CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1130 A Matter of Time: Factors Associated With Delayed nPEP Initiation Nicholas Brian Bana , Massimo Puoti, Chiara Baiguera, Alessandro Raimondi, Leonardo Rezzonico, Francesco Peracchi, Cristina Moioli, Leonardo Chianura, Giovanna Travi, Carloandrea Orcese, Fulvio Crippa, Carlotta Rogati, Marta Vecchi, Marco Merli, Roberto Rossotti ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy Background: Nonprofessional Post-Exposure Prophylaxis (nPEP) protects against HIV infection after risk exposure, but a prompt start is essential. According to the Italian guidelines, nPEP should be started within 24 hours after the exposure (preferably in the first 4 hours), but can be prescribed up to 72 hours. Aim of this study is to describe factors associated to users' presentation time to our Emergency Department (ED) asking for nPEP. Methods: Retrospective Monocentric Observational study including all individuals who consecutively accessed our ED asking for nPEP between January 2011 and July 2023. We collected demographic data, information about type of exposure, sexual orientation and additional risky behaviours, eventual previous nPEP courses or HIV testing, and presentation time to ED. Descriptive statistics and nonparametric tests were used to describe study population. Unadjusted and adjusted binary regression analyses were performed to test factors associated to an early (within 24 hours) presentation. Results: The analysis included 522 persons who accessed ED asking for nPEP: 486 (93.1%) were males, 354 (67.8%) MSM, 97.2% of them declared sexual intercourse as risk exposure. Median presentation time overall between biological exposure and ED presentation was 14.7 hours: 519 (99.4%) individuals accessed to our ED within 72 hours, 391 (74.9%) in the first 24 hours but only 111 (21.3%) within 4 hours (Figure 1). Median waiting time in ED before nPEP start was 1.4 hours. Multivariate binary regression analysis found that Italian nationality (OR 2.04, 95% CI 1.06-3.91, p=0.032), semen/ano-genital direct contact (OR 2.09, 95% CI 1.21-3.59, p=0.008) and previous HIV testing (OR 3.00, 95% CI 1.48-6.07, p=0.002) were significantly associated with presentation within 24 hours after exposure, while sexual intercourse under the effect of alcohol or recreational drugs was associated with late presentation after 24 hours (OR 0.33, 95% CI 0.15-0.73, p=0.006). No significant effect was detected for type of sexual intercourse, sexual orientation, HIV status of source individual, and previous nPEP courses. Conclusion: The majority of nPEP users accessed the ED within 24 hours after at risk contact, even if they had to wait often more than 1 hour for nPEP prescription. Use of alcohol and recreational drugs (including Chemsex practices) during sexual intercourses represents an important risk factor for HIV acquistion not only in terms of dangerous exposure, but also for delayed nPEP start.

increase in income, there was increased PrEP use by 45.9/100,000 persons, 95%CI [24.1,67.6]. Increased proportion of presidential election votes for the democratic candidate were associated with decrease in PrEP by -126/100,000 for each percentile point increase in proportion of votes, 95%CI [-218,-34]. Higher insurance coverage was associated with decreased PrEP by -0.54/100,000 for each new insured person per 100,000, 95%CI [-1.0,-0.08]. States with higher proportion of Asian persons had decreased PrEP use -3078/100,000 for each percentile point increase in the population, 95%CI [-4520,-1637]. States in the Midwest were had higher PrEP uptake by 18.4/100,000 95%CI [8.63-28.3] when compared to the South as reference. Conclusion: Region and demographic data display associations of regional characteristics with inequitable PrEP rates. Displayed variances between state and county levels may be accounted for by differences in HIV preventative medicine policy. 1129 Association of US Medicaid Expansion and Number of Persons Prescribed PrEP, 2017-2021 Karen W Hoover , Weiming Zhu, Sheila Salvant Valentine, Ya-Lin A. Huang Centers for Disease Control and Prevention, Atlanta, GA, USA Background: To accomplish goals of the Ending the HIV Epidemic in the U.S. initiative, increased PrEP uptake is needed especially in jurisdictions with higher HIV incidence. Expanded Medicaid eligibility and enrollment can provide PrEP financial access for persons who otherwise might not be able to afford its cost. The Affordable Care Act of 2010 included a provision for states to expand Medicaid coverage starting in 2014. Since then, 41 states and the District of Columbia have expanded Medicaid access. Our objective was to estimate the association between state Medicaid expansion and the use of PrEP. Methods: We analyzed national Medicaid data from the Centers for Medicare and Medicaid Services to estimate the PrEP-to-Diagnosis Ratio (PDR) among persons aged 16 years and older from 2017–2022. The PDR is a measure of PrEP coverage that estimates the need for increased PrEP implementation. It was calculated as the annual number of persons prescribed PrEP divided by the annual number of new HIV diagnoses. We identified persons prescribed PrEP using a validated algorithm with diagnostic and drug codes. We identified persons with newly diagnosed HIV using ICD diagnosis codes for HIV. We categorized states and the District of Columbia in three cohort groups based on the year they expanded Medicaid: before 2017, 2017–2021, and never. We calculated the estimated annual percentage change (EAPC) and 95% confidence intervals (CIs) for PDR trends by state Medicaid expansion cohort. Results: Among persons with Medicaid, the overall number of persons prescribed PrEP increased from 24,279 in 2017 to 53,434 in 2021. Among 32 states that expanded Medicaid before 2017, the PDR was 1.6 in 2017 and increased to 5.3 by 2021 with an EAPC of 35.3 (95% CI 35.3, 35.3) (Figure). Among 7 states that expanded Medicaid in 2017 through 2021, the PDR was 0.2 in 2017 and 2.8 by 2021 with an EAPC of 83.8 (83.3, 84.2). Among 12 states that did not Medicaid before 2022, the PDR was 0.2 in 2017 and 2.1 by 2021 with an EAPC of 91.0 (90.9, 91.1). Conclusion: Our study found that expansion of Medicaid was associated with increased PrEP coverage among persons with Medicaid insurance, suggesting that Medicaid expansion is an effective policy to increase access to HIV prevention services. Medicaid expansion can provide access to many services, including PrEP, that protect the health and wellbeing of the U.S. population.

Poster Abstracts

1131 HIV Post-Exposure Prophylaxis Prescription Trends: United States, 2013-2022 Mary R Tanner , Wei Wei, Weiming Zhu, Ya-Lin A. Huang, Jesse G. O'Shea, Athena Kourtis, Karen W. Hoover Centers for Disease Control and Prevention, Atlanta, GA, USA Background: HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) are effective HIV prevention interventions. PEP is the only intervention that can reduce the likelihood of HIV acquisition after exposure, yet U.S. population-level estimates of PEP are lacking. Our objective was to estimate trends in the number of persons prescribed PEP and compare with PrEP trends. Methods: We analyzed data from IQVIA Real World Data-Longitudinal Prescriptions database, representing 94% of all prescriptions from retail pharmacies in the U.S. We developed an algorithm to identify persons aged ≥16 years prescribed PEP between 2013−2022. We estimated the number of PEP users each year, stratified by sex, age, payer type, region, and prescriber type and specialty. We assessed trends by calculating the estimated annual

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