CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

in 2023 have the potential to increase PrEP uptake and further reduce HIV incidence in Zimbabwe. However, the impact and optimal implementation strategy of ring PrEP and LA PrEP are unclear. We aim to identify the cost effectiveness of different implementation strategies using the three types of PrEP in Zimbabwe. Methods: Using a validated HIV compartmental transmission model in Zimbabwe, we compared 3,136 permutations of PrEP implementation strategies. We compared three types of PrEP (oral, LA, ring) across various coverage levels (10%, 50%, 70%) and targeted different groups, including adolescent girls and young women ages 15-24 (AGYW), adolescent boys and young men ages 15-24, men aged 25 to 34, and high-risk groups such as female sex workers (FSW), men who have sex with men (MSM), people with alcohol use disorder, and people with major depressive disorder. Cost, effectiveness, retention, and coverage inputs were based on the literature, expert opinion, and national surveillance results. Outcomes were infections averted, quality adjusted life-years (QALYs) gained, cost per infection averted, and cost per QALY gained. Results: LA PrEP is more cost-effective than oral and ring PrEP. Implementing LA PrEP for FSW at 70% coverage level is the most cost-effective strategy, averting 10895 additional infections and adding 6711 additional QALYs through 2030. This strategy costs $11.8 million per year and has an incremental cost-effectiveness ratio (ICER) of $1081/infection averted or $1545/QALY, when compared to the baseline implementation of oral PrEP at 10% coverage. Targeting FSW for LA PrEP at various coverage levels has similar ICERs and is more cost-effective than other common HIV prevention programs, such as additionally scaling-up index tracing, differentiated care, voluntary medical male circumcision, HIV self-testing, and defaulter tracing. However, when LA PrEP is targeted to other risk groups beyond FSW, LA PrEP becomes less cost effective than other prevention programs. Conclusions: Targeting high-risk populations like FSW with LA PrEP is the most cost-effective PrEP implementation strategy and contributes to Zimbabwe’s Ending the HIV Epidemic 2030 goal. 1222 Leveraging Community to Provide PrEP to Key Population in China: Results From a PrEP Clinical Trial Weiming Tang 1 , Yifan Dai 2 , Chengxin Fan 2 , Chunyan Li 3 , Songjie Wu 4 , Quanmin Li 5 , Joseph D. Tucker 1 , Jonathan Lio 6 , Haojie Huang 7 , Ke Liang 4 , Linghua Li 5 , Aniruddha Hazra 8 , Renslow Sherer 6 , Zhuoheng Yin 2 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 University of North Carolina Project - China, Beijing, China, 3 University of Tokyo, Tokyo, Japan, 4 Wuhan University Zhongnan Hospital, Wuhan, China, 5 Guangzhou Eighth People's Hospital, Guangzhou, China, 6 University of Chicago, Chicago, IL, USA, 7 Wuhan LGBT Center, Wuhan, China, 8 University of Chicago Medical Center, Chicago, IL, USA Background: Data on PrEP usage is limited in China. This study aimed to provide information on PrEP uptake, persistence, discontinuation, adverse events, and HIV incidence among Chinese at-risk PrEP users. Methods: We conducted a 12-month PrEP demonstration project in Wuhan and Guangzhou, China, using a community and clinic hybrid delivery model. Healthcare providers implemented prescribing, medical consultation, and PrEP dispensing through clinic visits or courier delivery with CBOs' assistance. PrEP refill was monthly for the first quarter and trimonthly thereafter. PrEP continuation and adherence information (defined as self-reported taking more than 6 pills in 7 days for daily and strictly adherence to 2+1+1 for events driven) was surveyed quarterly. Enrollment, PrEP persistence, adherence, discontinuation, and adverse events were descriptively summarized. Results: From September 2021 to September 2024, a total of 3649 GBMSM were screened, and 1200 were enrolled. Of those, 1138 participants started oral PrEP, with a median age of 29.1(SD=5.9). Most participants identified as gay or bisexual (93.7%, 1066/1138), and 99.6% were cis-gender men(1134/1138). After initiation, PrEP persistence rates at 3, 6, 9, and 12 months were 82.9% (943/1138), 75.9% (864/1138), 70.1% (793/1131), and 65.4% (720/1101) respectively (ongoing). The self-reported adherence rate was 64.4%(733/1138), 59.3%(675/1138), 53.0% (599/1131), and 49.4% (544/1101) at months 3, 6, 9 and 12. In the first-time survey, 42.6% (412/943) and 57.5% (531/ 943) chose the daily and on-demand regimen. Among them, 40.3% (166/412) of daily users and 18.8% (100/531) of on-demand users had changed their regimens, thereafter. 381 participants (33.5%, 381/1138) discontinued PrEP use during the study. Twenty-three types of adverse effects were identified, with nausea (n=16), dizziness (n=12), and diarrhea (n=9) being the three most frequently reported.

1220 WITHDRAWN

Poster Abstracts

1221 Cost-Effectiveness of Different Risk-Group Targeting Across 3 Types of PrEP in Zimbabwe Mellesia Jeetoo 1 , Yao-Rui Yeo 1 , Dyanna Charles 1 , Jasmine Su 1 , Owen Mugurungi 2 , Tsitsi Apollo 3 , Getrude Ncube 3 , Ngwarai Sithole 3 , Karen Webb 4 , Kudakwashe Takarinda 4 , Emily Gwavava 5 , Bekezela Bobbie Khabo 5 , R. Scott Braithwaite 1 1 New York University Langone Medical Center, New York, NY, USA, 2 Ministry of Health and Child Care, Harare, Zimbabwe, 3 Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe, 4 Organization for Public Health Interventions and Development, Harare, Zimbabwe, 5 Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe Background: Oral pre-exposure prophylaxis (oral PrEP) has long been part of the HIV prevention portfolio in Zimbabwe. The introduction of long-acting, injectable PrEP (LA PrEP) in 2022 and the dapivirine vaginal ring (ring PrEP)

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