CROI 2016 Abstract eBook

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Poster Abstracts

prescribing, even for high-risk and obviously eligible patients, may remain in the hands of HIV specialists, which is contrary to implementation goals. During initial implementation of PrEP, an additional role of HIV physicians may be to help PrEP seekers find a comfortable primary care home 892 Early Adopters and Incident PrEP Prescribing in a Detailing Campaign, 2014-2015 Zoe R. Edelstein 1 ; Paul M. Salcuni 2 ; Arjee Restar 1 ; Julie Myers 3 ; BenjaminTsoi 2 ; Demetre C. Daskalakis 1 1 New York City DHMH, Queens, NY, USA; 2 New York City DHMH, Long Island City, NY, USA; 3 New York City DHMH, Long Island City, NY, USA Background: Pre- and post-exposure prophylaxis (PrEP and PEP) for HIV are effective yet under-prescribed. The New York City (NYC) Health Department conducted a public health detailing campaign October 2014-April 2015. Representatives visited primary care (PC) and infectious disease (ID) providers to promote prescribing PrEP and PEP, focusing on practices that had recently diagnosed HIV among at-risk populations. Initial and follow-up visits (~5-8 weeks later) consisted of short, individual-level presentations. We examined characteristics associated with PrEP prescribing at initial visit (early adopter) and with prescribing at follow-up visit (incident prescriber). Methods: We included potential prescribers [MDs, nurse practitioners (NPs), and physician assistants (PAs)] reached for both initial and follow-up visits. Providers were identified as early adopters or incident prescribers based on self-report of ever prescribing PrEP at initial or at follow-up only, respectively. Characteristics examined were provider specialty/ training [PC-MD, ID-MD or NP/PA]; practice characteristics, including type [hospital-affiliated (HA), private practice (PP), community health clinic (CHC)]; location (Manhattan vs. other); neighborhood HIV diagnosis and poverty rates; report of prescribing post-exposure prophylaxis (PEP); and length of initial visit (min). Multivariate models were constructed using generalized estimating equations. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported with all characteristics adjusted for each other except PEP; PEP was adjusted for all others. Results: At initial visit, 18% (155/881) of providers at 492 facilities were early adopters. Among all others, 13% (89/709) of providers at 412 facilities reported incident prescribing. Early adoption was associated with ID-MD (Table); CHC practice type vs. PP (aOR 1.9, CI 1.1-3.2) and vs. HA (aOR 2.5 CI 1.4-4.5); Manhattan location (aOR 4.2 CI 2.5- 7.2); and PEP prescribing (Table). Incident prescribing was associated with ID-MD; previous and incident PEP prescribing; and initial visit length ≥10 min, with no additional increase seen ≥20 (Table). Conclusions: We observed early adoption and incident PrEP prescribing at NYC practices serving at-risk and potentially low-income populations. Prescribing PEP may be an important step for newly prescribing PrEP, supporting the promotion of PrEP and PEP in tandem. Detailing may have influenced new PrEP prescribing, particularly if the initial presentation was ≥10 min.

Poster Abstracts

893 Correlates of Uptake of HIV Prevention Interventions Among Black MSM in DC, 2013-2014 Matthew E. Levy 1 ; ChristopherWatson 2 ; Madhu Balachandran 2 ; Irene Kuo 2 ; LeoWilton 3 ; Russell Brewer 4 ; Sheldon Fields 5 ; James Peterson 2 ; Manya Magnus 2 1 George Washington Univ Milken Inst Sch of PH, Washington, DC, USA; 2 George Washington Univ, Washington, DC, USA; 3 State Univ of New York at Binghamton, Binghamton, NY, USA; 4 Louisiana PH Inst, New Orleans, LA, USA; 5 Charles R. Drew Univ of Med and Sci, Los Angeles, CA, USA Background: Eliminating racial HIV disparities among MSM will require a greater uptake of HIV prevention interventions among Black MSM (BMSM), the group with the highest HIV incidence in the US. However, interventions such as PrEP necessitate engagement in a health care system that often does not meet the needs of BMSM. This study examined correlates of the uptake of HIV prevention interventions among BMSM. Methods: We interviewed two non-clinic-based samples of BMSM in Washington, DC: (1) peer-referred men who were inadequately engaged in health care and/or reported barriers to care (n=75) and (2) an Internet-based sample recruited irrespective of health care characteristics (n=93). Participants reported on their uptake of HIV prevention interventions in a computer-assisted self-interview. A randomly selected subsample of those with barriers to care provided ethnographic data on health care experiences in a qualitative interview (n=30). Correlates of uptake of interventions were assessed using Chi-square tests. Results: Of 168 total BMSM, 61%were <30 years old, 86% had health insurance, and 81%were HIV-negative, 54% of whomwere offered an HIV test at their last health care visit. Among HIV-negative BMSM in the first sample with barriers to care, a higher proportion of those who sought care at community-based clinics received HIV prevention interventions (testing, counseling, or PrEP) at these visits (90%) compared to those who accessed primary (53%) or acute care (44%) settings (p=0.005). In the Internet-based sample, PrEP uptake was positively associated with having accessed a community-based clinic but not a primary or acute care setting in the last year (OR= 4.7; 95% CI: 1.6- 13.9), and was negatively associated with having private health insurance (OR=0.23; 95% CI: 0.08-0.92). In qualitative interviews, BMSM expressed preferences for receiving interventions at community-based clinics that were known to have culturally competent providers despite also often having access to private primary care providers. Conclusions: In a non-clinic-based sample of BMSM, reported uptake of HIV prevention interventions was highest in community-based clinics that were culturally sensitive to the unique health needs of BMSM. Having access to health insurance and to health care does not necessarily facilitate the uptake of HIV prevention interventions for BMSM. It is critical that all health care encounters regardless of the setting support the uptake of prevention interventions for those at highest risk of HIV. 894 HIV Preexposure Prophylaxis: Adherence and Discontinuation in Clinical Practice Julia L. Marcus 1 ; Leo B. Hurley 1 ; C. Bradley Hare 2 ; Dong Phuong Nguyen 2 ;Tony Phengrasamy 2 ; Michael J. Silverberg 1 ; Jonathan E.Volk 2 1 Kaiser Permanente Northern California, Oakland, CA, USA; 2 Kaiser Permanente Northern California, San Francisco, CA, USA Background: High adherence was critical to the efficacy of daily oral emtricitabine/tenofovir (FTC/TDF) preexposure prophylaxis (PrEP) in clinical trials. Low adherence or early discontinuation may reduce the effectiveness of PrEP in clinical practice.

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CROI 2016