CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

are needed. These data are encouraging that programmatic level adherence support may be sufficient to achieve PrEP uptake in motivated clients. 993 PERSISTENCE WITH PrEP USE IN AFRICAN ADOLESCENTS AND YOUNG WOMEN INITIATING PrEP Kenneth K. Mugwanya 1 , Jillian Pintye 1 , John Kinuthia 2 , Harrison Lagat 3 , Felix Abuna 3 , Emily R. Begnel 1 , Julia C. Dettinger 1 , Grace John-Stewart 1 , Jared Baeten 1 , for the PrEP Implementation for Young Women and Adolescents Program Team 1 University of Washington, Seattle, WA, USA, 2 Kenyatta National Hospital, Nairobi, Kenya, 3 University of Washington in Kenya, Nairobi, Kenya Background: Young women in HIV high burden settings are a priority population for PrEP. Limited data are available on PrEP continuation in this population in real world settings. Methods: Data are from the PrEP Implementation for Young Women and Adolescents (PrIYA) project, an implementation program of PrEP integrated in maternal child health (MCH) and family planning (FP) clinics. Between November 2017 and June 2018, women 15-45 years seeking antenatal (ANC), postnatal (PNC) and FP services in 16 health facilities in Kisumu, Kenya were universally screened and offered PrEP according to national guidelines. We assessed for PrEP use and continuation and used robust Poisson regression methods to identify correlates of continuation at 3 and 6 months adjusted for age, marital status, partner HIV status, PrEP delivery point, and facility clustering. Medication possession ratio, assumed to represent PrEP use, was computed as the ratio of the number of tablets dispensed divided by the number of days between initiation and return date, with ratios >1 imputed to 1. Results: Of 2304 women initiated on PrEP [912 in ANC, 1114 in PNC, and 278 in FP], median age was 24 years (IQR 21-29), 58% had partner of unknown HIV status, and 96% reported recent history of condomless sex. Continuation at 1, 3, and 6 months was 38%, 21%, and 10% overall: 34%, 18%, and 8% for ANC; 39%, 24%, and 10% for PNC; and 41%, 25%, and 15% for FP. Of those continuing PrEP at Month 1 (n=866), median medication possession ratio was 1 (IQR: 0.86-1). Overall, continuation at 3 months was independently higher for women with HIV positive partners (positive 52%, unknown 19%, negative 18%; p<0.01) and in older women (<20 years 23%, 20-24 years 18%, 25-34 years 22%, and ≥35 years 37%; p=0.02). Only partner HIV status was independently associated with 6 month continuation (positive 30%, unknown 8%, negative 8%; p<0.01). Frequently reported reasons for discontinuing PrEP use were low perceived risk for HIV (23%), side effects (19%), pill burden (17%), and partner known to be HIV negative (17%). Conclusion: Integration of universal screening and counseling for PrEP in routine MCH and FP clinics in Kenya was feasible. There was high drop-off in PrEP continuation, but subset of women persisted with PrEP use through at least 6 months. Greater efforts to support PrEP normalization and persistence for African women are needed. 994 HIGH ADHERENCE AMONG YOUNG WOMEN IN CAPE TOWN IN THE FIRST 3 MONTHS AFTER PrEP START Connie L. Celum 1 , Katherine M. Gill 2 , Jennifer F. Morton 1 , Gabrielle Stein 1 , Ariane van der Straten 3 , Jared Baeten 1 , Margaret McConnell 4 , Menna Duyver 2 , Eve Mendel 2 , Keshani Naidoo 2 , Laura Myers 2 , Lubbe Wiesner 5 , Linda-Gail Bekker 2 1 University of Washington, Seattle, WA, USA, 2 Desmond Tutu HIV Foundation, Cape Town, South Africa, 3 RTI International, Berkeley, CA, USA, 4 Harvard University, Boston, MA, USA, 5 University of Cape Town, Cape Town, South Africa Background: In placebo-controlled PrEP trials, African adolescent girls and young women (AGYW) had low adherence; only 25-30% had any detectable tenofovir in blood samples. PrEP use may be higher when efficacy is known, as demonstrated among men who have sex with men (MSM) in open label studies. The 3P demonstration project was designed to evaluate PrEP demand creation, uptake, and adherence among AGYW in South Africa. Methods: We enrolled 200 sexually active, HIV negative, PrEP-naïve AGYW ages 16-25 in Cape Town, South Africa fromMarch 2017-2018, with visits at 0,1, 2, and 3 months. PrEP adherence was assessed by intracellular tenofovir diphosphate (TFV-DP) concentrations in dried blood spots, a measure of cumulative use in the prior month. All women received adherence counseling, including feedback about their drug levels at months 2 and 3. TFV-DP ≥700 fmol/punch was chosen as the threshold for high adherence, based on directly observed dosing (correlates with ≥4 doses/week and associated with high efficacy in MSM). Half of women were randomized to receive a 200 Rand ($13) incentive at 2 and 3 months if their TFV-DP was ≥700 at the prior visit.

Poster Abstracts

992 HIGH PrEP USE IN AFRICAN MEN AND WOMEN CONTINUING PrEP IN PUBLIC-HEALTH HIV CLINICS Elizabeth M. Irungu 1 , Kenneth K. Mugwanya 2 , Elizabeth A. Bukusi 1 , Nelly R. Mugo 1 , Josephine Odoyo 1 , Elizabeth Wamoni 1 , Kenneth Ngure 2 , Jennifer F. Morton 2 , Gabrielle O’Malley 2 , Sarah Masyuko 3 , Irene Mukui 3 , Jessica E. Haberer 4 , Peter L. Anderson 5 , Jared Baeten 2 , for the Partners Scale-Up Project Team 1 Kenya Medical Research Institute, Nairobi, Kenya, 2 University of Washington, Seattle, WA, USA, 3 Ministry of Health, Nairobi, Kenya, 4 Massachusetts General Hospital, Boston, MA, USA, 5 University of Colorado, Aurora, CO, USA Background: Adherence is central to the protective effectiveness of pre- exposure prophylaxis (PrEP) against HIV infection. Limited data are available on adherence in persons initiating and continuing PrEP in real world PrEP programs in Africa. Methods: The Partners Scale-Up Project is an ongoing cluster-randomized programmatic evaluation of national scale-up of PrEP delivery, primarily for HIV serodiscordant couples, integrated in 24 public health HIV care clinics in Kenya. Dried blood spots (DBS) were collected from individuals taking PrEP from randomly-selected clinics on a random subset of days each month. Intracellular tenofovir-diphosphate (TFV-DP) concentrations were quantified in DBS using validated liquid chromatography-tandemmass spectrometry. Results: Between February 2017 and October 2018, 3761 initiated PrEP, median age was 31 years [IQR: 26-39], 3208 (85%) reported an HIV-positive partner, and 3487 (93%) reported recent condom use. A total of 2009 (53%) were women of whom 230 (11%) used PrEP while pregnant (130 were pregnant at PrEP initiation and 100 became pregnant while on PrEP). Among those who became pregnant while on PrEP, 47 (47%) reported intending to conceive, while 18 (18%) had not planned to get pregnant at baseline. Of all initiating PrEP, 2444 (65%) continued PrEP (≥1 refill in 3 months). Continuation was independently more likely for those >30 years (68% vs 61% for ≤30 years, p<0.01), those with an HIV+ partner (68% vs 45%, p<0.01), and for women (66% vs 63% for men; p=0.04) but did not differ by pregnancy status (68% pregnant vs. 66% not pregnant; p=0.63). A total of 71 DBS were testedat a median duration of PrEP use of 1 month (range 1 to 4). Evidence of PrEP use was high with TFV-DP detectable in 68 (96%) of DBS samples; the median TFV-DP concentration was 515 fmol/ punch (IQR: 348 to 693) comparable to the estimate for ≥4 doses per week from a directly observed dosing study in the US. DBS TFV-DP concentrations were similar (p>0.05) by sex, age, and desire to conceive. Conclusion: In a Kenyan PrEP program setting, PrEP uptake was high and was taken by men and women, including pregnant women. TFV-DP was detected in 96% of blood samples of persons continuing PrEP and levels suggested relatively consistent adherence; thresholds specific to African populations

CROI 2019 389