CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

960 CHANGES IN KIDNEY FUNCTION AMONG MSM INITIATING ON-DEMAND TDF/FTC FOR HIV PrEP Geoffroy Liegeon 1 , Guillemette Antoni 2 , Gilles Pialoux 3 , Laurent Cotte 4 , Cécile L. Tremblay 5 , Catherine Capitant 2 , Eric Cua 6 , François Raffi 7 , Eric Senneville 6 , Pierre Charbonneau 1 , Soizic Le Mestre 8 , Veronique Dore 8 , Laurence Meyer 2 , Jean- Michel Molina 1 , for the ANRS IPERGAY Study Group 1 Hôpital Saint-Louis, Paris, France, 2 INSERM, Villejuif, France, 3 Tenon Hospital, Paris, France, 4 CHU de Lyon, Lyon, France, 5 Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada, 6 CHU de Nice, Nice, France, 7 CHU de Nantes, Nantes, France, 8 France Recherche Nord & Sud Sida-HIV Hépatites, Paris, France Background: Pre-exposure prophylaxis (PrEP) with TDF/FTC is recommended for HIV prevention. Daily PrEP with TDF/FTC is associated with a small but statistically significant decrease in estimated glomerular filtration rate (eGFR) similar to HIV-infected patients on TDF. We wished to assess whether on demand TDF/FTC based-PrEP could minimize the risk of eGFR reduction among MSM. Methods: We used data from the randomized double-blind placebo-controlled ANRS-IPERGAY trial conducted among HIV-uninfected MSM with creatinine clearance >60mL/min. eGFR was assessed using CKD-EPI equation at enrolment, months 1, 2 and every 2 months thereafter. We evaluated the mean decline slope of eGFR change from baseline and the occurrence of eGFR <70mL/ min/1.73m² in the placebo and on-demand TDF/FTC groups. We also determined risk factors for eGFR <70mL/min/1.73m² in all patients initiating TDF/FTC included in the blind or the open-label extension phases of the study. Results: During the blind phase, 201 participants were randomized to placebo and 199 to on demand TDF-FTC. Participants on TDF/FTC took a median number of 15 pills/month (IQR 11 to 21). The mean eGFR at baseline was 106mL/ min/1.73m². During a median follow up of 9.3 months, the mean decline slope of eGFR was -0.13 and -0.07 mL/min/1.73m² per month in the TDF/FTC and placebo group, respectively (P=0.27). The cumulative proportion of patients with an eGFR <70mL/min/1.73m² at 12 months was higher on TDF-FTC: 8% [95%CI 4-13%] than placebo: 3% [CI 0-6%], P=0.04. Compared to placebo, the risk of eGFR <70mL/min/1.73m² did not increase significantly in patients who took <15 pills/month: HR 1.75 [CI 0.65-4.7%] as compared to those using ≥15 pills/month: HR 2.54 [CI 1.07-6.04%]. Including both phases, 389 participants initiated on demand TDF/FTC with a median follow up of 19.1 months. Small but significant decline in eGFR occurred over time (mean slope: -0.09mL/ min/1.73m² per month, P<0.01). Only 2 participants had persistent eGFR <60mL/min/1.73m² and 3 discontinued TDF/FTC for kidney function decline. The cumulative proportion of eGFR <70mL/min/1.73m² from baseline was 14% [9-18%] at 24 months. Factors associated with eGFR <70mL/min/1.73m² were high pill use (HR 1.9 [CI 1.03-3.49%], P=0.04), age > 40 years (P<0.01) and low eGFR at baseline (P<0.01). Conclusion: On demand PrEP with TDF/FTC is associated with limited and non- clinically relevant eGFR decline, especially in young participants, those with low pill use and high baseline eGFR. 961 POINT-OF-CARE CREATININE TESTING WITHIN A PROGRAMMATIC PrEP DELIVERY SETTING Jillian Pintye 1 , Felix Abuna 2 , John Kinuthia 3 , Harrison Lagat 2 , Kenneth K. Mugwanya 1 , Julia Dettinger 1 , Emily R. Begnel 1 , Marline Serede 1 , Joseph Sila 2 , Jared Baeten 1 , Grace John-Stewart 1 , for the PrEP Implementation for Young Women and Adolescents (PrIYA) Program

959 PREEXPOSURE PROPHYLAXIS FOR KEY POPULATIONS IN UGANDA: EARLY SCALE-UP LESSONS Joseph Lubwama , Stella Alamo, Caroline Ajulong, Enos Sande, Lisa A. Mills,

Donna Kabatesi, Lisa J. Nelson CDC Uganda, Kampala, Uganda

Background: In 2015, WHO recommended PrEP for persons at substantial risk of HIV. In 2016, UNAIDS set aspirational targets to enroll 3 million people on PrEP by 2020. HIV prevalence in Uganda is 6.2%, substantially higher among key populations (KP) including sex workers (SW, 33%) and men who have sex with men (MSM, 13.7%) yet the legal environment in Uganda undermines access to HIV services for KP. With support from the US Centers for Disease Control and Prevention (CDC) and in partnership with the Ministry of Health (MoH), Uganda implemented PrEP, reaching 3846 individuals between July 2017 and June 2018. Methods: We reviewed PrEP data from PEPFAR Data for Transparency Impact Monitoring (DATIM) for July 2017 to June 2018. We compiled quarterly data from the 6 sites implementing PrEP for KP – including SW, MSM, Transgender (TG) persons and other high-risk groups (fisher folk [FF], discordant couples [DC], truckers, adolescent girls and young women [AGYW] and people who inject drugs). We also reviewed site-specific data from a rural fishing community in Southwestern Uganda, including 3- and 6-month retention within a 1.5 month window around timepoints. Results: During the analyzed period, 3,846 individuals initiated PrEP; 2,568 (67.2%) SW, 327 (8.5%) MSM, 15 (0.4%) TG, and 918 (23.8%) other high-risk groups. PrEP initiations increased 112% from July–Sept. to Oct.–Dec. 2017 and 17%more Jan.–March 2018. From July-Dec. 2017 there was a 36% increase in an urban program providing PrEP at community-based MSM-friendly drop-in centers. In the rural fishing community, 58.1% (894/1538) of PrEP clients were SW, 25.4% (391/1538) FF, 7.4% (114/1538) DC and 0.5% (7/1538) MSM. Other high-risk groups included AGYW, migrant workers, truckers and uniformed forces among others. The majority (69.2%, 1064/1538) were reached through outreach models versus fixed public health facilities. Overall, only 33.8 % (404/1195) of clients returned for PrEP refills at or around 3 months (3m), and 24.2% (212/876) at or around 6 months (6m). Return rates were higher among DC (56.9%@3m, 46.8%@6m) and low among SW (37.5%@3m, 26.3%@6m) and FF (16.4%@3m, 14.2%@6m). Conclusion: More SW than other KP and high-risk groups were reached with PrEP. Retention at 3 and 6 months was low for sex workers and fisherfolk, somewhat higher for discordant couples. Outreach approaches should be scaled up to reach more KP clients with PrEP. Retention strategies should be strengthened, especially for sex workers and fisherfolk, who may be highly mobile.

Poster Abstracts

CROI 2019 376