CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1119 Optimizing PrEP Outcomes for MSM Who Sell Sex: The Role of Stigma, Violence, and Mental Health Kaitlyn Atkins 1 , John Mark Wiginton 2 , Thomas Carpino 1 , Travis H. Sanchez 3 , Stefan Baral 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 San Diego State University, San Diego, CA, USA, 3 Emory University, Atlanta, GA, USA Background: Among gay men and other men who have sex with men (MSM) in the U.S., those who sell sex are disproportionately affected by HIV and report decreased uptake of pre-exposure prophylaxis (PrEP) and other HIV prevention methods. We sought to understand stigma experiences of MSM who sell sex and stigma's role as a potential barrier to PrEP in this population. Methods: Data were from two rounds of repeat cross-sectional online surveys of U.S. MSM (n=12,601) conducted from September 2021 through June 2023. We described stigma, violence, mental health, and PrEP experiences using chi-square tests to compare among MSM who sold sex for money, drugs, or something else in the last year to other MSM. Among MSM who sold sex who were PrEP eligible and not living with HIV, we used modified Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% confidence intervals (CI) for the association between stigma and (1) maximum oral PrEP adherence (reporting 30 of 30 doses in the last month) and (2) willingness to use injectable PrEP if available. Analyses adjusted for age, race, education, and survey year. Results: Compared to other MSM, those who sell sex reported higher levels of stigma from family and friends, general social stigma, physical violence, symptoms of post-traumatic stress disorder, and depressive symptoms (Table). Maximum daily oral PrEP adherence were lower among MSM who sell sex than other MSM (54% v 75%, p<0.001). In adjusted analyses with PrEP-eligible MSM who sell sex, decreased PrEP adherence was associated with lifetime exposure to violence (PR 0.68, 95% CI 0.47-0.99) and social stigma (PR 0.57, 95% CI 0.33 0.96. MSM who sell sex were more willing to use injectable PrEP (57% vs 43%, p=0.001) and on-demand PrEP (75.2% vs 63.6%, p=0.004). Those willing to try injectable PrEP most preferred delivery at home (39%) or in STI clinics (20%). Increased willingness to use injectable PrEP was associated with anticipated healthcare provider stigma (PR 1.38, 95% CI 1.01-1.90). Conclusion: Using data from over 12,000 MSM, we saw increased stigma, violence, and mental health concerns among MSM who sell sex. These issues should be concurrently addressed to optimize HIV prevention in this marginalized population. Addressing stigma and violence toward MSM who sell sex may improve adherence for those who intend to use daily. On-demand or injectable PrEP may more effectively reach MSM who sell sex if concerns about healthcare stigma are adequately addressed. The figure, table, or graphic for this abstract has been removed. 1120 Behavioral and Structural Interventions for PrEP Adherence Among Young Female Sex Workers in Kenya Kawango Agot 1 , Domonique M. Reed 2 , Matthew R. Lamb 2 , Dan Omollo 1 , Julie Franks 2 , Jane Moraa 1 , Joanne E. Mantell 3 , Allison Zerbe 2 , Timothy Okello 1 , Maria Lahuerta 2 , Doris Naitore 4 , Wafaa El-Sadr 2 1 Impact Research and Development Organization, Kisumu, Kenya, 2 ICAP at Columbia University, New York, NY, USA, 3 New York State Psychiatric Institute, New York, NY, USA, 4 ICAP at Columbia University, Kisumu, Kenya Background: In Kenya, estimated HIV incidence is substantially higher among young female sex workers (YFSW) compared to similar-age women not engaged in sex work (2.2% vs. 0.15%). Pre-exposure prophylaxis (PrEP) for HIV prevention is recommended for at-risk populations, but its effectiveness requires consistent access and adherence. We assessed the effectiveness of two behavioral and structural interventions on PrEP adherence among YFSW in Kisumu, Kenya. Study follow-up (F/U) coincided with national restrictions on travel and gatherings due to the COVID-19 pandemic. Methods: We conducted an unblinded, randomized-controlled trial enrolling 18-24 year-old HIV-negative YFSW with no current or recent PrEP use. Participants were provided oral PrEP and randomized to either weekly adherence support from a trained peer supporter (PS), or SMS reminders and resource transfer (RRT) for 12 months, and received PrEP with no adherence support interventions for another 12 months to assess durability of our interventions. Primary outcomes compared adherence in study arms via detectable metabolites in whole blood samples and self-report at 12, 18, and 24 months of F/U. We conducted an intention-to-treat analysis of differences in intervention effectiveness at months 12, 18 and 24. Sensitivity analyses used

zero OOP payment in 2021. The mean total payment of combined PrEP ancillary services decreased from $403.97 in 2017 to $268.11 in 2021, and the mean OOP payments decreased from $89.70 in 2017 to $74.52 in 2021 (Figure). Conclusion: Despite a decreasing trend in total and OOP payments for PrEP ancillary services from 2017-2021, about 30% of commercially insured PrEP users paid OOP payments after the ACA provision of no cost sharing went into effect in 2021. Efforts are needed to ensure that patient OOP payments are not required by applicable third-party payers.

1118 PrEP Indicators by Race/Ethnicity Among Heterosexual Women Receiving CDC-Funded HIV Testing Services Deesha Patel 1 , Weston O. Williams 2 , Carolyn Wright 1 , Shaliondel Benton 1 , Mesfin S. Mulatu 1 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Public Health Analytic Consulting Services, Inc., Atlanta, GA, USA Background: Pre-exposure prophylaxis (PrEP) is effective at reducing the risk of HIV acquisition. However, PrEP utilization among women remains low, especially among Black/African American (hereafter referred to as Black) and Hispanic/Latina women. We examined indicators for PrEP use and PrEP-related services by race/ethnicity among heterosexual women testing negative for HIV infection via CDC-funded HIV testing. Methods: We used 2019-2021 HIV testing data submitted by CDC-funded state and local health departments (n=60) and community-based organizations (n=150) to the National HIV Prevention Program Monitoring & Evaluation system. We analyzed the following indicators for heterosexual women: current PrEP use, eligibility for PrEP referral among those testing negative and not currently using PrEP, referral to a PrEP provider among those eligible, and assistance with linkage to a PrEP provider among those who received a referral. To compare each indicator by race/ethnicity, we calculated adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) and p-values—adjusting for age, U.S. Census region, and year—with White women as the referent group. Results: The prevalence of current PrEP use ranged from 0.5% to 1.1%; in adjusted models, current use was higher for multiracial (1.1%; aPR: 1.73) and Black (0.9%; aPR: 1.30) women compared to White women (0.7%; all p<0.05). Eligibility was higher for multiracial (47.2%; aPR: 1.23), Black (44.0%; aPR: 1.22), and Asian (43.3%; aPR: 1.16) women, and lower for Hispanic/Latina (32.0%; aPR: 0.90) and Native Hawaiian/Pacific Islander (33.5%; aPR: 0.89) women, versus White women (38.1%; all p<0.05). Referral was higher for American Indian/ Alaska Native (50.8%; aPR: 1.59) and Black (36.4%; aPR: 1.09) women, but lower for Asian women (25.4%; aPR: 0.85), versus White women (31.7%; all p<0.05). Assistance with linkage was higher for Black women (75.8%; aPR: 1.05), but lower for Hispanic/Latina (65.0%; aPR: 0.94), Asian (60.8%; aPR: 0.88), and multiracial (63.8%; aPR: 0.93) women, versus White women (69.5%; all p<0.05). Conclusion: PrEP use was low among all heterosexual women testing negative for HIV infection. PrEP-related services reached a greater proportion of Black heterosexual women; however, PrEP-related services need to reach all racial/ ethnic groups, especially Hispanic/Latina women, to increase PrEP use and reduce HIV acquisition for all heterosexual women at greater risk for HIV.

Poster Abstracts

CROI 2024 363