CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusions: Pharmacy-based PrEP was acceptable to SW in Zimbabwe and was associated with improved PrEP continuation at 3 months, demonstrating the potential of pharmacy-based PrEP delivery. Further research is needed to differentiate the effect of pharmacy collection from escalating incentives and confirm adherence with biomarkers.

1201 WITHDRAWN

1203 Patterns of Choice, Switching, and Discontinuation of Oral and Injectable PrEP Among Adolescents

Laio Magno Santos de Sousa 1 , Beo O. Leite 1 , Fabiane Soares 1 , Lorenza Dezanet 1 , Mateus Westin 2 , Diana R. Zeballos Rivas 1 , Dirceu Greco 2 , Paula Massa 3 , Alexandre Grangeiro 3 , Ines Dourado 1 , for the PrEP1519 Study Group 1 Federal University of Bahia, Salvador, Brazil, 2 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, 3 Universidade de São Paulo, São Paulo, Brazil Background: Long-acting injectable PrEP (LAI-PrEP) offers a promising alternative for adolescents from sexual and gender minorities (ASGM), as adherence to oral PrEP is a challenge for this population. This study examines patterns of choice and switching between oral and LAI-PrEP among ASGM in Brazil. Methods: PrEP15-19 Choices is an implementation study offering oral and LAI-PrEP (CAB) among cisgender men who have sex with men (MSM), transgender, and non-binary signed males at birth, aged 15 to 19, in three Brazilian cities. Data were collected through forms and PrEP prescription records. The outcomes analyzed included: i) initial PrEP choice after LAI-PrEP became available in the sites (April 2024); ii) switching, defined as the first change in modality after the initial choice; and iii) discontinuation, defined as 60 days without an injection for LAI-PrEP or 90 days without picking up oral PrEP from the scheduled return date. Descriptive and bivariate analyses were assessed using Pearson’s chi-square or Fisher’s exact test. Results: A total of 261 participants were enrolled, with 179 (69%) initiating oral PrEP and 82 (31%) choosing LAI-PrEP. Most were MSM (74%), Black (73%), and aged 18-19 (71%). The main reasons for choosing LAI-PrEP were: i) avoiding the need to take daily pills (80%), ii) preferring it over daily medication (78%), iii) not having to carry medication (52%). LAI-PrEP was more commonly chosen as a first option by those aged 15-17 (39% vs. 29%, p=0.110), by Black participants compared to White participants (35% vs. 20%, p=0.02), and by individuals with elementary or high school education compared to those with higher education (35% vs. 19%, p=0.02). No significant differences were observed based on gender identity, income, or prior experience with oral PrEP. By September 12, 2024, 25/179 (14%) had switched from oral PrEP to LAI-PrEP, while 2/82 (2%) had switched from LAI-PrEP to oral PrEP. The median time to switch was 43 days (IQR=52). Discontinuation rates were 5% (5/105) in the oral PrEP group and 3% (5/156) in the LAI-PrEP group. Conclusions: Although oral PrEP was the initial preferred option among Brazilian adolescents from ASGM, the proportion of participants switching to LAI-PrEP highlights the importance of offering diverse PrEP choices. Future efforts should focus on increasing the uptake of LAI-PrEP by addressing concerns about injectable formulations and raising awareness of their advantages. This could improve adherence and HIV prevention outcomes in ASGM populations.

Poster Abstracts

1202 Evaluating Pharmacy-Based PrEP Delivery for Sex Workers in Zimbabwe: Pilot Quasi-Experimental Study Oppah Kuguyo 1 , Marisa Fujimoto 2 , Constance Watadzaushe 1 , Albert Takaruza 1 , Laura Packel 3 , Primrose Matambanadzo 1 , Getrude Ncube 4 , Owen Mugurungi 5 , Frances Cowan 6 , Sandra I. McCoy 2 , Euphemia L. Sibanda 1 1 Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe, 2 University of California Berkeley, Berkeley, CA, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe, 5 Ministry of Health and Child Care, Harare, Zimbabwe, 6 Liverpool School of Tropical Medicine, Liverpool, UK Background: Sex workers (SW) experience high HIV incidence, yet the potential benefit of daily oral pre-exposure prophylaxis (PrEP) is limited by poor continuation. Enabling pharmacy-based PrEP collection has potential to improve continuation among SW allowing anonymity, convenient location, long operating hours and shorter waiting times. We piloted pharmacy-based PrEP prescription refills to improve continuation; the Together Optimizing PrEP Access in Zimbabwe (TOPAZ) intervention. Methods: TOPAZ was co-developed with SW and pharmacists and is embedded within Zimbabwe’s nationally scaled Key Populations (KP) program, which provides free HIV and sexual & reproductive health services to sex workers. Four randomly selected residential suburbs in Harare with at least 3 eligible pharmacies were allocated to TOPAZ and compared to one large KP program clinic (standard-of-care (SOC)). In the SOC site, SW ≥16 years initiating PrEP were advised to collect PrEP refills from any KP program clinic as usual. In TOPAZ suburbs, SW initiating PrEP had the option to collect refills from pharmacies or KP program clinics. To enhance habit formation, SW collecting refills at pharmacies were offered gift vouchers redeemable at the pharmacy, escalating in value, (US$5, US$6 and US$7 at months 1, 3 and 6, respectively). We present PrEP continuation at 1 and 3 months, defined as collecting prescription refills within a 14-day window at months 1 and 3. PrEP refill data were compared between TOPAZ and SOC arms over the same time period. We compared the proportion of participants continuing PrEP and risk difference (RD) computed using logistic regression models. Results: Between March-May 2024, we recruited 100 and 96 female SW with mean ages 29.3 (SD=7.2) and 27.7 (SD=6.1) years in TOPAZ and the SOC clinic, respectively. In the TOPAZ arm, all refills were made through pharmacies. At month 1, 78/100 (78.0%) participants collected PrEP refills in TOPAZ arm vs. 35/96 (36%) in the SOC clinic, RD 0.42 (95% confidence interval (CI): 0.31-0.52); p<0.01). At month 3, 67/100 (67.0%) in TOPAZ arm completed refills, cv 18/96 (19%) in SOC clinic, RD 0.48; 95% CI:0.4, 0.57; p<0.01), Figure 1.

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