CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

(360 new cases in 2018) which disproportionately affects people of color (71.1% Black and 9.2% Latinx). The DC Health and Wellness Center began prescribing PrEP in 2016 to start and maintain men who have sex with men (MSM) and transgender women of color on PrEP at low or no cost to them. We assessed differences between patients on PrEP <1 month and those on ≥1 month. Methods: Demographics and reasons for starting PrEP were collected in REDCap at initiation. Eligible patients received PrEP, scheduled a follow-up visit, and agreed to additional follow-ups every 3 months. REDCap data were merged with medical records to determine time on PrEP. Chart reviews were done to establish duration of therapy. Patients taking PrEP <1 month and ≥1 month were compared using chi-square analysis and multivariate logistic regression to explore the associations of race/ethnicity, age, gender identity, and insurance status. Results: From August 2016 - December 2018, 530 people were prescribed PrEP; 81.7%were people of color (47.2% Black, 28.5% Latinx, and 6.0% other), 80.2%were MSM, 10.0%were cisgender women, and 3.6%were transgender women. Of these, 280 (52.8%) were still on PrEP at ≥1 month and 250 (47.2%) were not. Likelihood of being on PrEP ≥1 month increased with age (AOR: 1.02, 95% CI 1.00-1.04). Patients on PrEP ≥1 month were less likely to be transgender women (AOR: 0.089, 95% CI 0.019-0.41) or cisgender women (AOR: 0.21, 95% 0.095-0.46) compared to cisgender men. Those with private (AOR: 0.52, 95% CI 0.33-0.81) or public insurance (AOR: 0.24, 95% CI 0.14-0.40) were less likely to still be on PrEP at ≥1 month compared to those with no insurance. Conclusion: This study shows that PrEP prescribing can successfully occur at a safety-net, public STI clinic with a high volume of persons of color and underinsured. The model of direct, immediate, and costless provision of initial medication with on-site enrollment in drug assistance programs could be responsible for increased uptake among uninsured individuals. The addition of a PrEP Case Manager to provide systematic appointment reminders, follow up for missed appointments, and linkage to additional services (e.g., gender-affirming therapy) might be beneficial, especially for youth, cisgender women, and transgender women. Reasons for stopping PrEP should routinely be collected and assessed. 990 DISCOVER: 96-WEEK FOLLOW-UP OF BLACK AND HISPANIC/LATINX STUDY PARTICIPANTS Edwin DeJesus 1 , Jason Halperin 2 , Indira Brar 3 , Eric Daar 4 , Jeffrey L. Stephens 5 , Yongwu Shao 6 , Lijie Zhong 6 , Ramin Ebrahimi 6 , Staci Bush 6 , Jonathon Anderson 6 , Moupali Das 6 , Scott McCallister 6 , Jeffrey H. Burack 7 , Michelle Iandiorio 8 , Gordon Crofoot 9 1 Orlando Immunology Center, Orlando, FL, USA, 2 CrescentCare, New Orleans, LA, USA, 3 Henry Ford Hospital, Detroit, MI, USA, 4 Harbor–UCLA Medical Center, Torrance, CA, USA, 5 Mercer University, Macon, GA, USA, 6 Gilead Sciences, Inc, Foster City, CA, USA, 7 East Bay AIDS Center, Oakland, CA, USA, 8 University of NewMexico, Albuquerque, NM, USA, 9 Crofoot Research Center, Houston, TX, USA Background: In the US, Black and Hispanic/Latinx (H/Lx) men and transgender women who have sex with men (MSM, TGW) are disproportionately impacted by HIV and underutilize PrEP. Contributing factors include low access to and retention in care. Among 5,387 randomized participants in the DISCOVER study, noninferiority of F/TAF to F/TDF for HIV prevention was shown in MSM and TGW with signficant risk of HIV infection. Methods: Using descriptive statistics, 96 week (W) follow-up data from study participants who confidentially self-identified as Black race or H/Lx ethnicity were analyzed for efficacy (HIV incidence, dried blood spot (DBS) adherence) and safety (renal biomarkers, serum lipids, bone mineral density). Results: Of 5387 participants enrolled from 94 sites in North America and Europe, 474 (9%) identified as Black and 1318 (24%) identified as H/Lx. Fifty participants identified as both Black and H/Lx ethnicity and are included in both sub-populations. Through 96W, among Black or H/Lx participants, 11 individuals acquired HIV, incidence rate: 0.34 (95%CI 0.17-0.61). Two had suspected baseline HIV infection and the 9 remaining individuals (n=4 Black, n=5 H/Lx) had low or undetectable drug levels at diagnosis. The percent of Black participants lost to follow-up (LTFU) was 14.6 vs 7.1 among non-Black participants (p<0.001). The percent of Black participants with an adverse event (AE) leading to discontinuation was 2.3% vs 1.5% among non-Black participants (p=0.18). The percent of H/Lx participants LTFU was 8.7% vs 7.4% among non-H/Lx participants (p=0.14). The percent of H/Lx participants with an AE leading to study drug discontinuation was 0.8% vs 1.9% among non-H/Lx participants (p=0.004). While study drug adherence for the overall population

was high, nonadherence was increased in Black vs non-Black participants: OR 2.4 (95%CI 1.2 to 4.8). Changes to eGFR, BMD, weight and lipids were similar in Black vs non-Black and H/Lx vs non-H/Lx participants (Table 1). Conclusion: Through 96W, all Black or H/Lx participants who acquired HIV during follow-up had low or undetectable drug levels at diagnosis. Black vs non-Black participants were more likely to be LTFU and 2.4 times more likely to be nonadherent. The proportion of study drug discontinuations due to AEs was lower among H/Lx vs non-H/Lx participants. Overall, both F/TAF and F/TDF were efficacious, safe, and well tolerated in Black and H/Lx participants.

991 FACTORS ASSOCIATED WITH PrEP PERSISTENCE AND ADHERENCE AMONG MSM IN 4 US CITIES

Poster Abstracts

Johanna Chapin-Bardales 1 , Amy Martin 1 , Richard Haaland 1 , Catlainn Sionean 1 , Ekow Kwa Sey 2 , Kathleen A.Brady 3 , Henry F. Raymond 4 , Jenevieve Opoku 5 , Irene Kuo 6 , Gabriela Paz-Bailey 1 , Cyprian Wejnert 1 , for the NHBS Study Group 1 CDC, Atlanta, GA, USA, 2 Los Angeles County Department of Public Health, Los Angeles, CA, USA, 3 Philadelphia Department of Public Health, Philadelphia, PA, USA, 4 Rutgers University, Newark, NJ, USA, 5 District of Columbia Department of Health, Washington, DC, USA, 6 George Washington University, Washington, DC, USA Background: Pre-exposure prophylaxis (PrEP) persistence and adherence are critical to achieving national HIV prevention goals. While there is no gold standard for measuring PrEP persistence (continued use) and adherence (effective use), biological testing for tenofovir diphosphate (TFV-DP) and emtricitabine (FTC) is considered best practice. We conducted testing for PrEP among HIV-negative men who have sex with men (MSM) in 4 U.S. cities as part of 2017 National HIV Behavioral Surveillance. Methods: MSMwere recruited via venue-based sampling in Los Angeles, Philadelphia, San Francisco, and Washington DC. Eligible, consenting MSM completed a survey, HIV testing, and dried blood spot (DBS) collection. DBS were tested for tenofovir (TFV), FTC, and TFV-DP by liquid chromatography mass spectrometry. Our analysis was limited to HIV-negative MSMwho had CDC- based PrEP indications and self-reported PrEP use in the past year. Persistence was defined as self-reporting PrEP use in the past 12 months and having any detectable TFV, FTC, or TFV-DP in DBS collected at the interview. Among those reporting past-month PrEP use, adherence was defined as TFV-DP ≥1250 fmol/ punch or TFV-DP ≥700 fmol/punch (consistent with an average of 7 doses/week or 4-7 doses/week, respectively). Poisson regression with generalized estimating equations clustering by recruitment event and adjusting for city was used to assess associations between key characteristics and persistence and adherence. Results: Overall, 81.2% (310/382) were persistently using PrEP based on biological testing. Persistence was significantly lower among MSMwho were younger (p=0.03), had lower education (p<0.01), had public insurance (p=0.02), and had fewer male sex partners (p<0.01). Among MSM reporting past-month PrEP use, 66.2% (200/302) were adherent at 7 doses/week and 80.5% (243/302) were adherent at 4-7 doses/week. Adherence was significantly lower among MSMwho were younger (all p<0.01), had less than high school education (p=0.02, p=0.04), were black race/ethnicity (p=0.04, p=0.01), had fewer male sex partners (p=0.03, p=0.05), and lived in Philadelphia (p<0.01, p=0.01). Conclusion: Approximately 19% of PrEP-using MSM in the 4 cities had not persistently used PrEP. About 34% of MSMwere not adherent at 7 doses/ week and 20%were not adherent at 4-7 doses/week. Efforts to support PrEP persistence and adherence are needed for MSM and should include strategies tailored to age, education, race/ethnicity, insurance type, and city context.

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