CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Results: Across the five countries, 3,772 PrEP-naïve clients initiated CAB-LA (Figure 1). By the end of September 2024, a total of 4,932 clients were on CAB-LA. Initial populations for early CAB-LA access varied by country and included key populations, adolescents and young adults, and men at higher risk. Country teams reported that clients were generally satisfied with the product and found it acceptable. Teams also indicated that government and political leadership, supportive policies, and capacity building facilitated implementation of CAB-LA. Training for clinical teams on options-based counseling, addressing client concerns, and providing clients with appointment reminders was also critical. A key limitation of this analysis is the reliance on aggregate data, which limits the ability to assess individual-level factors influencing CAB-LA uptake and persistence on treatment over time. Conclusions: Long-acting PrEP presents an opportunity to accelerate towards ending the HIV pandemic as a public health threat by 2030. Lessons learned from early CAB-LA introduction will inform continued scale-up of CAB-LA in additional PEPFAR-supported countries in 2025, with plans to reach 100,000 clients by the end of the year. This platform will also support future HIV prevention products including Lenacapavir.

Black TGW in Los Angeles County (LAC) from 2019 to 2023 and investigated correlates of PrEP use. Methods: We analyzed data from the National HIV Behavioral Surveillance system. The analysis was limited to HIV-negative Latinx and Black TGW residing in LAC who participated in surveys conducted in 2019 (n=295) and 2023 (n=351). To assess the changes in past-year PrEP use between 2019 and 2023, a log-linked Poisson regression model was applied, adjusting for demographic and healthcare-related covariates including age, insurance, recent medical visits, hormone therapy use, and substance use history. Results: Between 2019 and 2023, significant differences in PrEP use were observed in Latinx compared with Black TGW. In 2019, PrEP use was similar (28% for Latinx TGW, n=231, and 27% for Black TGW, n=64), but by 2023, PrEP use had increased by 61% to 45% among Latinx TGW(n=240) and decreased by 11% to 24% among Black TGW (n=111). After accounting for influential covariates, Latinx TGW remained significantly more likely to show a greater increase in PrEP use from 2019 to 2023 compared with Black TGW (adjusted Prevalence Ratio[aPR]= 1.9, 95% CI [1.1, 3.4]. Hormone therapy use within the past 12 months was positively correlated with PrEP use in both Black and Latinx TGW (aPR=1.6, 95% CI [1.2-2.0]). Further analysis showed having insurance was positively correlated with hormone therapy use for both Black and Latinx TGW (p <0.01). Conclusions: This study revealed disparity in changes in PrEP use from 2019 to 2023 between Latinx and Black TGW. The significant increase in PrEP uptake among Latinx TGW suggested that HIV prevention campaigns targeting Latinx communities had been effective. However, the lack of progress among Black TGW pointed to the urgent need for more racially and culturally tailored interventions addressing the unique social determinants of health within the Black TGW community. The positive correlation between use of hormone therapy and PrEP suggested that integrating gender-affirming care into HIV prevention strategies would be beneficial. Mobilizing the Black TGW community to increase access to PrEP should be a priority to achieve the goals of the Ending the HIV Epidemic initiative.

Poster Abstracts

1352 “I Like It but I Can’t Be the First”: Sex Workers’ Preferences for LAI PrEP Delivery in South Africa Katherine Rucinski 1 , Venessa Chen 1 , Chitra Singh 2 , Nosipho Dladla 2 , Nombuso Matenjwa 2 , Emma McNeilly 1 , Joel Steingo 2 , Mfezi Mcingana 2 , Carly Comins 1 , Joseph G. Rosen 3 , Amrita Rao 1 , Stefan Baral 4 , Harry Hausler 2 , Sheree Schwartz 1 1 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 TB/HIV Care Association, Cape Town, South Africa, 3 Brown University, Providence, RI, USA, 4 The Johns Hopkins University, Baltimore, MD, USA Background: Long-acting injectable PrEP (LAI-PrEP) represents an efficacious HIV prevention strategy, but rollout in 2024 has been limited, constraining our understanding of LAI-PrEP implementation within real-world HIV programs. We explored preferences and potential barriers to uptake and continuation of LAI-PrEP among female sex workers (FSW) accessing routine community-based HIV prevention services in South Africa. Methods: In May-June, 2024, we conducted two focus group discussions (FGD) and 24 in-depth interviews (IDI) with FSW in Ehlanzeni (rural) and eThekwini (urban) municipalities. Using the Consolidated Framework for Implementation Research (CFIR), FGDs explored preferences in PrEP modalities and service delivery features; and IDIs assessed knowledge of LAI-PrEP, coupled with perceived barriers to uptake and continuation. Using rapid thematic analysis, we deductively identified salient concepts and emerging themes across FSW. Results: Among 44 FSW (median age: 30 [IQR 26-38]) most reported past oral PrEP use, with determinants of LAI-PrEP use and implementation identified across three domains of the CFIR: innovation characteristics, implementation process, and the inner setting (Figure 1). FSW demonstrated autonomy in PrEP modality choice, believing in their own capability and decision-making power to start LAI-PrEP when ready. However, insufficient knowledge around how long LAI-PrEP remains in the body, coupled with concerns around potential side effects, made participants eager for additional education and counseling. FSW also expressed hesitancy in being the first of their peers to initiate LAI-PrEP and concerns surrounding potential interactions with other medications, including injectable contraceptives. Decentralized delivery via mobile van was generally preferred over drop-in-centers and clinics to support adherence to LAI-PrEP; however, FSW in eThekwini remained concerned about potential missed injections given frequent travel home, including away from South Africa

1351 Early PEPFAR Implementation of Cabotegravir-LA and Implications for Long-Acting HIV Prevention Carly E. LoVullo, Ashley Vij, Natasha Thaweesee, Nuha Naqvi, Trista Bingham, Emily K. Dokubo PEPFAR, Washington, DC, USA Background: Despite the availability of oral HIV pre-exposure prophylaxis (PrEP), gaps remain in reaching the UNAIDS target of 21.2 million people on PrEP by the end of 2025 and reducing HIV incidence. The U.S. President’s Emergency plan for AIDS Relief (PEPFAR) is leading the rollout of long-acting PrEP in high-burden settings, which provides an opportunity to increase PrEP uptake and curb new HIV infections globally. In 2024, PEPFAR-supported injectable cabotegravir (CAB-LA) was introduced to expand HIV prevention options in five initial countries. Methods: CAB-LA was introduced in 105 facilities in 45 districts across Zambia, Malawi, Zimbabwe, Eswatini, and Ukraine in the first three quarters of 2024. We assessed fiscal year (FY) 2024 Monitoring, Evaluation, and Reporting (MER) data on PrEP_NEW (number of PrEP naive individuals initiated on PrEP) and PrEP_CT (number of individuals who returned for PrEP at least once that quarter, or who switched from oral PrEP to CAB-LA), disaggregated by PrEP type (injectable) from February to September 2024. Qualitative data on facilitating factors and challenges with CAB-LA implementation was collected through a monthly PEPFAR CAB-LA collaborative with country teams.

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