CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Results: In the first two years of the cohort, 755 adolescents initiated daily oral PrEP. The majority of them was between 18 and 19 years old (79.5%), were MSM (91.1%), black and brown (70.1%), and had 12 years of schooling or more (50.8%). 330 (43.7%) adolescents persisted on PrEP, their mean followed time was 18.7 months (95% IC 17.9% – 19.4%). Adolescents who persisted on PrEP use had more chance to be black or mixed race (OR: 1.49; IC 1.08 – 2.06) and with moderate and high adherence according to self-report (OR 3.07: IC 1.99 – 4.77). No association was observed between PrEP persistence with sexual behavior and HIV risk perception. Conclusion: The persistence of daily oral PrEP use was observed in approximately half of the adolescents, those who had higher PrEP adherence. Our results emphasize the need for strategies to support PrEP persistence in the clinics. Besides, other alternatives for prevention, such as PrEP on-demand and long-acting injectable, may be more attracted and fit better with adolescents, considering their experiences and preferences. 1216 NICE: A Structural Intervention to Increase Status Neutral Care Among Sexual and Gender Minorities Rebecca Eavou, Ellen Almirol, Victoria Umutoni , John Schneider, Mickyala Jones University of Chicago, Chicago, IL, USA Background: Black and Hispanic Sexual and Gender Minorities (SGM) are highly impacted by HIV. Significant structural determinants of health, such as access to care, are major drivers of status neutral care engagement, an ending the epidemic imperative. We designed an insurance navigation intervention – NICE (Navigating Insurance Coverage Expansion) - that tested the impact of navigation at the point of community HIV testing and evaluated the effects of the intervention on successful insurance enrollment and linkage to status neutral care among SGMs. Methods: NICE aimed to test whether providing in-person assistance (enrolling, changing or learning how to use health insurance), at the HIV testing event would improve linkage rates for participants, particularly among persons living with HIV (PLWH). Black/Hispanic SGM aged 18 or older and living in Chicago were enrolled at community outreach testing events and randomized to NICE versus standard of care. Logistic regression was performed to see if there were differences in HIV linkage, PrEP linkage, and/or both (status neutral) by intervention assignment. Results: A total of 630 participants were enrolled, with 281 in the health insurance enrollment assistance arm and 349 in the control, with a third of the sample living with HIV (29.2%), trans* representing 8.1%, and a sizeable proportion insured at baseline (68.4%). There were no differences in sociodemographic factors at baseline across study conditions. Overall, about 46.7% PLWH were linked to care (OR 1.37, 95% CI 0.74-2.48, p=0.32), while only 16.5% for those HIV negative who attended PrEP providing clinic within 90 days (OR 0.84, 95% CI 0.50-1.43, p=0.53), however, not significant by intervention condition. Overall, about a quarter of participants were considered linked (25.8%) and there were no differences in status neutral outcomes across conditions when analysis was limited to the uninsured. Conclusion: Health insurance navigation, while likely an important component in accessing status neutral care, did not significantly impact linkage to care. Overall, linkage was low among SGM who had high rates of insurance at baseline. Future research should examine SGM understanding of their insurance and the ways in which it impacts their care decision making (e.g. obtaining prescribed medications, clinic choice) as well as how insurance navigation might impact care engagement in states newly adopting Medicaid or where insurance rates are low among minoritized SGM. 1217 DREAMS RE-AIM Assessment in Zambia Demonstrates High Uptake and Reach of AGYW With HIV Prevention Brianna Lindsay 1 , Kirsten Stoebenau 2 , Caitlin Baumhart 1 , Linah Mwango 3 , Godfrey Muchanga 4 , Choolwe Maambo 4 , Mwangala Mwale 4 , Monde Mwamba 4 , Chiti Bwalya 2 , Samara Toussaint 2 , Cassidy W Claassen 1 , Angshuman Kashyap 2 1 University of Maryland, Baltimore, MD, USA, 2 University of Maryland, College Park, MD, USA, 3 Ciheb Zambia, Lusaka, Zambia, 4 Maryland Global Initiatives Corporation, Lusaka, Zambia Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa countries like Zambia are at high risk of HIV acquisition. The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative provides comprehensive interventions to prevent HIV among AGYW. We

conducted a multi-year assessment of DREAMS program effectiveness in delivering HIV services to AGYW in Zambia. Methods: Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation science framework, we assessed DREAMS implementation from 2016 to 2022 in 14 Zambian districts. We used a mixed-methods approach including aggregate and line-listed client-level data for quantitative analyses across programs, costing analyses, and a three-site qualitative case-study with 134 interviews and 6 focus group discussions with beneficiaries, implementers, and stakeholders. Data were analyzed using R-Studio and Atlas.ti. Results: From October 2016 to September 2022, 1,091,641 AGYW were enrolled, with 976,689 accessing DREAMS services. Among enrolled AGYW, 350,127 (32.1%) were 10-14 years, 441,402 (40.2%) were 15-19 years, and 295,291 (27.1%) were 20-24 years. Engagement in the primary package of social asset building was high with 97.3% (922,947) of enrolled AGYW completing all 13 Stepping Stones sessions. Socioeconomic support services were the most commonly accessed DREAMS secondary service with 29.6% participation, while biomedical services, including condom distribution, family planning, and HIV testing, followed closely with 27.2%, 11.2%, and 9.6% participation, respectively. Overall, 2,328 (2.2%) of 104,859 AGYW tested positive for HIV. Qualitative data revealed high levels of satisfaction with the program, especially concerning the primary intervention package. Beneficiaries reported that the program enabled them to adopt condom use, increased their awareness of PrEP benefits, and enhanced their assertiveness and control over their sexual health and decision- making within intimate relationships. However, qualitative findings indicated need for further measures to improve the program's capacity to reach AGYW most at-risk of HIV acquisition. Conclusion: DREAMS successfully reached large numbers of at-risk AGYW in Zambia with HIV services, demonstrating potential effectiveness, high adoption rates, and effective implementation. Maintenance efforts are ongoing and yet to be determined. Holistic prevention programs like DREAMS should be considered for further scale-up of HIV prevention. 1218 Intention to Initiate PrEP Among Men Who Have Sex With Men (MSM) and Transgender Women (TGW) in Peru Carlos Benites 1 , Mary Reyes 1 , Patricia Alarcón 2 , Ricardo Alfaro 3 , Jorge A. Gallardo Cartagena 4 , Juan J Montenegro-Idrogo 3 , Kelika A. Konda 5 , Jorge L. Sánchez 3 , César Munayco 1 1 Ministry of Health, Lima, Peru, 2 Asociacion Civil Impacta Salud y Educacion, Lima, Peru, 3 Universidad Nacional Mayor de San Marcos, Lima, Peru, 4 Other Institution – Follow-up needed, Callao, Peru, 5 University of Southern California, Los Angeles, CA, USA Background: Recently, Peru incorporated PrEP into their combination HIV prevention strategy. However, data from the ImPrEP demonstration project shows that PrEP adherence and persistence are problematic among Peruvian MSM/TGW. As national scale-up of PrEP has begun, reasons behind poor progression along the PrEP cascade need to be fully understood. We aimed to explore factors associated with the intention to initiate PrEP among Peruvian MSM/TGW using national surveillance data Methods: Between April and July 2019, the HIV/STI Sentinel Surveillance was conducted in 11 Peruvian cities, enrolling 1768 MSM and 1198 TGW aged 18+ who provided informed consent. The survey collected socio-demographics, sexual behavior, self-reported STI diagnosis and HIV testing history, PrEP awareness and intention to initiate PrEP, along with sample collection for HIV/STI testing. Respondents who self-reported as HIV negative and had not initiated PrEP were included in the analysis. We used Poisson regression to identify factors associated with the intention to initiate daily oral PrEP, using covariates selected a priori, and stratifying by population. Results: The analysis included 1582 MSM and 904 TGW. Median age was 25 yo (interquartile range, [IQR] 21-32) among MSM and 28 (IQR 23-37) among TGW. Intention to initiate PrEP was 48.9% among MSM and 60.7% among TGW. Other covariates included in the analysis included monthly income (MSM: median US$243 [IQR 162-324]), TGW: median US$243 [IQR 135-324]), post-secondary education (MSM 36.5%, TGW 21.0%), prior PrEP awareness (MSM 16.1%, TGW 23.3%), having ≥5 sex partners in the past 6 months (MSM 30.9%, TGW 63.6%), engagement in transactional sex (MSM 24.6%, TGW 54.5%), prior HIV testing (MSM 66.4%, TGW 80.0%), and self-reported STI diagnosis (MSM 12.0%, TGW 23.4%). Age, post-secondary education, prior HIV testing remaining, and engagement in transactional sex, were significant covariates for intention

Poster Abstracts

CROI 2024 398