CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1269 High STI Prevalence and Low Past PrEP Use Among Women Who Engage in Sex Work in Southwestern Uganda Jane Kabami 1 , Cecilia Akatukwasa 1 , Jennifer Velloza 2 , Laura Balzer 3 , Hellen N. Atuhaire 1 , Alan Asiimwe 1 , Stella Kabageni 1 , Michael Ayebare 1 , Shem Ankwantiriire 1 , Blian Beinmatsiko 1 , Lisa Georgetti Gomez 2 , Richard Aruho 1 , James F. Rooney 4 , Moses Kamya 5 , Catherine A. Koss 2 , for the P4P Study Team 1 Infectious Diseases Research Collaboration, Kampala, Uganda, 2 University of California San Francisco, San Francisco, CA, USA, 3 University of California Berkeley, Berkeley, CA, USA, 4 Gilead Sciences, Inc, Foster City, CA, USA, 5 Makerere University College of Health Sciences, Kampala, Uganda Background: Women who engage in sex work (WESW) and their partners have an elevated risk of exposure to sexually transmitted infections (STI) and account for an increasing proportion of new HIV infections globally. In Uganda, HIV prevalence among WESW is over 30%. Oral pre-exposure prophylaxis (PrEP) could substantially reduce HIV incidence among WESW and is available through public health facilities in Uganda, but stigma and lack of flexible services at health facilities are barriers to PrEP use. Moreover, data are limited on STI prevalence among WESW in Uganda given that syndromic management is routinely used for diagnosis and treatment. We aimed to quantify PrEP use and STI prevalence among WESW in southwestern Uganda. Methods: We assessed demographic characteristics and prior PrEP use at enrollment into the Peers for PrEP (P4P) study (NCT06353295), which is testing a peer-led PrEP delivery strategy for cisgender WESW in two communities in southwestern Uganda. We tested urine samples for Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) via GeneXpert (Cepheid). We used descriptive statistics to summarize self-reported use of oral PrEP (TDF/XTC) in the last 0-3 and 4-6 months prior to enrollment as well as STI prevalence. Results: Among 140 participants, the median age was 23 years (range 15-42; IQR 20-27); 138 (99%) reported exchanging sex for goods or money in last 3 months; 91 (65%) reported commercial sex work; 69 (49%) reported alcohol use >=4 times per week. 37/140 (26%) reported using oral PrEP in the 3 months before study enrollment; 13 (9%) reported using PrEP in the 4-6 months before enrollment. Among a subset of 78 participants with STI testing completed, 31 (40%) had at least one STI detected: 22/78 (28%) CT and 17/78 (22%) GC. Among the 31 participants with CT or GC detected, 7 (23%) reported PrEP use in the 3 months prior to enrollment, whereas 17/47 (36%) of participants with no STI detected had recently used PrEP. Conclusions: In this HIV prevention study for WESW in southwestern Uganda, 40% of women had prevalent gonorrhea or chlamydia – double the rates of STIs in prior surveys in the region. Despite high STI prevalence and all participants having a PrEP indication, only one-quarter of women reported using PrEP in the last 3 months, while less than 10% had used PrEP 4-6 months prior to enrollment. Innovative strategies are needed to expand access to integrated STI and biomedical HIV prevention services to reduce the burden of HIV and STIs among women who engage in sex work. 1270 Sexually Transmitted Infection Prevalence Among Adolescents and Adults in Western Kenya Julius L. Tonzel 1 , Britt Gayle 1 , Natalie Burns 1 , Glenna Schluck 1 , Paul Adjei 1 , Josphat Kosgei 2 , Deborah Langat 2 , Rael Bor 2 , Christine Akoth 2 , Frederick Sawe 2 , Margaret Yacovone 3 , Trevor Crowell 1 , for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group 1 US Military HIV Research Program, Bethesda, MD, USA, 2 Walter Reed Project–Kericho, Kericho, Kenya, 3 National Institutes of Health, Bethesda, MD, USA Background: Kenyan guidelines recommend syndromic management for sexually transmitted infections (STIs) among people living with HIV at urogenital anatomical sites. However, STIs like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can cause morbidity and can be transmitted even without symptoms at multiple anatomical sites. We assessed the prevalence of CT and NG using universal nucleic acid amplification test (NAAT)-based testing among adults in Western Kenya. Methods: From December 2021 to May 2023, we enrolled participants living without HIV in Kericho and Homa Bay, Kenya, who were aged 14-55 years and reported a recent history of an STI, transactional sex, condomless sex, and/ or injection drug use. Participants provided urine, oropharyngeal swabs, and anorectal swabs for NAAT for NG and CT (GeneXpert®, Cepheid). Multivariable robust Poisson regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with the prevalence of both STIs combined.

Results: Upon enrollment, STI tests were performed on 405 participants, including 323 (79.8%) assigned female sex at birth and 324 (80.0%) aged 24 years or younger. A total 43 (10.6%) had a history of any STI diagnosed in the 24 weeks prior to enrollment. Inconsistent condom use was reported by 309 (76.3%) participants and 201 (49.6%) had ≥10 new sexual partners in the previous 12 weeks. NAAT identified an STI in 143 (35.3%) participants, with 111 (27.4%) CT and 76 (18.8%) NG diagnoses. CT/NG diagnoses were reported at a single anatomical site in 37 (9.1%) participants and multiple anatomical sites in 104 (25.7%) participants. Among 117 participants with an anorectal STI, 16 (13.7%) reported receptive anal sex and 3 (18.8%) participants did not report a urogenital STI. Females had higher prevalences of urogenital (33.7% vs. 18.3%, p=0.01) and anorectal STIs (31.9% vs. 17.1%, p=0.01). Prevalent STIs were reported in 19 (13.3%) participants at oropharyngeal and/or anorectal sites that were not detected at urogenital sites. In multivariable analyses, there were no statistically significant associations between sociodemographic variables and STI prevalence. Conclusions: A high prevalence of urogenital and anorectal STIs were identified in a Western Kenyan community, particularly among females. Implementing universal NAAT-based anorectal STI screening of sexually active adolescents and young adults could reduce STI burden in this population. The figure, table, or graphic for this abstract has been removed. 1271 Asymptomatic Sexually Transmitted Infections in a Population of High-Risk Men Who Have Sex With Men Pierluigi Francesco Salvo, Antonietta Vella, Valentina Iannone, Giuseppe Cucinotta, Rebecca Jo Steiner, Andrea Carbone, Francesca Lombardi, Simona Di Giambenedetto, Carlo Torti, Gianmaria Baldin Universita Cattolica del Sacro Cuore, Milan, Italy Background: Sexually transmitted infections (STIs) represent a major public health challenge, particularly as many cases are asymptomatic, complicating early detection, treatment, and partner notification, and contributing to ongoing transmission. This study aims to examine the role of asymptomatic STIs in a high-risk population of men who have sex with men (MSM), who regularly undergo STI screening. Methods: This retrospective observational study evaluated STI diagnoses between 2020 and 2023, in a cohort of at-risk individuals, specifically MSM on PrEP (MSM-PrEP) and MSM with HIV (MSMWH), with the aim of determining the rate of symptomatic and asymptomatic infections and comparing the 2 groups. Participants underwent regular screenings every 3 to 6 months, including serological tests for syphilis and molecular assays for gonorrhea and chlamydia on urethral, pharyngeal, and rectal swabs. Proportions were compared using the chi-squared test. Results: A total of 573 participants were enrolled (458 MSMWH and 115 MSM PrEP), resulting 1110 observed STI events (823 in MSMWH and 287 in MSM PrEP). The frequencies of asymptomatic events in the two groups are detailed in Table 1. MSM-PrEP were more likely to have multiple STI diagnoses per person during the follow-up period compared to MSMWH (p < 0.001). Among the STIs observed, syphilis was the most frequent, with 986 cases (819 in MSMWH and 167 in MSM-PrEP), resulting in an overall asymptomatic rate of 71.8% (708/986). Among PLWH, 543/819 cases (66.3%) were asymptomatic, compared to 165/167 cases (98.8%) in the MSM-PrEP, with a statistically significant difference (p <0.001). We identified 75 cases of gonorrhea (12 in MSMWH and 63 in MSM-PrEP), with an overall asymptomatic rate of 49.3% (37/75). For chlamydia, there were 50 cases (10 in MSMWH and 40 in MSM-PrEP), with 44.0% asymptomatic (22/50). There were no statistically significant differences in the clinical presentation of these two STIs between the two groups. Conclusions: Asymptomatic STIs are notably common in this population, with a significant frequence of syphilis observed. A significant difference in the rate of asymptomatic cases was found specifically for syphilis between the two groups. MSM-PrEP had a higher frequency of multiple STI diagnoses per person during the follow-up period compared to MSMWH. These findings emphasize the need for effective prevention strategies to manage STIs in these populations and highlight the importance of regular screening to ensure timely detection and treatment.

Poster Abstracts

CROI 2025 420