P448 Are we enrolling men who have sex with men with greatest HIV acquisition risk in a pre-exposure prophylaxis program?. (14th July 2019) - Fields, Errol
Abstract : Background: Black men who have sex with men (BMSM) experience severe HIV disparities. Pre-exposure prophylaxis (PrEP) is a potential tool for reducing disparities especially when those at greatest risk are prioritized for PrEP delivery. To evaluate whether IMPACT, a multi-site PrEP demonstration project, enrolled MSM at greatest risk, this study examined associations between age, race, and HIV risk factors with PrEP program enrollment. Methods: Age, (13–24, 25+), race (non-Hispanic black, non-Hispanic white, other), HIV risk factors (STI diagnosis, multiple partners in past 3 months and HIV-positive partner, condomless sex in past 12 months), and PrEP program enrollment (receipt AND acceptance of referral to PrEP provider) were collected from September 2015 through March 2018 for HIV-negative MSM screened by IMPACT. Multivariable logistic regression was used to determine the association between age, race, and HIV risk factors with PrEP program enrollment. Results: IMPACT screened 1883 MSM and enrolled 1413(75.0%). 1231(65.4%) were non-Hispanic black; 484(25.7%) were 13–24; 593(31.5%) had recent STI; 802(43%) reported multiple sex partners; 832(44%) reported condomless sex and 325(17.3%) reported an HIV-positive sex partner. Individuals with black race (compared to white) (AOR=0.2; 95% CI=0.15–0.31), an HIV-positive sex partner (AOR=0.32; 95% CI=0.24–0.42), and a recent STI (AOR=0.30; 95% CI=0.24–0.39) were significantly less likely to be enrolled. Individuals with multiple partners (AOR=1.34; 95% CI=1.04–1.73), age 13–24 (AOR=1.99; 95% CI=1.49–2.65), and condomless sex (AOR=2.24; 95% CI=1.74–2.88) were significantly more likely to be enrolled. Conclusion: These findings suggest significant barriers to PrEP enrollment for BMSM which may widen rather than reduce HIV disparities. Importantly, youth and MSM reporting condomless sex and multiple partners were more likely to be enrolled. Yet, negative associations between enrollment and black race, recent STI, HIV-positive sex partners suggest critical challenges engaging MSM at greatest risk for HIV which may diminish PrEP effectiveness as a public health prevention tool if unaddressed. Disclosure: No significant relationships. ART, PrEP, gay bisexual and other men who have sex with men, USA