CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: PrEP is recommended for use among pregnant and breastfeeding women at risk for acquiring HIV by the World Health Organization and Kenyan Ministry of Health. As PrEP implementation continues, accruing data on birth outcomes following prenatal PrEP exposure remains important. Methods: PrEP Implementation for Mothers in Antenatal Care (PrIMA) is a cluster randomized trial in Western Kenya (NCT03070600) evaluating different strategies for providing PrEP counseling to women attending antenatal care. Women enrolled in PrIMA are followed through 9 months postpartumwhether or not they elect to use PrEP. Women were identified as PrEP-exposed during pregnancy if they were prescribed PrEP at any antenatal study visits. Birth outcomes including, miscarriage (≤20 week gestation), stillbirth (>20 week gestation), gestational age at birth, birth weight, birth length, and congenital malformations are collected on all participants at six-weeks postpartum. Low birthweight (LBW) was defined as birthweight <2.5 kg among term infants, and small-for-gestational age (SGA) as below the 10th percentile for birthweight at gestational age at birth. The proportion of births with miscarriage, stillbirth, preterm birth, congenital malformations, LBW, SGA, gestational age at birth, birthweight, and birth length were compared by PrEP exposure status using generalized estimating equations (GEE) with a binomial link or a gaussian link. Analyses were repeated adjusting for partner HIV status, maternal age, and syphilis status. Results: As of September 2019, 4,445 women had enrolled during pregnancy and 3,882 had delivered; 654 (17%) used PrEP at any time during pregnancy and had delivered. Median gestational age at enrollment was 25 weeks (IQR: 20, 30) in the PrEP unexposed group and 24 weeks (IQR: 20, 28) in the PrEP exposed group. Compared to women who did not use PrEP, PrEP-exposed women were more likely to report having a partner who was known to be HIV-positive (61% v 33%) or a partner of unknown status (43% v 30%), and reported more HIV risk factors (p≤0.001 for all). Compared to PrEP-unexposed infants, there was no difference in miscarriage (0.5% for both, p: 0.41), stillbirth (3.3% v 2.2%, p: 0.98), preterm birth (17.2% v 17.6%, p: 0.67), birthweight (3.4kg for both, p: 0.51), or birth length (52 v 51cm, p: 0.99). Conclusion: In this large longitudinal study, we found no significant differences in birth outcomes by prenatal PrEP exposure status.

health clinics at our center to identify opportunities for improvement in the provision of CHPS. Methods: An electronic sexual health dashboard was used to identify patients with a positive bacterial STI test between January 1, 2019 and June 30, 2019 at 3 hospitals affiliated with an academic medical center in northern Manhattan. We excluded patients seen in our sexual health clinics. 690 patient encounters (PE) in 658 unique patients were reviewed to assess HIV testing, completeness of screening for STI, and HIV prevention discussions. Results: Patients were predominantly female (65%); median age was 24 (range 18-85). Positive tests occurred in 50 inpatient and outpatient locations; the most frequent were the family planning clinic (25%) and the three emergency rooms (27%). The most common test performed was a genitourinary (GU) gonorrhea/chlamydia nucleic acid amplification test (46% of all tests ordered). Multi-site testing was rarely performed (7.9% of PE) and was more frequent in men than women (22% vs. 0.45%, OR 62.5, 95% CI 15.1-263.2). Of 41 individuals with positive extra-genital tests, GU was positive only in 24% of cases. Of all individuals with a positive STI test, 65%, 9% and 13% had concurrent, >12 months, or no HIV testing, respectively. Women were more likely to be inadequately screened for HIV (17% vs. 25%, OR 0.61, 95% CI 0.41-0.91). Documentation of PrEP discussion was rare (6.8% of PE) compared with safe sex (45%) and condoms (50%). PrEP was discussed almost exclusively with men compared to women (17% vs. 1.3%, OR 15.03, 95% CI 6.28-35.97). Conclusion: In a cohort of patients with positive bacterial STI testing, gaps in CHPS exist. HIV screening, multi-site STI screening, and discussion of PrEP were particularly infrequent among women. Interventions to increase proper implementation of HIV prevention services must include improved HIV testing and provision of comprehensive sexual health services in all care settings and with all patients.

Poster Abstracts

1036 RESULTS FROM A PrEP DEMONSTRATION PROJECT FOR AT-RISK CISGENDER WOMEN IN THE US

Jill Blumenthal 1 , Sonia Jain 1 , Feng He 1 , Ryan M. Kofron 2 , Eric Ellorin 1 , Jamila Stockman 1 , Gifty Ntim 2 , Peter L.Anderson 3 , Katya Calvo 4 , Richard Haubrich 5 , K. Rivet Amico 6 , David J. Moore 1 , Sheldon Morris 1 , Raphael J. Landovitz 2 1 University of California San Diego, San Diego, CA, USA, 2 University of California Los Angeles, Los Angeles, CA, USA, 3 University of Colorado, Aurora, CO, USA, 4 Harbor– UCLA Medical Center, Torrance, CA, USA, 5 Gilead Sciences, Inc, Foster City, CA, USA, 6 University of Michigan, Ann Arbor, MI, USA Background: Data on TDF/FTC PrEP use by cisgender women have largely been from Africa. We report the primary results from the first US demonstration project of oral PrEP among at-risk cisgender women. Methods: Adherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week PrEP demonstration project in cisgender women ≥18 years old at-risk for HIV conducted at 5 Southern California sites. Adherence was supported using two-way text messaging (Individualized Texting for Adherence Behavior; ITAB) and titrated adherence counseling based on rapid- turnaround tenofovir diphosphate (TFV-DP) concentrations. Study visits occurred at baseline, week 4, week 12, then quarterly through week 48. Demographics were collected with computer surveys. Outcomes included PrEP adherence, retention and persistence. Adherence was assessed by quantifying TFV-DP concentrations in dried blood spots. Concentrations ≥1050 fmol/punch were considered protective, suggesting ≥6 doses on average per week. Self-reported PrEP adherence was determined by the proportion of participants responding positively to daily iTAB text prompts over 30 days prior to study visits. Results: Between 6/2016 and 10/2018, 136 ciswomen enrolled with mean age 40 (SD 11); 38%were non-Hispanic (NH) Black and 19% Latina. Over 48 weeks,

1035 WOMEN ARE LESS LIKELY TO BE TESTED FOR HIV OR OFFERED PrEP AT TIME OF STI DIAGNOSIS Caitlin S. Yumori 1 , Jason Zucker 1 , Deborah Theodore 1 , Michelle Chang 1 , Caroline Carnevale 2 , Jacek Slowikowski 2 , Elijah LaSota 1 , Susan Olender 1 , Peter Gordon 1 , Alwyn Cohall 1 , Magdalena Sobieszczyk 1 1 Columbia University Medical Center, New York, NY, USA, 2 New York Presbyterian Hospital, New York, NY, USA Background: Ending the HIV epidemic requires implementation of comprehensive HIV prevention services (CHPS), including identification, testing, and linkage to care of at-risk individuals across diverse healthcare settings. Missed opportunities for CHPS remain common. Sexually transmitted infections (STI) are significant biomarkers of HIV risk and should trigger pre-exposure prophylaxis discussion. We reviewed STI testing practices outside of sexual

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