CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We examined multilevel factors associated with PrEP uptake among AGYW in 12 clinic catchment areas in Tshwane (Pretoria), South Africa from 2019-2022. After consent/assent, PrEP-eligible AGYW (n = 802) completed a questionnaire assessing factors at the individual, interpersonal, and community levels and those who were interested in initiating PrEP were referred to the study clinic. Results: A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9- month period. Overall, 77% (n = 620) were prescribed PrEP. Of those who were prescribed PrEP, 76% (n = 471) were prescribed Truvada, 24% (n = 148) were prescribed Tenemine. At 9-month follow-up, 75% (n = 565) of AGYW reported that they started taking PrEP at some point during the study. At the individual level, age (p < 0.05) was inversely correlated with PrEP uptake. At the interpersonal level, physical and sexual gender-based violence were related to a lower odds of PrEP uptake (ps < 0.05). Conclusion: These findings are highly relevant given the high rates of physical and sexual violence toward AGYW, especially since the COVID-19 pandemic. To support AGYW to initiate PrEP, clinicians, legislators, and key decision makers should address gender-based violence. While PrEP has the potential to substantially reduce HIV in South Africa, its impact may be tempered if we do not also address the context in which AGYW live. 1222 Stigma in Young Kenyan Women Offered PrEP in a Peer-Supported, Community-Based PrEP Delivery System Bernard Nyerere 1 , Nicholas Musinguzi 2 , Kevin Oware 1 , Lawrence Juma 1 , Josephine Odoyo 1 , Vincent Momanyi 1 , Aaron J. Siegler 3 , Lindsey E. Garrison 4 , Jared Baeten 5 , Elizabeth Bukusi 1 , Jessica Haberer 4 1 Kenya Medical Research Institute, Kisumu, Kenya, 2 Global Health Collaborative, Mbarara, Uganda, 3 Emory University, Atlanta, GA, USA, 4 Massachusetts General Hospital, Boston, MA, USA, 5 University of Washington, Seattle, WA, USA Background: PrEP and HIV stigma are common and potential barriers for PrEP use. We used multiple approaches to measure stigma among young women accessing PrEP in a trial of a novel, peer-supported, community-based delivery system. Methods: In Kisumu, Kenya, 18-24-year-old women were recruited at PrEP initiation (July 2021-March 2022) and followed for 6 months. Participants received peer-supported, community-based delivery of PrEP and other sexual health services vs standard-of-care clinic-based services. We measured PrEP stigma at 0 and 6 months using a 13-item Likert response scale (range 1-5) and a 10-item semantic differential scale (the HIV PrEP Stigma Scale). We similarly measured HIV stigma with a 4-item modified Berger scale (range 1-4). Baseline socio- behavioral and demographic factors were assessed for association with each stigma type by multivariable linear regression analysis. PrEP use was determined at 6 months with dried blood spots. Results: Of 150 women, 75 received the intervention and 75 received standard of-care. Mean baseline HIV stigma was 2.8 (SD 0.6) and mean PrEP stigma was 3.5 (SD 0.5); neither differed by trial arms. Mean HIV stigma increased to 3.2 (SD 0.8) at Month 6 (p<0.001) and mean PrEP stigma increased from 3.5 (SD 0.5) to 3.8 (SD 0.6) (p<0.001). Using the Likert scale, most reported strongly agreeing/agreeing to positive feelings about PrEP use (taking care of their health, receiving support/praise, having sex with someone taking PrEP). To a lesser extent, most also strongly agreed/agreed with negative feelings (experiencing harassment, being treated unfairly/judged, feeling ashamed). On the semantic differential scale, almost all reported "People on PrEP are..." motivated, in control, supported, proud, safe, and responsible. Views on faithfulness, honesty/trust, attractiveness, and modesty/promiscuity varied. Education was associated with less HIV and PrEP stigma (-0.05 and -0.04 points/ year, respectively; p=0.04). History of STI was associated with PrEP stigma (0.5, p=0.003). PrEP use at 6 months was modest (16/123, 13%) in women with ongoing HIV prevention needs and not associated with either stigma type. Conclusion: PrEP and HIV stigma are moderately high among young women accessing PrEP in Kenya and multidimensional. Stigma was not improved by peer supported, community-based PrEP delivery. As we work to scale up PrEP, more research is needed to understand and address stigma as a barrier to PrEP use.

Poster Abstracts

1223 A Social Network-Based Intervention to Promote HIV Prevention and Treatment Among Fishermen in Kenya Zachary A. Kwena 1 , Lila Sheira 2 , Benard Ayieko 3 , Edwin Charlebois 2 , Kawango Agot 3 , Sarah Gutin 2 , Phoebe Olugo 3 , Monica Gandhi 2 , Elizabeth Bukusi 4 , Carol S Camlin 2 , Harsha Thirumurthy 5 1 Kenya Medical Research Institute, Kisumu, Kenya, 2 University of California San Francisco, San Francisco, CA, USA, 3 Impact Research and Development Organization, Kisumu, Kenya, 4 Kenya Medical Research Institute, Nairobi, Kenya, 5 University of Pennsylvania, Philadelphia, PA, USA Background: Men in sub-Saharan Africa are less likely than women to know their HIV status and utilize HIV prevention and treatment services. We previously showed a social-network based intervention increased HIV testing uptake by 50% among men in Kenya. Here, we evaluate the impact of the intervention on HIV prevention and treatment outcomes using objective metrics. Methods: Data are from the Owete study (NCT04772469), a RCT of an HIV status-neutral, social-network- based intervention to promote HIV self-testing and linkage to prevention and treatment among men in Lake Victoria fishing communities. After a census of fishermen, distinct social networks with a network-central "promoter" were mapped and randomized to study arms. Promoters were asked to (1) distribute self-tests to men in their network and encourage linkage and retention in prevention and care (intervention clusters) or (2) distribute vouchers for free self-tests redeemable at study-affiliated health facilities (control clusters). We evaluated PrEP adherence measured via urine assay for tenofovir among men initiating PrEP, and HIV RNA viral load assessed via the Xpert assay (40 copies/ml threshold) among people with HIV (PWH), at 3 months. We coded missing viral load as failure (detectable). We conducted logistic regression controlling for site (beach) and with a random intercept for cluster to evaluate the intervention's impact on PrEP adherence and viral suppression. Results: Of 934 men in the intent-to-treat sample, 733 were interviewed at baseline (374 intervention) and 339 linked to study-affiliated clinics: 71 initiated PrEP, and 169 were PWH. Urine tenofovir was detected among 12 of 71 participants on PrEP (14% of control vs. 12% intervention), and 107 of 169 participants on ART had undetectable viral loads (58% of control vs. 69% intervention). We did not detect a statistically significant difference between study arms in PrEP adherence (odds ratio [OR]: 0.85; 95% CI: 0.17, 4.23, p= 0.84) or viral suppression (OR= 0.59; 95% CI: 0.29, 1.22; p=0.16).

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