CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

(64.0%) initiated PrEP (503 [49.6%] women). Following the introduction of choice (June-September 2024), amongst 375 eligible/offered PrEP, 359 (95.7%) initiated PrEP/PEP (259 [72.1%] women). N=276/359 (76.9%) chose injectable cabotegravir (186 women), 55/359 (15.3%) chose oral PrEP (29 women), and 28/359 (7.8%) chose PEP (14 women). None chose the dapivarine ring. At enrolment, 88/315 (27.9%) had an STI (gonorrhoea or chlamydia). STI prevalence was highest amongst those who chose injectable cabotegravir (32.5%; 82/252) vs 13.3% (6/45) and 0/18 amongst those who chose oral PrEP and PEP, respectively. Conclusions: Providing a choice of PrEP/PEP modalities resulted in more of those who were offered chosing to take PrEP. The majority, especially women and those who had an STI, chose injectable PrEP. However, one in four chose an oral option. Providing choice that meets adolescents and youth’s preferences may improve effective PrEP use. 1343 Peer Mobilisation Into Sexual Health Clinics Creates PrEP Demand Among High-Risk Rural Youth in SA Maryam Shahmanesh 1 , Rohey A. Bangura 1 , Jacob Busang 2 , Thembelihle Zuma 2 , Carina Herbst 2 , Nonhlanhla Okesola 2 , Natsayi Chimbindi 2 , Nqobile Ngoma 2 , Jaco Dreyer 2 , Lucky Mtolo 2 , Theresa Smith 2 , Limakatso Lebina 2 , Janet Seeley 3 , Andrew Copas 1 , Kathy Baisley 2 , for the Thetha Nami ngithethe nawe (Let's Talk) Research Group 1 University College London, London, UK, 2 Africa Health Research Institute, Mtubatuba, South Africa, 3 London School of Hygiene & Tropical Medicine, London, UK Background: Providing oral pre-exposure prophylaxis (PrEP) has not achieved population-level impact in southern Africa due to challenges reaching those with the highest risk of HIV-acquisition. We hypothesise that peer-led mobilisation into mobile sexual reproductive health (SRH) clinics will promote oral PrEP use amongst adolescents and young adults (AYA) at higher risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Methods: We analysed data from a clinical cohort of 2515 AYA aged 15-30 years within the first period of “ Thetha Nami ngithethe nawe ” stepped wedge trial (NCT05405582), in 20 communities randomised to early rollout of the intervention. In intervention communities, trained peer-navigators conduct needs assessments with AYA and tailor referrals to mobile SRH clinics that visit monthly. HIV high-risk was defined as reporting ≥1 of following: condom-less sex with >1 partner or partner of unknown HIV status; buying or selling sex; sex under the influence of alcohol/drugs. PrEP uptake and retention were defined as initiating oral PrEP within 1 month of attending the clinic, and returning for at least 2 PrEP refills, respectively. GEE logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between HIV high-risk and PrEP uptake and retention. Results: June 2022-April 2024, peer navigators reached 11,921 AYA and 3046 [25.6%; 1143 (45.4%) men] attended the SRH clinics. N=240 were living with HIV and were started/continued on antiretroviral therapy. 1950 (77.5%) of 2515 AYA who agreed to point of care HIV testing and tested negative were at HIV high-risk. 863/2515 (34.3%) AYA initiated oral PrEP (805 HIV high-risk) and 151/863 (17.5%) continued PrEP (142 HIV high-risk). PrEP uptake was higher among high-risk than low-risk AYA (adjusted (a)OR 5.38, 95%CI=3.61-8.02, p<0.001). Women and AYA in urban/peri-urban areas had lower odds of PrEP uptake (aOR 0.76, 95%CI=0.61–0.95, p=0.015; aOR 0.84, 95%CI=0.72-0.98, p=0.027, respectively). PrEP retention did not differ between high-risk and low-risk AYA (aOR 1.45, 95%CI=0.62-3.38). Conclusions: Peer-led mobilisation into mobile SRH services promoted PrEP uptake amongst AYA at highest HIV risk. However, initiation and continuation of daily oral PrEP remains suboptimal. Long-acting injectable PrEP may overcome barriers to oral PrEP. 1344 Injectable Cabotegravir PrEP Discontinuations at a Peer Specialist-Led Program in Washington, DC Megan E. Dieterich, Rupa Patel, Juan Carlos Loubriel, Monica E. Gouzoulis, Erin E. Kelley, David A. Fessler, Meghan Davies, Rachel E. McLaughlin, Sarah Henn, H. Jonathon E. Rendina Whitman-Walker Health, Washington, DC, USA Background: Little is known about cabotegravir (CAB) HIV pre-exposure prophylaxis (PrEP) care disparities. We characterized injectable CAB PrEP discontinuations at a safety-net, primary care center. Methods: We extracted data from electronic health records and a dashboard (Relevant®) at Whitman-Walker Health’s peer PrEP Specialist program

(Washington, D.C.) from March 2022 to March 2024. The primary outcome was the number of discontinuations defined as injections stopped before 9 months of care (verified by medical chart review by 2 providers). The secondary outcome was 9-month adherence among CAB PrEP users defined as receipt of 6 consecutive, on-time injections (+/- 14 day window). A multivariate logistic regression analysis was conducted to determine independent risk factors for discontinuation. Results: There were 130 CAB PrEP users with 677 injections (median 3; range 1-12). Users were 52% White, 32% Black, 18% Latino, median age was 34 years (range 21- 62), 2% women, 80% men who have sex with men (MSM), 23% had public insurance, and 95% had switched to CAB from oral PrEP. There were no HIV seroconversions and there was one false positive HIV Ag/Ab test during a follow up care visit. Of the 130 CAB PrEP users, 87 (67%) were adherent to the +/-14d window, 41 (32%) were adherent to the +/-7d window, 13 (10%) received all their injections but had at least one out of the +/- 14d window, and 30 (23%) discontinued CAB. Discontinuations were higher among White (30%, 20/67) CAB users compared to Black (12%, 5/41) and Latino (21%, 5/24) CAB users. Of those who discontinued CAB and remained at risk for HIV, 93% (27/29) were transitioned to oral 2-1-1 or daily PrEP, while 7% (2/29) were lost to follow up after 5 attempts to contact them. When adjusting for race, ethnicity, age, sex, MSM, and insurance, Black CAB users had 76% lower odds of discontinuation compared to White CAB users (aOR: 0.24, 95% CI: 0.69 – 0.83). Side effects (43%, 13/30) and insurance coverage gaps (23%, 7/30) were the most common causes of discontinuations. Conclusions: We defined 9-month discontinuation among Black, Latino, and White CAB users receiving PrEP through a peer specialist-led program. Peer specialists fostered continued PrEP use among those who discontinued CAB and potentially reduced discontinuations in populations which have a higher risk for HIV. Insurance coverage gaps continue to undermine CAB implementation efforts.

Poster Abstracts

1345 Outcomes From a Multilevel Trial With Clinics and Young Women for PrEP in South Africa Courtney P. Bonner 1 , Alexandra Minnis 2 , Felicia A. Browne 1 , Ilene S. Speizer 3 , Laura Nyblade 1 , Jacqueline Ndirangu 1 , Tracy Kline 4 , Ayanna Smith 1 , Khatija Ahmed 5 , Wendee M. Wechsberg 1 1 RTI International, Research Triangle Park, NC, USA, 2 RTI International, Berkeley, CA, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4 RTI Health Solutions, Research Triangle Park, NC, USA, 5 Setshaba Research Centre, Tshwane, South Africa Background: HIV prevalence among South African AGYW increases by 10% as young women reach ages 20 to 24, highlighting the need to intervene during adolescence and emerging adulthood. PrEP for HIV prevention promises to reduce HIV incidence. However, its impact may be tempered by structural barriers and individual-level barriers. Few evaluations of multilevel interventions to support AGYW to initiate and use PrEP exist. To this end, we adapted The Health Policy Project Health Facility HIV Stigma and Discrimination Reduction Training curriculum to address stigma and discrimination (S&D) toward AGYW in public clinics. We also adapted an evidence-based, young woman–focused (YW) HIV prevention intervention to support AGYW to initiate and persist on PrEP. Methods: We conducted a cluster-randomized trial across 12 clinics to assess the impact of S&D reduction training and the YW intervention. There were four study conditions: PrEP/SRH only (Control); S&D + PrEP/SRH; PrEP/SRH + YW; and S&D + PrEP/SRH + YW. 802 AGYW were recruited, provided consent or assent,

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