CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: In this pilot study, POC implementation was feasible and adequate to reduce time to HIV-C and ART initiation. However, site-specific practices should be considered when implementing POC technologies in clinical settings. Healthcare systems need to adapt to facilitate the rapid ART initiation strategy.

HIVST uptake among at-risk groups—particularly those with no prior testing history—facilitating earlier detection and treatment.

This study was supported by Abbott Rapid Diagnostics Argentina S.A.

1200 Persistence of Oral PrEP Use in the United States, 2017-2023 Ya-Lin A. Huang, Weiming Zhu, Laura M. Mann, Karen W. Hoover Centers for Disease Control and Prevention, Atlanta, GA, USA

Background: Consistent use of daily oral preexposure prophylaxis (PrEP) during periods of HIV risk is essential for optimal HIV protection. This study estimated and compared persistence of oral PrEP among early and more recent cohorts of PrEP users using a national pharmacy database. Methods: We analyzed data from the IQVIA Real-World Data—Longitudinal Prescription Database (2017−2023) to identify persons aged ≥16 years newly prescribed oral PrEP for >30 days. Two cohorts were constructed based on PrEP initiation periods: 2017−2018 and 2021−2022, each followed for 12 to 36 months post-initiation. Data from 2020 were excluded due to the COVID-19 pandemic that resulted in decreased PrEP use. Persistence was defined as the duration of continuous PrEP prescription fills until a >30 days gap. Non persistence was the date when the prescribed supply would be depleted if taken daily. Individuals could restart PrEP after discontinuation and have multiple episodes. We reported median persistence duration by initiation cohort and used Kaplan-Meier survival curves to estimate time to non-persistence. We used Cox proportional hazards models to examine the associations between patient demographic characteristics and non-persistence. Results: We identified 183,584 new PrEP users in 2017−2018 and 321,224 in 2021−2022. The median duration of initial PrEP use was 4.0 months (interquartile range [IQR] 1.0−12.0) for the 2017−2018 cohort and 3.0 months (IQR 2.0−10.0) for the 2021−2022 cohort. Only 42.4% of the early cohort and 37.9% of the recent cohort persisted for 6 months (Figure). About 35.6% restarted PrEP at least once, with a median second episode duration of 3.0 months across cohorts. Factors associated with non-persistence across cohorts included being female (adjusted Hazard Ratio [aHR] 1.62, 95% CI 1.61−1.64), younger age (16-24 years: aHR 1.65, 95% CI 1.62−1.68) compared to those aged 55-64, Black race (aHR 1.18, 95% CI 1.16−1.20) compared to White, having public health insurance (aHR 1.35, 95% CI 1.33−1.36) or paying cash (aHR 1.63, 95% CI 1.59−1.67) compared to using commercial insurance. Conclusions: Less than half of new oral PrEP users persisted beyond 6 months, and persistence declined over time. This trend might reflect increased use of on-demand PrEP and transitions to injectable PrEP. Better understanding of on-demand PrEP uptake and adherence is needed to address persistence trends. Future studies can benefit from assessing the impact of switching between PrEP formulations on persistence.

1199 Characteristics of First-Time HIV Self-Testers Using the Online HIV Service ‘Stand By You’ Kantarida Sripanidkulchai 1 , Supattra Rungmaitree 1 , Theppharit Thiamprasert 1 , Yuitiang Durier 1 , Alan Maleesatharn 1 , Suthat Chottanapund 2 , Thanawong Buason 3 , Pichapun Pongsakul 3 , Usanee Kritsanavarin 4 , Yenjit Somphoh 5 , Pornvilai Urujchutchairut 1 , Benjawan Khumcha 1 , Kulkanya Chokephaibulkit 1 1 Mahidol University, Bangkok, Thailand, 2 Thailand Ministry of Public Health, Nonthaburi, Thailand, 3 Ministry of Public Health, Nonthaburi, Thailand, 4 US Centers for Disease Control and Prevention Nonthaburi, Nonthaburi, Thailand, 5 Thai National AIDS Foundation (TNAF), Bangkok, Thailand Background: First-time testers are often overlooked by conventional HIV services, yet they play a critical role in achieving the goal of ensuring all at-risk individuals know their status. Online platforms—such as TikTok and LINE— offer accessible, anonymous, and engaging options to reach these groups, especially at-risk adolescents and young adults. By leveraging digital channels, innovative HIV self-testing (HIVST) initiatives can connect with those reluctant to HIV testing. Methods: The ‘Stand by You’ initiative integrated free HIVST, online text-based counseling, and educational support on HIV prevention, covering pre- and post exposure prophylaxis (PrEP, PEP), facilitating linkage to care. TikTok ads targeted at-risk adolescents and young adults. After completing a self-administered risk assessment questionnaire, eligible individuals received HIVST kits by mail and were encouraged to voluntarily report their HIVST results without incentives. Instant text-based chatroom counseling (from 10:00–22:00) provided guidance and support on HIV and STI-related issues. Data from August 25, 2022, to December 31, 2024, were analyzed to describe the characteristics of first-time testers and identify factors associated with a positive HIVST result. Results: Among 8,234 participants, 4,677 (56.8%) were first-time testers. Compared with repeat testers, first-time testers were younger (under 25 years old 54.3% vs. 39.4%, P<0.001), less likely to identify as LGBTQIA+ (51.6% vs. 74.4%, P<0.001), and less likely to use HIV chemoprophylaxis (PrEP 0.6% vs. 12.2%; PEP 1.0% vs. 13.6%, P<0.001). They also reported lower condom use, had a slightly lower average number of sexual partners in the past month (2.6 vs. 2.8, P=0.04), and exhibited a higher HIV positivity rate (4.0% vs. 2.5%, P<0.001). In multivariable analysis, factors significantly associated with a positive HIVST result among first-time testers included identifying as LGBTQIA+ (adjusted odds ratio [aOR] 7.41, 95% CI: 4.82–11.39, P<0.001), having a history of sexually transmitted infections (aOR 1.86, 95% CI: 1.37–2.53, P<0.001), and being older (aOR 1.03 per year increase, 95% CI: 1.01–1.05, P=0.004). Conclusions: First-time testers showed a higher risk of HIV infection, emphasizing the importance of digital outreach in closing HIV testing gaps. By offering convenient and stigma-free avenues, online platforms can expand

Poster Abstracts

CROI 2025 394