Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi

Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care

"We don't treat your kind": Assessing HIV health needs holistically among transgender people in Jackson, Mississippi.

HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barriers and facilitators to accessing healthcare, including and beyond HIV, from the perspective of transgender men and women in Mississippi. Between June-August 2014, in-depth, semi-structured qualitative interviews (n = 14) were conducted with adult transgender persons at an LGBT healthcare setting in Jackson, Mississippi. In-depth interviews lasted between 60-90 minutes and followed semi-structured format (themes probed: HIV vulnerability, healthcare needs, and availability of gender-affirming medical care). Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18). Among participants (mean age = 23.3 years, standard deviation = 4.98), 43% identified as a transgender man or on a transmasculine spectrum, 43% as Black, and 21% self-reported living with HIV. HIV-related services were frequently described as the primary gateway to accessing healthcare needs. Nonetheless, participants' primary health concerns were: gender affirmation processes (hormones, silicone, binding/packing); mental health; and drug/alcohol use. Stigma and discrimination were commonly reported in healthcare settings and health-related information was primarily attained through social networks and online resources. Results highlight gender identity alongside race and pervasive marginalization as key social determinants of transgender health in Mississippi. As Mississippi is one of several states actively debating transgender access to public accommodations, findings underscore the need to treat transgender health as a holistic and multidimensional construct, including, but moving beyond, HIV prevention and care

A Pharmacist-Led, Same-Day, HIV Pre-Exposure Prophylaxis Initiation Program to Increase PrEP Uptake and Decrease Time to PrEP Initiation

Mississippi has one of the highest rates of HIV in the United States, but has low pre-exposure prophylaxis (PrEP) uptake, particularly among black men who have sex with men (MSM) and women. From November 2018 to May 2019, patients at high risk of HIV who tested negative for HIV at a nonclinical testing center in Jackson, Mississippi, were referred to an on-site clinical pharmacist for same-day PrEP initiation. The pharmacist evaluated patients for medical contraindications to PrEP, but no baseline labs were obtained. The pharmacist provided a PrEP prescription and scheduled a clinical appointment for patients within 6 weeks, at which time they were evaluated by a clinician and completed baseline labs. The pharmacist evaluated 69 patients for PrEP; 57% were MSM, 77% were black, and 65% were uninsured. All patients received a PrEP prescription; 83% received the prescription the same day and 97% received it within 5 days. Fifty-three (77%) of 69 clients filled the prescription; 87% of whom filled it within 1 week. Only 23 (43%) of 53 clients who filled their prescription attended their initial clinical appointment within 6 weeks of obtaining PrEP. There were no differences in PrEP initiation or retention by patient sex/gender. This pilot program suggests that an on-site pharmacist working in a nonclinical testing center in the southern United States can successfully initiate PrEP among predominately low-income black MSM. Future efforts should seek to better integrate laboratory testing into this demedicalized model of PrEP and to improve retention in care

Women's willingness to experiment with condoms and lubricants: A study of women residing in a high HIV seroprevalence area

The objective of this study was to investigate women's willingness to experiment with new condoms and lubricants, in order to inform condom promotion in a city with high rates of poverty and HIV. One hundred and seventy-three women (85.9% Black) sexually transmitted infection clinic attendees in Jackson, Mississippi, United States completed a questionnaire assessing willingness to experiment with condoms and lubricants and sexual pleasure and lubrication in relation to last condom use. Most women were willing to: (1) experiment with new types of condoms and lubricants to increase their sexual pleasure, (2) touch/handle these products in the absence of a partner, and (3) suggest experimenting with new condoms and lubricants to a sex partner. Previous positive sexual experiences with lubricant during condom use predicted willingness. The role women may play in male condom use should not be underestimated. Clinicians may benefit women by encouraging them to try new types of condoms and lubricants to find products consistent with sexual pleasure

Recovery does not always signal the end of the battle: A case of post SARS-CoV-2 multisystem inflammatory syndrome in an adult

We describe a case of SARS-CoV-2 post-infectious inflammatory syndrome in an adult who presented with multiorgan failure two months following his initial diagnosis of SARS-CoV-2 infection. This case highlights clinician’s early recognition of this devastating sequela and challenges in appropriate management of this patient

P2.33 Co-occurrence of trichomonas vaginalis and bacterial vaginosis among women; prevalence and treatment outcomes

IntroductionBoth Trichomonas vaginalis (TV) and bacterial vaginosis (BV) cause vaginitis and place women at higher risk for HIV infection. Both are treated with metronidazole (Mtz) but at different doses. The purpose of this study was to examine the co-occurrence of these infections and BV treatment outcomes among TV+/BV+ women multi-dose Mtz for the treatment of TV.MethodsWomen attending three sexually transmitted disease clinics in the southern US who had a diagnosis of TV (culture or NAAT confirmed) were interviewed and examined for BV using a Nugent score ≥7. Women were randomised to either 2 g single dose or 500 mg Mtz BID for 7 days multi-dose for the treatment of TV and followed 3–12 weeks post TV treatment and retested for both TV and BV. Medical records were abstracted for Amsel criteria for a subset of the cohort. ResultsOf 528 TV+ women at baseline, 49.8% also had BV per Nugent score, 44.3% reported a history of BV and 5.9% also had yeast. Of 289 women whose medical records were abstracted, 23.5% had a vaginal discharge consistent with BV (i.e. thin and white/grey), and 34.1% were BV+ per Amsel at baseline. Of the 46 women who were BV+ at baseline per Amsel (i.e. diagnosed at point of care) and per Nugent (i.e. lab diagnosed) and were treated with multi-dose Mtz, 96% reported taking all their medicine. While 36% of these women reported condomless sex during follow-up, there was no association between sexual exposure and BV status at TOC. Of these 46 women, 42.9% remained BV+ at TOC and 19.4% reported BV-related symptoms. BV status at TOC was not associated with TV cure rates (p>0.56).ConclusionA high rate of BV co-infection (49.8%) was found among women with TV, much of which was asymptomatic. The rate of BV persistence post multi-dose Mtz was also high both microbiologically (42.9%) and clinically (19.4%) and did not appear to be influenced by TV treatment status. Additional research and development of novel therapeutics (i.e. biofilm disruptors) are urgently needed for women with BV, particularly among TV+ women where BV rates are high

1554. Facilitators and Barriers to Engaging in PrEP and Gender Affirming Therapy for Black and Latina Transgender Women in South Florida

Abstract Background Black and Latina transgender women (BLTW) have the highest HIV rates among transgender women (Black: 62%, Latinx: 35%). PrEP-GAT is an EHE grant which evaluated barriers and facilitators to engagement in PrEP and gender affirming therapy (GAT) services and the use of friendship networks to promote these interventions. Methods Participants were recruited through the University of Miami’s GenWell Service, which provides bundled PrEP and GAT. This study has two components: qualitative and social networks. Qualitative component: 20 in-depth interviews focused on barriers and facilitators to PrEP and GAT services using Consolidated Framework for Implementation Research (CFIR) constructs. Data was analyzed using thematic analysis. Social network component: 27 social network-based interviews identified friendship dynamics that could promote conversations and encouragement to engage with PrEP and GAT. Analysis included multilevel logistic regression using R and network visualizations using UCINET. Results Qualitative Component. Barriers to accessing PrEP and GAT services included cost, need for Spanish-language materials, bias, stigma, and discrimination. Facilitators included access to telehealth, mobile services, pharmacists, and co-located PrEP-GAT services. BLTW were not comfortable disclosing their HIV status due to HIV stigma. “HIV clinics” discouraged individuals from seeking services. Social network component: most participants were using GAT (75%), and more than half reported lifetime PrEP use (56%). Bivariate analysis: having a Latinx friend, a friend who shared GAT status, and higher emotional closeness were associated with future conversations about PrEP and GAT (p< 0.05). Multilevel model: emotional closeness was associated with future conversations about PrEP and GAT (p=0.02). Conclusion Mental health, legal, employment and housing services are needed to meet BLTW access to PrEP. Social network approaches can identify key individuals in BLTW friendship networks to promote and disseminate information about PrEP and GAT. Future Directions: Future research will determine whether bundled PrEP-GAT, social network support, and telehealth is effective to increase BLTW’s engagement in these services. Disclosures Susanne Doblecki Lewis, MD, MSPH, FIDSA, Gilead Sciences: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Suppor