CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

contextual factors determining PrEP adherence call for a more supportive TGW and MSM-centred approach. MSMmay require additional adherence support. 879 HIV PREVALENCE AND RISK IN MALE‚ TRANSMALE, AND TRANSFEMALE SEX WORKERS IN ZIMBABWE Mariëlle Kloek 1 , Laura Van Noord 1 , Sungai T. Chabata 2 , Sithembile Musemburi 2 , Sake De Vlas 1 , Frances Cowan 2 , Jan A. Hontelez 1 1 Erasmus University Medical Center, Rotterdam, Netherlands, 2 Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe Background: National epidemics in sub-Saharan Africa become increasingly concentrated among high risk populations. In Zimbabwe, HIV prevalence is 13.3% in the general population compared to 56.5% amongst female sex workers. HIV services have been successfully set up for female sex workers (FSW) and reached over 45.000 women. However, male and transgender sex workers remain hidden and disconnected from services. Little is known about them, while their HIV risk is expected to be high. We determined HIV prevalence and risk among male and transgender sex workers in Zimbabwe. Methods: By July 2018, the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe has integrated an outreach intervention for male and transgender sex workers within the existing program for female sex workers. Participants were recruited through peer educator referral at multiple sex work hotspots throughout the country. From July 2018 to June 2019 in total 603 male and transgender sex workers enrolled the program. Trained staff administered a sociodemographic and behavioral survey and performed HIV voluntary counselling and testing. Determinants of HIV risk were analyzed through univariate and multivariate logistic regression analysis and compared to program data from 12,315 female sex workers. Results: In total 221 male sex workers (MSW), 233 transfemale sex workers (TFSW) and 149 transmale sex workers (TMSW) were included in the study. Crude HIV prevalence estimates were 28.2% in MSW, 37.6% in TFSW and 38.1% in TMSW, compared to 36.5% in FSW. Reported risk behavior appeared high in all groups, in particular high rates of condomless vaginal sex for all groups, and high rates of condomless anal sex amongst MSW and TFSW. High rates of female clients were reported by all groups. PrEP was significantly more commonly used amongst MSW and TFSW and appeared protective for HIV. Conclusion: To our knowledge this is the first study conducted in sub-Saharan Africa specifically focused at male, transfemale and transmale sex workers. HIV prevalence among Zimbabwean male and transgender sex workers was as high as for female sex workers. High numbers of transmale sex workers and female clients give a new insight into the diversity of people participating in sex work. HIV research and interventions focused on sex work should be made inclusive for all genders. 880 FACTORS ASSOCIATED WITH HIV, HCV, AND HSV-2 SEROSTATUS AMONG US TRANSGENDER WOMEN Morgan P. Keruly 1 , Andrea L.Wirtz 2 , George Mwinnyaa 3 , Sari L.Reisner, ScD 4 , Oliver Laeyendecker 1 , for the American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group 1 NIH, Bethesda, MD, USA, 2 Johns Hopkins University, Baltimore, MD, USA, 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 Harvard University, Cambridge, MA, USA Background: Transgender women (TW) bear a disproportional burden of disease in the United States. The Leading Innovation for Transgender Women’s Health and Empowerment (LITE) study recruited subjects from six eastern and southern cities in the US. We identified factors associated with the infection of HIV, HSV-2 and HCV among TW at enrollment. Methods: Serum samples were collected from 562 TW residing in Boston (n=110), New York (n=86), Baltimore (n=108), Washington DC (n=95), Atlanta (n=67) and Miami (n=96) fromMarch 2018 to March 2019. Sociodemographic, behavioral, and socioeconomic information were obtained and log-binomial models were used to assess the prevalence ratios of factors associated with infection. Results: Of the 562 individuals, 254 (44%) were sero-negative for all three infections. The prevalence of HIV, HSV-2, and HCV were 29%, 48%, and 5% respectively. 130 (23%) had laboratory-confirmed HSV-2 only, 5%were HIV only, and 1% HCV only. 21% (119/562) were co-infected with HIV and HSV-2 and 2%were infected with all three. Compared to Boston, the prevalence of having one or more infections was higher in New York (adjPR 1.88, 95%CI 1.36, 2.6), Baltimore (adjPR 1.51, 95%CI 1.12, 2.04), Atlanta (adjPR 1.38, 95%CI 1.02,

1.88), and Miami (adjPR 1.49, 95%CI 1.10, 2.01). The frequency of disease burden increased with age, as having any one or more infections increased from 27% for those <26 to 81% for those older than 45 years of age. Compared to white TW, Black, Hispanic and mixed race TW had a higher burden of disease (adjPR 3.21 95%CI 2.25, 4.59; 2.46 95%CI 1.68, 3.61; 2.28 95%CI 1.74, 3.54, respectively). Though those who ever experienced unstable housing or were without full–time employment had higher burdens of disease, these associations were attenuated in the full model. Of note, family support was associated with a higher burden of disease (adjPR 1.29, 95%CI 1.08, 1.55). This finding can be partially explained by the greater level of family support for Black TW (69%) vs. White TW (52%). Conclusion: We found a high burden of disease among TW. Difference in disease burden were found geographically, by race and ethnicity, family support studies and with age. Surprisingly, employment status and lifetime unstable housing status were not associated with an increased risk of infection. Findings highlight the need for prospective research to further evaluate TW vulnerabilities, including for incident infections. 881 HIV PREVALENCE AMONG TRANSGENDER MEN AT AN NYC COMMUNITY HEALTH CENTER Background: There have been multiple studies demonstrating elevated incidence and prevalence of HIV among transgender women (TW) especially African-American TW, however few studies have been conducted among transgender men (TM). HIV prevalence among TM in the US is estimated to be between 0-4%. There have not been any studies examining prevalence that stratify by HIV risk factor, e.g., TMwho have sex with MSM or use injection drugs. Callen-Lorde Community Health Center is a NYC-based clinic that predominately serves the LGBT communities and people living with HIV. It has the largest transgender patient population in the USA, serving nearly 5000 transgender and gender non-binary (TGNB) patients. The aim of this study was to examine HIV screening behaviors, prevalence and risk factors among TM. Methods: The Transgender Data Project was an IRB-approved retrospective chart review of all TGNB patients at the clinic, ages 18+. Charts were reviewed manually. Data retrieved included birth sex, gender identity, race/ethnicity, education, employment, housing, insurance status, sex work, receipt of gender- affirming care (hormones, surgeries), STI history, HIV screening and HIV status. Multivariable logistic regression models were used to assess associations with HIV screening and HIV status. Results: 577 TM, mean age 32.15 (18.3-70.5, SD 9.31) were included in this analysis. The majority were white (55%white, 13.9% black, 11.7% Hispanic, 5.8% Asian/Pacific Islander,13.5%mixed race). 78.9% had received testosterone and 41.6% had received at least one gender-affirming surgery. Fewer than half (242, 41.9%) had undergone HIV screening. HIV prevalence was 2.9% (7/242) and highest among African Americans(African American 6.8%, hispanic 3.2%, white 2.1%) and among TMwho had sex exclusively with cisgender men (11.1%). HIV screening was associated with gender-affirming surgery (aOR 1.67, 95% CI=1.08, 2.58), substance use (aOR 5.18, 95%CI=1.41-18.99) and non-white race (aOR 2.56, 95% CI=1.69-3.85). Having a high school diploma reduced the odds of HIV infection (aOR 0.10, 95% CI= 0.10-0.69). Conclusion: HIV prevalence is thought to be low among TM however this analysis found an HIV seroprevalence >10% among TM who exclusively have sex with cisgender men. These results underscore the need to account for sexual risk (sexual behaviors and sexual orientation identity) among TM when interpreting HIV prevalence data. TMwho have sex with cisgender men should be prioritized for inclusion in HIV prevention efforts. 882 PROGRESSION THROUGH THE HIV CARE CONTINUUM FOR TRANSGENDER WOMEN IN THE NA-ACCORD Catherine R. Lesko 1 , Jessie K. Edwards 2 , Yuezhou Jing 1 , Richard D. Moore 3 , Michael A.Horberg 4 , Peter F. Rebeiro 5 , Ashleigh Rich 6 , Michael J. Silverberg 7 , Angel M. Mayor 8 , Joseph J. Eron 2 , Heidi M. Crane 9 , W. C. Mathews 10 , Keri N. Althoff 1 , Tonia Poteat 2 , for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 Johns Hopkins Hospital, Baltimore, MD, USA, 4 Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA, 5 Vanderbilt University, Nashville, TN, USA, 6 British Columbia Centre for Excellence Asa Radix 1 , Zil Goldstein 1 , Alexander Harris 1 , Rona Vail 1 1 Callen–Lorde Community Health Center, New York, NY, USA

Poster Abstracts

CROI 2020 329