CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

PrEP non-persistence (off-PrEP). HIV diagnosis rates were calculated by dividing the number of new HIV infections by the observed person-years (PY) for each period using Poisson regression. Results: Among 123,901 PrEP-naïve adults (median age, 31 years; IQR, 25–40), 1,343 were diagnosed with HIV while on-PrEP (rate: 2.15 per 100 PY [95% CI: 2.04–2.27]) and 2,488 were diagnosed while off-PrEP (4.22 per 100 PY [95% CI: 4.06–4.39]). Overall, off-PrEP periods were associated with a 2-fold higher risk in the relative HIV infection rate compared to on-PrEP periods (rate ratio [RR]: 1.96 [95% CI: 1.84–2.10]). Higher rates of new HIV diagnosis during off-PrEP periods were observed across various subgroups, including cisgender men (RR: 2.26 [95% CI: 2.10–2.44]) and transgender women (RR: 3.64 [95% CI: 1.59–8.31]), as well as all age groups and geographic regions. Conclusion: In this real-world study involving >120,000 persons prescribed PrEP, off-PrEP periods were associated with an overall two-fold higher rate of new HIV diagnoses. These findings demonstrate how PrEP discontinuations and inconsistent use hamper the maximum public health impact of PrEP, underscoring the urgent need for strategies that can enhance persistence, including broader availability of long-acting PrEP options. The figure, table, or graphic for this abstract has been removed. 1125 Outcomes of a Community-Clinic Hybrid PrEP Trial in China During COVID Lockdowns, 2021-2023 Zhuoheng Yin 1 , Yifan Dai 2 , Chengxin Fan 3 , Gifty Marley 1 , Chunyan Li 4 , Songjie Wu 5 , Quanmin Li 6 , Joseph D. Tucker 7 , Jonathan Lio 8 , Haojie Huang 9 , Ke Liang 5 , Linghua Li 6 , Aniruddha Hazra 8 , Renslow Sherer 8 , Weiming Tang 10 1 Institute for Global Health and Infectious Diseases, Guangzhou, China, 2 Dermatology Hospital of Southern Medical University, Guangzhou, China, 3 Nanjing Medical University, Nanjing, China, 4 University of Tokyo, Tokyo, Japan, 5 Zhongnan Hospital of Wuhan University, Wuhan, China, 6 Guangzhou Eighth People's Hospital, Guangzhou, China, 7 London School of Hygiene and Tropical Medicine, London, United Kingdom, 8 University of Chicago, Chicago, IL, USA, 9 Wuhan Tongxing LGBT Center, Wuhan, China, 10 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Data on PrEP uptake, persistence, discontinuation, adverse events, and HIV incidence among Chinese at-risk PrEP users is limited. Methods: We conducted a 12 month PrEP demonstration project in Wuhan and Guangzhou, China, using a community and clinic hybrid delivery model for recruitment, participant engagement, and PrEP delivery. Healthcare providers implemented prescribing, medical consultation, and PrEP dispensing through clinic visits or courier delivery (Through community-based organizations). PrEP refill was monthly for the first quarter and trimonthly thereafter. PrEP continuation and adherence information (defined as self-reported taking more than 4 pills in 7 days for daily and over 75% strict adherence to 2+1+1 for events-driven) was surveyed quarterly. Enrollment, PrEP persistence, adherence, discontinuation, and adverse events were descriptively summarized. Lockdowns occurred during 2021-2022 due to covid restrictions. Results: From September 2021 to July 2023, a total of 3649 GBMSM were screened, and 1200 were enrolled. Of those, 1138 participants started oral PrEP, with a median age of 29.1(SD=5.9). Most participants identified as gay or bisexual(93.7%, 1066/1138), and 99.6% were cis-gender men(1134/1138). After initiation, PrEP persistence rates at 3, 6, 9, and 12 months were 84.2%(876/1059), 75.8%(640/845), 67.1%(472/703), and 55.5%(298/537) respectively(ongoing). 45.2%(396/876) and 54.8%(480/876) choosed the daily and on-demand regimen initially. At the end, 37.2% of participants reported regimen transition(111/298) in a inceasing trend (32, 41, 61, and 67 at 3, 6, 9, and 12 months). 62.7%(126/201) participants transferred from daily to on-demand regimen. The self-reported adherence rate was 75.4%(716/950), 67.1%(515/768), 58.6% (387/660), and 47.1%(237/503) at months 3, 6, 9 and 12. 239 participants (21.0%, 239/1138) discontinued PrEP use during study. 52.8% and 46% of subjects reported alcohol use and nitrates at baseline and 12 month.Overall STIs incidence within study period is 4.9%-8%. Six participants seroconverted, resulting in an HIV incidence rate of 0.73 per 100 person-years. Conclusion: The hybrid CBO and clinic-based model proved feasible for reaching and dispensing PrEP among Chinese at-risk populations. On-demand use and mail order drugs were popular alternatives, and one half of participants engaged in sex using alcohol and nitrates. Long-term PrEP persistence and optimal adherence continuously decreased among Chinese users during the 12-month period.

but similar across all levels of alcohol use. Hazardous alcohol use should not discourage PrEP implementation efforts to engage and retain young men. 1123 Characterizing HIV Preexposure Prophylaxis (PrEP) Discontinuation Among Men Who Have Sex With Men Wenting Huang , Travis H. Sanchez, Marissa J. Hannah, Kelsey C. Coy, Cristian S. Acero, Aaron J. Siegler Emory University, Atlanta, GA, USA Background: For PrEP to have optimal impact, persons indicated for PrEP must not only initiate it but also be retained in care. However, few studies have assessed characteristics associated with PrEP discontinuation among men who have sex with men (MSM). Methods: We conducted a descriptive analysis using data from the 2022 American Men's Internet Survey, a web-based behavioral survey of U.S. MSM. Eligible participants for this analysis were cisgender males aged≥15 years, resided in the U.S., HIV negative, and were gay, bisexual, or had a history of sex with other men. To explore the characteristics of MSM who have discontinued PrEP, we categorized participants into three groups: persons who never used PrEP, are currently using PrEP, or have discontinued PrEP (used in the past but not currently using). We performed multivariate logistic regression, adjusting for all covariates presented. Results: Over half (54%, 2033/3785) of MSM had never used PrEP, over one third (36%, 1365/3785) were using PrEP, and 10% (387/3785) had discontinued PrEP. Half of these (190/387) had discontinued PrEP within the past 12 months. MSM who discontinued PrEP were younger (mean=41) than those never using (mean=45) or currently using PrEP (mean=45). MSM discontinuing PrEP were less likely to have private health insurance (63%) than PrEP users (79%) and had similar insurance levels compared to MSM who never used PrEP (67%). There were no differences in PrEP discontinuation by race and ethnicity. MSM discontinuing PrEP had elevated sexual risk relative to those who never used PrEP: condomless anal sex with HIV-discordant partners was higher (33% vs 20%, aOR=1.83, 95%CI=1.43-2.34) and sexually transmitted diseases (STDs) were more frequent (14% vs 5%, aOR=2.69, 95%CI=1.86-3.90). These relationships were similar for MSM who had discontinued PrEP over a year ago and for those who discontinued PrEP within last year. Conclusion: One in ten MSM participants in this national survey had discontinued PrEP. Risk for this group, in terms of condomless sex and STDs, was elevated relative to MSM who never initiated PrEP. Structural barriers, such as health insurance and lower educational attainment, were associated with PrEP discontinuation indicating that discontinuation may not solely be due to decreased risk. Tailored intervention is needed to support persons who have discontinued PrEP, such as health messaging, clinical discussions, and ensuring few barriers to care, to optimally address the sexual health needs of this group. 1124 PrEP Non-Persistence and New HIV Diagnoses: A Real-World Analysis of >120,000 People Prescribed PrEP Li Tao , Juan Yang, J C. Hojilla, Anand P. Chokkalingam, Christoph Carter, Moupali Das Gilead Sciences, Inc, Foster City, CA, USA Background:HIV pre-exposure prophylaxis (PrEP) uptake has increased, but discontinuation and inconsistent use (referred to here as non-persistence) remain common. The impact of PrEP non-persistence on new HIV infections at the population level is not well characterized. In this study, we leveraged a large real-world dataset in the United States to evaluate the impact of non persistence on HIV diagnosis rates. Methods: PrEP-naïve adults with at least one oral F/TDF or F/TAF for PrEP prescription dispensed between April 2021 and March 2022 were identified from the IQVIA Real-World Longitudinal Prescriptions and Diagnosis Database, a retail pharmacy claims dataset, and were followed for up to 12 months from first prescription claim submitted. Periods of PrEP non-persistence were defined as gaps in prescription claims of >30 days following the end of the calculated PrEP supply. This approach allowed for the determination of HIV diagnosis rates during periods when individuals had PrEP on-hand (on-PrEP) versus periods of

Poster Abstracts

CROI 2024 365