CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1355 Long-Acting PrEP Preference Among Brazilian Sexual and Gender Minorities: Key Influencing Factors Thiago Torres 1 , Mayara Secco Torres da Silva 1 , Carolina Coutinho 1 , Brenda Hoagland 1 , Emilia M. Jalil 2 , Sandra W. Cardoso 2 , Marcos Benedetti 2 , Cristina Pimenta 2 , Paula Luz 2 , Valdilea Gonçalves Veloso 1 , Beatriz Grinsztejn 1 1 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 2 Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, 3 Oswaldo Cruz Foundation, Rio de Janeiro, Brazil Background: Oral PrEP uptake remains limited in Latin America, even as new HIV diagnoses continue to rise, especially among sexual and gender minorities (SGM). Previous research has highlighted a preference for long-acting PrEP in the region. With the approval of long-acting injectable cabotegravir and recent results of lenacapravir for PrEP, understanding PrEP preferences is vital for integrating these technologies into national PrEP programs. This study aims to describe PrEP preferences and identify factors associated with a 6-month long acting PrEP preference among Brazilian SGM. Methods: National cross-sectional online survey among Brazilian SGM aged 18+ years, self-reporting HIV negative/unknown, recruited through advertisements on dating apps (Scruff and Grindr) and social media (Instagram and Facebook). Main outcome was assessed with the question: “Assuming all of the PrEP modalities below are equally effective, which one would be your favorite”, with possible answers: daily oral (d-PrEP), event-driven oral (ED-PrEP), injectable in gluteus at each 2 months (2-month-PrEP), injectable subcutaneous at each 6 months (6-month-PrEP), would not use PrEP. We used logistic regression models to evaluate factors associated with preferring 6-month-PrEP (yes/no). Results: From August-September 2024, 3,665 completed the questionnaire. Median age was 38 (IQR:31-46) years; 94.3% cis-men, 2.9% non-binary persons, 0.8% trans-woman, 0.4% trans-men; 23.1% had secondary education or lower, 44.1% non-white, 21.3% low income (<500USD/month); 69.1% reported condomless anal sex, 29.6% chemsex and 12.6% STI, all in the past 6 months; 6% never tested for HIV; 32.4% ever used PrEP. Mean HIV knowledge score was high (11; SD1.3) and mean internalized LGBTQIAPN+phobia was low (10.6; SD8.9). Most (50.8%) preferred 6-month-PrEP, followed by 2-month PrEP (16.5%), d-PrEP (16.5%), ED-PrEP (13.8%), and 2.6% would never use PrEP. Factors associated with preferring 6-month-PrEP included higher HIV knowledge, lower internalized LGBTQIAPN+phobia, ever used PrEP and reporting chemsex (Table). Conclusions: Our results reveal a strong preference for long-acting PrEP among Brazilian SGM, highlighting the demand for prolonged protection. Urgent efforts are needed to increase awareness of HIV prevention and combat LGBTQIAPN+phobia. Priority should be given to implementation studies on the acceptability and uptake of lenacapravir in Brazil, especially among populations at increased vulnerability to HIV, such as those engaging in chemsex.

and adherence remain suboptimal. Long-acting injectable cabotegravir (CAB-LA) has shown high efficacy in trials, though real-world effectiveness data remain limited. We evaluated initial PrEP choices, reasons for selection, and associated factors in ImPrEP CAB Brasil, the first study to evaluate CAB-LA PrEP implementation in Latin America. Methods: ImPrEP CAB Brasil is an implementation study evaluating PrEP choice, feasibility, acceptability, and effectiveness of CAB-LA in sexual and gender minorities (ages 18-30) in public health PrEP services in 6 Brazilian cities. HIV-negative, PrEP-naive individuals chose between CAB-LA or F/TDF and received either a combination of mHealth education with a decision support tool plus standard of care (SOC) counseling, or SOC counseling alone to assist with PrEP choice. We compared characteristics by initial product choice and applied logistic regression to identify factors influencing CAB-LA choice. Decision making was assessed using the Decisional Conflict Scale (DCS). Results: A total of 1,447 participants were enrolled from October 2023 August 2024, with 1,200 (83%) choosing CAB-LA and 247 (17%) oral F/TDF. Most participants were cisgender MSM(91%), 42% aged 18-24, predominantly non-White(60%). Participants receiving the mHealth intervention were more likely to choose CAB-LA. Among those selecting oral PrEP, 46 % cited fear of injections, while 78% preferred CAB-LA due to difficulties with daily medication compliance. Most participants showed strong decision confidence (DCS mean: 1.9, SD: 4.8 ), with 82% believing they would continue their chosen method (Table). Among mHealth users, 65% found the intervention helpful, and 85% reported high satisfaction. Logistic regression indicated that mHealth exposure (OR=2.54; 95%CI:1.89-3.44; p < 0.0001) and CAS report (OR=1.32; 95%CI:0.98 1.77; p= 0.067) were associated with choosing CAB-LA. Younger participants (ages 18-20) and those with higher decision conflict were more likely to opt for oral PrEP (OR=0.94; 95%CI: 0.91-0.97; p< 0.0001). Conclusions: In this pioneering PrEP choice implementation study in Latin America, the majority of participants chose CAB-LA. Personalized HIV prevention approaches are critical to empower individuals to select a PrEP method aligned with their values and lifestyles, enhancing the likelihood of long-term adherence and effectiveness.

Poster Abstracts

1357 Acceptability of Long-Acting Cabotegravir Among Pregnant and Lactating People in South Africa Nafisa Wara 1 , Carey Pike 2 , Elzette Rousseau 2 , Pippa Macdonald 2 , Pakama Mapukata 2 , Bryan Leonard 2 , Keitumetse Lebelo 2 , Risa Hoffman 1 , Catherine Orrell 3 , Linda-Gail Bekker 2 , Dvora L. Joseph Davey 1 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Desmond Tutu HIV Foundation, Cape Town, South Africa, 3 University of Cape Town, Cape Town, South Africa Background: Providing pregnant and lactating people (PLP) with choice in PrEP methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to PrEP continuation. We evaluated PrEP preferences and acceptability of their chosen method among PLP offered CAB-LA versus oral PrEP in South Africa. Methods: The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15-29 at one clinic and one community-based mobile van offering sexual health services. Using informed choice counseling, participants were offered oral tenofovir disoproxil fumarate/emtricitabine or CAB-LA, with the option to switch modalities at follow-up visits over 18 months. We

1356 PrEP Choices Among Sexual and Gender Minorities in Brazil: The ImPrEP CAB-LA Study Carolina Coutinho 1 , Beatriz Grinsztejn 1 , Brenda Hoagland 1 , Alessandro S. Farias 2 , Jose Valdez Madruga 3 , Josué Lima 4 , Maria Paula Mourão 5 , Ronaldo Zonta 6 , Marcos Benedetti 7 , Cristina Pimenta 7 , Pedro Leite 1 , Gabrielle O'Malley 8 , Thiago Torres 1 , Valdilea Gonçalves Veloso 1 , for the ImPrEP CAB Brasil Study Group 1 Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil, 2 Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, Brazil, 3 Centro de Referência e Treinamento DST/AIDS-SP, Sao Paulo, Brazil, 4 Centro de Referência em Infecções Sexualmente Transmissíveis, Vitória, Brazil, 5 Fundação de Medicina Tropical Heitor Vieira Dourado, Manaus, Brazil, 6 Policlínica Centro, Florianópolis, Brazil, 7 Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, 8 University of Washington, Seattle, WA, USA Background: Oral pre-exposure prophylaxis (PrEP) with emtricitabine/ tenofovir (F/TDF) is highly effective in preventing HIV-1 acquisition, but uptake

CROI 2025 453