CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We analyzed data collected 2017-2019 from the Washington HIV/ STI Prevention Project (WHSPP), a statewide online survey, and an annual paper-based survey administered to men attending the Seattle Pride Parade in June of each year. Samples from both surveys were restricted to cisgender males residing in King, Pierce, and Snohomish counties who reported sex with a man in the past 12 months (N=213-291 for Pride surveys and 463-726 for WHSPP). To adjust for differences in sample composition between the surveys, we used a raking procedure to standardize the samples by age, race/ethnicity, education, sexual orientation, and county. We classified respondents as high risk if they reported any of the following in the past year: bacterial STI diagnosis, use of methamphetamine or poppers, ≥10 male anal sex partners, or condomless anal sex with an HIV-positive or unknown-status partner. For each year, we calculated the proportion of high-risk men who reported awareness, interest, and current use of PrEP, and we used logistic regression to test differences by calendar time and survey source. Results: After adjusting for demographic variables and calendar time, estimates from the Pride and WHSPP surveys were similar for all three outcomes (p=0.2- 0.4). The proportion of high-risk MSMwho had heard of PrEP increased over time (p<0.001) from 84% in 2017 to approximately 96% in 2019 (Figure 1). The proportion of men who reported use of PrEP or expressed interest in starting PrEP (a measure of total demand) remained stable over time at around 66% (p=0.7). Current use of PrEP increased from 33% in 2017 to 43-46% in 2019 (p<0.001). Conclusion: Awareness of PrEP increased among high-risk MSM in western Washington State from 2017-2019, but did not lead to increases in demand. The proportion of high-risk men using PrEP increased, tracking well with local prevention targets. Although the representativeness of samples from both surveys is unknown, the concordance in estimates supports continued use of these low-cost methods to monitor trends and inform ongoing HIV prevention efforts.

every 90 days. Additional investigations are needed to understand the factors influencing HIV testing frequency among MSM and TGW of color.

984 IMPLEMENTATION OF MOBILE PrEP, STI, AND HIV-PREVENTION SERVICES IN SOUTH FLORIDA Susanne Doblecki-Lewis 1 , Erin Kobetz 1 , Stefani A. Butts 1 , Katherine Klose 1 , Angela M. McGaugh 1 , Brian B. Leon 1 , Gilianne Narcisse 1 , Jessica Morel 1 , Yue Pan 1 , Gabriel Cardenas 1 , John Byrne 2 , Patrick Whiteside 2 , Marco Torrealba 2 , Daniel J. Feaster 1 , Mario Stevenson 1 1 University of Miami, Miami, FL, USA, 2 Prevention305, Miami, FL, USA Background: Pre-Exposure Prophylaxis (PrEP) can substantially reduce HIV incidence among those at risk for acquisition. To achieve population-level impact, effective dissemination of PrEP to priority groups in areas with a high incidence of HIV, such as black and Hispanic men who have sex with men (MSM) living in South Florida, is needed. To address multiple social, logistical, and structural barriers to PrEP uptake, we implemented PrEP/HIV and sexually transmitted infections (STI) services combined with cancer screening through the Sylvester Gamechanger vehicle. We describe demographics, utilization, and early retention in PrEP care during the first year of operation. Methods: The mobile clinic was positioned at 4 sites in Miami with high HIV incidence with input from community stakeholders. Key program personnel were a medical provider, HIV/PrEP counselors, and a pharmacist. In addition to self-referrals, Prevention305 and Latino Salud, community-based organizations, developed focused patient recruitment through social media. All services were provided at no cost. Normative demographics, risk behavior, STIs, and early-maintenance-in-care data, were collected. Descriptive statistics were compiled using SPSS. Results: From September 2018 to September 2019 services were provided to 429 clients. Of these, 266/429 (62%) sought PrEP. Of PrEP clients, 223 (83.8%) identified as Hispanic, 19 (7.1%) as non-Hispanic Black, 17 (6.4%) as non- Hispanic White, and 7 (2.6%) as other. 194/265 (73.2%) were foreign-born; 233/266 (87.6%) of PrEP clients identified as MSM (66.2%MSM only, and 21.4% MSMW). Ten (3.8%) PrEP-seeking clients were HIV positive at baseline. Of these, 2 were identified as acute/early infections. Among clients assessed for PrEP, an initial PrEP prescription was filled by 239/251 (95.2%). Of the 175 clients seen within the initial 6 months of operation, 129 (74%) completed a follow-up visit. Overall, 74/307 (24.1%) PrEP clients had positive STI results (gonorrhea, chlamydia, or syphilis) at baseline. STI treatment delivery on the mobile clinic began in August, 2019. Conclusion: Implementation of HIV-PrEP prevention and STI services using a mobile clinic model is acceptable and effective in engaging Hispanic/Latino immigrant MSM at risk for HIV and STIs. Low-barrier-to-entry services delivered through a mobile clinic inclusive of other prevention services can be an effective method for engagement of priority populations with difficulty accessing traditional clinic settings. 985 PrEP USE APPROACHING 50% AMONG HIGH-RISK MSM IN WESTERN WASHINGTON Darcy W. Rao 1 , Julia Hood 2 , Rachel Wittenauer 1 , Kelly Naismith 3 , Jonathon Downs 3 , Matthew R. Golden 1 1 University of Washington, Seattle, WA, USA, 2 Public Health–Seattle & King County, Seattle, WA, USA, 3 Washington State Department of Health, Tumwater, WA, USA Background: Washington State and Public Health—Seattle & King County promote the use of HIV pre-exposure prophylaxis (PrEP) among persons at elevated risk for HIV and provide financial support to help cover PrEP-related costs. To monitor progress towards a target of 50% uptake among high-risk men who have sex with men (MSM) by 2020, we compared estimates from two ongoing surveys of Washington State MSM.

Poster Abstracts

986 OPTIMIZING PrEP CASCADE OUTCOMES FOR SEXUAL HEALTH CLINIC NAVIGATION Sarit A. Golub 1 , Zoe D. Unger 1 , Ashanay S. Allen 1 , Chibuzo U. Enemchukwu 1 , Christine M. Borges 2 , Preeti Pathela 2 , Trevor Hedberg 2 , Anisha Gandhi 2 , Zoe R. Edelstein 2 , Julie Myers 2 1 Hunter College, CUNY, New York, NY, USA, 2 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: Sexual Health and STI clinics are increasingly integrating PrEP navigation services to identify, refer and link eligible patients to PrEP. Increasing the effectiveness of these programs requires optimizing each step of the PrEP cascade, i.e., acceptance of navigation and referral, PrEP initiation, and sustained PrEP use. Epidemiological data have focused almost exclusively on demographic predictors of cascade outcomes, which are not amenable to behavioral intervention. This implementation science study examined modifiable psychosocial predictors of cascade outcomes that can guide targeted intervention efforts. Methods: Data were collected as part of an NIH-funded sub-study of a PrEP navigation program in 8 NYC public sexual health clinics. Between Feb 2017 and Aug 2018, we recruited 279 patients with program-specific indications for

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