CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

Results: Women enrolled in 3P were young (median age 19) and at high risk for HIV; 30% had an STI (chlamydia, gonorrhea or trichomonas), 19% reported IPV, 13%weekly alcohol use and 71%who had a primary partner reported suspecting he had other partners . Retention was 89% at month 3. All but one sample had detectable TFV-DP, and median TFV-DP at months 1, 2, and 3 were 622, 707, and 694 fmol/punch, respectively. Half of AGYW had high (TFV-DP ≥700 fmol/punch) and ~80 % had medium (TFV-DP 350-699 fmol/punch) or greater adherence at months 2 and 3 (Figure). In univariate analyses, significant baseline correlates of TFV-DP ≥700 fmol/punch at month 3 included having an HIV positive partner or a partner of unknown serostatus (OR 2.0, 95% CI 1.1, 3.8), reporting no sex in the month before enrollment (OR 2.3, 95% CI 1.1, 4.9) and disclosure about their PrEP use (OR 3.5, 95% CI 1.0, 15.9). Conclusion: PrEP adherence was higher in this demonstration project than previous placebo-controlled trials among African AGYW. Intracellular TFV-DP levels indicate that by 2 months half of AGYWwere taking the majority of doses in the prior month. Having a partner of unknown or positive serostatus and disclosure about their PrEP use were associated with higher adherence; disclosure about PrEP should be supported among AGYW.

fmol/punch (2-3 doses/week). Baseline predictors of 3 month TFV-DP levels were assessed. Results: Of 427 who started PrEP, median age was 21 and median VOICE risk score was 7 (≥5 associated with >6% HIV incidence in prior cohorts). Most (84%) reported a primary sex partner (74% HIV-, 21% unknown status, and 1% HIV+). 33% thought their partner had other partners and 47% did not know. 22% reported anal sex in the past month, 23% transactional sex in the past 3 months, 50% intimate partner violence in the past year, and 49% depression symptoms. Among the 381 with a 3 month visit, 69% had attended ³1 adherence club (median 2). Median TFV-DP at month 3 was 485 fmol/punch (IQR 166,775): 25% ³700, 23% 350-699, 36% detectable<349 and 16% undetectable. Significant predictors (p-value<0.05) of TFV-DP levels at 3 months in multivariate analysis were uncertainty if their partner had other partners (145 fmol/punch lower vs. those who reported their partner did not have other partners) and a higher score on the HIV prevention readiness scale (5 fmol/punch higher for each unit on 100 point scale). Conclusion: Three months after starting PrEP, TFV-DP levels indicated that most young African women were taking PrEP in the prior month and 25% had high adherence, substantially higher than in the placebo-controlled trials which showed 25-30% had detectable tenofovir in plasma. Additional adherence support may be useful for young African women who are uncertain about their partner’s behavior and are less sure about using PrEP. Halli S. Olsen 1 , William J. Reidy 1 , Nadine Mushimbele 1 , Richted Tenda 1 , Tania Tchissambou 1 , Faustin Malele 1 , Gaston Djomand 2 , Trista Bingham 2 , Jacob Dee 3 , Elie Mukinda 3 , Raimi Ewetola 3 , Julie Franks 1 1 ICAP at Columbia University, New York, NY, USA, 2 CDC, Atlanta, GA, USA, 3 CDC, Kinshasa, Congo, The Democratic Republic of the Background: In the Democratic Republic of the Congo (DRC), HIV is concentrated in key populations (KP), primarily among female sex workers (SW) and men who have sex with men (MSM), with prevalence estimates of 7% and 18% respectively, compared to 1.2% in the general population. Pre-exposure prophylaxis (PrEP) to prevent HIV acquisition can impact the epidemic if made accessible to KP at trusted delivery points. In the absence of national PrEP guidelines, DRC’s National AIDS Control Program, US Centers for Disease Control and Prevention, and ICAP at Columbia University collaborated to implement PrEP services for a limited number of clients at 7 HIV facilities providing regular services to KP in DRC. We examined PrEP initiation and retention at these facilities. Methods: ICAP developed a PrEP training package to capacitate staff to deliver and monitor PrEP services at 4 facilities in Kinshasa and 3 in Lubumbashi. Active follow-up of PrEP patients included text message, phone, and face-to-face appointment reminders by both facility staff and peer outreach workers. PrEP initiation and follow-up visits were recorded by facility staff using ICAP- developed tools; data were summarized into aggregate reports by project staff. Retention on PrEP at 1 and 3 months was defined as a documented clinic visit within 14 days before or after the scheduled 1 month appointment date, and within 30 days before or after the 3 month appointment date. This analysis included data for patients initiating PrEP between February 20th to May 20th, 2018. Results: During the enrollment period, 356 patients initiated PrEP; 57% (202) in Kinshasa and 43% (154) in Lubumbashi. PrEP patients were 80% (285) SW, 19% (68) MSM, and 1% (3) transgender (TG). Overall retention at 1 month following initiation was 78% (277), including 74% (212) among SW, 94% (64) among MSM, and 33% (1) among TG. Overall 3-month retention was 93% (331); including 92% (262) among SW, 99% (67) among MSM, and 67% (2) among TG. Conclusion: Comprehensive training and clinic monitoring resulted in the successful introduction of PrEP in DRC. Although 22% of patients did not attend their 1 month appointment, increased outreach efforts led to improved 3 month retention for all clients. Focused efforts are needed to ensure high retention in PrEP services among these populations. Project findings will support the scale-up of PrEP in other impacted populations and facilities in DRC. 997 PREEXPOSURE PROPHYLAXIS: ACCEPTABILITY AND RETENTION IN SOUTH WESTERN UGANDA Joseph Kagaayi 1 , James Batte 2 , Gertrude Nakigozi 2 , Hadijja Nakawooya 2 , Boniface Kigozi 2 , Dorean Nabukalu 2 , Godfrey Kigozi 2 , Helena Nordenstedt 3 , Anna 996 SHORT-TERM RETENTION ON PREEXPOSURE PROPHYLAXIS IN DEMOCRATIC REPUBLIC OF THE CONGO

Poster Abstracts

995 ADHERENCE 3 MONTHS AFTER PrEP INITIATION AMONG YOUNG AFRICAN WOMEN IN HPTN 082 Connie L. Celum 1 , Nyaradzo Mgodi 2 , Linda-Gail Bekker 3 , Sybil Hosek 4 , Deborah J. Donnell 5 , Peter L. Anderson 6 , Bonnie J. Dye 7 , Subash Pathak 5 , Yaw Agyei 8 , Keolopile Makgamathe 9 , Sheetal Kassim 3 , Shorai Mukaka 2 , Heather Noble 5 , Adeola Adeyeye 10 , Sinead Delany-Moretlwe 9 1 University of Washington, Seattle, WA, USA, 2 University of Zimbabwe, Harare, Zimbabwe, 3 Desmond Tutu HIV Foundation, Cape Town, South Africa, 4 Stroger Hospital of Cook County, Chicago, IL, USA, 5 Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 6 University of Colorado, Aurora, CO, USA, 7 FHI 360, Durham, NC, USA, 8 Johns Hopkins University School of Medicine, Baltimore, MD, USA, 9 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 10 DAIDS, NIAID, Rockville, MD, USA Background: Pre-exposure prophylaxis (PrEP) is highly effective when used consistently. Young women in sub-Saharan Africa are at high risk of HIV and could benefit from PrEP. We evaluated PrEP adherence in young women in the context of known efficacy and open label use. Methods: HPTN 082 was conducted in Cape Town, Johannesburg (South Africa) and Harare (Zimbabwe) to evaluate the effect of drug level feedback on adherence. Sexually active HIV-negative women ages 16-25 were enrolled using the VOICE risk score and a PrEP readiness scale. Women starting PrEP were randomized to standard adherence support (counseling, 2-way SMS, and adherence clubs) or standard support plus drug level feedback at 2 and 3 months. Follow-up was 1, 2, 3, 6, 9 and 12 months. Adherence at 3 months was assessed by tenofovir-diphosphate (TFV-DP) in dried blood spots. High adherence is defined as TFV-DP >700 fmol/punch (>4 doses/week), which was associated with high protection in men, and medium adherence as 350-700

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