CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Results: We enrolled 400 cisgender YMSM; median age was 21 years (IQR: 20-23), 166 (41.6%) self-identified as Black, 241 (60.2%) completed secondary school, and 3 (0.8%) were currently using PrEP. Forty participants tested positive for HIV (HIV prevalence: 10%), 5.0% (N=20/400) newly tested positive for HIV, and of those, 5 (25.0%) had a recent HIV infection. The annualized HIV incidence rate was 2.81% (95%CI: 0.32-5.30). Overall, 108 (27.0%) never tested for HIV. Lower HIV knowledge was associated with never testing for HIV. Never testing was associated with being aged 18-19 years, reporting no STI in the last 12 months, fewer sexual partners and no chemsex (Table). Conclusion: HIV prevalence and incidence among YMSM in our sample was high. Almost a third of YMSM in our study had never been tested for HIV, although all participants accepted testing when offered. These results point to an urgent need for focused policies and interventions to reach and improve HIV prevention engagement among younger MSM in Brazil. Strategies to raise knowledge and awareness of the impact of HIV among parents, in schools and among youth may be needed to create demand for HIV prevention methods such as testing and PrEP that are readily available in Brazil.

1030 Recent HIV Infections and HIV Incidence in PrEP Among Adolescents From Key Populations in Brazil Diana Reyna Zeballos Rivas 1 , Fabiane Soares 1 , Laio Magno 2 , Celia Landmann 3 , Orlando Ferreira 4 , Matheus Westin 5 , Dirceu Greco 5 , Alexandre Grangeiro 6 , Ines Dourado 1 , for the PrEP1519 Study Group 1 Federal University of Bahia, Salvador, Brazil, 2 State University of Bahia, Salvador, Brazil, 3 Oswaldo Cruz Foundation - Fiocruz, Rio de Janeiro, Brazil, 4 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 5 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 6 University of Sao Paulo, Sao Paulo, Brazil Background: Over the last decade, HIV infection has increased among young men in Brazil, and PrEP is an effective prevention method that can help to reduce HIV incidence in this population. Recent HIV-1 infection (RHI) testing algorithms (RITAs) are used to estimate HIV incidence from cross-sectional data. We aimed to assess RHI among adolescents from key populations at enrollment and HIV incidence among adolescent men who have sex with men (aMSM) and transgender women (aTGW) who started using daily oral PrEP. Methods: PrEP1519 study is a PrEP demonstration cohort in three Brazilian capital cities among sexually active aMSM/aTGW aged 15-19. 1) We conducted a cross-sectional analysis with baseline data from 2020 including participants who were screened with a fourth-generation HIV rapid test. The RITA tested blood specimens using Sedia LAg assay that detects antigen-driven antibody response (Sedia BioSciences, Portland, OR), an HIV-1 RNA test, viral load and a CD4 count prior to ART use. Among these participants, RITA-based HIV incidence was calculated using a mean duration of recency infection of 167 days and a false-recent rate of 0.02. 2). Data from adolescents that had a HIV negative test and initiated PrEP in 2020 were used to calculate HIV incidence on PrEP. Incidence was calculated considering the time from first PrEP prescription until the last HIV test, PrEP prescription, or visit in 2020. Tenofovir-diphosphate (TDF-DP) concentrations in dried blood spots were estimated for those who tested positive for HIV. Results: Out of the 494 participants screened, 21 tested positive. Among those, 6 were classified as recent infections and 15 as long term infection. At baseline, the HIV prevalence was 4.3%, and the estimated RHI was 2.6 (95% CI 0.5-4.8) per 100 person-years. The HIV incidence over 418 adolescents who started PrEP was 2.5 (95% CI 0.7 – 6.4) per 100 person-years. All the adolescents who seroconverted had levels of TDF-DP below limits of quantification. Conclusion: The estimated RHI rate highlights the need for targeted HIV prevention interventions for sexual minorities adolescents. Integrating RHI testing into routine can aid in monitoring the effectiveness of prevention efforts and improve early entry to HIV care. Low adherence and PrEP discontinuation are challenges that need to be addressed among adolescents to enhance PrEP effectiveness. One strategy to tackle these issues involves offering adolescents a range of choices, including long-acting PrEP. 1031 HIV Incidence and Factors Associated With Never Testing for HIV Among Young MSM: Conectad@s Study Sylvia L Teixeira 1 , Emilia M. Jalil 2 , Cristina M. Jalil 2 , Rodrigo Scarparo 2 , Valdilea Veloso 2 , Erin Wilson 3 , Willi McFarland 3 , Beatriz Grinsztejn 2 , Thiago S. Torres 2 , for the Conectad@s Study Team 1 Oswaldo Cruz Institute, Rio de Janeiro, Brazil, 2 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 3 San Francisco Department of Public Health, San Francisco, CA, USA Background: New HIV cases are increasing among young men who have sex with men (YMSM) in Brazil. Research is needed to monitor new infections and examine HIV prevention engagement, including HIV testing. For this study, we estimated HIV incidence and explored HIV testing and factors associated with never testing for HIV in a large study of YMSM in Brazil. Methods: Data are from the Conectad@s study of YMSM aged 18-24 years in Rio de Janeiro, Brazil. Participants were recruited between Nov/2021 Oct/2022 using respondent driven sampling. Participants were offered HIV testing and were surveyed on demographics, behavior, sexually transmitted infection (STI) and HIV knowledge (validated 12-items measure with scores ranging from 0 to 12; higher scores mean higher knowledge). Recent HIV infection was determined using the Maxim HIV-1 LAg-Avidity EIA assay as part of recent infection testing algorithm (RITA). Annualized HIV incidence and 95% confidence intervals (95%CI) were calculated using the UNAIDS/WHO incidence estimator tool, excluding participants with known HIV diagnosis and those currently on PrEP. We used logistic regression models to assess factors associated with never testing for HIV.

Poster Abstracts

1032 Declines in HIV Incidence Among Gay, Bisexual and Other MSM in Vancouver, Canada, 2012-19 to 2017-23 David Moore 1 , Lu Wang 1 , Allan Lal 1 , Justin Barath 1 , Julio S. Montaner 1 , Mark Hull 1 , Junine Toy 1 , Viviane Dias Lima 1 , Paul Sereda 1 , Robert Hogg 1 , Nathan Lachowsky 2 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2 University of Victoria, Victoria, Canada Background: British Columbia (BC), Canada, has provided dedicated funding to support expanded access to HIV testing and engagement/retention in HIV care since 2010 and publicly funded PrEP since 2018. We compared HIV incidence for gay, bisexual and other men who have sex with men (GBM) in metropolitan Vancouver over an 11-year period. Methods: Participants were sexually active GBM aged ≥16 years and were recruited through respondent driven sampling into two cohort studies: Momentum I (M1; 2012-2019) and Momentum II (M2; 2017- 2023). Participants completed a self-administered computer-based survey and tests for HIV and other sexually transmitted infections every 6 months. For participants HIV negative at enrollment, we measured HIV incidence over four years of follow-up through data linkages with the BC HIV Drug Treatment Program. We excluded participants from the M2 analysis who also participated in M1. We calculated HIV incidence rates and rate ratios across time periods and used Poisson regression to identify risk factors for HIV infection, stratified by time period. Results: We recruited 774 participants in M1 and 753 in M2. Of these, 551 in M1 and 533 in M2 were HIV-negative at enrolment and included in the analysis. HIV PrEP use was reported by a maximum of 6.3% of participants at any visit in M1 and increased from 16.4% from 2017 to 59.6% in 2023 for M2 participants. We identified 16 new HIV infections in 2166.51 person-years (PYRs) of follow-up for an incidence rate [IR] of 0.74 per 100 PYRs in M1; and 6 new infections in 2124.22 PYRs for an IR of 0.28 per 100 PYRs in M2 (IRR= 0.38; 95% CI 0.15 – 0.97). In M1, HIV incidence was associated with age <30 years (IRR 2.74;p=0.056), having condomless anal sex (CAS) with an HIV-positive or unknown serostatus partner (IRR=4.88;p=0.002); sex work in the past six months (P6M) (IRR=4.27;p=0.02); number of male sex partners in P6M (IRR=1.01; p<0.001) and crystal meth use in P6M (IRR=4.08;p=0.007). HIV incidence in M2 was associated with CAS with an HIV-positive or unknown serostatus partner (IRR=8.50;p=0.035), P6M sex work (IRR=5.53;p=0.048) and crystal meth use in P6M (IRR=6.79;p=0.025), but not age, or number of male sex partners in P6M. Conclusion: HIV incidence declined by 62% for GBM in Metro Vancouver over the study period, likely reflecting the combined effectiveness of Treatment as Prevention and publicly funded PrEP. The figure, table, or graphic for this abstract has been removed.

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