CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Results: In all, 10% (95% confidence interval [CI] 8-13) of MSM with HIV- negative partners in the past 12 months reported having ≥1 partner on PrEP. MSM reported that 6% (CI 4-7) of their partners were on PrEP, 67% (CI 63-71) were not on PrEP but the HIV-positive person was virally suppressed, and 27% (CI 23-31) were not on PrEP and the HIV-positive person was not virally suppressed. MSM reported that PrEP use was more prevalent among white compared with black and Hispanic/Latino partners, and among partners with whom they had condomless receptive anal intercourse (Table). Reported partner PrEP use was not associated with viral suppression of the HIV-positive person or partner age. Among HIV-negative partners not on PrEP, black and younger persons were more likely to be the partner of a person who was not virally suppressed. Among HIV-negative partners not on PrEP, condomless receptive anal intercourse was more common when the HIV-positive person was virally suppressed. Conclusion: Reported PrEP use by partners of MSM in HIV care in the US was low, and over ¼were not on PrEP and were the partners of a person who was not virally suppressed. Reported PrEP use was lower among blacks and Hispanics, and among younger and black partners of MSM who were not virally suppressed. These data may help inform efforts to increase viral suppression among MSM and expand PrEP use in partnerships.

Conclusion: Delivering PrEP at scale for HIV serodiscordant couples in public HIV clinics in Kenya is feasible, with >1000 PrEP initiations done in 6 months at 24 clinics.

1054 NO RISK COMPENSATION BUT HIV EXPOSURE PERSISTS IN HETEROSEXUAL COUPLES USING PrEP

Kenneth K. Mugwanya 1 , Renee Heffron 1 , Nelly R. Mugo 2 , Elizabeth A. Bukusi 2 , Elly T. Katabira 3 , Stephen Asiimwe 4 , Kenneth Ngure 5 , Connie L. Celum 1 , Jared Baeten 1 1 University of Washington, Seattle, WA, USA, 2 Kenya Medical Research Institute, Nairobi, Kenya, 3 Makerere University College of Health Sciences, Kampala, Uganda, 4 Kabwohe Clinical Research Center, Kabwohe, Uganda, 5 Kenyatta University, Nairobi, Kenya Background: Wide-scale implementation of pre-exposure prophylaxis (PrEP) for HIV prevention is underway in several settings but concerns remain about the potential for increased HIV risk taking in persons using PrEP. We evaluated sexual behavior in heterosexual HIV serodiscordant couples enrolled in a programmatic PrEP demonstration project in Kenya and Uganda. Methods: Data were from the Partners Demonstration Project, an open label implementation study of integrated PrEP and antiretroviral treatment among 1013 high risk African heterosexual HIV serodiscordant couples conducted between November 2012 and June 2016. HIV uninfected partners were followed 3-monthly for up to 24 months with HIV testing, adherence and behavioral risk assessments, and comprehensive HIV prevention counseling. Results: Overall, 985 HIV-uninfected partners initiated PrEP: 33% (329) were female and median age was 29 years (IQR 26-36). The proportion of HIV- uninfected partners reporting any condomless sex declined during follow-up from 67% at baseline to 37% at month 3 (p<0.01), thereafter remaining relatively stable through 12 months; behavior as reported by the HIV-infected partners revealed a similar pattern: 68% at baseline to 32% at month 3 (p<0.01). A similar pattern occurred for both women and men and for younger and older persons (i.e., ≤25 vs >25 years of age), although the frequency of sex without condoms tended to be higher among younger persons compared to older persons: 47% vs 33% at month 3, and 48% vs 31% at month 6, 46% vs 32% at month 12 (p<0.05 for all). Conclusion: In this PrEP demonstration project in African HIV serodiscordant couples, self-reported condomless sex was common at PrEP initiation and declined by half during follow-up. Risk was higher at baseline and more likely to persist among younger HIV-uninfected partners. 1055 TDF/FTC PrEP, LUBRICANT USE, AND THE RECTAL MUCOSAL MICROBIOTA AMONG HIV-NEGATIVE MSM Colleen F. Kelley 1 , Jeffrey Fountain 2 , Angela Holder 2 , Chuong Dinh 2 , LaShonda Hall 1 , Sheila Heeke 1 , Yingtian Hu 1 , Colleen S. Kraft 1 , Nicole A. Pescatore 1 , Yijuan Hu 1 , Clyde Hart 2 , Richard Haaland 2 1 Emory University, Atlanta, GA, USA, 2 CDC, Atlanta, GA, USA Background: We previously reported that the rectal mucosal (RM) microbiota of men who have sex with men (MSM) engaging in receptive anal intercourse was enriched for Prevotellaceae; the mechanism for this enrichment and effect on clinical outcomes are unclear. We evaluated the effect of hyperosmolar lubricant and oral TDF/FTC on the RMmicrobiota among HIV-negative MSM. Methods: HIV-negative MSM engaging in receptive anal intercourse were randomly assigned to take daily, oral Tenofovir/Emtricitabine (TDF/FTC) (n=20), apply 4 ml of hyperosmolar lubricant to the rectum (n=16), or both (n=20) for 7 days. RM secretions were collected via rigid sigmoidoscopy before product use and on day 8 for 16s rRNA sequencing by Illumina MiSeq and clustered into Operational Taxonomic Units. Levels of tenofovir (TFV) and FTC in rectal secretions and intracellular tenofovir-diphosphate, emtricitabine-triphosphate in blood and rectal biopsies were measured by HPLC-mass spectrometry. Shannon index (a diversity measure) and microbiota composition were evaluated before and after product use, and changes were compared across different products via linear regression modeling. Associations of diversity and microbiota composition with TDF/FTC drug levels were also evaluated. Results: Rectal application of hyperosmolar lubricant was associated with increased RMmicrobiota diversity as measured by Shannon Index (median before 2.48 vs. after 2.64; p=0.006), a decrease in the relative abundance of the Bacteroides genus (median before 21.4% vs. after 8.9%; p=0.02), and a trend toward increased Prevotella genus (median before 4.8% vs. after 11.3%; p=0.09) (Figure). Oral TDF/FTC dosing was not associated with differences in

Poster Abstracts

1053 RAPID SCALE-UP OF PrEP FOR HIV SERODISCORDANT COUPLES IN HIV CARE CLINICS IN KENYA Elizabeth M. Irungu 1 , Kenneth K. Mugwanya 2 , Nelly R. Mugo 2 , Elizabeth A. Bukusi 1 , Kenneth Ngure 2 , Josephine Odoyo 1 , Elizabeth Wamoni 3 , Sarah Masyuko 4 , Jennifer F. Morton 2 , Lara Kidoguchi 2 , Gena Barnabee 2 , Gabrielle O’Malley 2 , Jared Baeten 2 1 Kenya Medical Research Institute, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 Partners in Health Research and Development, Thika, Kenya, 4 National AIDS and STD Control Programme, Nairobi, Kenya Background: In 2016, the Kenya Ministry of Health released guidelines recommending pre-exposure prophylaxis (PrEP) for persons at risk of acquiring HIV. As part of Kenya’s national roll-out of PrEP, we are conducting a national scale up of PrEP for HIV uninfected members of HIV serodiscordant couples, integrated into antiretroviral treatment (ART) clinics (the Partners Scale-Up Project). Methods: Between January and July 2017, we trained health providers using a 2-day, case-based interactive curriculum and began PrEP implementation in 24 high volume HIV care clinics in Western and Central Kenya in a phased manner, using a randomized stepped wedge design and following Kenya national PrEP programmeasures and training. At baseline and monthly thereafter, program indicators for numbers undergoing couple HIV testing and initiating PrEP and ART were obtained from all clinics. We compared the frequency of PrEP initiation prior and after clinics started implementation, using generalized mixed models adjusted for clustering and time trends. Results: Over the first ~6 months of the project, the number of HIV-uninfected partners initiating PrEP in HIV treatment clinics significantly increased from 146 prior compared to 1372 after clinics started implementation (p<0.01), and the number initiating per month increased each month of the period. Of those initiating PrEP, 52%were female and their median age was 32 years (IQR, 27 to 39). Overall, 716 public health staff, including nurses, clinical officers and HIV counsellors in 24 clinics were trained.

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