CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

965 HIGH CURABLE STI PREVALENCE AND INCIDENCE AMONG YOUNG AFRICAN WOMEN IN HPTN 082 Sinead Delany-Moretlwe 1 , Nyaradzo Mgodi 2 , Linda-Gail Bekker 3 , Jared Baeten 4 , Subash Pathak 5 , Deborah J. Donnell 5 , Denni Lennon 6 , Scott M. Rose 7 , Keolopile Makgamathe 8 , Sheetal Kassim 3 , Shorai Mukaka 2 , Heather Noble 5 , Adeola Adeyeye 9 , Connie L. Celum 4 1 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 2 University of Zimbabwe, Harare, Zimbabwe, 3 Desmond Tutu HIV Foundation, Cape Town, South Africa, 4 University of Washington, Seattle, WA, USA, 5 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 6 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 7 FHI 360, Durham, NC, USA, 8 University of the Witwatersrand, Johannesburg, South Africa, 9 National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA Background: African women face overlapping HIV and STI risks. PrEP programs among men who have sex with men have seen high STI incidence, but few data from African women taking PrEP are available. Syndromic STI case management is the standard of care in Africa but is reliant on symptom recognition and has significant limitations in women. Methods: HPTN 082 was conducted in Cape Town, Johannesburg (South Africa) and Harare (Zimbabwe) to evaluate the effect of drug level feedback on PrEP adherence. Sexually active HIV-negative women ages 16-25 were enrolled and enrollment vaginal swabs were tested for gonorrhea (GC) and chlamydia (CT) by nucleic acid amplification, and trichomonas (TV) by rapid test. Syphilis was assessed by serology. All women with positive test results received treatment. Repeat testing was conducted at 6 and 12 months. Results: Of the 412 women who initiated PrEP at enrollment, the median age was 21 years and 84% reported a primary sex partner. Women reported a median of 4 vaginal sex acts (IQR 2,8) in the prior month and 35% reported that they never or rarely used condoms with vaginal sex. 22% reported anal sex in the past month and 27% never or rarely used condoms with anal sex; anal sex was more common among women with a partner ≥5 years older. At enrollment 29% of women had CT, 8% GC, 7% TV and 2% reactive syphilis serology. STI incidence was 29.5 per 100 person-years (p-yrs) for CT (95% CI 24.3, 35.4), 12.2 per 100 p-yrs for GC (95% CI 9, 16.2), and 6.9 per 100 p-yrs for TV (95% CI 4.6, 10.1). The majority of incident STIs were new infections: 74 of 113 CT infections, 40 of 47 GC infections, and 21 of 27 TV infections were diagnosed in women who did not have these infections diagnosed at enrollment. Conclusion: The prevalence and incidence of treatable STIs were high among young women in a PrEP demonstration project in South Africa and Zimbabwe. Most incident STIs were new diagnoses, and unlikely to be reinfections or treatment failures. These data underscore the limitations of syndromic case management to control STIs in at-risk women, and the need for more sensitive diagnostic approaches. Innovative strategies that reduce STI acquisition and complications and their potential impact on future fertility need evaluation within the context of PrEP services. 966 HIGH PREVALENCE AND ANTIBIOTIC RESISTANCE OF M GENITALIUM INFECTIONS IN MSM ON PrEP Beatrice Bercot 1 , Isabelle Charreau 2 , Clotilde Rousseau 1 , Constance Delaugerre 1 , Christian Chidiac 3 , Gilles Pialoux 4 , Catherine Capitant 2 , Nadege Bourgeois- Nicolaos 4 , François Raffi 5 , Sabine Pereyre 6 , Eric Senneville 7 , Laurence Meyer 2 , Cecile Bebear 6 , Jean-Michel Molina 1 , for the ANRS Ipergay Study Group. 1 Hôpital Saint-Louis, Paris, France, 2 INSERM, Villejuif, France, 3 Hospices Civils de Lyon, Lyon, France, 4 AP–HP, Paris, France, 5 CHU de Nantes, Nantes, France, 6 CHU de Bordeaux, Bordeaux, France, 7 Centre Hospitalier de Tourcoing, Tourcoing, France Background: Mycoplasma genitalium (MG) is an emerging pathogen among MSM with raising rates of antibiotic resistance. We assessed the prevalence and incidence of MG infection in MSM enrolled in the open-label phase of the ANRS IPERGAY trial with on demand TDF/FTC for HIV prevention and the impact of doxycycline postexposure prophylaxis. Methods: During the open-label phase of the ANRS IPERGAY trial, participants could also be enrolled in a prospective randomized (1:1) open-label sub-study of postexposure prophylaxis (PEP) with doxycycline. All subjects were tested at baseline and at 6 months by real-time PCR assays for MG detection in urine samples, oro-pharyngeal and anal swabs. Resistance to azithromycin (AZM) and to fluoroquinolones (FQ) were investigated by the detection of mutations in 23S rRNA (ResistancePlusTMMG test, SpeeDx) and in parC determining region, respectively.

Poster Abstracts

964 LOW UPTAKE OF PREEXPOSURE PROPHYLAXIS AMONG KENYAN ADOLESCENT GIRLS AT RISK OF HIV

Lynda M. Oluoch 1 , Nelly R. Mugo 1 , Alison C. Roxby 2 , Anna Wald 2 , Stacy Selke 2 , Amalia Magaret 2 , Kenneth Ngure 1 , Murugi Micheni 1 , Steven Gakuo 1 , Bhavna Chohan 2 , Catherine Kiptinness 1 1 Kenya Medical Research Institute, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA Background: A fifth (21%) of new adult HIV infection in Kenya occur among adolescent girls and young women (AGYW) aged 15-24years. Asymptomatic screening of young women for sexually transmitted infections (STIs) is not the standard of care in Kenya. It has been proven that infection with most STIs make it easy to acquire HIV and even easier to transmit it. We examined whether availability of STI screening results would impact HIV Pre exposure prophylaxis (PrEP) acceptability and uptake in this population. Methods: We recruited a prospective cohort of adolescent girls aged 16-20 years in Kenya. To be eligible, the girls were either sexually naïve or had reported one lifetime sexual partner. The girls were followed up every 3 months with regular STI testing, consisting of nucleic acid testing(NAAT) of vaginal swabs for Neisseria gonorrhea, Chlamydia trachomatis, and Trichomonas vaginalis, and vaginal gram stains for bacterial vaginosis (BV). ELISA assay for HIV and HSV-2 was also done. Starting in January 2018, girls were screened with an HIV risk assessment tool, including real-time STI testing and offered PrEP based on their score. We used descriptive analysis to characterize this cohort. Results: We enrolled 400 girls, with a median age of 18.6 years (IQR 16-21); the cohort started prior to PrEP rollout in Kenya that was initiated in May 2017. After PrEP rollout, we identified 168 girls (42%) eligible for PrEP: 26 (15%) had a current STI, 133 (79%) reported inconsistent or no condom use with sex, 56 (33%) reported sex partner of unknown HIV status, and 6 reported (4%) other reasons. Median years of education for the eligible girls was 12 years. Ninety seven (57.3%) of these girls reported living in rural settlements. Only 9 (5.4%) of the girls who were offered PrEP, accepted it. The PrEP acceptance rate appeared higher in those with current STI (15%, or 4 of 26 accepted PrEP) than in those eligible for other reasons (4%, or 5 of 142 accepted PrEP). Girls who declined PrEP reported that they preferred condom use as a mode of HIV prevention. Conclusion: In a cohort of young women with access to targeted PrEP services after testing positive for an STI, PrEP acceptance was low. Specific evidence of their own high HIV risk, coupled with low- barrier access to PrEP, did not translate into PrEP uptake among these girls. Specific and targeted research of PrEP uptake reluctance in young women is needed. HIV risk awareness and knowledge is not enough to result in high PrEP uptake in this cohort.

CROI 2019 378