2078. Barriers and Facilitators to the HIV (PrEP) Care Continuum: Perspectives of Key Stakeholders and Formerly Incarcerated Individuals.

Abstract

Abstract Background Recently incarcerated individuals are at increased risk for HIV acquisition during community re-entry but have poor access to HIV pre-exposure prophylaxis (PrEP). There is an opportunity to integrate PrEP into an existing Formerly Incarcerated Transition (FIT) program in North Carolina (NC). We aimed to explore potential barriers and facilitators to post release PrEP implementation within the existing FIT program from the perspectives of formerly incarcerated individuals (FIT clients) and community stakeholders (community health clinicians, community health workers). Methods We conducted 28 semi-structured in-depth interviews (14 FIT clients and 14 community stakeholders). We used a rapid assessment method to summarize interview transcripts based on the domains of the semi-structured interview guide and to characterize the contents of the summaries as potential barriers or facilitators to steps of the PrEP cascade. Results HIV stigma was mentioned as a potential barrier at each step of the PrEP cascade among both FIT clients and stakeholders. Both groups emphasized the importance of PrEP education for FIT clients, stakeholders, and the community to facilitate awareness and HIV risk perception. Stakeholders and FIT clients believed that competing priorities would be a significant barrier to PrEP uptake post-release. Linking incarcerated individuals to PrEP services during incarceration was mentioned as a facilitator to increase PrEP uptake. A lack of ongoing social support was seen as a critical barrier by FIT clients to achieve the necessary adherence to PrEP and retention to PrEP appointments. Both groups cited financial and logistical challenges such as the cost of PrEP services and transportation as potential barriers to PrEP adherence and retention. Conclusion Community stakeholders and FIT clients recommended several strategies that can be implemented to increase PrEP knowledge, uptake, and retention upon release. However, they also identified critical structural barriers that must be overcome before PrEP can be adopted among formerly incarcerated individuals in a non-Medicaid expansion state. Disclosures All Authors: No reported disclosures.