CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

and violence victimization were significantly associated with PrEP willingness. In these models, history of sex work was not associated with PrEP awareness, and HIV risk perception was not significantly associated with willingness to take PrEP. Conclusion: PrEP awareness, willingness, and uptake remain low among TW in South Africa. HIV-negative TWwho perceived their risk for HIV acquisition to be high were not more willing to take PrEP than TWwith low perceived risk. In adjusted analyses, TW sex workers were not more likely to be aware of PrEP or willing to take PrEP than TWwho had not engaged in sex work. These findings suggest a need to raise awareness of PrEP in transgender communities and specifically include TW in strategies to increase engagement in PrEP services.

New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Background: HIV post exposure prophylaxis (PEP) guidelines recommend routine glomerular filtration rate (GFR), aspartate aminotransferase (AST), and alanine transaminase (ALT) testing at PEP initiation and follow up visits. Once daily tenofovir (TDF)/emtricitabine (FTC)/ dolutegravir (DTV) is the first line PEP regimen in CDC guidelines and New York City (NYC) Sexual Health Clinics (SHC) due to its high safety profile. We assessed the prevalence of abnormal AST/ALT/ GFR at baseline (BL) and follow up (FU) testing among patients without self- reported kidney or liver disease who were provided 28 days of PEP at NYC SHC. Methods: We extracted medical record data from PEP initiation visits during 9/2016-12/2017 with: TDF/FTC/DTV regimen, a baseline metabolic panel, and no HIV medication dispensed in the prior three months at NYC SHC. GFR/AST/ALT results were examined at BL and at the first FU testing 14-42 days. Normal renal function (RF) was defined as GFR ≥70 ml/min and normal liver function (LF) was defined as ALT and AST less < 50 U/L. Abnormal LF/RF tests were classified into grades based on the GFR and higher AST/ALT values (table). Chart review was done for visits ≥ grade 2 to determine whether PEP regimen was changed or discontinued. Results: Overall 1115 PEP initial visits were identified of 1051 unique patients. Median age was 29 years (IQR 25-35); 92%were male. At baseline, 3% of visits had an abnormal RF (33/1115) and 9% had an abnormal LF (95/1115). The majority of BL abnormal labs were grade 1(RF: 31/32; LF: 77/95). Among 575 BL visits with FU labs, 9% had abnormal RF (50/575) and 11% had an abnormal LF (64/575). The majority of FU abnormal labs were grade 1(RF: 49/50; LF: 51/64) (table). Visits with and without FU labs were similar with regards to age, gender, race, and baseline RF. Visits with abnormal BL LF were more likely to have FU lab visits (aOR 1.7;95%CI 1.1-2.6). Only twice was a PEP regimen changed based on BL grade 2 RF or LF abnormality and no PEP regimens were changed based on FU lab abnormalities. Conclusion: Baseline renal and liver testing among PEP visits on TDF/FTC/ DTV without known history of kidney and liver disease was normal in > 90 % and rarely resulted in changes in PEP regimen (0.2%). Follow up renal and liver testing did not result in any regimen change. As the safety profile of PEP regimens improves, routine renal and liver testing and monitoring for healthy patient population may not be necessary.

Poster Abstracts

982 WITHDRAWN POSTEXPOSURE PROPHYLAXIS AND HIV RISK IN RWANDA: POTENTIAL FOR PEP-TO-PrEP PROGRAMS Sabin Nsanzimana , Remera Eric Rwanda Biomedical Centre, Kigali, Rwanda Background: Rwanda and other African countries provide Postexposure Prophylaxis (PEP) at health facilities for HIV-negative persons with recent exposure to HIV, and are at early stages of implementing Pre-Exposure Prophylaxis (PrEP). PEP programs are an important, unappreciated opportunity to recognize and address HIV risk, both retrospectively relative to a suspected recent HIV exposure, and prospectively via PrEP. Women and girls may disproportionately seek PEP more often than men, often in response to gender- based violence and/or sexual assault. In addition, anecdotal evidence suggests some persons seek PEP repeatedly, and may be discouraged from doing so. We analyzed existing PEP data from a Rwanda national survey to determine whether PEP recipients (who were by definition HIV negative at the time of PEP services) had a higher burden of subsequent HIV, and might benefit from PrEP. Methods: We performed secondary analysis of Rwanda’s AIDS Indicator and HIV Incidence Survey 2013-2015. Logistic regression models were used to assess factors associated with HIV infection. All analyses accounted for the complex survey design and were done in STATA Version 13. Results: A total of 101/13,893 respondents ages 15-56 reported receiving PEP in the prior 12 months, 40 males and 61 females. Recent PEP recipients had 6.5 times higher odds of being HIV positive (unadjusted Odds Ratio [uOR] 6.5; 95% CI 3.8-11.2). This effect was seen across age and sex disaggregation, and was exaggerated among youth, with persons under 25 years having >9 times higher odds of being HIV positive (uOR 9.1; 95% CI 2.1-39.4). Adolescent girls/young women 15-24 years old with recent PEP exposure had >10 times higher odds of being HIV positive (uOR 10.1; 95% CI 2.26-45.14). Conclusion: Rwandan PEP recipients are at substantially increased risk of acquiring HIV, suggesting that existing prevention efforts are failing them. PEP programs should be re-emphasized and strengthened, and recipients should be provided effective ongoing prevention services including transition to PrEP for those with ongoing substantial HIV risk. Creation of PEP-to-PrEP transition programs would leverage the existence of PEP clients, who are already seeking HIV prevention services at health facilities because they recognize their own elevated HIV risk. Successful PrEP implementation will also require risk reduction and adherence support, and consideration of PrEP cessation when risk has reduced. 983 ARE ROUTINE RENAL AND LIVER LABS TESTING AMONG PEP PATIENTS ON TDF/FTC/DTV NECESSARY? Tarek Mikati , Addie Crawley, Demetre C. Daskalakis

984 POSTEXPOSURE PROPHYLAXIS NONCOMPLETION AND NONCONDOM USE IN FRANCE, 2004-2017 Pierre Gantner 1 , Clotilde Allavena 2 , Claudine Duvivier 3 , André Cabié 4 , Jacques Reynes 5 , Alain Makinson 5 , Isabelle Ravaux 6 , Laurent Cotte 7 , David Rey 1 , for the Dat’AIDS Study Group

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