CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Conclusion: While PrEP initiations are relatively high in the SFBA, disparities in persistence exist, particularly in youth and TW/NB. Efforts to address cost/ access barriers are critical to reversing disparities. Novel PrEP regimens and formulations could increase PrEP uptake and persistence.

among MSM in the US overall and by race between 2014 and 2017 using National HIV Behavioral Surveillance (NHBS) data from 20 U.S. cities. Methods: Men were recruited at events frequented by MSM in each city using venue-based sampling. We used log-linked poisson regression models with generalized estimating equations clustered on event to estimate the prevalence ratios (PR) and 95% confidence intervals (CI) for PrEP awareness and use, adjusted for income and health insurance. Analyses were limited to HIV- negative men who reported substantial risk for HIV infection consistent with PrEP indications (had either a male sex partner who was not known to be HIV negative or >1 male sex partner in the past 12 months and had either a sexually transmitted infection or condomless anal sex with a male partner also in the 12-month period). Results: We analyzed data from 3,978 MSM at substantial risk for HIV infection who were interviewed in 2014 and 4,182 who were interviewed in 2017. Between 2014 and 2017, PrEP awareness increased overall from 59% to 90% (adjusted PR (aPR) 1.14, CI: 1.13-1.16) and PrEP use increased from 5% to 34% (aPR 1.80, CI: 1.72-1.90). Both awareness and use increased in all racial and age groups. However, PrEP awareness was lower among black (85%; aPR 0.94, CI: 0.90-0.98) and Hispanic men (85%; aPR 0.92, CI: 0.89-0.96) than white men (94%). In 2017, PrEP use among men at substantial risk was lower among black (26%; aPR 0.71, CI: 0.60 – 0.84) and Hispanic men (29%; aPR 0.79, CI: 0.68 – 0.93) compared with white men (42%). Conclusion: From 2014 to 2017 PrEP use increased over 500% among MSM who are at substantial risk for HIV infection. PrEP awareness also increased significantly. However, PrEP use remains low, especially among black and Hispanic men. Efforts to raise PrEP use among black and Hispanic men may help reduce HIV disparities in the US. 973 ASSESSING THE PrEP CONTINUUM IN THE SAN FRANCISCO BAY AREA: THE QUICKIE MOBILE SURVEY Albert Y. Liu 1 , Kenneth Coleman 1 , Eric VIttinghoff 2 , Caitlin Turner 1 , Janie Vinson 1 , Nicole Walker 1 , Christina Quiñonez 1 , Edward M. Gardner 3 , Henry F. Raymond 1 , Susan P. Buchbinder 1 , Marguerita Lightfoot 2 , Susan Scheer 1 , Sean Arayasirikul 1 , Erin C. Wilson 1 1 San Francisco Department of Public Health, San Francisco, CA, USA, 2 University of California San Francisco, San Francisco, CA, USA, 3 Denver Health and Hospital Authority, Denver, CO, USA Background: Pre-exposure prophylaxis (PrEP) has great potential to curb the HIV epidemic. Population-level indicators of the PrEP continuum are lacking, yet are critical to monitor PrEP expansion and identify gaps. We report results of a mobile survey evaluating the PrEP continuum among MSM and transwomen (TW) in the San Francisco Bay Area (SFBA). Methods: Participants (ppts) were recruited using social media/sexual networking sites, print ads and phone outreach. Eligible ppts were HIV- uninfected MSM or TW, age ≥18, sexually active with a man and/or trans partner in the past year, English/Spanish speaking, and SFBA residents. We used a Qualtrics mobile survey to assess metrics of the PrEP continuum including awareness, initiation, adherence, and persistence. We conducted multivariable logistic regression to identify factors associated with PrEP initiation and persistence. Results: From June-September 2018, 460 ppts responded to the survey. Median age was 30; 46%were White, 22% Latinx, 15% Asian, 13% Black, 4% other; 86%were men, 14% TW/non-binary (NB). Over the past 6 months, the mean number of anal/vaginal sex partners was 7, and 74% reported condomless sex; 25% reported an STI in the past year. Overall, 96% had heard of PrEP, 47% had initiated PrEP, 33%were currently on PrEP, and 32% reported high adherence. Among 244 ppts never on PrEP, most (81%) expressed interest in taking it, but only 61% knew where to get PrEP, and few (36%) had talked with a provider about PrEP. In multivariable analyses, higher education, having a primary provider, and drug use were associated with PrEP initiation; younger age, other race, and TW/NB were associated with lower persistence; number of sex partners was associated with initiation and persistence (Table). Among 63 PrEP discontinuers, median duration of use was 7 months; the most common reasons for stopping PrEP included not feeling at risk for HIV (46%), insurance/access issues (36%), side effects/concerns (13%), and travel (10%). Among never/prior PrEP users, a substantial proportion would consider starting/restarting PrEP if offered on-demand PrEP (84%/73%), long-acting injectable PrEP (56%/68%), or a pericoital rectal formulation (douche/suppository) (32%/46%).

974 INFLUENCE OF PrEP4LOVE CAMPAIGN ON PrEP UPTAKE AMONG YMSM IN CHICAGO Gregory Phillips , Peter T. Lindeman, Anand B. Raman, Christina S. Hayford, Brian Mustanski Northwestern University, Chicago, IL, USA Background: While there have been significant increases in awareness of pre-exposure prophylaxis (PrEP) in recent years, uptake remains relatively low in populations most impacted by HIV – particularly young men who have sex with men (YMSM). This may partially be attributed to the lack of conversations between eligible individuals and their providers about PrEP and sexual health in general. Many major cities have launched campaigns aiming to address gap by using sex-positive messaging to empower individuals to be proactive in seeking out a PrEP prescription. In 2016, the citywide PrEP4Love campaign launched in Chicago. The campaign depicted racially diverse couples with catchy phrases (“Spread Tingle”) in a variety of settings, including bus stops, fliers, and bar coasters. The campaign linked interested parties to additional information about starting PrEP, including a list of providers in Illinois. Methods: RADAR is a longitudinal cohort study of YMSM to investigate multilevel factors associated with HIV infection in Chicago. At baseline, participants reported being assigned male at birth, aged 16-29 years, and either identified as LGBT or reported sex with another man. Between June 2017 and April 2018, additional questions were added to the core survey regarding awareness of the PrEP4Love campaign. Results: 75.9% of the 700 people responding to PrEP4Love questions had seen the ads in at least one location. Most saw them online (57.8%), at pride events (50.7%), through friends (35.0%), or at a healthcare provider’s office (32.0%). Participants who saw PrEP4Love ads were significantly more likely to have used PrEP in the prior 6 months (OR = 1.87; 95% CI: 1.15, 3.16). Further, those who saw PrEP4Love ads were nearly three times as likely to have spoken with a healthcare provider than those unaware of the campaign (OR = 2.77; 95% CI: 1.93, 4.00), and twice as likely to have initiated this conversation (OR = 2.07; 95% CI: 1.15, 3.85). Conclusion: A multimedia PrEP campaign in Chicago was effective at reaching populations at greatest risk for HIV – YMSM. Seeing ads for PrEP4Love was associated with provider conversations as well as PrEP initiation, two major outcomes for the campaign. Although the impact of citywide campaigns can rarely be evaluated, we saw evidence for the success of PrEP4Love. To encourage PrEP uptake among at-risk populations, other jurisdictions need eye-catching and continuous campaigns similar to Chicago.

Poster Abstracts

CROI 2019 381