CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

1046 PrEP AND EARLY ART FOR FEMALE SEX WORKERS IN SOUTH AFRICA: THE TAPS PROJECT Robyn Eakle 1 , Gabriela Gomez 2 , Niven Naicker 1 , Rutendo Bothma 1 , Judie Mbogua 1 , Maria A. Cabrera Escobar 1 , Elaine Saayman 1 , Michelle A. Moorhouse 1 , Willem D. Venter 1 , Helen Rees 1 1 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 2 Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands Background: Operational research is required to design delivery of pre- exposure prophylaxis (PrEP) and early antiretroviral treatment (early ART). This paper presents the primary analysis of the TAPS Demonstration Project, a demonstration project offering both interventions to female sex workers (FSWs) in two urban clinic sites in South Africa. Methods: TAPS was a prospective, observational cohort study with two arms delivered in existing service settings: 1) PrEP for HIV-negative FSWs, and 2) early ART for HIV-positive FSWs. The main outcome was retention at 12 months. We also present uptake, adherence, key demographic characteristics, number of sero-conversions, virological failures and sexually transmitted infections (STIs), as well as changes in sexual behaviour among participants and cost of services. Results: Of the 947 FSWs seen in clinic, 692 were HIV tested. HIV prevalence was 49%. Among those returning to clinic after testing and confirmed clinical eligibility, 98% (219/224) and 94% (139/148) took up PrEP and early ART, respectively. Of those enrolled, 22% on PrEP and 60% on early ART were seen at 12 months. The majority of women were married or had a stead partner, worked in brothels, and were born in Zimbabwe. Little change was seen over time in consistent condom use or the number of sexual partners, with high levels of consistent condom use with clients and low use with main partners in both study arms. There were no seroconversions on PrEP and seven virological failures on early ART. Total cost of service delivery was approximately $126 for PrEP and $406 for early ART per person-year. Conclusion: PrEP and early ART services can be implemented within FSWs routine services in high prevalence, urban settings, with good uptake for both PrEP and early ART. Retention can be challenging among FSWs on PrEP, but those remaining in care can be consistent in attendance and reported adherence. Costs of the TAPS programme were higher than previously published, however there is potential for cost reduction at scale. The TAPS demonstration project results provided the basis for the first government PrEP and early ART guidelines and the roll out of a national sex worker plan in South Africa. 1047 HIGH PrEP UPTAKE AMONG KENYAN PREGNANT WOMEN OFFERED PrEP DURING ANTENATAL CARE John Kinuthia 1 , Jillian Pintye 2 , Kenneth K. Mugwanya 2 , Marline Serede 3 , Joseph Sila 3 , Felix Abuna 3 , Harrison Lagat 3 , Julia Dettinger 2 , Tina Schuh 2 , Jared Baeten 2 , Grace John-Stewart 2 1 Kenyatta National Hospital, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 University of Washington in Kenya, Nairobi, Kenya Background: Women in high HIV prevalence regions of sub-Saharan Africa have substantial risk of acquiring HIV during pregnancy and postpartum. The PrEP Implementation for Young Women and Adolescents (PrIYA) Project provides real-world evidence on delivering PrEP to pregnant women in Western Kenya.

1045 PREDICTORS OF WILLINGNESS TO TAKE PrEP AMONG BLACK AND LATINA TRANSGENDER WOMEN Tonia Poteat 1 , Erin Cooney 1 , Mannat Malik 1 , Thespina Yamanis 2 , Maren Lujan 2 , Andrea L. Wirtz 1 1 Johns Hopkins University, Baltimore, MD, USA, 2 American University, Washington, DC, USA Background: Black and Latina transgender women (BLTW) in the U.S. are at high risk for HIV with reported annual incidence rates as high as 3.2 per 100 person-years. While PrEP has demonstrated efficacy in multiple clinical trials and implementation projects, uptake and adherence among transgender women (TW) has been low. Adherence was only 18% among TW in the seminal iPrEx trial and did not correlate with HIV risk behavior. Efforts to promote PrEP among key populations have scaled up since FDA approval in 2012. The aims of this study were to estimate PrEP uptake and identify predictors of willingness to take PrEP among BLTW. Methods: We recruited BLTW in Baltimore, MD and Washington, DC from April 2016 – May 2017, via community health centers, outreach, and network referrals. Each participant completed a face-to-face interview in English or Spanish, followed by OraQuick Rapid HIV 1/2 test and linkage to confirmatory testing, if positive. Interviews assessed psychosocial factors and HIV risk behaviors as well as PrEP awareness, willingness, and uptake. Bivariate and multivariable logistic regression models were used to test associations between legal gender affirmation (i.e. name or gender marker that matches current identity), transgender pride (measured via Likert scale), lifetime history of exchange sex, HIV risk perception, and PrEP willingness. Multivariable modeling controlled for age and survey language. Results: Among 201 BLTW, 86% (n=174) had heard of PrEP. Of those, 80% (n=139/174) knew where to get it. Among self-reported HIV-negative or HIV- unknown BLTWwho had not taken PrEP, 78% (n=59/76) were willing to take it, yet only 39% (n=30/76) had ever done so. The small number of participants on PrEP (n=30) limited the power to detect significant predictors of PrEP uptake. On bivariate analyses, greater transgender pride, history of exchange sex, and higher HIV risk perception were positively associated with PrEP willingness, while legal gender affirmation was negatively associated. History of exchange sex and legal gender affirmation remained significant in the multivariable model. Conclusion: More than three-fourths of HIV-negative BLTW reported awareness and willingness to take PrEP. Nevertheless, uptake remains quite low. More research is needed to improve PrEP uptake as well as to explain potentially complex relationships between gender affirmation, exchange sex, and PrEP acceptability among BLTW.

Poster Abstracts

CROI 2018 401