CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

994 PREEXPOSURE PROPHYLAXIS CASCADE AMONG MEN WHO HAVE SEX WITH MEN IN ZIMBABWE Lauren Parmley 1 , Tiffany Harris 1 , Innocent Chingombe 1 , Munyaradzi Mapingure 1 , Owen Mugurungi 2 , John H. Rogers 3 , Tsitsi Apollo 2 , Getrude Ncube 2 , Brian K.Moyo 2 , Perpetua Gozhora 1 , Yingfeng Wu 1 , Elizabeth Gonese 3 , Sophia Miller 1 , Avi Hakim 4 , Godfrey Musuka 1 1 ICAP at Columbia University, New York, NY, USA, 2 Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe, 3 CDC, Harare, Zimbabwe, 4 CDC, Atlanta, GA, USA Background: Pre-exposure prophylaxis (PrEP) for persons at high risk of acquiring HIV, including men who have sex with men (MSM), is increasingly being scaled-up in Zimbabwe, with goals to roll-out PrEP to all public facilities by 2020. We assessed gaps in PrEP awareness, uptake, and use among HIV- negative MSM in two cities of Zimbabwe. Methods: We used respondent-driven sampling to recruit 1538 MSM to participate in a cross-sectional survey assessing HIV-related outcomes in Harare and Bulawayo, Zimbabwe (March–July 2019). MSM were eligible for the survey if they were born male, engaged in anal or oral sex with a man in the past 12 months, and were aged ≥18 years. Consenting participants completed a questionnaire and received HIV testing. The sample did not reach equilibrium and was treated as a convenience sample. Unweighted univariate analyses were restricted to MSMwho self-reported negative/unknown HIV status that was confirmed via HIV testing. Results: Overall, 75.9% (1167/1538) of all participants tested HIV negative and self-reported HIV-negative/unknown status (Harare, 75.9%; Bulawayo, 75.9%). Awareness of PrEP was 45.8% (534/1167; Harare, 57.8%; Bulawayo, 35.2%; Figure). Of those aware of PrEP, 31.3% (167/534) had ever taken PrEP (Harare, 32.7%; Bulawayo, 29.2%). Most (71.1% [261/367]) reporting never taking PrEP were interested in starting PrEP (Harare, 65.1%; Bulawayo, 79.4%). The top 3 reasons for never starting PrEP included not knowing where to access PrEP (24.8 [91/367]), fearing side effects (20.4% [75/367]), and not feeling at risk for HIV (19.6% [72/367]). Most (74.9% [125/167]) MSM who had ever used PrEP had taken it in the last 6 months (Harare, 73.8%; Bulawayo, 76.6%). Reasons for discontinuing PrEP included side effects (59.5% [25/42]), trust in partner (7.1% [3/42]), inability to access PrEP (4.8% [2/42]), concern about others finding out (2.4% [1/42]), or other reasons (26.2% [11/42]). Most PrEP users in the last 6 months reported taking PrEP daily (70.4% [88/125]). Conclusion: Our findings highlight gaps in PrEP awareness and use among participants. Less than half of HIV-negative MSM were aware of PrEP, and awareness was lower in Bulawayo than Harare. Despite interest among participants in starting PrEP, uptake was low. To increase awareness and uptake, demand creation messaging could be strengthened by providing information on locations where PrEP is accessible, risk behaviors for HIV and PrEP eligibility, and side effects.

Center, New York, NY, USA, 10 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: PrEP decreases HIV acquisition in men who have sex with men (MSM), yet it has been underutilized. Successful strategies to scale-up PrEP implementation will require an understanding of the salient factors associated with use. Method : HPTN 078 screened 1305 MSM in Boston, Baltimore, Atlanta and Birmingham in 2018. The current analysis focuses on MSMwho screened HIV-negative and were at risk for infection (according to CDC criteria). Participants reported sociodemographic and behavioral risk factors, as well as PrEP attitudes. Plasma tenofovir concentrations were determined for those who indicated they had used PrEP in the prior 12 months. Univariate and multivariable models were constructed to determine the factors associated with having heard of PrEP, having used PrEP in the prior 12 months, and having protective plasma tenofovir concentrations (>40 ng/mL). Results: Of 382 HIV-negative MSM, 267 (70%) met CDC risk criteria for PrEP. Among the 267 at risk MSM, 21%were 18-24 and 39%were 25-35 years old; 42%were Black and 17% Latinx; 37% had a high school or less education; 21% did not have health insurance; 87% reported an income under $30,000 per year; 187 (72.5%) indicated that they had heard of PrEP. Among those who had heard of PrEP, 43 (23.1%) indicated that they used it in the past year, and among those who used it, 19 (57.6%) had protective blood concentrations. In the multivariable models, factors associated with having heard of PrEP included: younger age (p=0.001), being White (p<0.001), post-high school education (p=0.001). Correlates of having used PrEP included: being employed (p=0.025), living in Baltimore (p=0.012), having health insurance (p=0.040), self-perceived increased HIV risk (p<0.001), and not being concerned about side effects (p=0.023). Having protective PrEP drug concentrations was associated with not being concerned about side effects (p=0.007). Conclusion: The majority (83%) of the 267 at-risk urban American MSM in this sample were not using PrEP. White race and higher education correlated with PrEP knowledge, but among the majority who had heard of it, economic factors and PrEP beliefs correlated with use and maintenance of protection. Interventions to increase PrEP knowledge, uptake, and optimal use will need to provide information, address socioeconomic challenges and risk perceptions. Kenneth H. Mayer 1 , Johnathon B. Holmes 1 , Marcy Gelman 1 , Jessica C. Kraft 1 , Kathy Melbourne 2 , Douglas Krakower 3 , Matthew J. Mimiaga 4 1 The Fenway Institute, Boston, MA, USA, 2 Gilead Sciences, Inc, Foster City, CA, USA, 3 Beth Israel Deaconess Medical Center, Boston, MA, USA, 4 Brown University, Providence, RI, USA Background: The use of antiretrovirals for post-exposure prophylaxis (PEP) is well-established, although completion rates with prior regimens have been suboptimal because of pill burden or side effects. The purpose of the current study has been to evaluate the single tablet regimen of of bictegravir, emtricitabine, tenofovir alafenamide (BIC/FTC/TAF) for PEP, administered daily for 28 days after a high risk exposure. Methods: The analyses focused on a prospectively enrolled clinical cohort recruited through referrals from a busy medical department in a Boston community health center, specialized in HIV care, as well as from a community education campaign. Results: Of the first 39 enrollees, the median age was 33 years (range 22-71), with 12.8% Black and 5.1% Latinx. Most (76.9%) were cisgender gay or bisexual men. Other participants included 3 heterosexual cisgender men, 1 transgender woman and 2 cisgender women. Most (76.9%) completed college +/- advanced degrees. Behaviors that led to PEP initiation included: receptive anal (49.7%), insertive anal (43.6%), receptive oral (15.4%), and insertive or receptive vaginal sex (7.7% for each). The most commonly reported adverse events were nausea +/- vomiting (12.8%), fatigue (10.3%), and diarrhea (10.3%). One participant noted mild gastrointestinal discomfort and another reported flatulence. All but one of the symptoms were grade 1; a grade 2 report of fatigue led to product discontinuation. The only lab abnormalities were elevated transaminases (N=2) and decreased creatinine clearance (N=1). These changes did not lead to product discontinuation, and reverted after regimen completion. Of the 39 fully evaluable participants, 92.3% completed the regimen as prescribed; 2 did not return for follow-up, and one participant discontinued prematurely. No HIV seroconversions have been detected in the study.

Poster Abstracts

996 SAFETY AND TOLERABILITY OF ONCE-DAILY BIC/FTC/TAF FOR POSTEXPOSURE PROPHYLAXIS

995 CASCADE TO TRICKLE: REASONS FOR SUBOPTIMAL PrEP USE AMONG AT-RISK US MSM (HPTN 078) Kenneth H. Mayer 1 , Ethan A. Wilson 2 , James Hughes 2 , Julia Raifman 3 , Jason Farley 4 , D. Scott Batey 5 , Carlos del Rio 6 , Lynda Emel 2 , Vanessa Cummings 4 , Susan H. Eshleman 7 , Mark A. Marzinke 7 , Theresa Gamble 8 , Robert H. Remien 9 , Chris Beyrer 10 1 The Fenway Institute, Boston, MA, USA, 2 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 3 Boston University, Boston, MA, USA, 4 Johns Hopkins University, Baltimore, MD, USA, 5 University of Alabama at Birmingham, Birmingham, AL, USA, 6 Emory University, Atlanta, GA, USA, 7 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 8 FHI 360, Durham, NC, USA, 9 Columbia University Medical

CROI 2020 374