CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

California San Francisco, San Francisco, CA, USA, 7 Universidad Peruana Cayetano Heredia, Lima, Peru, 8 Brown University, Providence, RI, USA, 9 The Fenway Institute, Boston, MA, USA Background: While pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, uptake remains poor among transgender women (TW). We conducted a pilot randomized controlled trial of a social network-based intervention to promote PrEP adherence among Peruvian TW. Methods: From September, 2017-July, 2018, we screened 172 TW from three geographic areas of Lima, Peru. Screening visits were conducted to: assess HIV serostatus; introduce PrEP as a prevention strategy; and discuss PrEP adherence. We enrolled 89 HIV-uninfected TW into 6 groups based on pre-existing social network clusters. Clusters were randomized on a 1:1 basis to standard of care (n=44) or the TransPrEP intervention (n=45). Groups assigned to TransPrEP attended 4 weekly introductory workshops (to discuss principles of and barriers to PrEP adherence, and to construct and support group adherence goals). Biweekly maintenance workshops reviewed adherence strategies, discussed participants’ experiences taking PrEP, and encouraged network cohesion. Adherence was evaluated through self-report and by measurement of tenofovir (TFV) levels in hair. Intent-to-treat analyses compared intervention versus control conditions at baseline and 3-month follow-up. Results: Participants’ mean age was 26.9 years (range 18-58), with 76.5% using feminizing hormones. At 3-month follow-up, we evaluated 40 TW and obtained 21 hair samples. Though no statistically significant differences were observed in ITT analysis, a higher proportion of participants in the TransPrEP arm reported taking “Most” or “All” TDF-FTC doses in the prior 30 days (90.5% [19/21] versus 73.4% [14/19]). In hair sample analysis, 36.4% (4/11) of participants in TransPrEP and 10.0% (1/10) in the control arm had TFV levels >0.023 ng/ mg (consistent with taking >4 doses per week) while 81.8% (9/11) and 40.0% (4/10), respectively, had any detectable amount of TFV in their hair. Participants in the intervention arm described the workshops as “helpful,” “enjoyable,” and “comfortable,” settings to discuss HIV prevention. Conclusion: Pilot assessment of our network-based intervention showed improvements in PrEP adherence among TW in Peru according to both biological and behavioral adherence markers but did not achieve statistical significance. Mixed-methods data identified potential modifications to improve participant involvement and retention. Additional research to assess the TransPrEP intervention with a larger sample is needed. 1018 PrEP CONTINUUM OF CARE AMONG MSM AND TGW OF COLOR IN THE THRIVE DEMONSTRATION PROJECT Kashif Iqbal 1 , Weiming Zhu 1 , Kenneth L.Dominguez 1 , Mary Tanner 1 , Kirk D. Henny 1 , Karen W. Hoover 1 1 CDC, Atlanta, GA, USA Background: Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition when taken daily as prescribed. Access to and uptake of PrEP have been suboptimal among populations with the highest rates of HIV diagnoses, including men of color who have sex with men (MSM of color) and transgender women (TGW) of color. The THRIVE demonstration project funded seven U.S. health departments to lead community collaboratives that consisted of community-based organizations and clinical providers to implement comprehensive HIV prevention and care services for MSM and TGW of color. In this analysis, we estimated the PrEP care continuum among MSM and TGW in the THRIVE demonstration project. Methods: We analyzed data collected from a cohort of 10,422 HIV-negative MSM and 1,009 TGW enrolled in THRIVE from September 2015 through March 2019. We estimated the proportions who were included at each step in the PrEP care continuum: screened, eligible, referred, linked, and prescribed PrEP, stratified by age and race and ethnicity. For both MSM and TGW, we used multivariable logistic regression models to estimate the associations of being linked, referred, and prescribed PrEP among persons who were eligible for PrEP, by race/ethnicity and age group (aged <30 and >30 years). Results: Among HIV-negative MSM and TGW in THRIVE, 8,339 (80.0%) were MSM of color and 916 (90.8%) TGW of color. At each step of the continuum, there were significantly larger proportion of MSM of color compared to TGW of color (Figure). In the multivariate model, among MSM eligible for PrEP, there were similar proportions of white MSM and MSM of color who were referred (77.8% and 84.6%, p=0.50) and linked (44.1% and 65.0%, p=0.62), but fewer MSM of color were prescribed PrEP than white MSM (40.0% and 38.9%) (p<0.05). In addition, among MSM of color, a smaller proportion of men aged

1016 REDUCED RELIANCE ON SEX WORK: RESULTS OF AN INTERVENTION FOR YOUNG WOMEN IN TANZANIA Jenny Tiberio 1 , Susie Welty 1 , Joel Ndayongeje 1 , Christen Said 1 , Ritha Mboneko 1 , Tania Reza 1 , Willi McFarland 1 1 University of California San Francisco, San Francisco, CA, USA Background: In sub-Saharan Africa, adolescent girls and young women (AGYW) account for 25% of new HIV infections. Gender, age, and economic disparities are drivers of HIV infection. To address these factors, the PEPFAR- funded “DREAMS” program employs a holistic approach to reduce HIV incidence among AGYW, including an economic-strengthening group intervention of starting a business. We evaluated the effect of these interventions on HIV risk and vulnerability of AGYW in Tanzania. Methods: We recruited a prospective cohort of AGYW from DREAMS communities and measured changes in economic situation and vulnerability to HIV. DREAMS interventions targeted seven districts that included urban, semi- urban, and rural communities identified as uniquely vulnerable for AGYW due to their situation along transit corridors, in major urban centers, or in proximity to mining activities. Eligible participants for the DREAMS program and the cohort were sexually-active, out-of-school AGYW aged 15-24 years. Data were collected fromMay 2017 to February 2019. We used conditional logistic regression to examine significant changes in HIV risk and vulnerability from baseline to 12 months in association with program interventions. A key outcome was dependence upon sex work as primary source of income. Results: We enrolled 778 AGYW, and 598 (77%) completed follow-up (70 were lost to follow-up, 59 moved, 49 dropped, and 2 died). The economic- strengthening group intervention reduced dependence on sex work as primary income source (OR=0.55, p<0.05). The effect was particularly strong among those whose business was established by the end of follow-up (OR=0.33, p<0.05). In the cohort as a whole, AGYW reported significantly increased food security, adult support, planning for the future, self-esteem, and condom self- efficacy. No negative effects on sexual health and well-being were observed. Conclusion: Economic strengthening interventions offer alternative livelihoods to AGYWwho previously relied on sex work. As HIV prevention strategies advance worldwide, protection of AGYW lags behind. Our study supports economic strengthening as a promising tool in the struggle to keep AGYW AIDS-free. 1017 TRANSPREP: SOCIAL NETWORK–BASED PrEP ADHERENCE FOR TRANSGENDER WOMEN IN LIMA, PERU Jesse L. Clark 1 , Sari L.Reisner, ScD 2 , Amaya G. Perez-Brumer 3 , Leyla Huerta Castillo 4 , Hugo Sanchez 5 , Hideaki Okochi 6 , Maria Mamani Luque 4 , Ximena Salazar 7 , Matthew Mimiaga 8 , Monica Gandhi 6 , Kenneth H. Mayer 9 , Javier R. Lama 4 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Boston Children's Hospital, Boston, MA, USA, 3 University of Toronto, Toronto, ON, Canada, 4 Asociacion Civil Impacta Salud y Educacion, Lima, Peru, 5 Epicentro, Lima, Peru, 6 University of

Poster Abstracts

CROI 2020 382