CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

suppression (<400 HIV-RNA/mL before January 1, 2023; <200 HIV- RNA/mL on or after January 1, 2023) at 18 months. Effectiveness was estimated as the difference in viral suppression at 18-months comparing the two trial arms using a doubly robust generalized estimating equation accounting for dropout and adjusting for baseline viral load. The primary outcome from both trial arms were also compared to an additional n=300 propensity-matched controls receiving usual care (UC) alone. Results: The sample was 52 years of age, 75% female and viral suppression at baseline was 94%. There was no intervention effect on viral suppression at 18-months when comparing MF+ICB to MF+SOC (odds ratio, OR: 1.20, 95% Confidence Interval CI: [0.90, 1.60], p-value =0.23). There was an increase in viral suppression in the MF+ICB (OR: 2.16, 95% CI [1.48, 3.19], p-value <0.001) and MF+SOC (OR: 1.42, 95% CI [1.05, 1.92], p- value = 0.023), compared to the matched UC group. Conclusion: Among MF groups, those who received integrated HIV+NCD care did not have statistically higher viral suppression compared to SOC. This may be due to high viral suppression at baseline in both arms. However, improvements in viral suppression among MF group participants compared to matched usual care patients suggests that microfinance improves HIV treatment outcomes among patients in rural Kenya, yet additional research is necessary to understand the mechanisms for how MF improves viral suppression. Differentiated care models for addressing multilevel barriers to the maintenance of HIV viral suppression may be more effective if socioeconomic barriers are mitigated. 1253 Persistence on Contraception and PrEP in Hair Salons in South Africa Ingrid V Bassett 1 , Joyce Yan 1 , Sabina Govere 2 , Sthabile Shezi 2 , Lungile M. Ngcobo 2 , Shruti Sagar 1 , Jana Jarolimova 1 , Dani Zionts 1 , Christina Psaros 1 , Nduduzo Dube 2 , Robert A. Parker 1 1 Massachusetts General Hospital, Boston, MA, USA, 2 AIDS Healthcare Foundation, Durban, South Africa Background: Young women have high HIV incidence and risk for unintended births in sub-Saharan Africa. Women congregate regularly in hair salons; these may be useful community settings for providing HIV prevention and family planning. Our objective was to assess PrEP and contraceptive persistence following dispensing in hair salons in South Africa. Methods: We conducted a pilot randomized trial to evaluate uptake and persistence of a nurse-supported intervention offering PrEP (TDF-FTC) and contraception (oral/injectable) in 5 salons in urban KwaZulu-Natal. Women could start PrEP and/or contraception at the initial visit or opt in at a later visit. We defined persistence as one additional visit within 6 months with continued treatment (PrEP, contraception, or both). We assessed the association of PrEP persistence among intervention participants using contingency tables. Factors assessed included age, self-perceived risk of HIV, partner ≥5y older, primary sex partner having other partners, intimate partner violence, curable STI at enrollment, and persistence on contraception. Results: Among 125 participants in the intervention salons, median age was 26y (IQR 22-29). 93 (75%) reported visiting the salon at least every 2 months; 34 (27%) were taking hormonal contraception at enrollment. 25 (28%) described themselves as having moderate or greater chance of getting HIV in the next year and 35 (32%) think their primary sex partner has other partners. 46 (37%) initiated PrEP during the study; among the 40 returning for at least 6 months of follow-up, 17 (43%) persisted. 39 (31%) opted for oral contraception and 77 (62%) for injectable contraception; among the 94 with at least 6 months follow up, 66 (70%) persisted on contraception. Persistence on salon-based PrEP was associated with age ≥25y (RR: 3.45 [95% CI: 1.16,24.5]) and intimate partner violence (2.57 [1.24,4.91]). PrEP persistence was also related to no/low perceived risk of HIV and contraceptive persistence (RR undefined). Conclusion: Young women in South Africa found receipt of HIV prevention services and family planning in a hair salon acceptable over time, with persistence for contraception (70%) greater than for PrEP (43%). Factors related to PrEP persistence include age ≥ 25y, intimate partner violence, a low or no perceived risk of HIV, and persistence on contraceptives. Hair salons are a novel venue for delivering long-term sexual reproductive health services, however, a menu of PrEP delivery methods may be required to support persistence.

1254 Persistence in Care After PrEP Initiation Through a Community-Based Mobile Clinic Susanne Doblecki-Lewis 1 , Ariana L. Johnson 1 , Katherine King 1 , Katherine Klose 1 , Gilianne Narcisse 1 , Mario Stevenson 1 1 University of Miami, Miami, FL, USA Presenting Author: Dr Susanne Doblecki-Lewis University of Miami - University of Miami (Miami, FL, USA) Background: PrEP can reduce HIV infections substantially when implemented effectively. Miami, the area of the United States (US) with the highest rate of new HIV infections, has significant structural, social, and logistic barriers to PrEP care. Alternative care models, such as mobile clinics, can increase access to PrEP. There are no available data on persistence in PrEP care through a community based mobile clinic. Methods: Clients sought PrEP services through one of 5 mobile sites or at the fixed site from August 2018- March 2023 excluding March-September 2020 due to the COVID-19 pandemic. 24-week persistence was defined as at least 1 follow-up appointment within 24 weeks of initiation, and 48-week persistence as having at least 1 additional follow-up appointment between 24 and 48 weeks. Cox proportional hazards models were used to estimate adjusted Hazard Ratio (aHR) of risk factors for discontinuation of care by 48 weeks by gender, race, ethnicity, insurance status, and visit site. Results: 919 clients initiated PrEP before March 2022. Clients were primarily self-reported male (86.8%), white (69.7%), Hispanic (74.6%), insured (50.6%), and initiated services at the mobile clinic (52.2%). Overall persistence on PrEP was 56.7% at 24 weeks and 41.5% at 48 weeks. Individuals who were uninsured, identified as male, and initiated services in the mobile clinic were more likely to continue PrEP (HR:1.20, p=0.01; HR:2.02, p<0.01; HR:1.68, p<0.01, respectively). Overall persistence in care (including visits for other sexual health services) was 76.2% to 24 weeks and 55.7% at 48 weeks. Individuals who identified as male, and those who initiated services at the mobile clinic had increased continuation (HR:1.51, p=0.02; HR:2.21, p<0.01, respectively). Conclusion: Persistence in PrEP and sexual health care is improved for those initiating services in a community-based mobile clinic compared with a fixed clinic with otherwise identical services, staff, and barrier- lowering strategies. In our analysis, uninsured clients had improved persistence on PrEP compared with those who were insured, suggesting that our no-cost service model with aggressive navigation to available assistance programs can successfully overcome barriers due to insurance coverage. Race and ethnicity were not associated with persistence in our analysis. Persistence among women initiating PrEP in both the mobile and fixed clinics was decreased. Future research to assess the potential role of mobile clinics in PrEP delivery are warranted. 1255 Availability of Onsite Substance Use Disorder Services in HIV Facilities by Urbanicity in the US Kashif Iqbal , Preetam A. Cholli, Yunfeng Tie, Stacy Crim, Jesse G. O'Shea, John Weiser, Sharoda Dasgupta Centers for Disease Control and Prevention, Atlanta, GA, USA Background: HIV outbreaks related to injection drug use continue to be reported in the U.S., including in rural communities, where accessing HIV care services and substance use disorder (SUD) services may be challenging. We describe availability of onsite SUD services at HIV care facilities attended by a representative sample of people with HIV (PWH) in the U.S. and the percentage of persons receiving these services by urbanicity. Methods: We analyzed 2021 survey data from 514 HIV care facilities representing all facilities providing care to a national probability sample of

Poster Abstracts

CROI 2024 412