCIALLY INSURED PERSONS INCREASED WITH AVAILABILITY OF PrEP Ya-Lin A. Huang 1 , Kenneth L. Dominguez 1 , Anne Patala 2 , Karen W. Hoover 1 1 CDC, Atlanta, GA, USA, 2 ICF International, Atlanta, GA, USA Background: Antiretroviral (ARV) drugs can be used for HIV postexposure prophylaxis (PEP) within 72 hours after exposure to the virus to prevent the risk of acquiring an infection. In 2005, CDC issued guidelines for PEP use and updated its recommendations in 2016. However, awareness of and access to PEP has been low, and population-level estimates of PEP use are lacking. In this study, we compared PEP and preexposure prophylaxis (PrEP) uptake among persons with commercial health insurance in the United States. Methods: Using 2005-2015 MarketScan health services data, we developed an algorithm to identify persons prescribed PEP each year. First, we included persons who filled any ARV prescription in a given year and defined the earliest ARV prescription as the index date. Next, we excluded persons with HIV infection identified by an HIV diagnostic code or an ARV prescription before the index date. We further excluded persons with hepatitis B virus (HBV) infection if they had an HBV diagnosis and ARV prescriptions used to treat HBV. Lastly, we excluded possible PrEP users if their medications was prescribed for >30 days. Using similar methods, we estimated PrEP uptake for persons with a Truvada prescription on the index date who used it for >30 days. We characterized PEP users and estimated the prevalence of PEP and PrEP use by year. Results: The number of persons prescribed PEP increased from 576 in 2005 to 2,797 in 2015; the prevalence of the PEP use increased from 32.8 per million in 2005 to 98.7 per million in 2015 (Ptrend <.001). The mean age of PEP users ranged from 34.1-36.4 years. The proportion of the male users among all users increased from 60% before 2014 to 70% after 2014. PEP use increased in metropolitan statistical areas from 90% in 2005 to 97% in 2015. When stratified by sex, the prevalence of male PEP users nearly quadrupled from 2005 (40.9 per million) to 2015 (149.2 per million) (Ptrend <.001); while the prevalence of the female users nearly doubled (from 25.3 per million in 2005 to 51.5 per million in 2015) (Ptrend <.001). Increases in PEP use mirrored increases in PrEP use (Figure). Conclusion: We found an increasing trend in the prevalence of both PEP and PrEP use during 2005-2015. The increase in PEP use might be associated with increased awareness of PEP as a result of PrEP social media and educational campaigns that included information on PEP. Our methodology provides a feasible approach to estimate PEP use at the population level among users of private health insurance.

Poster Abstracts

CROI 2018 396