CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1044 CHARACTERIZING THE HIV CONTINUUM OF CARE FOR TRANSGENDER WOMEN IN NORTH AMERICA Tonia Poteat 1 , David B. Hanna 2 , Peter F. Rebeiro 3 , Marina Klein 4 , Michael J. Silverberg 5 , Joseph J. Eron 6 , Michael A. Horberg 7 , Mari Kitahata 8 , W. C. Mathews 9 , Kristin Mattocks 10 , Angel Mayor 11 , Ashleigh Rich 12 , Richard D. Moore 1 , Keri N. Althoff 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 Albert Einstein College of Medicine, Bronx, NY, USA, 3 Vanderbilt University, Nashville, TN, USA, 4 McGill University, Montreal, QC, Canada, 5 Kaiser Permanente Northern California, Oakland, CA, USA, 6 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 7 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 8 University of Washington, Seattle, WA, USA, 9 University of California San Diego, San Diego, CA, USA, 10 VA Central Western Massachusetts Healthcare System, Leeds, MA, USA, 11 Universidad Central del Caribe, Bayamon, Puerto Rico, 12 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Background: Transgender women (women assigned male at birth), particularly Black TW, bear a disproportionate burden of HIV in the U.S. Prior studies suggest TW have lower viral suppression (VS) but similar retention in clinical care (RIC) compared with cisgender women (CW) and cisgender men (CM) with HIV. We sought to characterize the HIV Continuum of Care (CoC) over time, comparing TW to CW and CM participants, in the NA-ACCORD. Methods: We analyzed CoC outcomes annually among adults from 9 clinical cohorts with longitudinal data (2001-2015) on transgender participants within the NA-ACCORD. CoC outcomes included retention (proportion >=2 visits >90 days apart), and viral suppression (proportion with HIV RNA <200 copies/mL at final measurement in the year). Log-binomial regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals ([,]) for retention and viral suppression by gender status in recent years (2013-14), adjusted for age, race, a history of injection drug use, and cohort. Results: The study population includes TW (n=188), CW (n=5,469) and CM (n=22,722). Median age at baseline was higher for CM (40 interquartile range [IQR] 33-47 years) compared with CW (38 IQR 32, 46 years) and TW (37 IQR 30, 44 years) patients (p<0.001), with 37% of TW patients age >=40 years versus 44% of CW and 51% of CM (p=<0.001). Among TW, 39%were black compared with 62% of CW and 28% of CM (p<0.001). Although there was greater variability in estimates, TW had lower proportions retained in care than CW and CM; there was little change in retention over time for TW, CW, and CM (Figure). All three groups saw improvements in viral suppression, with CM showing the highest proportions and TW and CW having similar proportions over time. In 2014, the prevalence of retention in care and viral suppression did not differ by gender status (retention in care: TW vs. CM aPR=0.99 [0.88, 1.12] and CW vs CM aPR=1.02 [1.00, 1.05]; viral suppression: TW vs. CM aPR=0.96 [0.87, 1.06] and CW vs CM aPR=1.01 [0.98, 1.03]). Conclusion: TW in the NA-ACCORD have successfully engaged in care; many of the 9 clinical care sites contributing data on transgender participants have instituted gender-affirming practices that are likely influencing the high proportions of TW retained and with viral suppression. The study is limited by use of a one-step method to identify transgender participants. Research into long-term health outcomes in TWwith HIV are needed.

Poster Abstracts

1043 PATTERNS OF ORAL PrEP ADHERENCE AND HIV RISK AMONG EASTERN AFRICAN WOMEN Maria Pyra 1 , Elizabeth Brown 2 , Jessica E. Haberer 3 , Renee Heffron 1 , Elizabeth A. Bukusi 1 , Stephen Asiimwe 4 , Connie L. Celum 1 , Elly T. Katabira 5 , Nelly R. Mugo 1 , Jared Baeten 1 1 University of Washington, Seattle, WA, USA, 2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 3 Massachusetts General Hospital, Boston, MA, USA, 4 Kabwohe Clinical Research Center, Kabwohe, Uganda, 5 Makerere University, Kampala, Uganda Background: Understanding when and how women use PrEP is important to developing successful implementation programs and adherence counseling. We sought to identify unique patterns of PrEP adherence, as well as predictors of these adherence patterns, and compare adherence patterns by HIV risk. Methods: We used data from 233 HIV-uninfected women enrolled as members of serodiscordant couples in a PrEP demonstration project in Kenya and Uganda. Weekly PrEP adherence, assessed by daily electronic monitoring via MEMS Caps, and HIV risk, defined as any sex reported at study visits, over the first six months after PrEP initiation were modeled using group-based trajectory models. Results: There were four unique adherence patterns identified (Figure 1): women with high steady adherence (55% of population); moderate steady adherence (29%); late declining adherence (8%); and early declining adherence (9%). No baseline characteristics, including age, marital status, education, or problem drinking, were significantly different across adherence patterns. Adherence patterns differed by average weekly doses (6.7 vs 5.4 vs 4.1 vs 1.5, respectively). Two risk groups were identified, steady HIV risk (78% of population) and declining HIV risk (22%). Women with steady HIV risk were more likely to have high steady adherence compared to women with declining HIV risk (61% vs 35%); women with steady HIV risk were also less likely to have early (6% vs 17%) or late (4% vs 19%) declining adherence compared to those with declining HIV risk. Conclusion: Patterns of adherence to oral PrEP among women were associated with their concurrent HIV risk. Specifically, women with steady HIV risk were more likely to have high steady adherence and less likely to have declining adherence over the first six months of PrEP use compared to women with declining HIV risk.

CROI 2018 400