CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: Knowledge and use of PEP/PrEP was limited among women in the study. Many factors may affect use of PEP, PrEP and TasP among women. Reporting higher risk was associated with willingness to use these biomedical prevention modalities. Further studies are needed to identify modifiable factors to improve uptake of biomedical interventions for high risk women. 1051 DEPRESSION AND PrEP ADHERENCE AMONG HIGH-RISK HIV- UNINFECTED WOMEN IN EAST AFRICA Jennifer Velloza 1 , Jared Baeten 1 , Jessica E. Haberer 2 , Kenneth Ngure 3 , Elizabeth M. Irungu 3 , Nelly R. Mugo 3 , Connie L. Celum 1 , Renee Heffron 1 1 University of Washington, Seattle, WA, USA, 2 Massachusetts General Hospital, Boston, MA, USA, 3 Kenya Medical Research Institute, Nairobi, Kenya Background: Oral pre-exposure prophylaxis (PrEP) is highly efficacious but low adherence undermines its efficacy. PrEP implementation programs are working to identify modifiable factors to improve product adherence, especially for young women. Mental health factors, particularly depression, could be associated with lower PrEP adherence. Methods: We analyzed data from 334 Kenyan and Ugandan HIV-uninfected female participants in the Partners Demonstration Project, an open-label study of integrated PrEP and ART delivery for HIV serodiscordant couples. HIV-uninfected participants completed quarterly visits over two years and were encouraged to use PrEP until their HIV-infected partners had ≥6 months of ART use. PrEP adherence was measured daily with electronic MEMS caps. Participants were considered “adherent” if MEMS data indicated that ≥80% of expected doses were taken between quarterly study visits. Depressive symptoms were assessed at enrollment, 12-month, and 24-month visits using the 16-item Hopkins Symptoms Checklist (HSCL-D); mean score ranges from 1-4 and scores >1.75 indicate “probable depression”. We used linear methods to estimate the mean HSCL-D scores between annual visits and generalized estimating equations to determine whether depressive symptoms influenced PrEP adherence. Results: The median age was 29 years (IQR: 24-35 years). At enrollment, 39 (11.7%) women reported symptoms indicating probable depression, decreasing to 9 (3.1%) at month 24 (p-value for trend <0.001). Almost all women initiated PrEP at enrollment (96.7%) and more than half stopped PrEP by their 12-month visit because of their partners’ sustained ART use (N=196; 58.7%). Low adherence to PrEP was detected at 26.9% of 1,433 quarterly study visits and occurred more often during periods when women reported probable depression (41.1% of visits) relative to periods without depression (25.9% of visits). Probable depression during follow-up was significantly associated with reduced PrEP adherence after adjusting for site, age, pregnancy status, any unprotected sex acts, and relationship satisfaction with their study partner (aRR=0.70; 95% CI=0.50-0.98; p-value=0.04). Continuous HSCL-D score was similarly associated with reduced PrEP adherence (aRR=0.75; 95% CI=0.56-0.99; p-value=0.05). Conclusion: Depression was relatively uncommon and was associated with lower PrEP adherence in this sample. Integration of depression screening and treatment into PrEP delivery programs may improve PrEP effectiveness among African women. 1052 REPORTED PrEP USE AMONG HIV-NEGATIVE PARTNERS OF US MSM RECEIVING HIV MEDICAL CARE Linda Beer, R. L. Shouse, Dawn K. Smith , Amy R. Baugher, Jennifer Fagan CDC, Atlanta, GA, USA Background: Pre-exposure prophylaxis (PrEP) is efficacious for reducing HIV transmission and has the potential to drastically reduce HIV incidence. Lower PrEP use among groups most vulnerable to HIV may reduce PrEP’s impact, especially for the partners of HIV-positive persons who are not virally suppressed. However, population-based data are lacking. Methods: The Medical Monitoring Project (MMP) is a surveillance system that produces representative estimates of HIV-positive adults receiving medical care in the United States. Using weighted interview and medical record data collected 6/2014-5/2015, we examined the prevalence of reported partner PrEP use in discordant HIV status sexual partnerships among 918 HIV-positive MSM, and the association of partner PrEP use with viral suppression of the HIV- positive person. We examined partner-level factors associated with PrEP use among 1912 HIV-negative/unknown status (“HIV-negative”) partners; among partners not on PrEP, we evaluated associations with HIV-positive MSM partners having durable viral suppression using Rao-Scott χ2 tests.

scale. Women interested in PrEP were enrolled regardless of initial decision to initiate PrEP. PrEP ‘acceptors’ were randomized to standard adherence support (cognitive behavioral counseling, 2-way SMS, and adherence clubs) or enhanced adherence support based on drug level feedback at 8 and 13 weeks plus standard adherence support, with follow-up for one year. Results: Of 434 enrolled, 396 initiated PrEP at and 13 after enrollment (94%) and 25 (6%) declined PrEP. Median age was 21 years. The median VOICE risk score was 7 in both acceptors and decliners (maximum score=10; score ≥5 associated with 6-8% HIV incidence in prior cohorts). 84% of acceptors reported a primary sex partner-60%were thought to be HIV negative, 19% of unknown status, and 1% HIV positive (21%missing data). Most acceptors thought their partners had other partners (24%) or were not sure (60%). Most acceptors reported risk behaviors - 66% inconsistent or infrequent condom use, 22% transactional sex in the past 3 months, and 50% intimate partner violence in the past year. STI prevalence was high: 30% C.trachomatis, 8% N. gonorrhoeae, and 7% T. vaginalis. 41% had depression based on a CES-D-10 score ≥11. Motivation for pregnancy prevention was high; 80% reported it was very important to them to not become pregnant in the next year and 71%were using contraception other than condoms. Only 16% reported a moderate or high chance of acquiring HIV in the next year. Of acceptors, 62% had a friend encourage them to take PrEP, 94% reported they were ready to start PrEP, 81% planned to tell family and friends about PrEP use, 94% thought they could take it daily, and 39% anticipated side effects. Conclusion: Uptake of PrEP is very high among young African women participating in HPTN 082. A majority felt they could take PrEP daily and planned to disclose PrEP use. Women in HPTN 082 are appropriate for PrEP, given risk behaviors and high STI prevalence. 1050 HIV BIOMEDICAL PREVENTION AMONG US WOMEN: KNOWLEDGE, BELIEFS, AND PRACTICES Seble Kassaye 1 , Lakshmi Goparaju 1 , Amanda D. Castel 2 , Lari Warren-Jeanpiere 1 , Anandi N. Sheth 3 , Adaora Adimora 4 , Margaret Fischl 5 , Elizabeth T. Golub 6 , Kathleen M. Weber 7 , Jennifer Cohen 8 , Oluwakemi Sosanya 9 , Anna Rubtsova 3 , Deborah Konkle-Parker 10 , Tracey Wilson 11 , Chenglong Liu 1 1 Georgetown University, Washington, DC, USA, 2 George Washington University, Washington, DC, USA, 3 Emory University, Atlanta, GA, USA, 4 University of North Carolina Chapel Hill, Chapel Hill, NC, USA, 5 University of Miami, Miami, FL, USA, 6 Johns Hopkins University, Baltimore, MD, USA, 7 Cook County Health & Hospitals System, Chicago, IL, USA, 8 University of California San Francisco, San Francisco, CA, USA, 9 Montefiore Medical Center, Bronx, NY, USA, 10 University of Mississippi, Jackson, MS, USA, 11 SUNY Downstate Medical Center, Brooklyn, NY, USA Background: Though biomedical HIV prevention measures including post- exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) are now available, U.S. women’s knowledge, attitudes, and behavior (KAB) about PEP, PrEP and TasP are limited. We sought to identify important barriers and disparities to women’s access. Methods: A nested cross sectional survey among 2406 participants (1690 HIV+ and 716 HIV-) in the Women’s Interagency HIV Study (WIHS) assessed PEP, PrEP and TasP KAB. Data collected in 2014-2015 included questions about HIV testing and risk perception, sexual partners, current medication adherence, PEP, PrEP and TasP awareness and experience, stigma, and prevention beliefs. We used logistic regression to assess factors associated with willingness to use PEP, PrEP or TasP, respectively, and only included those variables statistically significant in univariate analyses into multivariate models. Results: Mean age of the sample was 47 years, and the majority (72%) were Black. Only 20% of women had heard of PEP and 14% had heard of PrEP. In multivariate analyses, HIV(-) women who would recommend PEP to others (Odds Ratio (OR): 20; 95% confidence interval (CI): 11-37; P < 0.0001) or thought they were at higher risk of HIV infection (OR: 2.2; 95% CI: 1.2-4.2; P = 0.015), were more willing to take PEP. Whereas older women (OR:0.95; 95%CI: 0.92-0.98; P = 0.001) and Black women (OR: 0.34; 95% CI: 0.12-0.96; P = 0.042) were less willing to use PrEP, women with casual sexual partners (OR:0.36; 95% CI:0.14-0.91; P = 0.030), those who believed PrEP will prevent HIV (OR:7.28; 95% CI: 1.92-27.68; P = 0.004), and those willing to recommend PrEP to others (OR; 95%CI; P<0.001) reported willingness to take PrEP themselves. No women in the sample were on PrEP at the time of the study. Interest in learning more about TasP was independently associated with willingness to take PEP/PrEP to prevent transmission to others (OR: 3.09; 95% CI: 1.1-8.7; P = 0.033) among HIV+ women.

Poster Abstracts

CROI 2018 403