CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1141 Enhancing HIV PrEP Coverage Through Primary Care Initiation: A French Nationwide Study Sophie Bamouni 1 , Sophie Billioti De Gage 2 , David Desplas 2 , Julie Valbousquet 1 , Julie Lamant 3 , Jean-Philippe Joseph 4 , François Dabis 3 , Agnès Viot 1 , Salim Fakir 1 , Rosemary Dray-Spira 2 , Michel Carles 1 1 Nice University Hospital, Nice, France, 2 EPI-PHARE, Saint-Denis, France, 3 Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France, 4 University of Bordeaux, Bordeaux, France Background: In France, until mid-2021, as HIV pre-exposure prophylaxis (PrEP) initiation (PrEPi) was limited to hospitals and sexual health centers, access to PrEP remained mainly limited to socio-economically advantaged MSM living in large urban areas. To improve access to PrEP, PrEPi has then been extended to any practitioner, including primary care (PrC) practitioners. The aim of this study was to describe the deployment and characteristics of the PrC PrEPi in the French health system. Methods: Using the National Health Data System (SNDS) covering healthcare reimbursements of 99% of French residents, we included all people ≥15 years-old, receiving a PrEPi in a PrC setting from 06/01/21 to 12/31/22. Monthly numbers of PrEPi over the period, characteristics of PrEP initiators and PrEPi modalities (including prescribers profile and assessment of biological tests) and renewals were reported. Results: Overall 13,500 PrEPi were done in PrC during the study period. The mean number of PrEPi increased from 654/month (2nd semester of 2021) to 783/month (2nd semester of 2022). PrEP initiators were predominantly men (96.3%), mean age 36 years, mostly living in large urban areas (72.0%). A minority (7.5%) were socio-economically disadvantaged. Among PrEPi prescribers, 88.0% were general practitioners, 77.0% had a fully private practice and 44.6% were the patient's family practitioner. Reimbursements for HIV, renal and liver function tests, 60 days before to 30 days after the first PrEP dispensation, were available for 72.5%, 66.8% and 54.7% of PrEPi, respectively. Syphilis, chlamydia or gonorrhea screenings were reimbursed for 64.7% and 59.7% of PrEPi, respectively. In the six months post PrEPi, 70.8% of PrEP initiators had at least one renewal (2.3 renewals on average). Most of them (80.0%) had the PrEP renewal by the PrEPi prescriber, especially when the PrEPi prescriber was the family practitioner (92.5%). Conclusion: While the number of PrEP initiations in primary care steadily increased over time, the profile of users remains similar to that observed before PrC initiation. The high rate of PrEPi not done by the patient's family practitioner highlights potential barriers of sharing sexual health concerns with his own family practitioner. Tracking of biological tests required at PrEPi could be improved to confirm compliance with national guidelines. Extending PrEP to women and socio-economically disadvantaged people still requires raising awareness among target audiences and practitioners. 1142 Uptake of HIV prevention by Notified Seronegative Partners in HIV-Discordant Couples in Uganda Edith Namulema 1 , Elizabeth Mutambuze 1 , Isaac Lwanga 1 , Allan Simwogerere 2 , Racheal Ankunda 1 , Tonny Tumwesigye 2 , Nelson Mugume 2 , Arthur G. Fitzmaurice 3 , Maria Bafumba 1 1 Mengo Hospital, Kampala, Uganda, 2 Makerere University College of Health Sciences, Kampala, Uganda, 3 US Centers for Disease Control and Prevention Kampala, Kampala, Uganda Background: Assisted Partner Notification (APN) is an effective HIV epidemic control strategy and is part of the interventions to increase case identification and reduce HIV transmission in Uganda. The focus for APN is un diagnosed contacts of index clients living with HIV. APN facilitates in linkage of sexual partners to HIV prevention (negative contacts in HIV status-discordant relationships) or treatment. However, failure of notified contacts to disclose their negative results to positive partners might expose them to ongoing HIV risk. Our objectives were to assess uptake and factors associated with HIV prevention among notified HIV-negative partners. Methods: We analyzed cross-sectional data from partners of index clients tested January 2019–December 2022 at Mengo Hospital, Kampala, Uganda. After APN and testing seronegative at the hospital, we determined uptake of HIV retesting; disclosure of seronegative status to current sexual partner; reporting of abstinence, being faithful, condom use, and/or pre-exposure prophylaxis (PrEP); and safe male circumcision (SMC). We used multiple logistic regression (R4.22) to generate adjusted odds ratios and 95% confidence intervals (CIs) of uptake of prevention methods. Results: Among 3,068 elicited partners of 1,977 index clients, 89% (2,732) were notified; 61% (1,672/2,732) tested HIV-seronegative, 24% (657) positive,

was higher overall among participants starting with DPP vs those starting with 2 pills (not significant, Fig 1). Conclusion: While we did not find differences between the DPP and 2 separate pills for any outcome, this small study used an over-encapsulated pill as a proxy for the co-formulated DPP. A larger study with the actual DPP – a smaller pill – will be a better indicator of the potential impact of the DPP on HIV and pregnancy prevention in this population.

1140 Enabling Mobility of Health Workers With Motorcycles to Improve PrEP Uptake Among Key Populations Mwedi Mohamedi 1 , John Roman 1 , Ola F. Jahanpour 1 , Appolinary Bukuku 1 , Japhet Daud 1 , Damian Laki 1 , Frederick Ndossi 1 , Eva Matiko 1 , Redempta Mbatia 1 , Josephat Francis 2 , Ramadhani Gongo 3 , Nyagonde Nyagonde 3 , Galal King'ori 3 , Oscar Rwabiyago 3 1 Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania, 2 Ministry of Health and Social Welfare, Pwani, United Republic of Tanzania, 3 US Centers for Disease Control and Prevention Tanzania, Dar es Salaam, United Republic of Tanzania Background: In Tanzania HIV prevalence among key populations (KP) including female sex workers (FSW), men who have sex with men (MSM) and people who inject drugs (PWID) is estimated to range from 25% to 36% compared to the 4.7% in the general population. Reaching and engaging KP in HIV prevention and treatment services is challenging in Tanzania due to several challenges such as geographical locations, and limited access to transport. Previously, community-based health workers used public transport or hired vehicles to reach out to KP in remote areas, which hindered the effective provision of HIV prevention and treatment services. Recognizing this challenge Tanzania Health Promotion Support (THPS) collaborated with Pwani Regional and Council Health Management teams (R/CHMT) to enable mobility of community-based health workers with motorcycles to improve Pre-exposure prophylaxis (PrEP) uptake to KP Methods: In October 2022, THPS procured and allocated 40 motorcycles and drivers to various health facilities (HF) identified to enable mobility of health workers in provision of PrEP services in Pwani region Tanzania. The objective is to bolster the efforts of community-based health workers in accessing KP and offering PrEP services regardless of their location. Targeted areas included mapped community hotspots such as local bars, brothels, truck parking areas and fishing and constructions sites. The initiative ensured that KP could easily access PrEP services where they lived, worked, or socialized Results: Clients newly initiated on PrEP increased by 100% (1212 to 2428) and clients returning for PrEP refills increased by 154% (674 to 1714) between pre- (January-September 2022) and post- (October 2022-June 2023) implementation periods. Ninety percent of new clients (2185/2428) enrolled through mapped community hotspots, while 10% (243) enrolled in facilities. FSW comprised 97% (2354), PWID 2% (56) and MSM 1% (18) of total new clients. From October 2022 to June 2023, 88% (1510/1714) of PrEP clients refilled through community hotspots, and 12% (204/1714) through health facilities. Conclusion: Enabling mobility of community-based health workers with motorcycles improved PrEP uptake among KVP particularly those from hard-to reach areas. Community-based health workers enabled with motorcycles brings PrEP services closer to KP, therefore addressing the gaps on accessibility of PrEP services. THPS will continue to work with R/CHMT to strengthen and expand implementation of motorcycle enabled health workers

Poster Abstracts

CROI 2024 371