CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

900. Among later recruits, 36.4% reported learning of the study through social media. The majority of MSW, 75%, chose a package with Truvada for PrEP. The ITSA showed an 82% increase in monthly recruitment following the start of SMI promotion (95% CI = 31%, 154%; p < .001). Conclusion: Social media is a key platform for health messaging and outreach. SMI further extend this reach by serving as credible advocates with high relatability and followings within target communities. The success of the COPE campaign confirms the use of SMI to increase engagement and enrollment for at-risk individuals marginalized from traditional health structures.

1015 IMPACT OF THE "CHARISMA" INTERVENTION PILOT ON PARTNER DISCLOSURE, IPV, AND ADHERENCE

Poster Abstracts

1014 PrEP NONADHERENCE, WHITE COAT DOSING, AND HIV RISK AMONG A HIGH-RISK COHORT OF MSM Cherie S. Blair 1 , Matthew R. Beymer 1 , Ryan M. Kofron 1 , Robert Bolan 2 , Wilbert C. Jordan 3 , James F. Rooney 4 , Amy R. Wohl 5 , Raphael J.Landovitz 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Los Angeles LGBT Center, Los Angeles, CA, USA, 3 Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA, 4 Gilead Sciences, Inc, Foster City, CA, USA, 5 Los Angeles County Department of Public Health, Los Angeles, CA, USA Background: Therapeutic drug monitoring is critical to interpretation of PrEP trials as a biomarker of adherence and correlate of protection. Perceived expectations from providers or study staff may lead individuals to participate in “white coat dosing” (WCD), or increased adherence to study products just prior to a study visit. As little is known about WCD, this analysis seeks to explore factors associated with this practice. Methods: This is a secondary analysis of PATH-PrEP, an open label study evaluating TDF/FTC PrEP for MSM at high risk for HIV acquisition at two sites in Los Angeles, California. Study participants received daily oral TDF/FTC for 48 weeks. Adherence was assessed using TFV-DP and FTC-TP in dried blood spots (DBS) and TFV in plasma. TFV concentrations were measured at weeks 4, 12, 24, 36, and 48. WCD was defined as TFV-DP < 350fmol/punch on DBS and either or both FTC-TP > 0.1pmol/punch or plasma TFV > 40ng/mL at the same time point. Optimal and sub-optimal levels were defined as TFV-DP ≥ 700fmol/punch and < 700fmol/punch on DBS, respectively. CASI assessed sexual behaviors and STI screening occurred at each visit. Generalized structural equation modeling with multinomial logit compared optimal with 1) sub-optimal and 2) WCD at study visits, adjusting for demographics, incident syphilis, and risk behaviors in last 30 days: condomless anal intercourse with multiple partners, exchange sex, and discussing HIV serostatus before intercourse. Results: Between April 2014 and July 2016, 300 MSM were enrolled. 281 MSM had at least one follow-up visit and were included in the analysis. Median age was 34 (range 20-69) and 53.2%were White, 26.8% Latino, and 8.0% Black. Optimal drug levels were detected at 1,118 (89.2%) visits, sub-optimal at 122 (9.7%) and WCD at 14 (1.1%). Compared to visits with optimal levels, incident syphilis was associated with WCD. Individuals with sub-optimal and WCD had lower odds of discussing HIV serostatus before intercourse, compared to optimal levels (Table). Conclusion: Individuals who participate in WCD demonstrate behavioral and STI-associated risk for HIV acquisition. Sub-optimal chronic use of PrEP with WCD in the setting of ongoing condomless sex is a precarious clinical scenario in which HIV protection may be limited, and post-infection WCD carries high rates of selection for resistant viral variants, particularly M184V/I.

Elizabeth Montgomery 1 , Sarah T.Roberts 1 , Krishnaveni Reddy 2 , Betsy Tolley 3 , Miriam Hartmann 1 , Ellen Wilson 4 , Florence Mathebula 2 , Danielle Wagner 1 , Seth Zissette 3 , Michele Lanham 3 , Rose Wilcher 3 , Jared Baeten 5 , Thesla Palanee- Phillips 2 1 RTI International, San Francisco, CA, USA, 2 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 3 FHI 360, Durham, NC, USA, 4 RTI International, Research Triangle Park, NC, USA, 5 University of Washington, Seattle, WA, USA Background: Biomedical, female-initiated HIV prevention methods can help address disproportionately high HIV rates among women in sub-Saharan Africa, but male partner resistance and intimate partner violence (IPV) may decrease effective use. Methods: To promote consistent use of the dapivirine vaginal ring, we pilot tested the CHARISMA relationship counseling intervention with women enrolled at the Wits RHI (WRHI) site (Johannesburg) of the multisite open-label MTN-025/HOPE trial. Lay counselors used a 42-item tool with 5 subscales to tailor counseling at enrolment, followed by a booster at Month 1 and follow-up (FU) checks at Months 3 and 6. Though not fully-powered, we evaluated potential impact by comparing indicators of ring disclosure to partners, partner clinic attendance, incident social harms (SH) and IPV, and biomarkers of ring adherence at WRHI vs. 3 comparator sites using multivariable regression models. Comparator clinical sites were purposively selected as those most similar to WRHI for baseline characteristics identified a priori. Results: At WRHI, 95 (95%) of HOPE participants enrolled into CHARISMA. Mean age was 30, 36.8% lived with a partner, and 85.3% received his financial support. During FU, CHARISMA participants reported: partner disclosure at 72.7% visits; 4.3% partners attending the research clinic; 1 partner-related SH; and 9.5% experiencing IPV. The mean level of dapivirine released was 3.4mg (SD 1.56), suggesting moderate adherence. In adjusted regression models (Table 1), partner clinic attendance was lower at all comparator sites; and significantly so at Site A (aRR 0.12, 95% CI 0.00-0.98). Sites B and C had lower levels of dapivirine released (less adherent), but this was not significant. Site B women were more likely to report partner disclosure at FU visits (aRR 1.12, 95% CI 1.00-1.25). The risk of IPV report during FU was significantly lower at Site A (aRR 0.20, 95% CI 0.04-0.98). Conclusion: CHARISMA participants had high IPV but were nevertheless able to adhere to ring use, and more CHARISMA male partners came to the research clinic vs. comparators. CHARISMA taught women skills to decide on levels of disclosure; therefore it is difficult to interpret differences in partner disclosure with other sites. Similarly, CHARISMA heightened awareness of abuse, possibly increasing IPV reports. Testing CHARISMA under fully-powered controlled conditions will improve understanding of its impact on women’s relationships and ability to use female-initiated HIV prevention methods.

CROI 2020 381