CROI 2025 Abstract eBook

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Poster Abstracts

may not be necessary to measure antiretroviral adherence. The next-gen LFA demonstrated enhanced diagnostic accuracy in identifying early non adherence.

1216 Suboptimal Laboratory Testing of PrEP Users: United States, 2022-2023 Karen W. Hoover 1 , Weiming Zhu 1 , Ya-Lin A. Huang 1 , Laura M. Mann 1 , Rupa Patel 2 , Athena Kourtis 1 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Whitman-Walker Health, Washington, DC, USA Background: To ensure the safety of PrEP use, CDC recommends testing all PrEP users for HIV and sexually transmitted infections (STIs) at PrEP initiation and regular intervals during use. CDC also recommends testing oral PrEP users for hepatitis B virus (HBV) at initiation, and creatinine at initiation and during use. Testing users of tenofovir alafenamide and emtricitabine (TAF/FTC) for lipids is recommended at initiation and annually during use. Methods: We analyzed the MarketScan commercial insurance database and identified persons who initiated oral or CAB-LA PrEP during 2022-2023. We analyzed testing records for HIV antigen/antibody (Ag/Ab), HIV RNA, HBV, STIs, creatinine, and lipids stratified by PrEP type. For each test, we estimated proportions of persons tested at PrEP initiation (±14 days from first prescription), and at follow-up within 90 days after the inferred end of PrEP use. To ensure sufficient time for follow-up, we used denominators based on the recommended interval for each test: HIV Ag/Ab testing was assessed among persons prescribed PrEP ≥3 months; STI testing for those prescribed ≥6 months; creatinine testing for those either aged ≥50 years and prescribed ≥6 months or all users prescribed ≥12 months; and lipid testing for those prescribed TAF/FTC ≥12 months. We calculated the median time and interquartile range (IQR) from PrEP initiation to the first follow-up test. Results: Among 35,132 oral PrEP users, only 38% had an HIV Ag/Ab test at initiation and 56% had a follow-up test while using PrEP (Table). At initiation of oral PrEP, testing rates were 21% for HBV, 35% for syphilis, 35% for chlamydia, 34% for gonorrhea, 34% for creatinine, and 15% for lipids. Among 453 CAB-LA PrEP users, only 55% had an HIV Ag/Ab test and 31% had an HIV RNA test at initiation. At follow-up, 82% of CAB-LA PrEP users had an HIV Ag/Ab test and 53% an HIV RNA test. At initiation of CAB-LA PrEP, 39% had a syphilis test, 37% had a chlamydia test, and 37% had a gonorrhea test. Conclusions: Lab testing of PrEP users, including HIV testing, was suboptimal and not in accordance with CDC recommendations. PrEP users might have been tested for HIV using only a point-of-care (POC) test to facilitate rapid PrEP initiation despite a recommendation to confirm a negative POC test result with lab-based HIV testing. Implementation of clinical decision supports with automated lab order sets tailored to each type of PrEP medication could increase adherence to recommended PrEP lab testing.

1215 Technology-Based Oral Daily Pre-Exposure Prophylaxis Intervention for Online Population in India Jalpa Thakker 1 , Sunil S. Solomon 1 , Dinesh Kumar 2 , Jade Bell 1 , Allison M. McFall 3 , Rifa T. Khan 2 , Subash Gosh 2 , Viswanathan Arumugam 2 , Jagadish Patil 2 , Latika Karve 2 , Kanchan Pawar 1 , Conjeevaram K. Vasudevan 2 , Anthony Reddy 1 , Deepak Naren 2 , Sukhvinder Kaur 4 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 YR Gaitonde Center for AIDS Research and Education, Chennai, India, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4 United States Agency for International Development, Washington, DC, USA Background: Rise of web-based dating platforms have created a "virtual vulnerable population" who do not visit traditional HIV sites, with an HIV burden 20 times higher than the national average (0.2%) highlighting the need to adapt virtual service delivery of interventions such as PrEP . Given the penetration of mobile technology in India with resource limited settings, PrEP delivery via a virtual platform could close this gap. Methods: Since 2020, the Safe Zindagi (SZ) website has provided comprehensive HIV and sexual health services such as HIV testing (self-testing), PrEP and treatment services through a virtual network of doctors, pharmacies, and counselors by reaching diverse populations across India via social media and dating applications. For PrEP, virtual counselors (VCs) assist clients to book subsidized baseline lab tests and tele-consultation with a doctor on SZ. If eligible, subsidized medications are couriered or picked-up by clients through pre-selected pharmacies. VCs, doctors, and automated messages support adherence and retention via tele-counseling, periodic HIV testing and refill reminders. We describe the PrEP uptake and retention over a 4-year period Results: 3486 clients across 90 Indian districts (June 2020-August 2024) were interested in PrEP, of whom 3329 were eligible and 3063 (92%) initiated PrEP. Median age at initiation was 26 years; 59% were cisgender men, 18% ciswomen, and 23% transgender persons. Of the 3063 clients who initiated PrEP, 39% were still on PrEP as of August 31, 2024. The median time on PrEP per client was 156 days; 71% of clients were retained at least for 12 months. Over 4 year period, retention was higher in cisgender men and women compared to TG and was lowest (35%) in clients aged 15-29 years and highest (58%) in 40-55 year old clients. Among clients that discontinued PrEP, 18% were sero-discordant couples, 43% reported reduced HIV risk (e.g. change in sexual behaviors) and other issues like affordability, migration, and lost to follow up.There have been 3 documented sero-conversions among PrEP clients – all clients had a PrEP interruption prior to seroconversion. Conclusions: Data highlight the feasibility of a web-based platform in delivering PrEP services virtually to vulnerable virtual populations in low- and middle- income settings with retention comparable to other physical PrEP programs. Such a platform lends itself to expansion for other services (e.g., PEP, DoxyPEP, etc.) to ensure individually tailored services at scale.

Poster Abstracts

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