CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

transmitted infections. We analyzed data from the Tanzania HIV Impact Survey (THIS) 2022-2023, a nationally representative, cross-sectional survey of adults aged ≥15 years, to determine associations between male circumcision status and HIV and hepatitis B virus (HBV) infections among sexually active men. Methods: Consenting male participants reported sociodemographic data, circumcision status, sexual history, and knowledge of HIV in a questionnaire. They were offered testing for HIV in accordance with the national testing algorithm and testing for HBV using an algorithm of antibody to hepatitis B core antigen and hepatitis B surface antigen tests. Analysis was restricted to males reporting ever having sexual intercourse with reported circumcision status. We used modified Poisson regressions to assess association of circumcision status with HIV and HBV infection separately, adjusted for age, residence, marital status, education, wealth quintile, and HIV knowledge. We reported population proportions and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). Analyses were weighted and accounted for survey design. Results: The analysis had 12,406 men, of whom 13.6% (95%CI: 12.4-15.0) were uncircumcised. HIV prevalence was 7.0% (95%CI: 5.7-8.6) and 2.9% (95%CI: 2.5-3.3) among uncircumcised and circumcised men, respectively. HBV infection prevalence was 6.0% (95%CI: 4.8-7.5) and 4.9% (95%CI: 4.3-5.4) among uncircumcised and circumcised men, respectively. In the adjusted HIV multivariable model, uncircumcised men had twice (aPR: 2.1; 95%CI: 1.7-2.8) the HIV prevalence compared to circumcised men. In the adjusted HBV multivariable model, there was no statistical difference (aPR: 1.2; 95%CI: 0.9-1.6) in HBV infection prevalence between uncircumcised and circumcised men. Conclusions: In Tanzania, circumcision was associated with HIV prevalence but not HBV infection prevalence in sexually active men. The VMMC program is a key prevention strategy; delivering VMMC services to all men could decrease the spread of HIV. Efforts to improve access to HBV services, including vaccination and education programs, may help mitigate the disease's impact alongside ongoing HIV prevention programs.

1204 Support for Over-the-Counter PrEP Among Transgender Women and Transfeminine Nonbinary People Lauren R. Violette 1 , Samuel Jenness 2 , Vanessa M. McMahan 3 , Iaah L. Lucas 4 , Mariah Valentine-Graves 4 , Joanna A. Caldwell 4 , Travis Sanchez 4 , Stefan Baral 5 , Douglas Krakower 3 , Julia Marcus 3 1 Harvard Medical School, Boston, MA, USA, 2 Rollins School of Public Health, Atlanta, GA, USA, 3 Harvard Pilgrim Health Care Institute, Boston, MA, USA, 4 Emory University, Atlanta, GA, USA, 5 The Johns Hopkins University, Baltimore, MD, USA Background: The population-level impact of HIV PrEP in the US has been limited by structural barriers to access, particularly in historically marginalized populations. Making PrEP available over the counter (OTC) on pharmacy shelves or online, without the need for a prescription, may address some of those barriers. However, it is unknown if populations likely to benefit from PrEP would support OTC availability. Methods: We analyzed cross-sectional data from the Transgender Women’s Internet Survey and Testing study from December 2023-May 2024. Respondents were US transgender women and transfeminine non-binary people assigned male at birth who were aged ≥15 and reported ever having sex. Respondents were asked whether or not they would support making daily oral PrEP available OTC if research showed it was safe and effective. We used modified Poisson regression to compute unadjusted prevalence ratios (PR) to identify correlates of support for OTC PrEP. Results: Among 1,918 respondents, median age was 24 years, 75% were white, and 11% PrEP-experienced. Overall, 87% supported OTC PrEP; 7% did not support it and 6% were unsure. Support for OTC PrEP did not differ by age, race, or ethnicity but was higher among respondents with >1 sex partner in the prior year compared with those with 0-1 partner(s) (PR=1.04, 95% CI=1.02-1.07) and among respondents with a recent bacterial STI (PR=1.08, CI=1.06-1.09). There was greater OTC PrEP support among respondents who had ever worried that a healthcare provider would treat them differently due to the respondent’s gender identity (PR=1.04, CI=1.01-1.07) or sexual partnerships (PR=1.03, CI=1.01-1.06). Among PrEP-naïve respondents, there was greater support for OTC PrEP among those who reported they had never taken PrEP because they were worried a doctor would treat them poorly if they asked about PrEP (PR=1.05, CI=1.01-1.09), people would think they were very sexually active (PR=1.07, CI=1.04-1.10), or about privacy while insured by a parent’s health plan (PR=1.06, CI=1.03-1.09). Support for OTC PrEP was also higher among those who had never taken PrEP because they did not know enough about it (PR=1.04, CI=1.00-1.07) or which doctor to see to access it (PR=1.06, CI=1.03-1.09). Conclusions: Support for OTC PrEP was high among transgender women and transfeminine non-binary people, especially those who anticipated stigma in healthcare settings. Future research should explore how OTC PrEP might address barriers to PrEP use experienced by historically marginalized populations. 1205 Male Circumcision, HIV, and Hepatitis B: Results From the Tanzania HIV Impact Survey Alexander Kailembo 1 , Sarah Porter 1 , Daimon Simbeye 1 , Oscar E. Rwabiyago 1 , Samwel Sumba 2 , Ahmed Khatib 3 , Mohamed Hassan 4 , Tepa Nkumbula 5 , Jonathan Grund 1 , George S. Mgomella 1 , Mahesh Swaminathan 1 1 US Centers for Disease Control and Prevention Dar es Salaam, Dar es Salaam, United Republic of Tanzania, 2 Tanzania Commission for AIDS (TACAIDS), Dodoma, Tanzania, 3 Zanzibar AIDS Commission (ZAC), Zanzibar, United Republic of Tanzania, 4 Zanzibar Integrated HIV, Hepatitis, TB and Leprosy Programme, Zanzibar, United Republic of Tanzania, 5 ICAP at Columbia University in Tanzania, Dar es Salaam, Tanzania Background: Voluntary medical male circumcision (VMMC) has been widely recognized for its role in HIV prevention and protection against other sexually

Poster Abstracts

1206 Online and Less Frequent Monitoring of Oral HIV PrEP Use Are Noninferior to Standard of Care

Marije L. Groot Bruinderink 1 , Anders Boyd 2 , Lotte Werner 1 , Vita W. Jongen 1 , Laura Blitz 3 , Colette van Bokhoven 4 , Joey Woudstra 1 , Sophie Boers 5 , Hannelore M. Götz 5 , Allard R. Feddes 6 , Frenk van Harreveld 6 , Maria Prins 1 , Elske Hoornenborg 1 , Udi Davidovich 1 , Maarten Schim van der Loeff 1 1 Public Health Service Amsterdam, Amsterdam, Netherlands, 2 Amsterdam University Medical Centers, Amsterdam, Netherlands, 3 Public Health Service of Haaglanden, The Hague, Netherlands, 4 Public Health Service of Gelderland-Zuid, Nijmegen, Netherlands, 5 Public Health Service of Rotterdam Rijnmond, Rotterdam, Netherlands, 6 University of Amsterdam, Amsterdam, Netherlands Background: Oral HIV pre-exposure prophylaxis (PrEP) is highly effective to prevent HIV in men who have sex with men (MSM). PrEP use is usually monitored in-clinic every 3 months (mo). However, this set-up is burdensome for some PrEP users. Reducing the number of in-clinic visits by online-mediated or 6-monthly monitoring may reduce barriers, but could affect PrEP adherence. The primary objective of the study was to establish the noninferiority in terms of PrEP adherence of online-mediated PrEP monitoring (vs. in-clinic) and of 6-monthly monitoring (vs. 3-monthly). Methods: EZI-PrEP was an 18-month, 2×2 factorial, open-label, multi-center, randomized, controlled, noninferiority trial conducted at 4 sexual health centers in the Netherlands. Participants were randomized 1:1:1:1 to one of 4 study arms: (1) in-clinic monitoring every 3 mo, (2) in-clinic monitoring every 6 mo, (3) online-mediated monitoring every 3 mo, and (4) online-mediated monitoring every 6 mo. Eligible individuals were MSM and transgender and gender diverse people aged ≥18 years, currently using oral PrEP or initiating this at study enrollment. The primary outcome is the incidence rate (IR) of unprotected

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