CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1010 Changes in PrEP Awareness Among Men Who Have Sex With Men and PWID: 19 US Cities, 2018 and 2022 Patrick Eustaquio , Janet Burnett, Ruthanne Marcus, Joseph Prejean, Johanna Chapin-Bardales, Susan Cha, for the National HIV Behavioral Surveillance Study Group Centers for Disease Control and Prevention, Atlanta, GA, USA Background: HIV preexposure prophylaxis (PrEP) is effective at preventing infection among persons at risk for acquiring HIV. PrEP campaigns have focused on sexual behaviors, particularly same-sex behaviors, and may not be reaching heterosexual-identifying men or people who inject drugs. This analysis aimed to explore changes in PrEP awareness and use among men who have sex with men and inject drugs (MSM-ID) in 2018 and 2022 by sexual orientation. Methods: We analyzed data from 2018 and 2022 National HIV Behavioral Surveillance among people who inject drugs recruited via respondent-driven sampling in 19 US urban areas. The analytic sample was restricted to HIV negative males who inject drugs and who had sex with another man in the past 12 months (MSM-ID). Using log-linked Poisson regression models, adjusted prevalence ratios (aPRs) and 95% confidence intervals (95% CIs) were calculated to estimate changes in PrEP awareness stratified by sexual orientation. Models were adjusted for age, race/ethnicity, city, and network size, and accounted for clustering by recruitment chain. Small sample size of PrEP users precluded statistical comparison on PrEP use. Results: Of HIV-negative MSM-ID, 71.5% (331/463) in 2018 and 66.8% (197/295) in 2022 identified as gay/bisexual. Between 2018 and 2022, there was a significant increase in PrEP awareness among gay/bisexual MSM-ID (45.5% in 2018, 64.5% in 2022; aPR=1.51, 95% CI=1.32-1.72) but not for heterosexual MSM-ID (39.4% in 2018, 40.8% in 2022; aPR=0.98, 95% CI=0.73-1.31) (Figure). Among MSM-ID aware of PrEP, PrEP use was low in both years regardless of sexual orientation (gay/bisexual: 15.3% in 2018, 10.2% in 2022; heterosexual: 7.7% in 2018, 2.5% in 2022). Conclusion: The increase in PrEP awareness was limited to gay/bisexual men, however, PrEP use was low overall among MSM-ID regardless of sexual orientation. Without adequate HIV prevention, MSM-ID may be at risk of acquiring or transmitting HIV through injecting drugs and sex. Provider training may be useful to encourage assessment of both injection- and sex-related indications for PrEP during provider visits. Educational campaigns tailored to MSM-ID are warranted, particularly around risk behavior and benefits of PrEP regardless of one's sexual orientation.

Results: N=511 participants in 2018 and N=229 participants in 2022 were included in the analysis. More than 70% of both samples were male. Compared to 2018, a higher proportion of PWID were >65 years old and fewer identified as Non-Hispanic Black in 2022. In 2022, a higher proportion of PWID reported using ≥2 most frequently injected drugs (6.3% vs. 16.0%, p<0.0001). In 2022, more PWID owned naloxone (35.0% vs. 81.8%, p<0.0001) and sought out fentanyl (10.6% vs. 26.2%, p<0.001) in the past year. No differences were found in having a usual healthcare source, HIV testing, or PrEP awareness and uptake. However, a significantly lower proportion of 2022 participants reported sharing needles (40.5% vs. 21.6%%, p<0.01), cookers/cotton/water (53.4% vs. 35.8%, p=0.0058), or syringes (40.8% vs. 23.0%, p<0.01) than those in 2018. Fewer PWID obtained needles from syringe service programs (SSPs) over time (74.8% vs. 59.9%, p=0.03), but a larger proportion in 2022 obtained needles from places other than SSPs or HIV prevention programs (9.4% vs. 23.3%, p=0.01). In 2022, past year engagement in drug treatment programs also increased from 31.4% to 61.6% (p<0.0001). Conclusion: Significant decreases in injection-related risk behaviors and increases in utilization of drug-related services were observed among PWID in Washington, DC. Changes in drug use behaviors over time and where PWID received services were also observed, suggesting the need to better understand how changes in service utilization and drug use patterns impact PWID health. 1009 Changes in HIV PrEP Awareness and Use Among PWID in 19 US Cities, 2018 and 2022 Johanna Chapin-Bardales, Dita Broz, Patrick Eustaquio , Jonathan Feelemyer, Teresa Finlayson, Savannah Harris, Cyprian Wejnert, for the NHBS Study Group Centers for Disease Control and Prevention, Atlanta, GA, USA Background: HIV pre-exposure prophylaxis (PrEP) awareness and use among persons who inject drugs (PWID) has been low since the introduction of PrEP in the U.S. in 2012. Limited data are available to monitor PrEP awareness and use specifically among PWID. Methods: In 19 U.S. cities participating in 2018 and 2022 National HIV Behavioral Surveillance, PWID were recruited using respondent-driven sampling and offered a behavioral survey and HIV testing. We examined the prevalence of PrEP awareness and PrEP use in the past 12 months, overall and by key characteristics, among HIV-negative PWID in 2018 and 2022. We obtained adjusted prevalence ratios, 95% confidence intervals, and p-values using log-linked Poisson models accounting for clustering by recruitment chain and adjusting for city and participant network size to assess changes in PrEP outcomes over time. Results: From 2018 to 2022, PrEP awareness among PWID increased from 25.6% to 35.3% (p<0.01), yet PrEP use in the past year remained stable at 1.2% (p=0.35). The approximate 10 percentage-point increase in PrEP awareness between 2018 and 2022 was consistent across demographic and behavioral subgroups. PrEP awareness increased significantly among PWID who had receptively shared syringes, shared injection equipment, had condomless vaginal or anal sex, and had a bacterial STI in the past year (all p-values <0.01). Minimal yet significant increases in PrEP use were observed for those who had receptively shared syringes, shared injection equipment, and received a recent HIV test (all p-values <0.05); nevertheless PrEP uptake in these groups did not surpass 2%. PrEP use was highest among those reporting past-year male-male sex and bacterial STI (both 4.8% in 2022); this was stable compared with 2018. Conclusion: PrEP awareness significantly increased from 2018 to 2022 among PWID. Still, only about one-third were aware of PrEP in 2022. Increases in awareness were consistent across subgroups, suggesting that PrEP messaging is reaching groups with a greater risk of HIV acquisition, yet changes may be due to a generalized increase in awareness overall. PrEP use remained suboptimal. PWID at higher risk of injection-related HIV acquisition and those who obtained HIV-related services did experience significant increases in PrEP uptake unlike other subgroups; however, increases were small. Efforts to improve PrEP messaging, provider training, and access specifically for PWID may serve to further increases in PrEP awareness and use. The figure, table, or graphic for this abstract has been removed.

Poster Abstracts

1011 RDS Network Size Among People Who Inject Drugs in Kenya as a Predictor of HIV and HCV Positivity Matthew Akiyama 1 , Amirhossein Alvandi 2 , Krista Gile 2 , Yun Jiang 2 , Lindsey Riback 1 , Mercy Nyaokowa 3 , Jebet Boit 3 , Rose Wafula 3 , Nazila Ganatra 3 1 Albert Einstein College of Medicine, Bronx, NY, USA, 2 University of Massachusetts, Worcester, MA, USA, 3 Ministry of Health, Nairobi, Kenya Background: People who inject drugs (PWID) are a key population for HIV and HCV transmission in sub-Saharan Africa. Understanding transmission networks is critical to reducing prevalence and incidence among PWID. Yet, network related factors associated with seropositivity are poorly understood. Methods: We are recruiting PWID using respondent driven sampling (RDS) from syringe services programs in Kenya. Upon enrollment, participants complete biobehavioral surveys, receive HIV, HCV, and HBV testing, and are provided with 3 coupons to recruit their peers who are not already in the study. Upon return of 3 coupons, 5 tokens are given to establish crossties among PWID

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