CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Seven participants were seroconverted, resulting in an HIV incidence rate of 0.67 per 100 person-years. Conclusions: The hybrid CBO and clinic-based model proved feasible for reaching and dispensing PrEP among Chinese at-risk populations. On-demand use drugs were popular alternatives and one-half of participants engaged in sex using alcohol and nitrates. Long-term PrEP persistence and optimal adherence continuously decreased among Chinese users during the 12-month period. The figure, table, or graphic for this abstract has been removed. 1223 Longer Distances Traveled by Rural vs Urban PrEP Users for PrEP Care: United States, 2023 Weiming Zhu 1 , Laura M. Mann 1 , Rupa Patel 2 , Ya-Lin A. Huang 1 , Karen W. Hoover 1 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Whitman-Walker Health, Washington, DC Background: Preexposure prophylaxis (PrEP) is an effective intervention for the prevention of HIV acquisition associated with both sexual and injection drug use behaviors. Many rural communities are considered medically underserved areas with limited access to healthcare services. Our objective was to assess the distance traveled for PrEP services by persons who live in urban and rural communities. Methods: We analyzed the 2023 IQVIA Real-World Data—Longitudinal Prescription Database to determine the number of providers who prescribed PrEP and the number of persons prescribed PrEP stratified by urban and rural location, PrEP user sex, and provider type (physician or midlevel provider that included nurse practitioners and physician assistants). We identified antiretroviral prescriptions for PrEP using a validated algorithm. For urban and rural PrEP users, we estimated the distance traveled for PrEP services and interquartile range (IQR) using the 5-digit zip code of the PrEP provider’s location and, as a proxy for the PrEP user’s location of residence, the 5-digit zip code of the dispensing pharmacy location. We used the 2023 Centers for Medicare & Medicaid Services Provider Locality file to categorize provider and pharmacy locations as urban or rural. We excluded PrEP prescriptions dispensed by mail order pharmacy outlets when estimating service distance. Results: In 2023, 472,782 urban PrEP users were prescribed PrEP by 86,712 providers; 28,205 rural PrEP users were prescribed PrEP by 16,421 providers. Among urban PrEP users, 92.1% were men; among rural PrEP users 89.9% were men. Among urban PrEP users 58.8% received care from a physician; among rural PrEP users 56.3% received care from a nurse practitioner or physician assistant. Urban PrEP users traveled a median distance of 6.2 miles (IQR 1.8, 32.0) for PrEP care. Rural PrEP users traveled a median distance of 39.0 miles (IQR 7.9, 203.7) to an urban provider and 36.0 miles (IQR 0.0, 211.6) to a rural provider. Conclusions: Rural PrEP users traveled longer distance for their PrEP care compared with urban users. Lack of convenient access to a PrEP provider might be a barrier to PrEP use by persons who reside in rural communities. Understanding PrEP services in rural areas is important to guide the development of interventions to ensure equitable access to effective HIV prevention interventions. PrEP delivery models that use telehealth and local pharmacies can help to increase access to PrEP in rural areas.

Epidemic (EHE) initiative prioritizes 57 jurisdictions for targeted HIV prevention and treatment interventions. To identify opportunities for optimizing HIV prevention in women, we (i) evaluated whether designated EHE jurisdictions geographically overlap with counties of highest female-to-male HIV prevalence and (ii) assessed opportunity for PrEP uptake in these areas. Methods: We used AIDSVu 2021 data to estimate female-to-male HIV prevalence ratios (PR) at the county level and in all EHE jurisdictions. For HIV prevalence, we included counties if the population was >500 persons and HIV prevalence >12 cases, and excluded if the county contained any correctional facilities. For PrEP data, we included counties if population was >100 persons and number of PrEP users was >3. For entire states specified as an EHE jurisdiction, every county in that state that met criteria for analysis was categorized as EHE -designated. Counties were ranked by female-to-male HIV PR, categorized by decile, and then we tested for discrepancies in EHE designation status and availability of PrEP utilization data between top vs bottom decile counties using a chi-square test. Results: A total of 870 US counties (including Puerto Rico) met inclusion criteria (Figure). Of the top decile counties, female-to-male HIV PR ranged from 0.58-1.36, and 80% were located in the South. Of the bottom decile counties, female-to-male HIV PR ranged from 0.07-0.19, and 25% were located in the South. Comparing top vs bottom decile counties, 23 (26%) vs 22 (26%) were EHE -designated ( p =0.89), however, nine (9%) vs 67 (79%) had available PrEP utilization data ( p <0.0001). PrEP data availability were primarily limited by low or nonexistent PrEP users. Conclusions: Using AIDSVu data, in 2021, 80% of U.S. counties with the highest ratio of female-to-male HIV prevalence were located in the US South. While EHE jurisdiction status at the county level did not significantly differ between top vs bottom decile counties, there were limited PrEP data available in regions of highest female-to-male HIV prevalence, primarily due to low PrEP uptake in these areas. As the biomedical toolkit for PrEP options expands, it is critical to optimize HIV prevention reach, use, and outcomes using geographically- and sex and gender-tailored approaches. The figure, table, or graphic for this abstract has been removed. 1225 Self-Reported Frequent vs Infrequent HIV Risk and Actual Diagnoses in MSM: Implications for PrEP Nicolas Salvadori 1 , Suwalai Chalermpantmetagul 1 , Sirintip Piyarad 1 , Sawitree Chairahaeng 1 , Sumet Ongwandee 2 , Jullapong Achalapong 3 , Surachet Arunothong 4 , Pra-Ornsuda Sukrakanchana 1 , Woottichai Khamduang 1 , Nicole Ngo-Giang-Huong 5 , Jean Yves Mary 6 , Sakorn Pornprasert 1 , Gonzague Jourdain 1 1 Chiang Mai University, Chiang Mai, Thailand, 2 Ministry of Public Health, Nonthaburi, Thailand, 3 Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand, 4 Office of Disease Prevention and Control Region 1 Chiang Mai, Chiang Mai, Thailand, 5 French National Research Institute for Sustainable Development, Marseille, France, 6 Université Paris Cité, Paris, France Background: In Thailand, pre-exposure prophylaxis (PrEP) is primarily offered as a daily regimen and focuses on men who have sex with men (MSM) who report frequently engaging in condomless sex. However, MSM reporting less frequent HIV risk exposure may also benefit from PrEP. This retrospective study investigates HIV incidence based on self-reported risk frequency. Methods: As part of the Napneung project (NCT02752152), which aimed to improve access to screening for HIV, syphilis, hepatitis B and C and other sexually transmitted infections, anonymous testing was offered to consenting individuals aged ≥18 years at four facilities in two large cities in northern Thailand (Oct 19, 2015 to Oct 19, 2020). Outreach activities encouraged participation of at-risk individuals. Before knowing their test results, participants confidentially self-reported their behavioral characteristics on tablet computers and were categorized based on the number of condomless sex acts in the past 3 months: frequent risk (>6 acts), infrequent risk (1-6 acts), or no risk (0 acts). In case of positive HIV test, confirmation tests, CD4 enumeration and HIV RNA load measurement were performed in a quality-controlled laboratory. The duration since HIV acquisition was estimated using Western blot (HIV-1 BLOT 2.2, MP Biomedicals, Singapore), and HIV incidence using an HIV-1 limited antigen avidity enzyme immunoassay (Sedia Biosciences, Portland, OR). MSM previously diagnosed with HIV (N=32) or on PrEP (N=13, none testing positive for HIV) were excluded from this analysis. Results: Of 894 MSM (median age 23 years), 69 (8%) reported frequent risk, 412 (46%) infrequent risk and 413 (46%) no risk in the past 3 months. Sixty-four (7%) had a confirmed HIV diagnosis, with prevalence rates of 7% (5/69) in the

Poster Abstracts

1224 Preexposure Prophylaxis Uptake in High Female-to-Male HIV Prevalence Regions in the US Ashvini Vaidya 1 , Lauren F. Collins 1 , Anandi N. Sheth 1 , Jessica M. Sales 1 , Daniel Westreich 2 1 Emory University, Atlanta, GA, USA, 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Background: Despite high efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, uptake is low among cisgender women in the US, especially in the South where >50% of new HIV diagnoses occur. The Ending the HIV

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