CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

introduced in Germany shortly. This will facilitate early treatment and thereby reduce further spread. Counselling of PrEP users should address condom use and risk factor party drugs.

851 WHY STIs ARE INCREASING IN AT-RISK BOSTON MEN: MORE SCREENING PLUS Kenneth H. Mayer 1 , Kevin Maloney 2 , Kenneth Levine 1 , Dana King 1 , Chris Grasso 1 , Douglas Krakower 3 , Eli Rosenberg 2 1 Fenway Health, Boston, MA, USA, 2 Emory University, Atlanta, GA, USA, 3 Beth Israel Deaconess Medical Center, Boston, MA, USA Background: Since the advent of HAART and PrEP, STI rates have increased in high risk men. However, it has not been clear if these increases were due to increased routine screening of HIV+ and PrEP patients, or due to increasing STI prevalence, or both. Methods: Participants (Pts) were born male and were seen for ≥ 1 medical visit at a Boston health center specializing in HIV care between 2005 and 2015. Pts contributed person-time to any year in which a medical visit occurred. Gonorrhea (GC) or Chlamydia (CT) tests in different sites on the same day were considered 1 test in calculating the screening (S) and diagnoses (D) rates. We calculated the test-positivity rate (D/S; # positive tests / # tests), S rate (tests / 1,000 person-years) and diagnosis rate (positive tests / 1,000 person-years) adjusted for race, insurance status, sexual orientation, age, and year. Results: Between 2005 and 2015, 19,232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0%were black, and 6.1%were Latino. Almost half self-reported as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, the overall STI diagnosis rate increased more than 7-fold for GC and 4-fold for CT (see Figure). In 2005, there were 10 GC and 25 CT diagnoses per 1,000 person-years, compared to 73 and 106 in 2015, respectively. Among HIV- men, the GC diagnosis rate was 8 per 1,000 person- years in 2005, 14 in 2010, and 69 in 2015, and 19, 27, and 95 for HIV+men during the same time, with comparable increases for CT. The adjusted GC screening rate per 1,000 person years went from 386 in 2005 to 702 in 2010 to 1244 in 2015 for HIV- pts, and from 646 to 861 to 1231 for HIV+ pts in the same years. CT screening also increased. GC test positivity rate increased significantly between 2005 and 2015, but the CT test positivity rate only increased between 2010 and 2015. In 2015, the GC D/S was 4.8% for HIV- pts who were not using PrEP, 6.8% for PrEP users, and 7.7% for HIV+ pts; the CT D/S was 7.3%, 10.8%, and 10.4% for the respective groups. Conclusion: Over the decade since 2005, both GC screening rates and test positivity increased significantly in at risk Boston men with similar trends in CT since 2010, suggesting increasing community disease burden. Test positivity rates were highest among HIV+ and PrEP patients, underscoring the need for routine bacterial STI screening for at risk men .

852 THE BURDEN OF HIV AND OTHER STIs AMONG TRANSGENDER PERSONS IN NAIROBI, KENYA Adrian D. Smith 1 , Rhoda Kabuti 2 , Erastus Irungu 2 , Chrispo Nyamweya 2 , Elizabeth Fearon 3 , Peter Weatherburn 3 , Adam Bourne 4 , Joshua Kimani 2 1 University of Oxford, Oxford, UK, 2 Partners for Health and Development, Nairobi, Kenya, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 La Trobe University, Melbourne, Australia Background: Globally transgender persons (TP) are disproportionately affected by HIV and other STIs, as well as victimisation that may limit access to preventive and treatment resources. In Kenya, sexual and gender identities have been conflated in sexual health research into gay, bisexual and other men who have sex with men (GBMSM), hampering the articulation of sexual health needs and responses specific to TP. Methods: The TRANSFORM study enrolled TP and GBMSM via respondent- driven sampling in Nairobi, 2017. Eligibility criteria: age 18+, male at birth/ currently, Nairobi residence and consensual intercourse with a man in the last year. Participants completed a computer-assisted survey including sexual risk behaviour and HIV/STI testing & treatment history. Gender identity was elicited by a piloted two-step method recording natal sex and current identity. Participants tested for HIV, HIV viral load and anogenital gonorrhoea and chlamydia (Xpert® CTNG urine and rectal swab). Frequency measures, and multivariable logistic and ordinal regression analyses were weighted using the RDS-II method. Results: Among 618 recruits, 522 (84.5%) identified as cisgender men, 86 (13.9%) trans-feminine & 4 (0.7%) trans-masculine (6 missing). Compared to cisgender GBMSM, trans-feminine and trans-masculine persons (TP) were similar in terms of age, education level, employment and country of birth. TP were more likely than cisgender GBMSM to be HIV positive (39.9 v 24.6%), have confirmed rectal gonorrhoea (23.6 v 11.8%) and report clinical symptoms of a rectal STI (18.6 v 7.0% aOR 3.6 (1.7-7.9) p=0.001). TP were more likely never to have tested for HIV (15.0 v 6.8% p=0.035). Among HIV negative participants, TP more often reported condomless receptive anal intercourse (46.6 v 20.6%, p=0.001) and exchange sex with men (53.0 v 39.0%, p=0.064) in the last 3 months than did cisgender GBMSM. Among HIV positive participants, 90-90-90 indicators were poorer for TG (63-81-82) than cisgender GBMSM (73-84-83; not statistically significant p=0.333) Conclusion: TP persons in Nairobi have a higher burden of HIV and rectal gonorrhoea, report higher sexual risk behaviour yet have lower uptake of HIV testing than GBMSM in the same setting. Future research should assess wider sexual and reproductive health needs specific to TP in surveys directly addressing this population. Providers should reconsider the appropriateness of existing prevention and service models that may fail to distinguish between sexual and gender diversity of users.

Poster Abstracts

CROI 2019 332