CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

must implement tailored interventions to tackle stigma within health services and optimize adherence among the most vulnerable, such as those with lower education and sex workers. Long-acting PrEP can be strategical to improve PrEP adherence in these populations.

inverse probability weighting with stabilized weights to correct for selection bias due to lost to F/U. Results: We screened 289 YFSW and enrolled 200 (100 per arm). Socio demographic and sexual behavior characteristics are presented in Table 1. At 12-month F/U (n=179), 86% in PS and 93% in RRT arms reported decreases in number of weekly clients. At 12, 18, and 24 months, detectable levels of PrEP were 3%, 1%, and 0% in the PS arm compared to 9%, 9%, and 1% in the RRT (p-value = 0.4). Our sensitivity analysis found similar results. In contrast, 85%, 81% and 83% in the PS arm, and 86%, 87% and 76% in the RRT arm self reported perfect 7-day adherence at months 12, 18 and 24, respectively. Two seroconversions were identified; one at 12- and one at 18-months F/U. Conclusion: In this population of YFSW, no difference in adherence by drug levels or self-report was noted across study arms. The very low levels of drug metabolites in contrast to high self-reported adherence may be due to perceived lower HIV risk resulting from decreased sex work during COVID-19 and to socially desirable responses. Findings highlight the urgent need for long-acting PrEP for this population.

1121 Factors Associated With Inadequate PrEP Adherence Among TGW and Young MSM: ImPrEP Study Mayara Secco Torres da Silva 1 , Thiago S. Torres 2 , Carolina Coutinho 1 , Iuri Leite 1 , Ronaldo Moreira 1 , Brenda Hoagland 1 , Cristina Pimenta 3 , Kelika A. Konda 4 , Hamid Vega 5 , Sergio Bautista 6 , Carlos Caceres 4 , Peter L. Anderson 7 , Valdilea Veloso 1 , Beatriz Grinsztejn 1 , for the ImPrEP Study Group 1 Institute Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 2 Instituto Nacional de Infectologia Evandro Chagas (INI, Fiocruz), Rio de Janeiro, Brazil, 3 Ministry of Health, Brasilia, Brazil, 4 Universidad Peruana Cayetano Heredia, Lima, Peru, 5 Instituto Nacional de Psiquiatria Ramon de la Fuente Muñz, Mexico City, Mexico, 6 Instituto Nacional de Salud Pública, Mexico City, Mexico, 7 University of Colorado, Denver, CO, USA Background: The HIV epidemic disproportionally affects transgender women (TGW) and young men who have sex with men (YMSM) in Latin America. Monitoring adherence is key to designing tailored strategies to improve PrEP persistence, targeting these vulnerable populations. We aimed to identify factors associated with non-protective TDF-FTC levels in dried blood spots (DBS) in TGW and YMSM using PrEP. Methods: ImPrEP was an implementation study offering same-day oral PrEP (TDF/FTC) for 9509 MSM/TGW in Brazil, Mexico, and Peru (2018-2021). Follow-up visits were scheduled 4 weeks post-enrolment and then quarterly. In this analysis, YMSM (18-24 years) and TGW (all ages) who had at least one DBS obtained during study follow-up were included. We used generalized estimating equations to identify factors associated with inadequate PrEP adherence (tenofovir diphosphate [TFV-DP]<550 fmol/punch [week 4] or 800 fmol/punch [weeks 28-124] in DBS) among MSM/TGW (18-24 years) and TGW (all ages), separately. Results: We analyzed 3573 DBS samples of 1,802 young participants [week 4: 1645 (46%); weeks 28-124: 1928 (54%)], and 928 DBS samples of 404 TGW [week 4: 358 (39%); weeks 28-124: 570 (61%)]. Of young participants, 94% were MSM, 14% aged 18-19 years, 75% non-white and 70% had post-secondary education. Among TGW, 27% were 18-24 years, 77% non-white and 57% had secondary education. For both populations, being from Peru and low educational level (primary or secondary education) increased the odds of inadequate PrEP adherence, while having more than 10 partners decreased the odds of inadequate adherence. Sex work and being TGW were associated with inadequate adherence among young participants, while for TGW, being 18-24 years showed the same association. Use of poppers (for young participants) and reporting condomless anal sex (for TGW) decreased the odds of inadequate adherence (Figure). Conclusion: Sexual behavior might have influenced HIV risk perception, leading to higher PrEP adherence. Social determinants of health such as education played a major role in PrEP adherence among TGW and young MSM/ TGW in Latin America. In Latin America, PrEP programs for young MSM/TGW

Poster Abstracts

1122 Alcohol Use and the Preexposure Prophylaxis Continuum of Care Among Men in Rural South Africa Alison C Castle 1 , Jacob Busang 2 , Jaco Dreyer 2 , Carina Herbst 2 , Nonhlanhla Okesola 2 , Natsayi Chimbindi 2 , Thembelihle Zuma 2 , Jana Jarolimova 1 , Christina Psaros 1 , Judith Hahn 3 , Sheela Shenoi 4 , Maryam Shahmanesh 5 , Mark J. Siedner 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Africa Health Research Institute, Mtubatuba, South Africa, 3 University of California San Francisco, San Francisco, CA, USA, 4 Yale University, New Haven, CT, USA, 5 University College London, London, United Kingdom Background: Despite freely available pre-exposure prophylaxis (PrEP), HIV incidence among young men in South Africa is high. There is conflicting evidence around the association between alcohol use behaviors and PrEP utilization. We explore the impact of hazardous alcohol use on PrEP initiation and retention among South African men. Methods: We performed a secondary analysis of data from a trial that included men aged 16-29 randomly selected from a demographic surveillance site in KwaZulu-Natal. All participants were referred to HIV and sexual reproductive health services, where those at risk for HIV were offered oral PrEP. Alcohol consumption was assessed at monthly visits and categorized as: non-drinking (0), low/moderate risk drinking (1-5), and high/very high-risk drinking (6-12) based on AUDIT-C criteria. Primary outcomes were PrEP initiation and retention in PrEP services for >3 months. We fitted logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between PrEP initiation/retention and hazardous alcohol consumption. Results: Of the 847 men referred to study clinics, 528 (62%) attended at least once. 156 were excluded due to missing data (n=107), positive HIV testing (n=20) or declined HIV testing (n=29), leaving 372 men in the analytic cohort. Average age was 22.5 years (SD 3.6) and 131 (35%) had high/very-high alcohol consumption (AUDIT-C score ≥6). Men with the highest risk alcohol use also reported frequent condomless sex (89%, vs 56% in no alcohol group). We found the greatest uptake of PrEP among the high/very high-risk group (46/131, 35%), followed by the low/moderate risk group (17/63, 27%) and the no alcohol group (25/172, 17%). The high-risk group remained significantly more likely to initiate PrEP compared to the non-drinking group in multivariable models adjusted for confounders (aOR 2.02 95%CI 1.07-4.02; p-value 0.045). 30% (26/88) of men remained on PrEP at 3 months. Men with high/very high-risk drinking had similar PrEP retention at 3 months compared to men who identified as non drinkers (aOR 1.43 95% CI 0.33-6.12; p-value 0.63). Conclusion: High-risk alcohol use is common among men in rural South Africa and associated with increased PrEP initiation. PrEP retention was low overall,

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