CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

993 HIGH REPORTED ADHERENCE BUT LOW PrEP LEVELS AMONG KENYAN MEN WHO HAVE SEX WITH MEN Susan M. Graham 1 , Duncan O. Okall 2 , Supriya D. Mehta 3 , Eve Obondi 2 , Robert C. Bailey 3 , Frederick O. Otieno 2 1 University of Washington, Seattle, WA, USA, 2 Nyanza Reproductive Health Society, Kisumu, Kenya, 3 University of Illinois at Chicago, Chicago, IL, USA Background: Gay, bisexual, and other men who have sex with men (MSM) are at high risk of HIV acquisition in Kenya, where pre-exposure prophylaxis (PrEP) has recently become available. Our aimwas to evaluate factors associated with tenofovir diphosphate (TFV-DP) detection and protective TFV-DP levels in a cohort of high-risk, HIV-negative MSM in Kisumu, Kenya. Methods: HIV-negative MSM≥18 years were enrolled if they reported recent unprotected anal sex, ≥3 male sex partners, sexually transmitted infection (STI), transactional sex, or injection drug use. All participants were offered PrEP at baseline, with adherence counselling at each visit. Follow-up occurred at week 2; months 1, 2 and 3; then quarterly for 1 year. Adherence was measured by visual analogue scale (VAS) and qualitative self-rating. Dried blood spots (DBS) were collected at months 3 and 9 for TFV-DP testing. Generalized estimating equations (GEE) with robust variance were used to detect associations with (1) TFV-DP detection and (2) protective TFV-DP levels (≥700 fmol/punch, compatible with ≥4 weekly doses). Results: DBS were provided at 275 visits by 161 participants. At baseline, median age was 26, 46.6% reported unprotected anal sex, 86.5% reported >3 male partners, 9.8% reported a recent STI, 66.3% reported transactional sex, and 5.5% reported injection drug use. Median VAS adherence was 98% (IQR 90%-100%), and men reported taking PrEP “most” or “all of the time” at 89% of visits. DBS results showed no detectable TFV-DP at 178 visits (64.7%), and protective TFV-DP levels at only 28 visits (10.2%). In GEE analysis, age, education, occupation, sex with female partners, injection drug use, depressive symptoms, social support, and time were associated with one or both outcomes in bivariable analysis. Only time was associated with TFV-DP detection in multivariable analysis (adjusted odds ratio [aOR] 0.84, 95% confidence interval [CI] 0.78-0.90 per month). Increasing age (aOR 1.12, 95% CI 1.04-1.21), sex with a female partner in the past 3 months (aOR 3.98, 95% CI 1.33-11.9), and lower social support score (aOR 0.97, 95% CI 0.95-0.99) were associated with protective TFV-DP levels in multivariable analysis. Conclusion: Despite high reported adherence, drug levels were undetectable in most participants, and only 10% had protective levels. These results suggest that PrEP adherence is not aligned with risk among GBMSM in Kenya, and that tailored interventions to address PrEP adherence in this population are urgently needed.

Poster Abstracts

992 HIV-1 INCIDENCE, PrEP UPTAKE, AND ADHERENCE AMONG KENYAN MSM Elizabeth Wahome 1 , Susan M. Graham 2 , Alexander N.Thiong'O 1 , Khamisi Mohamed 1 , Tony H. Oduor 1 , Evans Gichuru 1 , John Mwambi 1 , Maria Prins 3 , Elisabeth M.Van Der Elst 1 , Eduard Sanders 1 1 KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 University of Amsterdam, Amsterdam, Netherlands Background: Data on HIV-1 incidence following programmatic pre-exposure prophylaxis (PrEP) uptake by men who have sex with men (MSM) in sub-Saharan Africa is not available. We assessed PrEP uptake and adherence, and HIV-1 incidence, in at-risk MSM with access to PrEP in coastal Kenya. Methods: Since June 2017, at-risk MSM followed at monthly visits were offered daily PrEP with adherence and risk reduction counselling. At each visit, we assessed PrEP adherence, intention to continue, and HIV-1 status using rapid antibody tests. If symptoms of acute HIV-1 (e.g. fever) or risk criteria (e.g. receptive anal sex,) were met, X-pert RNA Qual testing was done. We determined tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots 6-12 months after PrEP initiation, and tenofovir (TFV) concentrations and genotypic drug resistance in plasma samples when HIV-1 was detected. HIV-1 incidence was assessed as per reported PrEP use, and population-averaged multivariable Poisson regression with robust standard errors was used to identify predictors of HIV-1 acquisition. Results: Of 167 at-risk MSM, 162 (94.9%) were eligible for PrEP, 131 (80.9%) started it, and 57 (43.5%) reported PrEP use at study censoring, for a median follow-up time of 21.2 (interquartile range: 10.2–22.1) months. Nine MSM acquired HIV-1 [incidence rate: 3.9 (95% confidence interval (CI), 2.0–7.4) per 100 person-years (PY)]. Of these, 5 MSM reported PrEP use at the time of HIV-1 acquisition [incidence rate: 3.7 (95% CI, 1.5–8.8) per 100 PY] and 4 MSM had stopped or had never started PrEP [incidence rate: 4.2 (95% CI, 1.6–11.1) per 100 PY; figure]. Among 75 (57.3%) MSM who reported PrEP use, 11 (14.7%) had protective TFV-DP levels of ≥700 fmol/punch (≥4 tablets a week). Among the 5 MSM who acquired HIV-1 while reporting to take PrEP, only one had detectable but low TFV levels in plasma (66.0 ng/mL) and none had genotypic HIV-1 resistance. In multivariable analysis, no factors were significantly associated with HIV-1 acquisition. Conclusion: HIV-1 incidence among at-risk MSM with access to programmatic PrEP was high and did not differ by reported PrEP use. Only one in seven MSM taking PrEP had protective tenofovir levels, and a substantial proportion of MSM stopped taking PrEP despite frequent risk reduction counselling. Strengthened PrEP adherence support is required among MSM in Kenya.

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