CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

for CAB LA delivery and for implementation support at Month 1 (M1; n=86) and Month 4 (M4; n=80). Change in mean FIM and AIM scores (scores averaged over four items measured as 1=completely disagree to 5=completely agree) was assessed. SSPs completed questions on the utility of implementation supports and telehealth delivery of CAB LA at M4. Results: Of 86 SSPs at M1, 50% were cisgender female, 55% White, 15% Black, and 24% Hispanic, with mean age 41 (range: 23-72). SSPs reported high levels of acceptability and feasibility of CAB LA and implementation support at M1 (mean scale scores≥4.0) and M4 (mean scale scores≥3.9). Except for FIM for CAB LA in RI, mean scores decreased slightly over time for both arms (≤0.4). At M4, toolkits with the highest use (>40% SSPs) were found useful/ very useful by over 58% of SSPs (Table). DI only toolkits and support with the highest use (>33% SSPs) were found useful by over 47% of SSPs (Table). 69% of DI SSPs found one-on- one and group facilitation support useful/very useful. Of 51 DI arm SSPs at M4, 57% reported using telehealth for CAB LA delivery. Of those using telehealth, the systems used included virtual visits (83%), online appointment scheduling (52%)/reminders (76%), and at home testing (38%)/ injections (24%). DI SSPs found the systems very/somewhat easy to use (range: 71%-86%), very helpful/helpful (range: 71%-93%) and were very/somewhat satisfied (range: 80%-94.7%). DI SSPs reported high levels of acceptability and feasibility of telehealth delivery of CAB LA (mean scale scores≥4.1). Conclusion: Findings suggest that CAB LA telehealth delivery is acceptable and feasible. Scaling telehealth and implementation resources may support efficient integration of CAB LA into care and user adherence and retention on CAB LA. The figure, table, or graphic for this abstract has been removed. 1241 Insurance Type Drives Cabotegravir Delays: Real-World Long-Acting PrEP Outcomes in the Midwest US Aniruddha Hazra 1 , John Schneider 1 , Megan Murray 2 , Jean Williams 2 , Drew Halbur 2 , Catherine Creticos 2 1 University of Chicago, Chicago, IL, USA, 2 Howard Brown Health Center, Chicago, IL, USA Background: Long-acting cabotegravir (CAB-LA) is the first FDA-approved injectable agent for HIV PrEP. However, limited data exist on its use in a real world setting. We describe clinical characteristics and outcomes of CAB-LA for PrEP at a federally qualified health center and the largest PrEP clinic in the Midwest US. Methods: We conducted a single-center retrospective cohort study of all patients without HIV who received at least one dose of CAB-LA at Howard Brown Health between July 1, 2022 and December 31, 2023. Demographics and clinical characteristics were collected; associations between delays in initiation as well as therapy interruption and discontinuation were assessed by logistic regression. Results: A total of 270 patients met the inclusion criteria with median age 33, 80.4% cisgender men, 54.1% White, 23.7% Hispanic, 60.4% with private insurance, and 29.6% residing in a high HIV vulnerability community area. The majority (90.4%) had been on oral PrEP in the past, 72.2% transitioned directly from oral PrEP, 2.2% had a CAB oral lead-in, and 31.1% had a BMI >30kg/m 2 . Patients experienced a median delay of 24 days (IQR 11-51) between a provider initiating a CAB-LA prescription and their first injection, 41.9% of patients experienced delays >30 days. The median number of CAB-LA doses received was 4 (range, 1-12); 8.1% experienced at least one delayed or missed injection and 10% of patients discontinued CAB-LA of which 25.9% were placed on an oral PrEP regimen after discontinuation. While on CAB-LA, 67% had HIV screening by viral load assay at every injection visit; 49.6% had STI screening at the recommended 4-6 month intervals with 26.3% testing positive for an STI during the study period. Insurance status was the only variable associated with delays in initiation. Compared to patients with private insurance, those without insurance were significantly more likely to experience delays while those with public insurance were significantly less likely to experience delays >30 days in initiating CAB-LA (OR 1.97 vs 0.60, p=0.03). Conclusion: CAB-LA for PrEP was successfully implemented at a large urban community health center. Most patients experienced delays in initiation which were associated with insurance type; interruptions and discontinuation of injections were less common without any significant associations. More work is needed to support patients and health systems with challenges specific to long-acting agents, particularly regarding insurers and payors.

women (TW) in the United States (US), uptake among those at risk of acquiring HIV could potentially reduce new infections and contribute to Ending the HIV Epidemic efforts. However, a lack of data on LAI PrEP interest among TW in the US has limited scientific understanding of the potential impact of LAI PrEP scale-up on new infections within TW communities. Thus, our objective was to identify correlates of interest in LAI PrEP among a large sample of TW. Methods: Data were drawn from the LITE cohort, which followed TW with risk factors for HIV acquisition in the eastern and southern US. Participants who completed 12-month surveys between March 2019 and September 2021 (corresponding to the period between establishing LAI PrEP efficacy and prior to FDA approval) were asked about their interest in using LAI PrEP. We estimated crude and adjusted prevalence ratios for LAI PrEP interest with sociodemographic characteristics, healthcare access indicators, prior PrEP experience, and PrEP indication correlates using Poisson regression with robust variance. Results: Among 867 TW, 23% reported they were very interested in LAI PrEP, 22% somewhat interested, 19% neutral, 7% somewhat uninterested, 12% very uninterested, and 16% unsure. In the adjusted model, interest in LAI PrEP (somewhat or very interested) was more common among TW who identified as Black, college- educated TW, and TW indicated for PrEP based on CDC guidelines (Figure). LAI PrEP interest was also more common among adherent users of oral PrEP and those who had discontinued oral PrEP, compared to PrEP-naïve participants. There were no statistically significant differences in LAI PrEP interest for young adults ages 18-24 years compared to those >=25 years, those who identified as Latina/x, and those who were publicly insured or uninsured compared to those privately insured. Conclusion: Interest in LAI PrEP among TW in the eastern and southern US varied by several demographic and clinical characteristics. Increased interest in LAI PrEP among Black TW, those who were PrEP indicated, and those who had previously discontinued oral PrEP underscores the need to increase LAI PrEP access for TW who express interest. Efforts to increase awareness of and access to LAI PrEP among young TW and Latina/x TW are needed to ensure equitable scale-up among TW most impacted by HIV.

Poster Abstracts

1240 Healthcare Staff Acceptability and Feasibility of Telehealth Delivery of Cabotegravir for PrEP Albert Liu 1 , Alvin Kingcade 2 , Toyin Nwafor 3 , Bo Li 4 , Neelima Jain 4 , Stephen Maher 5 , Ray Hsieh 5 , Alison Gaudion 6 , Riya Moodley 6 , Deanna Merrill 3 , Lisa Petty 3 , Piotr Budnik 6 , Jean Van Wyk 6 , Maggie Czarnogorski 3 , Nanlesta Pilgrim 3 1 San Francisco Department of Public Health, San Francisco, CA, USA, 2 Bebashi - Transition to Hope, Philadelphia, PA, USA, 3 ViiV Healthcare, Durham, NC, USA, 4 GSK, Collegeville, PA, USA, 5 Evidera, Bethesa, MD, USA, 6 ViiV Healthcare, Brentford, United Kingdom Background: Telehealth can be leveraged to support PrEP delivery; however, limited evidence exists on how it is being used with injectable PrEP. We report interim findings from the PILLAR study, a Phase IV implementation science study, on healthcare staff acceptability and feasibility of long acting cabotegravir (CAB LA) for PrEP, use of telehealth, and utility of implementation supports for CAB LA delivery in the U.S. Methods: 17 sites were randomized 2:1 to Dynamic (DI) or Routine (RI) implementation. RI received standard toolkits and DI received standard and enhanced toolkits and supports. Staff study participants (SSPs) completed the acceptability of intervention (AIM) and feasibility of intervention measures (FIM)

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