CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1127 PrEP Uptake and Persistence Among Incarcerated People in Zambia: Early Results From a Cohort Study Cassidy W Claassen 1 , Brianna Lindsay 1 , Muyunda Siyambango 2 , Linah Mwango 3 , Caitlin Baumhart 1 , Nasho Nyirongo 4 , Gideon Daka 4 , Clement Moonga 2 , Chiti Bwalya 5 , Maurice Musheke 2 , Michael Herce 6 1 University of Maryland, Baltimore, MD, USA, 2 Center for Infectious Disease Research in Zambia, Lusaka, Zambia, 3 Ciheb Zambia, Lusaka, Zambia, 4 Maryland Global Initiatives Corporation, Lusaka, Zambia, 5 University of Maryland - College Park, College Park, MD, USA, 6 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: The time during and immediately after incarceration can be high-risk periods for HIV acquisition, particularly in sub-Saharan Africa (SSA). Incarcerated people often have very limited access to effective HIV prevention measures. In 2019, Zambia began offering HIV pre-exposure prophylaxis (PrEP) in correctional facilities. We report early results from one of the first longitudinal studies of PrEP uptake and persistence in a correctional setting in SSA. Methods: In August 2023, we launched a cohort study of PrEP users and non users in three correctional facilities in Lusaka, Zambia. Following HIV testing, HIV-negative incarcerated persons were offered PrEP by the corrections health system, and then were approached by study staff for participation. Consenting participants were followed from incarceration through release into the community for PrEP outcomes, including uptake, persistence, and adherence. A subset of participants on PrEP underwent urine tenofovir (TFV) screening for adherence, and another subset of both PrEP users and non-users will be consented to participate in qualitative interviews in October 2023. Results: From 8 August to 21 September 2023, we screened 124 incarcerated persons; 120 (97%) were eligible and consented. Participants were 18-52 years old, majority (84%) male, less than half (36%) completed secondary education, and three (3%) indicated previous incarceration. Of the 120 enrolled, 93 (78%) initiated PrEP while 27 (22%) declined. As of 21 September, 39 were eligible for one-month study follow-up and 74% (29/39) had completed a visit, all in a correctional facility. Of these, 22/29 (76%) had initiated PrEP at enrollment and all were HIV-negative at follow-up. Two (9%) who had initiated PrEP at enrollment chose to discontinue PrEP at follow-up. Two of 7 (29%) who had not initiated PrEP at enrollment chose to initiate at follow-up. Of the 22 who initiated PrEP at enrollment and had ≥1 follow-up visit recorded, 13 (59%) were randomized to the TFV screening sub-cohort and tested. Of these, 62% (8/13) demonstrated TFV metabolites consistent with adherence. Conclusion: Early results suggest high demand for PrEP among incarcerated persons in Zambia. This is one of the first observational studies of PrEP uptake, persistence, and adherence among incarcerated persons, and may have future implications for HIV prevention efforts in this population. 1128 Social Determinants of Health and PrEP Uptake in the US: Repeated Measures Correlational Study Hollie David , Alan Wells, Susan J. Little, Sanjay R. Mehta, Thomas Martin University of California San Diego, La Jolla, CA, USA Background: Pre-exposure prophylaxis (PrEP) is a cornerstone of the United States (US) Ending the HIV Epidemic plan. PrEP use was evaluated in jurisdictions with highest HIV diagnosis rates to address disparities at state and county levels on national scale. Methods: PrEP data from 2012-2019 was analyzed using linear mixed methods modeling. Within the model, dependent variables were county and state PrEP rates. Fixed effects were year, new HIV diagnoses rates, mean income, population insurance coverage, proportion of democratic presidential candidate votes in 2020 and race, while random effects were states and counties. Public health data was from AIDSVu; demographic data from US Census Bureau ACS; 2020 presidential election results from MIT. Results: County Level: Beginning in 2012, each sequential year was associated with increased PrEP use by 7.22/100,000, 95%CI [2.87, 11.8]. For each $10,000 increase in mean income, there was increase in PrEP use by 65.7/100,000 persons, 95%CI [47.7,83.3]. Increased presidential election votes for the democratic candidate were associated with increased PrEP by 633/100,000 for each percentile point increase in proportion of votes, 95%CI [314, 999]. Higher HIV diagnosis rates were associated with decreased PrEP use by -1.9/100,000 for each new diagnosis per 100,000 in the population, 95%CI [-2.8,-0.9]. Jurisdictions with higher proportion of Asians were associated with decrease in PrEP by -1991/100,000 for each percentile point increase in population proportion, 95%CI [-3357, -632]. State Level: For each $10,000

1126 Homelessness, HIV Vulnerability, and PrEP Willingness Among Young Transgender Women in Lima, Peru Dorothy Apedaile 1 , Alfonso Silva-Santisteban 2 , Leyla Huerta 3 , Segundo R. Leon 4 , Sari Reisner 5 , Amaya Perez-Brumer 1 1 University of Toronto, Toronto, Canada, 2 Universidad Peruana Cayetano Heredia, Lima, Peru, 3 Feminas, Lima, Peru, 4 Universidad Privada San Juan Bautista, Lima, Peru, 5 Harvard Medical School, Boston, MA, USA Background: Globally, transgender women continue to face a high burden of HIV. In Peru, there has been no decrease in the incidence of HIV among transgender women over the last 15 years. Better understanding homelessness among young transgender women is critical to inform HIV prevention and treatment strategies and to ending the HIV epidemic. We sought to estimate the proportion of young transgender women experiencing homelessness and the associations between homelessness, HIV-related vulnerability, and PrEP willingness. Methods: We recruited young transgender women aged 16-24 through peer workers to participate in a biobehavioural survey and testing for HIV and other STIs (chlamydia, syphilis, gonorrhea, hepatitis B). Poisson regression with robust standard errors was used to estimate the association between past experiences of homelessness and HIV-related outcomes, adjusted for potential confounding by age and education. Results: A total of 211 young transgender women participated in the study, of whom 156 completed HIV and STI testing. The median age of participants was 23 years, 72.7% had completed secondary school, and the overall prevalence of HIV was 41.5%. A total of 64 participants (30.6%) had been homeless at least once in their life and 4.8% has been homeless in the past 30 days. Currently 35.9% lived in their own apartment or room, 27.7% stayed in a relative's home, and 34.0% stayed with a friend or sexual/romantic partner. Among participants who tested positive for HIV, 35.8% reported past homelessness compared to 31.6% of those testing negative for HIV (p = 0.69). After adjusting for age and education, past homelessness was not associated with testing positive for HIV or other STIs but did increase risk of recent (past 30 days) sex work (aPR = 1.48, 95% CI: 1.15 – 1.90), condomless anal sex in the past 6 months (aPR = 1.90, 95% CI: 1.50-2.41), and ever attempting suicide (aPR = 1.82, 95% CI: 1.14-2.90). Among HIV-negative participants, homelessness was associated with having heard of PrEP (aPR=1.94, 95% CI: 1.26-2.98) and willingness to try oral PrEP (aPR=1.63, 95% CI: 1.20-2.21). Conclusion: The prevalence of past homelessness is high among sampled transgender women aged 16 to 24 and past experiences of homelessness can elevate HIV vulnerability. HIV prevention and treatment programs for transgender women, particularly youth, must consider past and on-going experiences of homelessness to reduce barriers to program access that persist despite interest and willingness to engage.

Poster Abstracts

CROI 2024 366