CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

PrEP, defined as at least one prescription of >30 days of Truvada, each year from 2012-2016. People with HIV or hepatitis B were excluded. We created two metrics of PrEP access in 2016: the number of individuals starting PrEP per 100K population and the number of individuals with a PrEP prescription in each of the four quarters of 2016 per 100K population (i.e., prevalent users). Using public health surveillance data, we created three metrics of PrEP need in 2016: the number of HIV diagnoses per 100K population; the number early syphilis and gonorrhea diagnoses per 100K population; and the number of acute or chronic hepatitis C diagnoses among patients aged 16-30 years per 100K population. We calculated six metrics of PrEP access-to-need by dividing each of the access measures by the need measures. Results: The number of individuals with a new PrEP prescription increased from 8 in 2012 to 571 in 2016. Most new PrEP users were men, aged 25-34 years, identified as white, lived in an urban area, had commercial insurance, and had an internal medicine PrEP prescriber. In 2016, there were 17.2 PrEP starts and 9.9 individuals with a PrEP prescription in all four quarters of 2016 per 100K population. There were 6.7 HIV cases, 136.0 early syphilis and gonorrhea cases, and 109.1 acute and chronic hepatitis C cases per 100K population. Per HIV diagnosis, there were 2.6 PrEP starts and 1.5 prevalent users. However, there were 0.13 PrEP starts and 0.07 prevalent users per early syphilis and gonorrhea diagnosis and 0.16 PrEP starts and 0.09 prevalent users per hepatitis C diagnosis. Women, people aged 16-24, people of color, and people in rural areas experienced lower PrEP access-to-need. Conclusion: Access metrics based on prevalent users (a measure of longer-term adherence to PrEP), STI diagnoses (a measure of HIV acquisition risk), and HCV diagnoses among those less than 30 years of age (a measure of need among people who inject drugs) may provide a more complete assessment of PrEP access-to-need than those based on PrEP starts and HIV diagnoses.

in the Northeast, a plan in the South was 15.9 (95% Confidence Interval (95% CI), 12.6-20.1) times as likely to require PA whereas the Midwest and West were 5.7 (95% CI, 4.5-7.3) and 2.7 (95% CI, 2.0-3.5) times as likely, respectively. Figure 1 demonstrates QHPs' PA rate for PrEP by rating area. National issuers were more common in the South (Risk Ratio [RR] 1.9, 95% CI, 1.7-2.2) and were more likely to require PAs (RR 3.3, 95% CI, 3.1-3.6). This may mediate part of the high PA rate in the South, but it does not completely explain the disparity. QHP factors that shift drug costs to consumer, such as co-insurance cost sharing, specialty drug tiering, catastrophic level plans, were associated with lower likelihood of PA, but these characteristics were unlikely to explain regional disparities. Conclusion: QHPs in the South are 16 times as likely to require PrEP PA. PA reduces the chance of obtaining a prescribed medication. High PA rates are a possible barrier to PrEP access in the South, which is the region with the most new HIV diagnoses. Due to PrEP’s USPSTF Grade A rating, QHPs must start offering PrEP without cost-sharing starting in 2021. However, there is no regulation on QHPs’ use of PA for PrEP. We have the tools to end the HIV epidemic, and we will also need robust health policies to end the HIV epidemic.

Poster Abstracts

1010 FACTORS ASSOCIATED WITH LOSS TO RETENTION AMONG FREE AND FEE- BASED PrEP IN THAILAND Tanat Chinbunchorn 1 , Oranuch Nampaisarn 1 , Sita Lujintanon 1 , Surang Janyam 2 , Theeranat Sangprasert 3 , Phongthorn Chanlearn 4 , Akarin Hiransuthikul 5 , Matthew Avery 6 , Stephen Mills 6 , Ravipa Vannakit 7 , Reshmie Ramautarsing 1 , Praphan Phanuphak 1 , Nittaya Phanuphak 1 1 Thai Red Cross AIDS Research Center, Bangkok, Thailand, 2 Service Workers In Group Foundation, Bangkok, Thailand, 3 Rainbow Sky Association of Thailand, Bangkok, Thailand, 4 Mplus Foundation, Chiang Mai, Thailand , 5 Chulalongkorn University, Bangkok, Thailand, 6 FHI 360, Bangkok, Thailand, 7 United States Agency for International Development, Bangkok, Thailand Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. PrEP is currently available in Thailand for free through demonstration projects, while some healthcare settings provide fee-based services. This study aims to look at retention in the two largest PrEP programs in Thailand; PrEP-15, a fee-based service available at the Thai Red Cross Anonymous Clinic (TRCAC) and Princess PrEP, a free service at the TRCAC and at 9 community clinics in 6 provinces with high HIV burden. Methods: Self-reported demographic and risk behavior data was collected from January 2016-July 2019. Retention was determined if the client came back for a scheduled visit and measured at months 1, 3, 6, 9, and 12 after PrEP initiation. Multivariable linear regression was used to observe factors associated with loss to follow up at one month and one year after enrollment. Results: A total of 5,687 clients were provided with PrEP, 66.6% through Princess PrEP. 80%were men who have sex with men, 9.5% transgender women, 21.2% had education lower than bachelor’s degree, 72.3% reported inconsistent condom use, and 6.8% used amphetamine.Retention rates in PrEP-15 were 45.1%, 37.3%, 31.5%, 28.3%, and 25.2%, and in Princess PrEP were 65.4%, 56%, 48.2%, 44.5%, and 39.9% at month 1, 3 ,6, 9, and 12, respectively. In the multivariable analysis, factors associated with loss to follow up after month 1 were having an education lower than bachelor’s degree (adjusted odds ratio -aOR:1.56; 95% confidence interval -CI 1.32-1.84, p<0.001), clients aged less than 20 years (aOR:1.76; 95%CI 1.2-2.59, p<0.05), inconsistent condom use (aOR:1.31; 95%CI 1.1-1.55, p<0.05), reporting sex work (aOR:1.66; 95% CI

1009 STUDY SUGGESTS PrEP ACCESS ISSUE: DISPARITY IN PRIOR AUTHORIZATIONS ACROSS US REGIONS

Kathleen A. McManus 1 , Samuel Powers 1 , Amy Killelea 2 , Sebastian Tello-Trillo 1 , Elizabeth Rogawski Mcquade 1 1 University of Virginia, Charlottesville, VA, USA, 2 National Alliance of State and Territorial AIDS Directors, Washington DC, Maryland, USA Background: With the goal of ending the HIV epidemic in the United States, access to HIV Pre-exposure Prophylaxis (PrEP) is essential to curb new HIV infections. There has been differential regional uptake of PrEP with the South lagging behind. We explore a potential systemic barrier: prior authorization (PA) requirements. This study explores differential PA for PrEP across geography and insurance characteristics. Methods: The design was a cross-sectional study of all individual Qualified Health Plans (QHPs) offered in the 2019 Affordable Care Act Marketplace. QHP PA requirement for combined tenofovir disoproxil fumarate and emtricitabine (PrEP) was our primary outcome. Log binomial regression was used to estimate the association between region and PA requirement, and assess whether other plan characteristics (national issuer, high deductible, PrEP cost sharing structure, PrEP specialty drug tier status, plan level, rating area urbanicity, and rating area competition) may explain regional disparities in PA. Results: 16,853 QHPs were analyzed (18% Northeast, 20%West, 25%Midwest, and 37% South). Overall, 19% of plans required PA for PrEP. Compared to plans

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