CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

PrEP navigation; this analysis includes participants who were PrEP-naïve and completed baseline and 3-month study visits. Results: Of 171 patients (31%≤ 25 years; 90% cis male; 57% Black or Latinx), 74% accepted navigation, 53% accepted PrEP referral, 37% initiated PrEP, and 27%were still on PrEP at 3-months. PrEP referral, initiation, or persistence were not associated with HIV risk behavior, belief in PrEP effectiveness, or desire for condomless sex. The strongest predictor of PrEP outcomes at every step of the cascade was a 6-itemmeasure of personal PrEP efficacy (Fig. 1), including positive attitudes toward PrEP pills, self-efficacy for pill-taking, and confidence in PrEP’s ability to work “for me.” All cascade outcomes were positively associated with HIV worry; PrEP initiation and sustained use were negatively associated with medical mistrust. Perceived HIV risk was not associated with navigation acceptance, referral, or PrEP initiation, but was negatively associated with sustained PrEP use at 3-months (aOR=.97, 95% CI .95-.99). Conclusion: These data are some of the first to identify specific, modifiable targets for psychosocial intervention to optimize PrEP cascade outcomes in the context of sexual health clinic navigation. In contrast to focusing on risk behavior, risk perception, or effectiveness, these data suggest the importance of messaging and counseling that enhances self-efficacy beliefs, promotes PrEP as an antidote to HIV worry, and builds trust. Findings can inform development of interventions to be tested in implementation science RCTs in public clinics.

reasons for non-daily use were not consistently engaging in sexual activity (59%), high cost of PrEP (49%), concerns about potential long-term side effects (39%), not engaging in sex perceived as high-risk for HIV (37%), and planning sex in advance (25%). Conclusion: In this national sample, interest in non-daily PrEP was high, and 5% of recent PrEP users reported non-daily dosing. Given the use of non-daily strategies that have not been evaluated in clinical studies, there is an urgent need for US public health authorities to provide clear guidance for safe and effective non-daily dosing options. 988 EFFECTIVENESS OF PrEP NAVIGATION MODELS IN THE THRIVE DEMONSTRATION PROJECT Kirk D. Henny 1 , Weiming Zhu 1 , Kenneth L.Dominguez 1 , Kashif Iqbal 1 , Mary Tanner 1 , Karen W. Hoover 1 1 CDC, Atlanta, GA, USA Background: HIV pre-exposure prophylaxis (PrEP) uptake has been suboptimal among populations with the highest rates of HIV diagnoses, including men who have sex with men (MSM) of color. Effective navigation models for PrEP clinical care can help persons at risk of acquiring HIV to initiate, adhere to, and persist with PrEP. PrEP providers currently lack evidence-based models for PrEP service navigation. The THRIVE demonstration project funded seven state health departments to develop collaboratives comprised of community-based organizations (CBOs) and clinical providers to implement comprehensive HIV prevention and care services for MSM of color. THRIVE used several different PrEP navigation models in the demonstration project. Methods: We analyzed cohort data of 8,339 MSM of color enrolled in THRIVE from September 2015 through March 2019. Study locations included Alabama, Baltimore, Louisiana, New York City, Philadelphia, Virginia and Washington (DC). We estimated the number of MSM of color who were eligible for and linked to PrEP care. We explored possible navigation models based on the following navigation components common across all seven jurisdictions: navigator education (professional with a college or higher vs. peers from the community with no formal educational requirement) and source of navigation protocol development (health department or clinic/CBO); three navigation models were identified. We conducted multivariable regression analyses [risk ratio, 95% confidence intervals (CI)] to estimate the associations between type of PrEP navigation model and linkage to care. Results: Among 4,999 MSM of color who were eligible for PrEP, 4,227 (84.6%) were linked to care. Our analyses identified three navigation models. We found that navigation models that combined professional and peer navigators with protocols designed by clinics/CBOs were more than 3 times as likely to link eligible clients to PrEP compared to navigation models that combined peer navigators with protocols designed by health departments (88.8% vs. 21.5%) (RR: 3.48, 95% CI=2.61–4.62). Conclusion: Navigation models that included professional navigators and CBO-developed protocols were more effective for increasing linkage to PrEP healthcare services. Our analyses of interim data from the THRIVE demonstration project provide evidence to guide the development of PrEP navigation models that can be used in U.S. jurisdictions funded by the Ending the HIV Epidemic federal initiative.

Poster Abstracts

987 NONDAILY USE OF HIV PREEXPOSURE PROPHYLAXIS IN A LARGE ONLINE SAMPLE IN THE US Whitney C. Sewell 1 , Victoria Powell 2 , Douglas Krakower 3 , Kenneth H. Mayer 2 , Aileen Ochoa 4 , Julia L. Marcus 1 1 Harvard University, Cambridge, MA, USA, 2 Fenway Health, Boston, MA, USA, 3 Beth Israel Deaconess Medical Center, Boston, MA, USA, 4 Harvard Pilgrim Health Care Institute, Boston, MA, USA Background: Event-driven dosing of HIV preexposure prophylaxis (PrEP) using a 2-1-1 strategy has been shown to be efficacious in reducing HIV risk for men who have sex with men (MSM). However, data on interest in and use of non- daily PrEP in the US are limited. Methods: We developed a survey to assess interest in and experiences with PrEP, including non-daily use, among HIV-negative adults in the US. We distributed the survey nationally in May 2019 on geosocial networking sites commonly used by MSM. We used chi-square tests and t-tests to identify factors associated with interest in and use of non-daily PrEP. Results: Our study sample included 9,697 respondents. Mean age was 43 years, 67%were non-Hispanic white, and 90%were MSM. Nearly all (96%) had heard of PrEP, 40% had ever used PrEP, and 33% had used PrEP in the last 6 months. Interest in non-daily PrEP was high (67%). A greater proportion of those interested in non-daily than daily PrEP were aged <30 years (21% vs 18%, P=0.013), had no graduate degree (76% vs 71%, P<0.001), had annual income <$80,000 (76% vs 73%, P=0.02), and were uninsured (11% vs. 9%, P<0.001). Of the 3232 who used PrEP in the past 6 months, only 5% used non-daily dosing. Non-daily dosing strategies included event-driven (49%), regular but not daily use (e.g., on days of the week starting with T or S; 24%), daily but only for short periods (e.g., on vacations; 19%), and other strategies (8%). Of the 85 using event-driven dosing, 65% used the 2-1-1 strategy; the remaining 35% used a variety of strategies, including daily dosing for a week before and after sex, 1 pill before and after sex, or 1 pill around the time of sex. A greater proportion of non-daily than daily users had annual income ≥$80,000 (36% vs 30%, P=0.04) and always planned sex in the past 6 months (21% vs 11%, P=0.007). Common

989 TURNING INTENT INTO ACTION: ASSESSING PrEP UPTAKE AT A PUBLIC STI CLINIC Kate Drezner 1 , B.W. Furness 2 , Chantil Thomas 1 , Jason Beverley 1 , Adam Allston 1 , Adam Visconti 1 1 District of Columbia Department of Health, Washington, DC, USA, 2CDC, Atlanta , GA, USA Background: Consistently taking pre-exposure prophylaxis (PrEP) reduces the risk of acquiring HIV by almost 90%. Washington, DC has a high incidence of HIV

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