CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: Determinants of HIV Pre-Exposure Prophylaxis (PrEP) initiation in U.S. women at risk for HIV are poorly understood. We sought to identify barriers and facilitators of PrEP initiation among women at high risk for HIV in a high prevalence community. We hypothesized that there would be significant demographic, behavioral, and psychosocial barriers to PrEP initiation. Methods: We offered an anonymous, validated survey to women presenting for care in a hospital-based family planning clinic and a government sexual health clinic in Washington, DC. We measured socio-demographics, HIV behavioral risk factors, knowledge, attitudes, norms, and self-efficacy regarding PrEP initiation. We used chi-squared and Fisher’s exact tests for categorical variables, t-tests for continuous variables, and Mann-Whitney U test for ordinal variables. This analysis included women at high risk for HIV acquisition (i.e. ≥3 reported behavioral risk factors). Results: 1118 women completed the survey; 32.4% (N = 362) were categorized as high risk for HIV acquisition. Of women at high risk, mean age was 27. The majority were Black (71.6%), single (88.5%), had completed ≥ high school/GED (94.6%), and reported household incomes <$25,000 (51.5%). 13.4% (n=48) were committed to starting PrEP in the next 12 months. Although specific behavioral risk factors for HIV were not associated with uptake intention, composite number of reported risk factors for HIV was positively associated (r=0.18, p<0.01). 8.7% perceived moderate-high risk of HIV acquisition in the next 12 months and 15.7%moderate-high lifetime risk. Perceived risk was not associated with intention to initiate PrEP. Age, race, marital status, income, distance from clinics, insurance status, transportation, housing, illicit drug use, and prior knowledge of PrEP were not associated with uptake intention. Prior discussion about PrEP with a medical provider was associated with intention to initiate. Attitudes toward PrEP, perceptions of norms (injunctive and descriptive) and efficacy, were positively associated with uptake intention (Table 1). Conclusion: Demographic factors, behavioral risks, and perceived risk were not associated with intention to initiate PrEP among women at high risk for HIV. Psychosocial factors and healthcare provider support, however, were positively associated with intention to initiate PrEP. Our findings have important implications for PrEP messaging and development of interventions that center on the role of providers and social networks in the destigmatization and provision of PrEP.

high for CAS acts with unknown and known casual sex partners, suggesting that MSM use event-driven PrEP when they are most at risk for HIV. Observed TDF levels in event-driven PrEP users are lower than those reported from studies among daily users. 1032 USE OF A TENOFOVIR URINE TEST TO IMPROVE PrEP ADHERENCE AND PREDICT NON-RETENTION Shane Hebel 1 , Elijah Kahn-Woods 1 , Landon Larabee 1 , Bibiana Osorio 1 , Kenneth H. Mayer 2 , Patrick S. Sullivan 3 , K. Rivet Amico 4 , Giffin Daughtridge 1 1 UrSure Inc, Boston, MA, USA, 2 The Fenway Institute, Boston, MA, USA, 3 Emory University, Atlanta, GA, USA, 4 University of Michigan, Ann Arbor, MI, USA Background: Daily pre-exposure prophylaxis (PrEP) effectively prevents new HIV infections. Poor adherence and retention are pervasive, undermining PrEP’s utility. Objective adherence monitoring (OAM) tools that identify non- adherent patients and drive behavioral change are urgently needed. A Liquid Chromatography Mass Spectrometry (LC-MS/MS) urine test for Tenofovir (TFV), a component of PrEP, was used clinically to identify non-adherent patients and target support services. Adherence data were analyzed to describe the association between recent adherence, missed visits, and loss to follow up (LTFU). Methods: Urine samples were collected from PrEP patients at 16 clinics in the US during routine visits. The LC-MS/MS test detected recent non-adherence (no dose in 48 hours) versus recent adherence (a dose in the last 6 days). Non- adherent patients received adherence support, per clinics’ standards of care. We assessed results from patients who attended ≥2 visits and analyzed follow-up test results to determine if non-adherent patients had repeat non-adherence or improved adherence at their next visit. Clinic visits were recorded based on dates of adherence testing. Missed visits were defined as a gap in care of >120 days since the last visit. LTFU was defined as a gap in care of >180 days since the last visit with no future visit. Rates of missed visits and LTFU were calculated based on patients’ adherence status at the previous visits. Results: 688 patients received urine screening and targeted adherence support at ≥2 visits. At Visit 1, 606 (88%) were adherent. Of the 606 adherent patients at Visit 1, 544 (88%) remained adherent at Visit 2. Of the 82 non-adherent patients at Visit 1, 61 (74%) were adherent at their next visit. Non-adherence was associated with missed visits and LTFU. Non-adherent patients were 70%more likely to miss their next visit and 114%more likely to be LTFU than adherent patients. Individuals who were initially non-adherent but became adherent had a similar chance of missing a visit or LTFU as patients with two adherent results in a row (25% vs 25%, 9% vs 8%, respectively). Conclusion: Use of OAM coupled with targeted support for non-adherent individuals was associated with increased adherence. OAM also proved to be an invaluable tool to predict future non-retention and demonstrated the potential to reduce non-retention. This evidence indicates that OAM can be a key tool to identify and improve behavioral determinants of PrEP efficacy.

Poster Abstracts

1033 DETERMINANTS OF HIV PREEXPOSURE PROPHYLAXIS INITIATION IN WOMEN AT HIGH RISK FOR HIV Rachel K. Scott 1 , Shawnika Hull 2 , Jim C. Huang 1 , Adam Visconti 3 , Megan Coleman 4 , Peggy Ye 5 , Pam Lotke 5 , Dhiksha Balaji 1 , Jason Beverley 3 , Alison Ward 6 , Jennifer Holiday 6 , Richard A. Elion 3 1 MedStar Health Research Institute, Hyattsville, MD, USA, 2 George Washington University, Washington, DC, USA, 3 District of Columbia Department of Health, Washington, DC, USA, 4 Whitman-Walker Health, Washington, DC, USA, 5 MedStar Health, Washington, DC, USA, 6 Georgetown University, Washington, DC, USA

1034 PRENATAL PrEP EXPOSURE AND LONGITUDINAL BIRTH OUTCOMES IN KENYA Julia C. Dettinger 1 , John Kinuthia 2 , Laurén Gómez 1 , Jillian Pintye 1 , Joshua Stern 1 , Nancy M. Ngumbau 2 , Ben O.Odhiambo 2 , Mary M. Marwa 2 , Salphine A. Wattoyi 2 , Felix Abuna 2 , Jared Baeten 1 , Grace John-Stewart 1 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya

CROI 2020 388