CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We approached HIV-uninfected pregnant women seeking routine antenatal (ANC) services at 10 maternal and child health clinics in Kisumu County, Kenya from June to August 2017. Women were screened for behavioral risk factors and willingness for PrEP counseling according to national PrEP guidelines. Women who wanted to consider PrEP were counseled on PrEP and assessed for medical eligibility. Eligible women willing to initiate PrEP received oral PrEP. Results: We screened 1,008 pregnant women for willingness to be counseled for PrEP. The median age was 23 years (interquartile range 20-28) and 57% of women were ≤24years. Overall, 347 (34%) women accepted PrEP counseling. Compared to women who declined PrEP counseling, women who accepted more frequently had a partner of unknown HIV status (81% vs 19%, p<0.001), engaged in transactional sex (3% vs 1%, p=0.02), were forced to have sex (2% vs 1%, p=0.02) and were diagnosed with STIs (6% vs 1%, p<0.001) in the last 6 months. Acceptance of PrEP counseling was similar among women ≤24 and >24 years (35% vs 33%, p=0.55). There were no differences in gestational age between women who accepted and declined PrEP counseling (median 28 [IQR 24-32] vs 28 [IQR 23-34] weeks, p=0.26). Of the 347 women counseled for PrEP, one woman (<1%) was medically ineligible, and 252 (73%) wanted to initiate PrEP and were prescribed PrEP the same day. Compared to women who did not choose to initiate PrEP, initiators more frequently had a known HIV-infected partner (9% vs 2%, p<0.001) and >1 sex partner (6% vs 1%, p=0.04). Women in polygamous marriages more frequently initiated PrEP than women in monogamous marriages (88% vs 71%, p=0.05). PrEP initiators less frequently reported any fears about starting PrEP than women who did not initiate (4% vs 59%, p<0.001). Among women who did not initiate PrEP, the most frequently reported fears were pill burden (28%) and stigma (13%). Conclusion: It was feasible to implement PrEP during ANC in a high HIV prevalence region. A substantial proportion of pregnant women chose to initiate PrEP (25% overall, 73% of those counseled on PrEP). Pregnant women who chose to start PrEP more frequently had risk factors for HIV than those who did not. 1048 PREDICTORS OF PrEP ELIGIBILITY AMONG AT–RISK WOMEN IN THE SOUTHERN UNITED STATES Anar S. Patel 1 , Lakshmi Goparaju 2 , Jessica M. Sales 1 , Cyra Christina Mehta 1 , Oni J. Blackstock 3 , Dominika Seidman 4 , Igho Ofotokun 1 , Mirjam-Colette Kempf 5 , Margaret Fischl 6 , Elizabeth T. Golub 7 , Adaora Adimora 8 , Audrey French 9 , Gina Wingood 1 , Seble Kassaye 2 , Anandi N. Sheth 1 1 Emory University, Atlanta, GA, USA, 2 Georgetown University, Washington, DC, USA, 3 Montefiore Medical Center, Bronx, NY, USA, 4 University of California San Francisco, San Francisco, CA, USA, 5 University of Alabama at Birmingham, Birmingham, AL, USA, 6 University of Miami, Miami, FL, USA, 7 Johns Hopkins Hospital, Baltimore, MD, USA, 8 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 9 Cook County Health & Hospitals System, Chicago, IL, USA Background: Women of color in the South have disproportionately high rates of new HIV infections, but low use of HIV pre-exposure prophylaxis (PrEP). Mechanisms to best identify US women eligible for PrEP are lacking, which contributes to limited PrEP uptake. Identifying factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk for HIV. Methods: We applied CDC criteria for PrEP use to at-risk HIV negative women enrolled in the Southern sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women’s Interagency HIV Study (WIHS) from 2014-15 to estimate PrEP eligibility. PrEP eligibility was determined using number of male sex partners, partner HIV status, condom use, and injection drug use in the past 6 months. Factors associated with PrEP eligibility were assessed using unadjusted odds ratios (OR) and 95% confidence intervals (CI). PrEP willingness and use was determined at baseline visit. Results: Of 225 women, 187 (83%) identified as African-American, median age was 45 years, and 120 (53%) had health insurance. In the past 6 months, 43% reported ≥ 2 partners, 7.1% had a partner with HIV, and 11.1% reported a sexually transmitted infection. Overall, 72 (32%) women met CDC criteria for PrEP; the most common PrEP indicator was condomless sex (25.5%). Education of ≤ high school (OR 2.66, CI 1.45, 4.85); experienced physical violence (OR 2.56, CI 1.07, 6.13), sexual violence (OR 4.74, CI 1.56, 14.44) or engaged in transactional sex (OR 3.99, CI 1.76, 9.06) in the last 6 months; non-injection drug use in the last 6 months (OR 2.07, CI 1.15, 3.72); and any previous incarceration (OR 1.87, CI 1.05, 3.36) were associated with PrEP eligibility (Table 1). Further, self-perception of

HIV risk (medium vs low/none OR 3.46, CI 1.52, 7.88; high vs low/none OR 16.44, CI 5.28, 51.18) was highly predictive of PrEP eligibility. At baseline, 24 (11%) women previously heard of PrEP, and only 1 reported prior use. Overall, 189 (84%) were willing to take PrEP, including the majority of PrEP-eligible women (86%). Conclusion: Nearly one-third of Southern HIV negative WIHS women were eligible for PrEP. Extremely low PrEP awareness and use despite high acceptability signify a critical need to enhance PrEP delivery for women in this region. Supplementing CDC eligibility criteria with questions about violence, transactional sex, incarceration, non-injection drug use and HIV risk self- assessment may enhance PrEP screening and uptake among US women.

Poster Abstracts

1049 RISK BEHAVIOR, PERCEPTION, AND REASONS FOR PrEP AMONG YOUNG AFRICAN WOMEN IN HPTN 082 Connie L. Celum 1 , Sinead Delany-Moretlwe 2 , Sybil Hosek 3 , Bonnie J. Dye 4 , Linda-Gail Bekker 5 , Nyaradzo Mgodi 6 , Wonderful Mabuza 2 , Goodness Zoh Mvuyane 5 , Shorai Mukaka 6 , Deborah J. Donnell 7 , Subash Pathak 7 , Heather Noble 7 , Denni Lennon 8 , Jessica M. Fogel 8 , Peter L. Anderson 9 1 University of Washington, Seattle, WA, USA, 2 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 3 Stroger Hospital of Cook County, Chicago, IL, USA, 4 FHI 360, Durham, NC, USA, 5 University of Cape Town, Cape Town, South Africa, 6 University of Zimbabwe, Harare, Zimbabwe, 7 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 8 Johns Hopkins Hospital, Baltimore, MD, USA, 9 University of Colorado Anschutz Medical Campus, Aurora, CO, USA Background: Oral pre-exposure prophylaxis (PrEP) is highly effective when used consistently, and recommended for people at substantial risk of HIV infection. Young women in sub-Saharan Africa are an important population who could benefit from PrEP, but may experience barriers to consistent use. Strategies are needed to support PrEP uptake and adherence in this population. Methods: HPTN 082 is an open label PrEP study in Cape Town and Johannesburg, South Africa and Harare, Zimbabwe, enrolled sexually active HIV-negative women ages 16-25 using the VOICE risk score and a PrEP readiness

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