CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

1 University of California San Diego, San Diego, CA, USA, 2 Harbor–UCLA Medical Center, Torrance, CA, USA, 3 University of California Los Angeles, Los Angeles, CA, USA, 4 Gilead Sciences, Inc, Foster City, CA, USA, 5 University of Michigan, Ann Arbor, MI, USA Background: Little information is known about the risk profiles of women who initiate pre-exposure prophylaxis (PrEP) for HIV prevention in the US. We analyzed baseline risk factors of women in a PrEP demonstration project using TDF/FTC to assess correlates of PrEP uptake. Methods: Adherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) is a PrEP clinical trial in Southern California of 136 HIV-negative cisgender women ≥18 years old at risk for HIV who completed enrollment. At baseline, women were surveyed for sociodemographics and risk behaviors with testing for STIs. Women in three primary HIV risk groups according to main partner type ([1] serodiscordant partnerships (SD), [2] sex workers [SW], and [3] risk attributable to known and unknown partner behavior [UP]) were compared using Fisher’s exact or Kruskal-Wallis tests to determine differences by risk group. Results: Sixty-four women (47%) were grouped in the SD risk group, 21 (15%) in SW and 51 (38%) in UP. Despite SW reporting significantly more sex partners than SD or UP, overall baseline STI rate was low at 8%with no difference by risk group. SWwere more likely to report problem drinking and drug use (p=0.002) and history of intimate partner violence in the last year (p<0.001) compared to SD and UP. HIV literacy was higher among SW vs. the other risk groups (p=0.023). Nearly all SW (95%) and most UP women (83%) wanted to take PrEP to protect themselves from HIV vs. only 33% of SD (p<0.001). There were no differences between groups in depression score or HIV risk perception. Of 103 women reporting a main partner, 80%were aware of partner’s HIV status. Among the 51 women reporting an HIV+ partner, 96% thought their partner was on ART and 71%were suppressed. Black women were less likely to know if their partner was HIV+ compared to White and Latina women (p=0.032). Black and Latina women vs. White women (p=0.006), and SW and UP vs. SD (p<0.001) more frequently suspected partner infidelity. Conclusion: Women enrolled in this PrEP demonstration project were predominantly in serodiscordant relationships but many had partners of uncertain risk and almost one in six were engaged in sex work. We found differences between individuals in the three HIV risk groups by race/ethnicity, employment, HIV knowledge and risk behaviors, PrEP motivations and main partner dynamics. Interventions to increase PrEP uptake among women may need to be customized based on the varying partnership types found among women at risk for HIV.

1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya Background: Understanding pregnant women’s risk perception and whether this correlates with their actual HIV risk is important to guide PrEP implementation in high HIV prevalence regions. Methods: The PrEP Implementation for Mothers in Antenatal Care (PrIMA) study (NCT03070600) is a cluster-RCT in western Kenya that assesses strategies for delivering PrEP to pregnant women. At enrollment, HIV risk perception was assessed using two risk perception scales (Napper and Vargas). Intimate partner violence (IPV) was assessed using the Hurt, Insulted, Threatened with Harm and Screamed screening tool. HIV risk was assessed using a validated empiric risk score for predicting HIV acquisition designed for pregnant women which includes behavioral and partner characteristics: scores >6 indicate high-risk for HIV. Women self-reported their partner’s HIV status. Women’s perceived HIV risk was compared between women with a high (>6) and low (≤6) empiric risk scores. Results: Of the 2,280 women enrolled, median age was 24 years (IQR 20-29), median gestational age was 25 weeks (IQR 20-30), and 84%were married. Overall, 33% reported having partners of unknown HIV status and 40% had empiric HIV risk scores >6; 7% believed they had a ‘great chance’ of acquiring HIV in the next year. Compared to women with lower risk scores, women with scores >6 were more likely to believe they had a ‘great chance’ of acquiring HIV in the next year (15% vs 2%). Mean perceived HIV risk was 21 (SD, 4.5) and 1.8 (SD, 1.9) using the Napper and Vargas scales, respectively, signifying moderate perceived risk. Women with high-risk scores (>6) reported greater perceived risk in both scales compared to women with low risk scores (Napper, Mean [M]: 23.2 vs 19.5 and Vargas, M, 2.69 vs 1.19). Women who experienced IPV had greater perceived risk in both scales (Napper, M: 24 vs 21) and (Vargas, M: 2.7 vs 1.7). Compared to women with HIV-uninfected partners, women with partners of unknown or known positive status had higher perceived risk (positive partners, Napper, M: 26 vs 19; Vargas, M: 3.8 vs 1.2) and (unknown partner status, Napper, M: 23 vs 19; Vargas, 2.6 vs 1.2). All P values <0.001. Conclusion: Women with high empiric HIV risk scores were more likely to report a higher perceived risk of acquiring HIV. This suggests that women may accurately assess their own risk for HIV and providers may be able to universally counsel women on PrEP rather than conducting a risk assessment to target PrEP. 981 LOW PrEP AWARENESS AND WILLINGNESS AMONG TRANSGENDER WOMEN IN SOUTH AFRICA Tonia Poteat 1 , Leigh Ann van der Merwe 2 , Allanise Cloete 3 , Dee Adams 4 , Mannat Malik 4 , David B. Hanna 5 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 2 Social Health and Empowerment, East London, South Africa, 3 Human Sciences Research Council, Pretoria, South Africa, 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 5 Albert Einstein College of Medicine, Bronx, NY, USA Background: Transgender women (TW) face elevated vulnerability to HIV. Recent studies indicate a pooled prevalence of 25% across 8 sub-Saharan African countries, with no data available for South Africa. In 2016, the South African National Department of Health implemented PrEP for high-risk populations at select sites. However, transgender people were only targeted as a subset of sex workers. Data are needed to guide strategies on how best to implement PrEP among TW in South Africa. This study aimed to identify predictors of PrEP knowledge, willingness, and uptake among South African TW to inform development of effective interventions. Methods: Between May-September 2018, 210 TWwere recruited in Cape Town, East London, and Johannesburg through community outreach. Each TW completed an interviewer-administered survey. Data were collected on psychosocial factors, HIV risk behaviors, self-reported HIV status, and PrEP awareness, willingness, and uptake. Bivariate and multivariable logistic regression modeling tested associations between HIV risk behaviors and perception, violence, and PrEP awareness and willingness. Multivariable models included random effects for city. Results: Only 50% (105/210) of TW had heard of PrEP. Of those, 87% (91/105) knew where to get PrEP, and 19% (20/105) had ever taken it. The 67 (32%) TW who reported living with HIV had 2.6 times the odds (95% CI: 1.4-4.9; p=0.002) of PrEP awareness compared to HIV-negative TW. Among HIV-negative TW not on PrEP, 51% (54/106) were willing to take it. In multivariable modeling, violence victimization and history of substance abuse were significantly associated with PrEP awareness, while history of sexually transmitted infections

Poster Abstracts

980 CONCORDANCE OF HIV RISK PERCEPTION AND EMPIRIC RISK SCORE AMONG PREGNANT KENYAN WOMEN Laurén Gómez 1 , John Kinuthia 2 , Julia C. Dettinger 1 , Jillian Pintye 1 , Anjuli D. Wagner 1 , Nancy M. Ngumbau 2 , Ben O. Odhiambo 2 , Mary M. Marwa 2 , Salphine A. Wattoyi 2 , Felix Abuna 2 , Joshua Stern 1 , Grace John-Stewart 1 , Jared Baeten 1

CROI 2019 384