CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

1242 Rapid Long-Acting Injectable PrEP Implementation in a Vulnerable Urban Safety Net Clinic Population Ezra Bisom-Rapp, Christina Camp, Jon Oskarsson, Mary Shiels, Matthew A. Spinelli, Francis Mayorga-Munoz, Anthonia Chimezie, Monica Gandhi, Sarah Puryear University of California San Francisco, San Francisco, CA, USA Background: Despite effective oral PrEP, barriers to uptake and adherence persist, including stigma, substance use (SU), housing/food insecurity, and mental health issues. Long-acting cabotegravir (CAB) PrEP is highly efficacious and may address barriers for patients with adherence challenges, but uptake has been low and real- world data is lacking. Methods: We describe a CAB demonstration project at Ward 86, an urban safety-net clinic in San Francisco serving vulnerable patients with high rates of homelessness, mental illness, and SU living with or at risk for HIV. Patients were initiated on CAB via a structured process of provider referral and multidisciplinary review and monitored for on-time injections. Patients were offered low-barrier, multidisciplinary care with rapid PrEP initiation. We report CAB PrEP program evaluation data from chart extraction and PrEP tracking logs for patients initiated on CAB between 3/1/2022-6/1/2023 and followed through 9/1/2023. On-time injections were defined as given 28±7 days for initiation/ re-initiation doses or 56±7 days for maintenance doses. Results: We initiated 30 participants on CAB PrEP: 70% cisgender men, 13% cisgender women, 7% transgender women, 10% nonbinary people. Median age was 39 years (range 21-63); 10% of participants were Black, 30% Hispanic, 7% Asian/Pacific Islander, 3% multi-racial. Of the 30, 20% were homeless; 23% were unstably housed. All participants had public insurance (93%) or were uninsured (7%). Active SU disorder was documented in 67%; 53% had at least 1 serious mental illness. We administered 184 injections during the study period, with a median of 6 injections/person (range 1-10). Median time from CAB referral to first injection was 14 days (range 0-111). The median duration of follow-up was 271 days (IQR 87-469). All patients had direct-to- inject CAB; 50% were not on oral PrEP at CAB initiation. Of 157 scheduled follow-up injections, 86% were on time, 4% early, 8% late, and 2% missed/not done. Of late or missed/not done injections, 47% were ≥1 month late, of which 43% were covered by oral PrEP bridging. CAB was discontinued by 3 participants for risk change (1), loss-to-follow-up (1), and transfer of care (1). All remain HIV-negative. Conclusion: This demonstration project shows that a rapid start CAB PrEP program serving patients with numerous psychosocial stressors is feasible and has high retention. Delivery of CAB via a low-barrier, comprehensive care model may expand uptake to high-risk, adherence-challenged populations. 1243 High Acceptability of Long-Acting Injectable PrEP and ART Among MSM and PWID in India Allison M McFall 1 , Talia A. Loeb 1 , Jiban J. Baishya 2 , Ashwini Kedar 3 , Archit Sinha 4 , Aylur K Srikrishnan 4 , Sunil Suhas Solomon 1 , Gregory M. Lucas 1 , Shruti H. Mehta 1 1 The Johns Hopkins University, Baltimore, MD, USA, 2 The Johns Hopkins University, New Delhi, India, 3 YR Gaitonde Center for AIDS Research and Education, New Delhi, India, 4 YR Gaitonde Center for AIDS Research and Education, Chennai, India Background: Long-acting injectable PrEP (LA-PrEP) and ART (LA-ART) hold significant potential to overcome challenges of daily adherence to oral modalities. Their population-level impact requires acceptability and uptake by populations with the most need, such as people who inject drugs (PWID) and men who have sex with men (MSM) in low/middle income settings. Methods: We used respondent-driven sampling to accrue samples of PWID and MSM in India Nov 2022-Aug 2023 (3 PWID sites; 2 MSM sites; ~750/site). Participants were ≥18 years old and reported injection drug use in the prior 2 years (PWID) or sex with a man in the prior year (MSM). Participants completed a survey and blood draw. Those reporting a prior HIV diagnosis were asked questions about LA-ART and those without a prior diagnosis were asked about LA-PrEP. We present acceptability and correlates of LA-PrEP and LA-ART using multilevel logistic regression models by modality and population separately. Results: 2250 PWID and 1502 MSM were enrolled. PWID HIV prevalence was 41%, of whom 45% were on ART and 34% suppressed (≤150 copies/mL). MSM HIV prevalence was 21%, of whom 65% were on ART and 75% suppressed. Of those not reporting a prior HIV diagnosis, 10/14% (PWID/MSM, respectively) reported no/very little chance they would be willing to get injections to prevent HIV and 65/78% a very good chance. Main reasons for LA-PrEP unwillingness

among PWID were inconvenience of injections and low risk perception; among MSM, reasons were injection pain and cost. Among PWID, women and those homeless were less willing to take LA-PrEP and those with more sexual partners were more willing; injection behaviors were not associated (Table). Among MSM, those with more partners were less willing to take LA-PrEP; unprotected sex was not associated. Of those with a prior HIV diagnosis, 3/2% (PWID/MSM, respectively) reported no/very little chance they would willing to take LA-ART and 83/89% reported a very good chance. Among PWID, those injecting daily were more willing to take LA-ART but those viremic were less likely. Among MSM, those with more partners and viremic were more willing. ART use was not associated with LA-ART willingness for either population. Conclusion: There was high interest in using LA-PrEP and LA-ART among populations that experience a disproportionate HIV burden and barriers to HIV treatment engagement. However, there remain vulnerable subgroups for which these may not be appropriate and other prevention and treatment approaches will be required.

Poster Abstracts

1244 Gender Affirmation and Incentives for Long-Acting PrEP: Stated Preferences of Transgender Adults

Marta Wilson-Barthes 1 , Arjee Restar 2 , Emerson Dusic 2 , Don Operario 3 , Timothy Souza 1 , Omar Galárraga 1 1 Brown University, Providence, RI, USA, 2 University of Washington, Seattle, WA, USA, 3 Emory University, Atlanta, GA, USA Background: Transgender and nonbinary (trans) people face a disproportionately high HIV risk, yet adherence to pre-exposure prophylaxis (PrEP) remains low. Conventional approaches to PrEP programming have not sufficiently engaged trans populations. Gender affirmation and conditional economic incentives could help improve the uptake of PrEP, but user-centered approaches are needed to inform the optimal design of trans- specific PrEP programming. Methods: We conducted a discrete choice experiment among 385 trans adults in Seattle/King County, Washington State to inform the optimal design of a conditional economic incentive (CEI) program that would provide free long-acting injectable PrEP (LA-PrEP) and gender-affirming care. We used a best-best elicitation method where respondents were first asked to select their best option from three hypothetical choice profiles (Program A, Program B, or No Program), and to then select their second-best option from the remaining two profiles. We used a rank-ordered mixed logit model for main results, and estimated respondents' marginal willingness-to-accept each program attribute. Results: We find the optimal program design would: (1) deliver incentives in cash, (2) confirm LA-PrEP adherence via blood testing, (3) provide counseling in-person, and (4) provide co-prescriptions for injectable gender-affirming hormones. From a maximum yearly incentive amount of $1,200, respondents were willing to forgo up to $795 to receive incentives in cash (instead of voucher) and up to $587 to receive injectable rather than oral hormones. As shown in the figure, the probability of choosing a hypothetical program over no program waned as adults aged (>40 years) and as annual income increased (>$75,000/year). Conclusion: Conditional economic incentives may be effective for improving LA-PrEP adherence among trans adults who are younger and have fewer financial resources. A randomized trial is needed to confirm the validity of the DCE for predicting actual program uptake.

CROI 2024 408