CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

976 PrEP-RELATED BARRIERS AMONG MEN WHO HAVE SEX WITH MEN IN BRAZIL, MEXICO, & PERU Vincent B. Ofori 1 , Ryan D. Assaf 1 , Kelika A. Konda 2 , Thiago S. Torres 3 , E. Hamid Vega-Ramirez 4 , Oliver A. Elorreaga-Reyes 2 , Dulce Diaz-Sosa 4 , Steven D. Diaz 4 , Cristina Pimenta 3 , Hugo López-Gatell 5 , Rebeca Robles-Garcia 6 , Beatriz Grinsztejn 3 , Carlos Carceres 2 , Valdilea Veloso 3 , for the ImPrEP Study Group 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Universidad Peruana Cayetano Heredia, Lima, Peru, 3 Institute Nacional de Infectologia Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil, 4 Clinica Especializada Condesa, Mexico City, Mexico, 5 Instituto Nacional de Salud Pública, Mexico City, Mexico, 6 Ministerio de Salud, Mexico City, Mexico Background: Although PrEP has been publicly available in Brazil since early- 2018 and through demonstration projects in Mexico and Peru since mid-2018, little is known about PrEP-related barriers. We examined factors associated with PrEP-related barriers among MSM in these countries. Methods: MSM were recruited in 2018 to complete an online survey. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, lived in these countries and provided informed consent. The survey asked about 12 PrEP-related concerns on a 5-point Likert scale, which were then categorized into informational, behavioral and belief barriers. Responses by domain were summed to create three continuous outcomes; then, multiple linear regression was conducted for each outcome using Stata 14. Results: Of the 43,687 participants who started the survey, 19,457 MSM remained for analysis after dropout and application of exclusion criteria. Most respondents were Brazilian (58%), had post-secondary education (60%), reported low to middle income (83%); and their median age was 28 (IQR: 24-34). Overall, concern regarding informational barriers was higher than behavioral or belief barriers (see graph). Respondents with lower informational barriers were: Brazilian(-1.7), aware of PrEP(-0.6), ever taken PrEP(-0.1) and at higher risk of contracting HIV(-0.4); while Peruvians(0.2) had higher informational barriers. Respondents with lower behavioral barriers were: Brazilian(-0.6), aware of PrEP(-1.1), 18-24 years old(-0.4), middle(-0.5) or high income(-1.2), used drugs(-0.7), had a stable male partner(-0.2) and ever tested for HIV(-0.7); whereas Peruvians(0.5) and those without secondary education(0.8) had higher behavioral barriers. Respondents with lower belief barriers were: Brazilian(-0.9), aware of PrEP(-1.5), 18-24 years old(-0.3), middle(-0.4) or higher income(-0.9), had a stable male partner(-0.3) and ever tested for HIV(-0.4). Peruvians(0.4) and those without secondary education(0.6) had higher belief barriers. All regression model coefficients had p-values<0.05. Conclusion: Informational barriers were the highest of the 3 domains; simultaneously, those most informed (e.g., Brazilians and PrEP aware) had consistently lower barrier scores across all 3 domains. These findings indicate that PrEP barriers are likely amenable to interventions promoting PrEP awareness and education. Such interventions will be needed to reduce PrEP- related barriers, increase its uptake, and reduce HIV incidence in these countries.

975 ASSOCIATION OF HIGHER RISK AND PrEP AWARENESS AMONG MSM IN BRAZIL, MEXICO, AND PERU Ryan D. Assaf 1 , Kelika A. Konda 2 , Thiago S. Torres 3 , E. Hamid Vega-Ramirez 4 , Oliver A. Elorreaga-Reyes 2 , Dulce Diaz-Sosa 4 , Steven D. Diaz 4 , Cristina Pimenta 3 , Hugo López-Gatell 5 , Rebeca Robles-Garcia 6 , Beatriz Grinsztejn 3 , Carlos Carceres 2 , Valdilea Veloso 3 , for the ImPrEP Study Group 1 University of California Los Angeles, Los Angeles, CA, USA, 2 Universidad Peruana Cayetano Heredia, Lima, Peru, 3 Institute Nacional de Infectologia Evandro Chagas (INI/Fiocruz), Rio de Janeiro, Brazil, 4 Clinica Especializada Condesa, Mexico City, Mexico, 5 Instituto Nacional de Salud Pública, Mexico City, Mexico, 6 Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico Background: PrEP has been publicly available in Brazil since early 2018 and through demonstration projects in Mexico and Peru since mid-2018. We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among men who have sex with men (MSM) from these countries. Methods: MSM were recruited to complete an online survey via advertisements on Facebook, Grindr and Hornet fromMarch-May 2018. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, lived in these countries and provided informed consent. Higher risk was defined using a CDC score indicating increased risk of HIV infection and the suggested cutpoint of 10. We used Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk and PrEP awareness; socio- demographics and other risk variables were considered potential confounders. Analyses were conducted in STATA 14. Results: After exclusion criteria were applied, 19,457 MSMwere available for analysis of the 43,687 who began the questionnaire. Median age was 28 (IQR: 24-34), most respondents were Brazilian (58%), had post-secondary education (60%) and reported low to middle income (83%). PrEP awareness was 65%, 4% of respondents had ever used PrEP, and 53%were classified as higher risk. However, only 10% of respondents perceived their HIV risk as high. Among individuals classified as higher risk, 66.8%were aware of PrEP vs. 62.3% of lower risk respondents. The association between higher risk and awareness remained significant (aPR 1.03; 95% CI 1.00, 1.05) after adjustment. Additionally being 25+ years old (vs. 18-24 years), Brazilian, post-secondary education, high income and Gay Social Network (GSN) App use were associated with PrEP awareness. While being Peruvian, having less than secondary education and low income were negatively associated with PrEP awareness (all p-values<0.05). Conclusion: Higher risk of HIV infection was associated with increased PrEP awareness. However, this association was weak indicating that MSM at higher risk, who would benefit from PrEP, are often not aware of this prevention strategy. As PrEP is introduced, awareness should increase, as seen in Brazil where PrEP has been available longer. Interventions to increase PrEP awareness are paramount, especially among MSM at higher risk, to increase PrEP uptake and prevent HIV infections. Gay Social Network apps and social media could play an important role to achieve this goal.

Poster Abstracts

CROI 2019 382