CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Whether intermittent PrEP provides similar coverage of sex events compared to daily PrEP is still unclear. We wished to assess in the setting of the ANRS IPERGAY trial among men who have sex with men (MSM), the coverage of sex events with «on demand» event-based PrEP. Methods: A 2-month sub-study was proposed to participants (pts) enrolled in the open-label phase of the trial. On demand TDF/FTC dosing regimen included two pills within 2-24h before sex, one pill 24h later and a last pill 48h after the first drug intake. Pts received an electronic MEMS device to record each bottle opening. Questionnaires collected information on daily PrEP intake and sexual behavior by text messages and computer assisted self-interviews. Adherence was also measured by pill count. PrEP full coverage was defined by ≥ 1 pill taken within 24 hours before sex and 1 pill taken within 48 hours following sex, and partial coverage as either one. Two groups of pts were defined according to the number of bottle openings: those who used intermittent PrEP (< 5 openings per week) and those using daily PrEP (≥ 5 openings per week). Results: FromMarch 1st, 2016 to May 3rd, 2016, the study was proposed to 228 pts and 54 pts were enrolled, all MSMwith a median age of 41 years. Pts reported 361 sex events with a median of 4 sex events/pt/month (IQR: 2-8), 81 oral sex only (23%), 279 anal sex (77%) and one unknown. Among the 154 receptive anal sex events, 80% (124) were condomless. There was a strong correlation (r=0.92) between bottle openings and pill count. Forty-two pts (78%) used intermittent PrEP and 12 (22%) used daily PrEP, median number of bottle openings/month of 11.5 (IQR: 4-16) and 24.9 (IQR: 24-27) respectively (p<0.0001). Coverage of sex events is reported in the Table. Conclusion: Reported PrEP coverage of sex events was high both with daily and intermittent PrEP. In the MSM using intermittent PrEP, coverage increased with at-risk practices and was highest for condomless receptive anal sex. 1035 FEASIBILITY OF SHORT-TERM PrEP UPTAKE FOR MSMWITH EPISODIC HIGH-RISK FOR HIV James E. Egan 1 , Ken Ho 1 , Ronald Dean Stall 1 , Morgan T. Drucker 2 , Ryan Tappin 2 , Craig W. Hendrix 3 , Mark A. Marzinke 3 , William Clarke 3 , Kenneth H. Mayer 2 1 University of Pittsburgh, Pittsburgh, PA, USA, 2 Fenway Health, Boston, MA, USA, 3 The Johns Hopkins University, Baltimore, MD, USA Background: Although TDF/FTC Pre-Exposure Prophylaxis (PrEP) was approved for daily use to prevent HIV transmission in at risk men who have sex with men (MSM), some may have discrete periods of high risk (e.g. on vacation), and this use has not been previously evaluated. The current study evaluated the feasibility of short term, fixed interval PrEP. Methods: Participants agreed to participate in an open label study of TDF/ FTC plus a focused behavioral intervention. At least 2-weeks prior to vacation participants received a single session cognitive behavioral therapy--based intervention and were given a 30-day supply of TDF/FTC and instructed to adhere to daily dosing starting 7-days prior to vacation through 7-days post vacation. Adherence was assessed via self-report and plasma TFV concentration levels within 3-days post-vacation. Safety labs and behavioral assessments were collected at baseline, post-trip, and at 3-months. Results: 54 participants were enrolled in Boston and Pittsburgh, of which 48 completed the post-vacation visit. Participants were mostly white (72.2%), had a mean age of 30.0 (range 24-64), 83.3% identified as gay, and 68.5%were employed full-time. Only 3 individuals (6.3%) had drug levels below protective levels (≤4 daily doses during the week). There was high concordance between biological markers and self-reported adherence with 95.8% reporting their ability to take daily PrEP as excellent or very good; 6 participants reported missing 2 or fewer doses and only 1 participant missing six of seven doses. Of the 3 people with less than protective levels of drug, none reported drug use. 55.5% of participants reported being likely or very likely to remain on PrEP after the study. 1 participant became HIV-infected more than 2 months after vacation

because of lapse in insurance to cover ongoing PrEP; no other did after 3 months of follow-up. 77% of the sample reported condomless sex during 1 to 14 of their vacation days. All who reported condomless sex were adherent to PrEP except for 1 participant who reported partial PrEP use and condomless sex on 8 days. Conclusion: These findings suggest that most MSM can be adherent to short- term fixed-interval episodic PrEP (Epi-PrEP) during short high risk vacation periods. Time-limited dosing strategies may be a realistic, feasible, acceptable and useful option for some high-risk MSM whose behaviors are episodic, but non-random. For others, initiating PrEP on vacation may provide a helpful way to initiate long term PrEP. 1036 PrEP USE HISTORY OF PERSONS NEWLY DIAGNOSED WITH HIV: NEW YORK CITY, 2015-2017 Kavita Misra , Jamie Huang, Chi-Chi Udeagu New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: The partner services (PS) program of the New York City (NYC) health department routinely interviews persons newly diagnosed for HIV in NYC. Since 2015, the interview has included questions on pre-exposure prophylaxis (PrEP) use prior to HIV diagnosis. Methods: We performed a cross-sectional analysis of data from PS investigations and the NYC HIV/AIDS surveillance registry of persons newly HIV diagnosed from November 2015 to September 2017. We compare sociodemographic characteristics and sexual risk behaviors of persons who reported any PrEP use prior to diagnosis with those who did not. We describe self-reported period and duration of PrEP use, weekly pill dosing, and reasons for discontinuing PrEP. Results: Over 22 months, 3739 (96%) of 3908 persons newly diagnosed with HIV in NYC were investigated for PS. Of these, 95 persons (3%) reported any PrEP use prior to HIV diagnosis. A significantly greater proportion of ever-PrEP users than non-users were male (90% vs 76%), transgender women (6% vs 3%), white (40% vs 14%) and men who had sex with men (MSM) (87% vs 66%). Females, blacks and heterosexuals constituted 3%, 22% and 4% of ever-PrEP users respectively, versus 21%, 46% and 29% of non-users. Reasons for discontinuing PrEP included HIV diagnosis (19%), payment/insurance issues (16%), provider- discontinued refills or documented poor adherence (16%) and side-effects (12%). Among the 81% of ever-PrEP users whose PrEP stop date preceded their HIV diagnosis date, the median period between PrEP cessation and first HIV positive test was 5 months. The median duration of PrEP use was 3 months and the average number of pills taken per week was 7. About 23% of ever-PrEP users were diagnosed in the acute phase of HIV infection and 38%were screened in the past year for sexually transmitted infections (STI). Six ever-PrEP users reported having used post-exposure prophylaxis (PEP). Condomless anal sex in the past year was reported by 77%, sex with a known HIV-positive partner by 41% and sex while drunk or high on drugs by 32%. Conclusion: PrEP use prior to diagnosis was rare among newly HIV diagnosed persons investigated for PS in NYC. Disproportionately low percentages of black, heterosexual and female ever-PrEP users suggest disparities in PrEP awareness, availability and uptake. High risk sexual behaviors and STI diagnoses were commonly reported among the ever-PrEP users, indicating the need for stronger messaging on condom use in conjunction with PrEP, as well as substance use counseling. 1037 DECREASES IN HIV INCIDENCE IN A MONTREAL CLINIC COINCIDE WITH EXPANDING PrEP USE Marieve Beauchemin, Zoe Greenwald, Jason Szabo, Louise Charest, Judith Fafard, Danièle Longpré, Stéphane Lavoie, Réjean Thomas Clinique Médicale l’Actuel, Montreal, QC, Canada Background: With the objective to eliminate HIV transmission for 2030 now signed into political action by Montreal’s Fast-Track City Initiative, combined prevention measures are the key to eliminating HIV transmission. There is little evidence to link decreases in HIV incidence with increased rates of individuals initiating PrEP or changes in other combined prevention strategies. Methods: To examine the effects of combined prevention on rates of HIV transmission, we measure annual trends in HIV incidence, PrEP consults, PEP episodes, number of individuals screened annually, mean number of HIV tests per individual annually, and at the proportion of seropositive patients having an undetectable viral load from 2011–2016 at Actuel, a large sexual health clinic serving a majority MSM population in Montreal. HIV incidence was calculated based on the number of HIV diagnoses per 100 individuals screened per year.

Poster Abstracts

CROI 2018 397