CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

finger prick collection (53%). 93% (14/15) would choose the ePrEP system over standard PrEP care. Conclusion: Among a group of young, Black MSM in the rural US South, the offer of telemedicine PrEP led many to initiate. ePrEP had high acceptability ratings, and most would choose it over standard care. Remote care interventions may be an important tool for increasing PrEP access and the ePrEP system holds substantial promise.

956 RAPID PrEP UPTAKE IN A PUBLICLY FUNDED POPULATION-BASED PROGRAM IN BRITISH COLUMBIA K. Junine Toy 1 , Jason Trigg 1 , Wendy Zhang 1 , Paul Sereda 1 , Viviane D. Lima 1 , Katherine Lepik 1 , Mark Hull 1 , Raquel M. Espinoza 1 , Silvia Guillemi 1 , David Hall 2 , David M. Moore 1 , Rolando Barrios 1 , Julio S. Montaner 1 1 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, 2 Vancouver Coastal Health, Vancouver, BC, Canada Background: In January 2018, a 100% publicly funded population-based HIV Pre-Exposure Prophylaxis (PrEP) programwas launched in British Columbia (BC), Canada. Persons meeting BC PrEP eligibility criteria qualified for daily emtricitabine-tenofovir DF PrEP at no cost. Here we describe client and prescriber characteristics in the first 6 months of this province-wide program. Methods: Clients enrolled from 1-Jan-2018 through 30-Jun-2018 were characterized by clinical and demographic characteristics. Prescribers were summarized by practice setting and HIV management experience. Comparisons between prescriber settings for PrEP enrolment, prescriber experience, and days from baseline HIV test to PrEP dispensing used Chi-Squared test for categorical and Wilcoxon rank sum test for continuous variables. Reported reasons for PrEP discontinuation and adverse drug reactions (ADR) were summarized. Results: In the first 6 months, 1955 clients were approved for PrEP (see Table). Clients were 98.7%male, 0.9% transfemale, and <0.5% female, transmale, or other gender identity. Median (Q1-Q3) age was 35 (29-46) years. The majority (85%) of clients resided in the Greater Vancouver area. Most (73%) enrolees were PrEP-naïve, the remainder transferred from client-paid or private insurance coverage. There were 351 enrolling PrEP prescribers, of whom 46% had no previous HIV care and treatment experience. 67% of PrEP clients were seen at a Sexual Health or HIV Specialty clinic. The 21 prescribers at specialty clinics had median 32 (5-70) PrEP clients each vs. 1 (1-2) clients for the other 330 prescribers (p<0.001). Time from baseline HIV negative test to first PrEP dispensing was median 10 (7-13) days for specialty clinic clients vs. 10 (7-14) days for clients seen in general medical settings (p=0.028). PrEP discontinuation was reported for 25 clients (1.3%). Reasons for stopping included: 16 clients no longer at risk, 4 PrEP not tolerated, 1 drug interaction, 4 unspecified. Although BC guidelines recommend daily PrEP, intermittent use was noted for 17 clients. Overall, there were 7 reports of possible PrEP ADRs: 2 dermatologic; 2 gastrointestinal; 2 renal; 1 transient neutropenia. Conclusion: Rapid uptake of PrEP was seen in the first 6 months of the publicly funded program in BC, with almost 2000 clients enrolled by over 350 prescribers. Early participation was largely represented by the at-risk MSM population in urban areas. To date, there have been few reports of PrEP discontinuation or adverse reactions.

Poster Abstracts

955 PILOT TEST OF A PrEP TELEMEDICINE SYSTEM FOR YOUNG BLACK MSM IN THE RURAL US SOUTH Aaron J. Siegler 1 , James B. Brock 2 , Colleen F. Kelley 1 , Lauren A. Ahlschlager 1 , Charlotte-Paige M. Rolle 3 , Saiya Sheth 1 , Gretchen Wilde 1 , Karen Dominguez 1 , Shanita Greer 2 , Leandro A. Mena 2 1 Emory University, Atlanta, GA, USA, 2 University of Mississippi Medical Center, Jackson, MS, USA, 3 Orlando Immunology Center, Orlando, FL, USA Background: HIV disproportionately impacts young and Black men who have sex with men (MSM), yet PrEP uptake is low among these groups. MSM living in rural areas face additional barriers to care, with an estimated 108,000 PrEP- eligible MSM living more than a one-hour roundtrip drive from their nearest PrEP provider. We sought to develop a culturally appropriate, smartphone- based PrEP telemedicine system to increase uptake by decreasing barriers to care. Methods: We developed and piloted ePrEP, a smartphone telemedicine system with video consultations, lab testing using home specimen collection, and when possible home prescription delivery. The goal was to develop a low-touch system that removes barriers to PrEP care. Eligible participants were Black MSM, aged 18-24, and lived in small towns or rural areas in Georgia and Mississippi. We piloted using ePrEP to initiate patients into PrEP care, who were then linked to care to the nearest PrEP provider. Outcomes were feasibility (PrEP prescription filled) and acceptability (‘acceptable’ or ‘very acceptable’ on a 5-point Likert scale, and willingness to reuse). Results: Of 50 screened-eligible participants contacted, 64% (n=32) completed a baseline survey, returned the self-collected specimen kit, and were enrolled in the study. 9% (3/32) tested positive for HIV. 86% (25/29) with a negative test for HIV had a telemedicine visit and were prescribed PrEP. A confirmed prescription fill was determined for 72% (21/29). A call referring participants to care after PrEP initiation through the study was only moderately successful, with 43% (9/21) linked to care, but 33% (7/21) lost to follow-up and 24% (5/21) refusing linkage to care. For those refusing linkage, the most commonly stated reason was the distance to in-person care. Among 15 participants completing a follow-up survey, the systemwas rated as acceptable by: video (93%), mailing specimens (93%), urine collection (93%), rectal swab collection (73%), and

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