CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1348 US Socioeconomic Disparities and Geographic Variations in HIV Preexposure Prophylaxis Providers

1349 Social Networks Influence PrEP Use and Preference for Long-Acting PrEP Among MSM in Baltimore Steven J. Clipman 1 , Amit (Mickey) Dhir 2 , Rose P. Kaptchuk 3 , Miles Landry 1 , Katie J. C. Zook 1 , Allison M. McFall 3 , Shruti H. Mehta 3 , Sunil S. Solomon 1 1 The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 The Johns Hopkins University, Baltimore, MD, USA, 3 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: With advances in HIV prevention, understanding factors that promote uptake of novel PrEP agents, including social networks, could be critical to increasing coverage and interrupting HIV transmission in vulnerable populations, such as men who have sex with men (MSM). Methods: We conducted a network-based online survey among MSM and transgender women (TGW) in Baltimore, MD that included PrEP use and preferences. Participants provided data on recent sexual partners and close MSM/TGW friends, who were referred to complete the survey, allowing us to map sexual and social networks using a sociometric design. We constructed networks integrating reported ties and referral patterns, applying fuzzy matching to identify cross-linkages. Logistic regression assessed network associations between the proportion of ties ever taking PrEP and individual PrEP use, as well as the influence of network members’ preferences on personal preference for long-acting injectable PrEP (LA PrEP) — nodes with unknown PrEP status or HIV-positivity, were excluded. Results: The network ( Figure ) comprised 149 survey participants recruited Apr–Aug 2024; 93% were cisgender men, 3% TGW, and 4% non-binary; median age was 34; 51% were Black, and 20% reported Hispanic/Latino ethnicity; 55% ever took PrEP. They reported 406 additional contacts and 594 ties (65% social, 35% sexual). Adjusting for sociodemographics, each five-percentage point increase in the proportion of ties on PrEP raised an individual’s odds of ever taking PrEP by 10% (AOR: 1.10; 95% CI: 1.05 – 1.16), equating to 5.3 times greater odds when one’s entire network is on PrEP. When ties were stratified by relationship, a significant association was only observed in the proportion of close friends on PrEP and not sexual partners. In univariable models of LA PrEP preference, network member preference was one of the strongest correlates, with an individual’s odds of preferring LA PrEP increasing by almost three times when all their ties preferred LA PrEP (OR: 2.75; 95% CI: 1.24 – 6.13). This association was attenuated and no longer statistically significant after adjusting for education or PrEP knowledge. Conclusions: Social networks, specifically close friends more than sexual partners, may play a key role in an individual’s PrEP use. With LA PrEP, education and knowledge play a critical role in shaping PrEP choice. Interventions to enhance PrEP uptake should consider prioritizing PrEP literacy alongside peer based approaches to empower informed choices about PrEP.

Li Tao, Juan Yang, Chris Nguyen, Joshua Gruber, Kristin Baker, Julia Green, Dona Khoshabafard, Gina Brown, Woodie Zachry Gilead Sciences, Inc, Foster City, CA, USA Background: Despite increasing pre-exposure prophylaxis (PrEP) utilization, access to providers offering PrEP services remains limited and unevenly distributed across the US. This study leveraged a novel linkage of commercial and public datasets to examine socioeconomic and geographic disparities in PrEP provider availability. Methods: Providers who prescribed ≥1 PrEP regimen from 2021 to 2023 were identified using the IQVIA LAAD claims database. This dataset was linked with (1) Zip Code Tabulation Area-level demographic data from the Census 2020 and the American Community Survey 2018–2023 estimates, and (2) county-level primary care provider data from the County Health Rankings & Roadmaps. At multiple US geographic levels, we evaluated the ratio of PrEP providers to (1) PrEP users and (2) all primary care providers, as well as (3) the mean proportion of PrEP claims dispensed. Results: The number of PrEP providers increased from 64,790 in 2021 to 75,371 in 2022 and 83,708 in 2023. Most providers were nurse practitioners/physician assistants (36.5%) or family medicine physicians (30.1%). Most providers practiced in predominantly White neighborhoods (65.1%), with only 4.7% in predominantly Black and 7.7% in predominantly Hispanic neighborhoods; 12.5% practiced in low-income neighborhoods. Although the ratio of PrEP providers to primary care providers increased over time (0.27 in 2021 to 0.34 in 2023), the ratio of PrEP providers to PrEP users remained steady (0.23 in 2021 to 0.22 in 2023), and substantial geographic variation persisted. ‘Ending the HIV Epidemic’ (EHE) regions had a lower ratio of PrEP providers to users (0.16) versus non-EHE jurisdictions (0.31) in 2023. Rates of dispensed PrEP claims were higher for providers in the Northeast (83%) than in other regions (77–79%). Southern states, where HIV prevalence is high, had low PrEP provider availability; in particular, Alabama had a very low ratio of PrEP providers to primary care providers, and Florida and Texas had very low ratios of PrEP providers to PrEP users ( Figure ). Conclusions: This is the first study to illustrate socioeconomic and geographic disparities in PrEP provider availability in the US. The disproportionate growth of PrEP users relative to providers and low ratios of providers in high HIV incidence regions underscore the urgent need to improve access to HIV prevention services. Ensuring equitable PrEP access for key populations across geographies is critical for addressing these disparities and combating the HIV epidemic.

Poster Abstracts

1350 Disparities in PrEP Use Among Latinx and Black Transgender Women in Los Angeles County, 2019 vs 2023 Yingbo Ma, Kwa Sey Los Angeles County Department of Public Health, Los Angeles, CA, USA Background: Latinx and Black transgender women (TGW) often face unique social, economic, and healthcare barriers that may limit their access to HIV prevention tools like PrEP. Research on racial disparities in PrEP use in these groups is limited. This study examined trends in PrEP uptake among Latinx and

CROI 2025 450