CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1220 The Motivational PrEP Cascade Among Peruvian Men Who Have Sex With Men (MSM) Jorge A Gallardo-Cartagena 1 , Patricia Alarcón 1 , Juan J. Montenegro-Idrogo 1 , Javier R. Lama 2 , Javier A. Valencia 2 , Robinson Cabello 3 , Martín Casapía 4 , David Velasquez 1 , Hugo Sánchez 1 , Yamir Salazar 2 , Felipe Vilcachagua Tadeo 2 , José L. Castro 3 , Kelika A. Konda 5 , Susan P. Buchbinder 6 , Jorge L. Sánchez 1 1 Universidad Nacional Mayor de San Marcos, Lima, Peru, 2 Asociación Civil Impacta Salud y Educación, Lima, Peru, 3 Vía Libre, Lima, Peru, 4 Asociación Civil Selva Amazónica, Iquitos, Peru, 5 University of Southern California, Los Angeles, CA, USA, 6 San Francisco Department of Public Health, San Francisco, CA, USA Background: In several recent studies, MSM HIV incidence was >5/100 person years in Peru, where PrEP scale-up is urgently needed. The Motivational PrEP Cascade (MPC) explains dynamic movement on a PrEP continuum including planning, uptake, and persistence. We aimed to describe key MPC steps and interest in tailored mHealth interventions among Peruvian MSM, at the time the National PrEP Program (NPP) began in mid-2023. Methods: We conducted an online survey from June to August 2023. MSM were recruited through social media ads. Following informed consent, respondents answered a survey on demographics, sexual behavior, key MPC steps, smartphone use, and mHealth intervention preferences. Only PrEP candidates based on NPP guidelines (HIV negative by self-report with condomless anal sex in past 6 months) were included in this analysis. We describe the distribution of MSM by MPC steps and identified associated factors using multivariate Poisson regression. Results: Among the 464 included respondents, median age was 29yo (IQR: 25-35). Most respondents earned Conclusion: Peruvian MSM who completed a PrEP survey when the NPP began showed great interest in PrEP, self-identified as good PrEP candidates, and/or decided to start PrEP. However, most MSM struggled to progress to later MPC steps, highlighting access barriers outside of research studies. The MPC could help identify subgroups with unique informational and/or skill development needs, which can be used in the design of tailored mHealth interventions supporting the NPP implementation in Peru.

to initiate PrEP among MSM; while prior PrEP awareness and engagement in transactional sex were significant covariates for TGW (Table 1). Conclusion: Factors significantly associated with intention to initiate PrEP varied by population, though engagement in transactional sex was associated with intention to initiate PrEP in both groups. In the context of national PrEP scale-up, these findings could inform differentiated interventions to improve PrEP uptake among MSM/TGW. Issues of PrEP awareness and steps along the PrEP cascade toward planning and uptake should be addressed.

1219 WITHDRAWN Assessing Antiretroviral-Focused HIV Prevention and Treatment Among Key Population in Kenya Patrick E Amakulie , Kinley M. Samwel, Edward Mboya, Violet Booko, Peter Kyalo Center for International Health, Education, and Biosecurity (CIHEB), Nairobi, Kenya Background: Key population (KP), including female sex workers (FSWs) and men who have sex with men (MSM), are disproportionately affected by HIV and require tailored services for HIV epidemic control. A status- neutral approach in HIV testing coupled with engagement in antiretroviral (ARV)-focused HIV prevention or treatment is recommended. We evaluated HIV status-related uptake of ARV-based medications and its association with overall retention of FSWs and MSM at a KP-friendly clinic in Machakos County, Kenya. Methods: We conducted a retrospective cohort analysis of data collected from October 1, 2022, to July 31, 2023, at a KP-friendly clinic providing peer-led HIV prevention and treatment services to FSWs and MSM at the clinic and through outreaches. Individual-level data were extracted from the clinic's electronic database and analyzed to assess the uptake of ARV-based services, retention in the program, and associated factors. Results: We abstracted data from 3128 KPs with 53.7 % (n=1,680) being FSWs. Of those who tested HIV negative at first contact, 59.3 % (n=1,621) received pre-exposure prophylaxis (PrEP), with 46.4% (n=1,269) being newly initiated. All KP living with HIV (KPLHIV) were on ART with all newly diagnosed receiving ART at the KP clinic (onsite) while 53.9% (n=205) of those previously diagnosed verified to be on ART offsite. The majority, 75.6% (n=1,270) of FSWs were retained at the clinic while more than half, 57.5% (n=833) of MSM were lost to follow-up (LTFU). Younger KPs aged 15 – 19 years had the least retention at 39.3%(n=33). Newly diagnosed KPLHIV were better retained at 90.9% (n=10) compared to KPs tested HIV negative at 59.9% (n=1,639). MSM were three times more likely to be LTFU than FSW [aOR=3.20 (95% CI 2.62 – 3.90)]. KPs aged 15 – 19 years had higher odds of getting lost [aOR=1.93 (95% CI 1.10 – 3.39)] compared to those aged more than 35 years. The KPLHIV on ART offsite and those who restarted PrEP had the highest odds of getting lost compared to those on ART onsite [aOR=11.2 (95% CI 5.68-22.1)] and [aOR=17.9 (95% CI 7.24-44.2)] respectively. Conclusion: These findings emphasize the importance of targeted interventions to improve uptake and retention in ARV-focused HIV prevention and treatment among KPs in Machakos, Kenya. Furthermore, the challenges in retention among MSM, young KPs, KP restarting PrEP, and KPLHIV on ART offsite, highlights the significance of tailored support to minimize loss to follow up and ensure effective HIV prevention and treatment.

Poster Abstracts

1221 The Need to Address Violence for PrEP Uptake Among Adolescent Girls and Young Women in South Africa Courtney P Bonner 1 , Felicia A. Browne 2 , Jacequline W. Ndirangu 2 , Alexandra M. Minnis 3 , Ilene Speizer 4 , Laura Nyblade 5 , Khatija Ahmed 6 , Tracy Kline 2 , Wendee M. Wechsberg 2 1 RTI International, Atlanta, GA, USA, 2 RTI International, Research Triangle Park, NC, USA, 3 RTI International, Berkeley, CA, USA, 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 RTI International, Washington, DC, USA, 6 Setshaba Research Center, Tshwane, South Africa Background: Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. We have conducted several NIH-funded studies with AGYW to address HIV risk and prevention and gender-based violence, yet pre-exposure prophylaxis (PrEP) had not been approved. Working with the national government as PrEP was approved and rolled out in South Africa, we conducted an NICHD-funded cluster- randomized implementation trial to assess the effectiveness of a multilevel intervention to increase uptake of sexual and reproductive healthcare, including PrEP. This study focuses on understanding factors that may contribute to PrEP uptake among a large community-based sample of AGYW attending public healthcare clinics.

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