CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: Between Dec 2018 and Sep 2019, we enrolled 150 TGW (55%≤ 29 years; 25%White; 66% publicly insured). TGW in the PrEP cohort (n = 100) had been taking daily oral PrEP for at least 3 months (range 4 to 54 months; median =17.5 months); TGW in the non-PrEP cohort had never taken PrEP. Across both arms, 85%were taking feminizing hormones (49 % injection, 39% pill; 6% patch, 6% combination), 70%were taking spironolactone, and 66% had received one or more gender-affirming surgery. All were receiving gender-affirming care at the CBHC. We collected survey and EMR data at enrollment and 3-months, and measured PrEP adherence with a urine TFV assay at 3-months (n = 45). Results: The PrEP and non-PrEP cohorts did not differ by demographics, medical mistrust or PrEP-related attitudes (e.g., beliefs about hormone interactions). Among TGW not taking PrEP, 56% reported that they had never talked to a doctor about PrEP, and 58% reported that the reason they were not taking PrEP was because it had not been offered or prescribed. A higher percentage of TGW in the PrEP cohort had a CDC indication for PrEP (82%) compared to those in the non-PrEP cohort (47%, p < .001); however, PrEP indication was not associated with talking to a provider about PrEP. Among TGW in the PrEP cohort, a high percentage reported two or fewer missed pills in the past 30 days at baseline (61%) and 3M (74%), and 75% reported “always/almost always” taking PrEP as prescribed at both time points. Self-reported adherence was consistent with urine TFV levels, with 70% of TGW at >1000ng/ml. PrEP adherence did not differ by hormone use, PrEP-related attitudes, substance use, housing insecurity, or insurance status. Conclusion: TGWwho are engaged in care can successfully uptake and adhere to PrEP. Research should focus on interventions to enhance patient-provider communication about PrEP for TGW, and adherence support for TGW should be provided consistent with findings on adherence across priority populations and medications 1023 HIV PREVENTION AND DRUG-USER HEALTH CARE ON SITE AT A SYRINGE -EXCHANGE PROGRAM Andrea L.Jakubowski 1 , Irene L.Soloway 1 , Mercedes L.Guzman 1 , Christine Fitzsimmons 2 , Leonardo Dominguez-Gomez 2 , Franklin Ramirez 2 , Brackets Kaplan 2 , Brent Gibson 2 , Joseph DeLuca 1 , Julia H. Arnsten 1 , Brianna L. Norton 1 1 Montefiore Medical Center, Bronx, NY, USA, 2 New York Harm Reduction Educators, Bronx, NY, USA Background: Syringe exchange programs (SEPs) serve populations who are high risk for acquiring HIV and other infectious diseases. Adherence to offsite healthcare referrals is low. We describe a novel partnership between an academic medical center and an SEP to deliver low barrier healthcare to people who use drugs (PWUD) onsite at an SEP. Methods: A Montefiore Medical Center clinic was opened within the drop-in center of a local SEP on February, 11, 2019. In this setting clients are able to access clean syringes, laundry, showers, group education, and psychosocial counseling. We conducted a retrospective chart review of patients seen at the drop-in center clinic from 2/11/2019-5/29/2019 using the electronic medical record. Sexual risk factors for HIV were defined: multiple sex partners, unprotected sex, sex worker, STD in the last 12 months, and/or sexual partners who are anonymous, HIV+, or currently injecting drugs. Results: A total of 118 patients were seen by a provider during the study period. The mean age was 43 (IQR 17). The majority f patients were female (53%) and Hispanic (44%) or non-Hispanic Black (32%). 30% of patients were homeless. 61% of patients had ever injected drugs and 61% of patients also had one or more sexual risk factors for HIV. The most common current substances used were heroin (50%) and crack/cocaine (44%). The primary reason for a patient’s first visit to the clinic was for buprenorphine treatment (32%), followed by PrEP (20%), hepatitis C treatment (20%), and PEP (8%). Of those who initiated buprenorphine treatment, 50%were retained in treatment at 90 days. 27% of patients who initiated PrEP were retained in treatment at 90 days. Of the 8 patients who received PEP, 3 initiated PrEP afterward. Of the 22 patients who were HCV positive, 20 (91%) were evaluated for treatment and had fibrosis staging, 10 (50%) initiated treatment. Conclusion: Through a novel SEP-academic medical center partnership, PWUD received well-established HIV-prevention services (buprenorphine and PrEP/ PEP), as well as HCV treatment on-site at an SEP, demonstrating the feasibility of such initiatives. Rates of retention in buprenorphine treatment are comparable to retention rates at other low-barrier programs. PrEP retention was slightly lower than reported in other populations, but few studies have evaluated PrEP engagement among PWUD. Low barrier care delivered onsite at an SEP should

1021 ASSOCIATIONS BETWEEN HORMONE USE, PrEP USE, AND STIGMA IN US TRANSGENDER WOMEN Jessica L.Maksut 1, John Mark L.Wiginton 1 , Maria Zlotorzynska 2 , Carrie E. Lyons 1 , Travis Sanchez 2 , Ayden Scheim 3 , Stefan Baral 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Emory University, Atlanta, GA, USA, 3 Drexel University, Philadelphia, PA, USA Background: The association between hormone therapy and PrEP use among transgender women is unclear. Qualitative research suggests that hormone use may facilitate PrEP use for some, while others may prioritize hormone therapy or have concerns about hormone-PrEP interactions. Methods: We analyzed data (collected March-May 2019) from 330 sexually active transgender women aged ≥15 years who resided in the US. We used bivariate multinomial regression to estimate the association between self- reported past-year hormone use (i.e., no hormone use, provider-prescribed hormone use, and non-prescription hormone use) with past-year PrEP use. We used Chi-squared (χ2) tests to compare past-year sexual practices (i.e., condomless anal intercourse [CAI], condomless vaginal intercourse [CVI], and transactional sex) and past-year healthcare engagement across the provider- prescribed and non-prescription groups. Results: Median age was 24 (IQR: 20,31) and 72.7% (240/330) of the sample was White, non-Hispanic. 104 (31.5%) participants reported no hormone use while 190/330 (57.6%) reported provider-prescribed and 35/330 (10.6%) reported non-prescription hormone use. 22 participants (6.66%) used PrEP. 115 individuals (34.85%) reported CAI, 128 (38.79%) CVI, and 29 (8.79%) engaging in transactional sex. 303 (91.8%) reported a past-year healthcare provider visit. Compared to no hormone use individuals, provider-prescribed participants had 10.78 times the odds (95% CI 1.42-81.94), and non-prescription participants had 9.65 times the odds (95% CI 0.97-96.09) of having used PrEP. There were no differences in PrEP use across the provider-prescribed and non-prescription groups. Among hormone-users (n=226),non-prescription individuals were more likely to have engaged in CAI (χ2=5.89, p=0.015) and transactional sex (χ2=15.31, p<0.001), while provider-prescribed individuals were more likely to have visited a health care provider (χ2=5.91, p=0.015). Conclusion: Integrated hormone therapy and PrEP provision strategies may support health care engagement for individuals in the provider prescribed group who may not be taking PrEP and for encourage individuals in the non- prescription group who may be engaged in PrEP care to use provider-prescribed hormones. 1022 HIGH PrEP ADHERENCE AND PERSISTENCE IN A NATURALISTIC COHORT OF TRANSGENDER WOMEN Sarit A. Golub 1 , Augustus Klein 1 , Lila A. Starbuck 1 , Alexander Harris 2 , Amiyah Guerra 2 , Christopher A.Rincon 1 , Pedro Carneiro 2 , Asa Radix 2 1 Hunter College, CUNY, New York, NY, USA, 2 Callen–Lorde Community Health Center, New York, NY, USA Background: Transgender women (TGW) are a highest priority population for HIV prevention intervention, but there are limited data on PrEP uptake and adherence among TGW in naturalistic, real-world settings. FIRED-UP is an NIH cohort study of 150 TGW (100 on PrEP; 50 not on PrEP) designed to examine rates and correlates of PrEP uptake, adherence, and persistence among TGW receiving care at a community-based health center (CBHC).

Poster Abstracts

CROI 2020 384