CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

services would ensure the continuum care and contribute to the improvement of the HIV cascade. 1321 Community FSW Peer Model or HIV Prevention to Reach Epidemic Control and Sustainability: Tanzania Neema Makyao 1 , Amos Nyirenda 1 , Mary P. Ngowa 1 , Magreth Kagashe 2 1 Amref Health Africa in Tanzania, Dar es Salaam, United Republic of Tanzania, 2 Tanzania Commission for AIDS, Dar es Salaam, Tanzania Background: FSW like other KVP have limited access to health services due to stigma and discrimination, increasing their vulnerability for HIV and other infections. There is evidence for community interventions to improve access to HIV services and linkage to care. Amref through Global Fund Support implemented a community peer model intervention among FSWs in nine regions of Tanzania from January 2021 to December 2023. Methods: We identified 254 FSW peers, and trained and enrolled them in the program. Peer selection was based on diverse characteristics such as of age, geographical disparities, hotspots, and nearby health facilities. Interventions provided were community mobilization for HIV testing, linkage to care and treatment, and preventive interventions such as condom distribution and PrEP. Economic empowerment through income generation activities (IGA), social behavior communication, and strengthening FSW -led community-based organizations and networks were also integrated. Results: Between the period of January 2021 to December 2023, we reached a total of 37,173 FSW who completed SBC training sessions (12 sessions for 3 visits) as part of a comprehensive package of HIV prevention services; we tested for HIV a total of 31,951 (103% of our target) and identified 2092 living with HIV which is 7% positivity rate, 94% were linked to ART services and 99% initiated ART. A total of 171 psychosocial groups were formed under peer supervision for HIV prevention messages and support, and 108 groups received funds with 887 FSWs benefiting for income -generating activities as part of HIV prevention strategies. Conclusions: A broad package of community interventions including a combination of behavioral, peer support and structural activities designed with specific strategies to reach FSWs is effective and sustainable for epidemic control. It should be taken to scale to reach more FSW in the country. 1322 Trial of Enhanced Peer Referral With HIV Self-Testing on PrEP Initiation Among Young Kenyan Women Katrina Ortblad 1 , Njeri Wairimu 2 , Carlos Culquichicon 3 , Irene Njeru 2 , Rachel C. Malen 1 , Adriana M. Reedy 1 , Maureen McGowan 4 , Margaret Mwangi 2 , Agata Muthoni 2 , Dorcas Kiboi 2 , Fei Gao 1 , Jared M. Baeten 3 , Kenneth Ngure 5 , for the Peer PrEP Study Team 1 Fred Hutchinson Cancer Center, Seattle, WA, USA, 2 Kenya Medical Research Institute, Kilifi, Kenya, 3 University of Washington, Seattle, WA, USA, 4 Heidelberg University, Heidelberg, Germany, 5 Partners in Health and Research Development, Thika, Kenya Background: In Africa, adolescent girls and young women (AGYW) have high risk of HIV acquisition and low engagement in prevention programs. Knowledge of HIV-negative status, paired with peer support, might motivate AGYW—who have tight social connectivity and are influenced by peers—to initiate HIV prevention services, including pre-exposure prophylaxis (PrEP). Methods: We conducted a cluster-randomized controlled trial (CT.gov: NCT04982250) in Central Kenya where AGYW (≥16-24 years) who had used PrEP in the past 12 months (“index peers”) were randomized 1:1 to: 1) enhanced peer referral , including an in-person group training on PrEP referral strategies and HIV self-testing (HIVST); or 2) standard peer referral , including informal PrEP referral strategies ongoing among AGYW. All index peers were encouraged to identify and refer 4 peers (“referred peers”) who could benefit from PrEP and give them cards with information on clinics delivering free services; those assigned to enhanced referral were issued 8 HIVST kits for peer delivery. Index peers were followed up 3 months later and reported outcomes for referred peers: PrEP initiation (primary), PrEP continuation (any refilling), and HIV testing (following referral). Results: From May 2023-June 2024, we screened 318 index peers and enrolled 82, who reported outcomes for 136 referred peers in the enhanced and 105 in the standard referral groups. The median age of index peers was 22 years (IQR 20-23) and of referred peers was 22 years (IQR 21-24); roughly half of referred peers had casual sexual partners (55%, 58/241). At follow up, there were no statistically significant differences in PrEP initiation among referred peers in the enhanced (29%, 40/136) and standard (40%, 42/105) referral groups (RD 11%, 95% CI -30%, 9%); nor any differences in PrEP continuation between the

groups (enhanced: 13%, 17/136; standard: 11%, 11/105; RD 2%, 95% -10%, 14%). Recent HIV testing at follow up, however, was significantly higher among referred peers in the enhanced (91%, 124/136) versus standard (52%, 55/105) referral group (RD 39%, 95% CI 23%, 55%); 3 referred peers tested HIV-positive. Conclusions: Enhancing peer referral to PrEP services with training and HIVST did not increase PrEP initiation among Kenyan AGYW. The intervention did, however, increase HIV testing, presenting an opportunity to layer other interventions with peer-delivered HIVST to potentially increase AGYW’s engagement in HIV prevention services. 1323 nPEP When You Need It: A 24/7 Post-Exposure Prophylaxis Hotline in the District of Columbia Rachel Harold 1 , Jason Beverley 1 , Adam Visconti 2 , Matthew Copeland 2 , Princy Kumar 3 , Leah Lujan 1 , Ashleigh Dunworth 1 , Camilla Stanley 1 , Ronald Beaulieu 2 , Elizabeth Selden 2 , Rebecca N. Kumar 2 , Amanda Spence 3 , Mariam Ayub 2 , Kate Drezner 1 , Christiana Williams 1 1 District of Columbia Department of Health, Washington, DC, USA, 2 MedStar Georgetown University Hospital, Washington, DC, USA, 3 Georgetown University, Washington, DC, USA Background: Nonoccupational post-exposure prophylaxis (nPEP) is a powerful biomedical intervention used to lower the risk of HIV transmission following potential exposure. It is underutilized due to barriers patients face accessing the medication within 72 hours after exposure and without prohibitive cost. Methods: In April 2021, the District of Columbia Department of Health (DC Health), in partnership with MedStar Georgetown University Hospital, launched a hotline where callers possibly exposed to HIV can consult with a clinician 24 hours a day. If nPEP is indicated, the caller can receive a 5-day supply of nPEP from a partnering pharmacy and then seen at a clinic operated by DC Health within the next 5 days to receive lab testing, the remainder of the medications, and follow-up care after completing nPEP, including transition to pre-exposure prophylaxis (PrEP) if desired. All services are free of charge. Results: In the first 30 months, the DC PEP Hotline received 838 calls and 632 (75.4%) callers initiated nPEP and attended an initial nPEP appointment at the clinic. 391 (61.8%) of callers who attended their initial nPEP appointment came for a post-nPEP appointment within 45 days. 14.1% of callers used PEP Hotline services more than once. Participants’ self-identified race was 35.3% Black, 39.7% White, 8.7% Asian, 12.7% other, 0.3% unknown; ethnically, 17.1% identified as Latino. 78.6% of the nPEP users identified as cisgender men, 18.7% as cisgender women, 1.4% as transgender women, 0.3% as transgender men and 1.0% as genderqueer. 272 (43.0%) of those who initiated nPEP (69.6% of those who completed nPEP) transitioned to PrEP. Cisgender men and transgender patients transitioned to PrEP at higher rates (76.2% and 100%) compared to cisgender women (34.3%) (p<0.01). Heterosexual patients were less likely to transition to PrEP (38.7%) compared to those who identified as lesbian, gay or homosexual (84.1%) or bisexual (78.8%) (p<0.01). 9% of the participants in the first 18 months of the program were diagnosed with a bacterial STI (gonorrhea, chlamydia, or syphilis) at their intake or follow-up visit. No HIV seroconversions were identified apart from one participant who acquired HIV four months after completion of nPEP. Conclusions: Expanding access to nPEP beyond emergency departments and traditional medical settings can improve timely and equitable HIV prevention. A 24-hour PEP hotline can also serve as an effective tool for transitioning people at risk of HIV to PrEP and identifying STIs. 1324 HIV Health Care Transition: Five-Year Rates of Retention and Viral Suppression Camille Knable 1 , Patrick Ryscavage 2 , Vicki Tepper 2 , Matthew Grant 2 1 University of Maryland Medical Center, Baltimore, MD, USA, 2 University of Maryland, Baltimore, MD, USA Background: Health care transition (HCT) from pediatric/adolescent (P/A) to adult HIV care is a period of care continuum vulnerability. Outcomes of HIV HCT in the U.S. have only been studied up to 24 months post-transition and have not included the COVID pandemic. The University of Maryland STEP Program is a multi-disciplinary HCT program staffed by pediatric and adult providers and staff. It includes early engagement with an adult HIV provider in the P/A clinic and a comprehensive retention model pre- and post-transition. We sought to examine HCT outcomes among patients in the STEP Program 5 years post transition and through the COVID pandemic. Methods: This was a retrospective cohort study of patients enrolled in the STEP program. The primary end point was retention in adult care, defined as ≥2

Poster Abstracts

CROI 2025 440