CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: Using various differentiated service delivery (DSD) models, EpiC offered HIV-negative people AMAB who are MSM, who purchase sex, who are transgender, and other people AMAB options for daily PrEP and ED-PrEP in Ghana, Liberia, and Eswatini. ED-PrEP was recommended for people who had infrequent and predictable sexual encounters or anyone who wanted to enroll. Routinely collected programmatic data was analyzed to understand preference and uptake by population and age groups across the three countries. Results: Between October 2021 and May 2023, EpiC newly initiated 8,495 individuals AMAB on oral PrEP in the three countries, among whom 7,101 (84.40%) initiated on ED-PrEP. A larger proportion of people AMAB who were not MSM chose ED-PrEP over traditional daily PrEP (95.36%) compared to MSM (76.85% chose ED-PrEP). The proportion of those who initiated ED-PrEP over daily PrEP was highest among individuals 40–44 years of age (95.20%; 536/569) and lowest among those 50 and over (49.72%; 90/195) (Figure 1) Oral PrEP uptake among people AMAB who were not MSM (84.58%) was higher than among MSM (75.92%). PrEP uptake among those to whom it was offered increased from 39.99% (October 2020–September 2021) to 72.57% (October 2021–May 2023) after ED-PrEP was offered in Ghana and Eswatini. The increase was most pronounced among those aged 50 year and older, from 18.95% to 75.58%. Conclusion: The results demonstrate the feasibility of offering ED-PrEP to all people AMAB and the preference of some of these individuals for ED-PrEP compared to daily oral PrEP. Scale-up of ED-PrEP may improve oral PrEP uptake among all people AMAB warranting ED-PrEP expansion efforts beyond MSM. More efforts are needed to improve access to ED-PrEP through various DSD models as we scale oral PrEP provision. More research is needed to understand preferences for all individuals AMAB-not just MSM-and to improve uptake strategies. 1196 HIV Risk Factors and PrEP and Contraceptive Use Among Women Seeking Postabortal Care in Kenya Lavender A June 1 , Felix Mogaka 2 , Torin T. Schaafsma 3 , Katherine K. Thomas 3 , Josephine Odoyo 1 , Bernard Nyerere 1 , Lydia Etyang 2 , Margaret Mwangi 2 , Nelly R. Mugo 2 , Elizabeth Bukusi 2 , Renee Heffron 4 1 Kenya Medical Research Institute-UCSF Infectious Disease Research Training Program, Kisumu, Kenya, 2 Kenya Medical Research Institute, Nairobi, Kenya, 3 University of Washington, Seattle, WA, USA, 4 University of Alabama at Birmingham, Birmingham, AL, USA Background: Adolescent girls and young women (AGYW) in Kenya are a priority population for HIV prevention and face high rates of HIV incidence, recurrent unintended pregnancies, and sexually transmitted infections. Methods: Between March 2021 and March 2023, we implemented a project on HIV PrEP delivery among AGYW seeking postabortal care (PAC) in 15 public and private health facilities in Kenya. Eligible AGYW aged 15-30 years were offered PrEP. In women initiating PrEP and enrolling for research procedures, study questionnaires (at enrollment and month 1) and tenofovir point of care urine tests (at month 1) were administered. We assessed the association between sexual behavior, HIV risk perception, and PrEP readiness on 1) 1-month PrEP continuation, 2) 1-month PrEP adherence, and 3) contraceptive uptake at enrollment. Multivariable modified Poisson regression analyses were performed to estimate relative risks (RRs) for these associations, adjusting for key confounders. Results: Among 401 AGYW participants, the median age was 22 years (IQR 20-25), three quarters received financial support from their sexual partners, and 18% had a new sex partner within the last 3 months. Among the 96 participants who returned at month 1, 72% self-reported good adherence and 66% had tenofovir detected in urine. In the full cohort (imputing missing data as not detected), there was a trend for people with higher risk perception scores to have TFV detected in urine (aRR: 1.48, 95% CI: 0.99-2.22). In addition, participants reporting no sex partners in the last 3 months were twice as likely

to self-report good adherence (35% of the time) than participants reporting 1 sex partner (16% of the time) (aRR 2.0; 95% CI 1.1-3.7). Any condom use in the past 3 months was positively associated with initiating contraception (aRR: 0.85; 95% CI: 0.70-1.0). Conclusion: While we observed low PrEP continuation overally, women with greater awareness of their HIV risk were more likely to be adherent to PrEP. Strategies focusing on AGYW understanding of their risk level and tailored messaging for PrEP and contraception may improve PrEP use in this population. 1197 High Individual- and Community-Level Variability in Male Circumcision Coverage in Rakia, Uganda Hadijja Nakawooya 1 , Mary Kate Grabowski 1 , Victor Ssempijja 1 , Robert Ssekubugu 1 , Anthony Ndyanabo 1 , Joseph Kagaayi 1 , Arthur G. Fitzmaurice 2 , Ping T. Yeh 3 , Larry W. Chang 1 , Aaron A. R. Tobian 4 , Ronald H. Gray 1 , Maria J. Wawer 1 , David Serwadda 1 , Steven J. Reynolds 1 , Godfrey Kigozi 1 1 Rakai Health Sciences Program, Kalisizo, Uganda, 2 US Centers for Disease Control and Prevention Kampala, Kampala, Uganda, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Voluntary medical male circumcision (VMMC) is a proven intervention for reducing HIV incidence in men. Identifying specific populations and geographic areas with low VMMC coverage for targeted service outreach may help prioritize limited resources and achieve HIV epidemic control. Methods: We used data from the Rakai Community Cohort Study, a population based HIV surveillance cohort in Uganda, collected June 2018-November 2020, to assess individual and community-level factors associated with MC coverage among non-Muslim HIV-negative men across 39 communities. Muslims participants were excluded because circumcision is routine religious practice. Individual factors assessed included age, marital status, religion, education level, and past year number of sexual partners. Community-level factors included community type (agrarian, trading, and Lake Victoria fishing), percentage of population <30 years, percentage with primary education or less, percentage Muslim, average distance of households to the nearest health facility (level III/IV), average distance of households to a main road, and HIV seroprevalence. Hierarchical multivariable Poisson regression with community random effects was used to estimate individual- and community-level associations with MC coverage. Results: Of the 8,757 men in the cohort, 86.4% (7,570) identified as non Muslim, and 85.2% of these (n=6,448) were HIV-seronegative and enrolled in the study; Muslims were excluded from this analysis due to the expected full MC coverage as a religious practice. Of those enrolled, 61.7% were circumcised. Being circumcised was strongly associated with age, with 77% of boys and young men 15-24 years circumcised, compared to 51% of men 40-49 years old (prevalence ratio (PR)=0.64, 95% CI: 0.59-0.70). Median community coverage of MC was 66% ranging from 32% to 88% across communities. MC coverage was lower in communities with a greater percentage of people living with HIV (adj. PR=0.87,95% CI: 0.77,0.97). MC coverage decreased with greater distances to the main road (adj. PR=0.81, 95% CI: 0.69,0.95) and non-significantly with health facilities. Communities with larger Muslim populations had significantly higher MC coverage among non-Muslim HIV-negative men (adj. PR=1.13, 95% CI: 1.04,1.23). Conclusion: We observed individual and community-level variation in VMMC coverage among HIV-negative non-Muslim men. Prioritizing VMMC services in communities with higher HIV burden and limited health facility access may improve VMMC coverage . The figure, table, or graphic for this abstract has been removed. 1198 Increased Viral Suppression With Adherence Counseling Incorporating a Point-of-Care Urine TFV Test Leonard T Bikinesi 1 , Matthew A. Spinelli 2 , Ntombizodwa M. Nyoni 2 , Jesaya Hifindwako 3 , Assegid Mengistu 1 , Jacques Kamangu 1 , Gram Mutandi 4 , Daniella Mouton 3 , Fekir Negussie 2 , Rachel S. Beard 5 , Monica Gandhi 2 , Steven Y. Hong 5 1 Ministry of Health and Social Services, Windhoek, Namibia, 2 University of California San Francisco, San Francisco, CA, USA, 3 Namibia Institute of Pathology, Windhoek, Namibia, 4 Centers for Disease Control and Prevention, Atlanta, GA, USA, 5 US Centers for Disease Control and Prevention Windhoek, Windhoek, Namibia Background: Innovative approaches are needed to achieve the third UNAIDS 95-95-95 target, to increase and sustain virologic suppression (VS) in patients on ART, specifically co-formulated tenofovir (TFV)-lamivudine-dolutegravir (DTG) or TLD. Virologic failure in patients on TLD is likely due to non-adherence because of DTG's high resistance barrier. Identifying non-adherence to TLD

Poster Abstracts

CROI 2024 391