HIV Prevention Research Articles

P-505. Integrating PrEP Services into a Gynecology Clinic in Alabama: A Qualitative Analysis of Key Determinants

Abstract Background In the Southeastern United States, Black women are disproportionately diagnosed with HIV compared to White women. Client-centered approaches are needed to increase uptake of HIV prevention tools, including pre-exposure prophylaxis (PrEP). Gynecology (GYN) clinics are uniquely positioned to provide PrEP for women and Black women prefer receiving PrEP from GYN providers, but PrEP delivery in GYN settings has been limited. Thus, we evaluated barriers and facilitators to PrEP provision in GYN clinics. Methods From 08/2022-04/2023, we conducted dyadic focus groups and in-depth interviews with providers (i.e., physicians, nurses, and medical assistants) and clients accessing care at a university-affiliated GYN clinic in Alabama where clients face high STI burden. Interview guides grounded in the Information-Motivation-Behavioral Skills Model explored barriers to PrEP service delivery. Inductive qualitative analysis identified emergent themes from transcripts. Results 10 providers and 21 clients (100% Black, 100% female, median age 32 (range 19-44), 90.5% insured (67% with Medicaid)) were interviewed. Emergent themes included: (1) Sexual health – including STI/HIV prevention – as part of routine women’s healthcare. Providers preferred a risk-based approach to sexual healthcare while clients preferred a sex-positive approach. (2) Incorporation of PrEP services into women’s healthcare. Both clients and providers supported that PrEP is important for women’s health. Providers felt PrEP discussions should be limited to specific visits whereas clients desired regular discussions of PrEP. (3) Multi-level barriers for PrEP service delivery in GYN clinics. Barriers included limited client and provider PrEP knowledge, inadequate clinic resources, financial costs, and STI/HIV stigma. Conclusion Incorporating PrEP services into GYN clinics could increase PrEP uptake amongst Black women. Effective multi-level interventions should focus on increasing client and provider PrEP knowledge, integrating sexual health history assessment into routine care, mitigating STI/HIV stigma, and addressing structural barriers. Disclosures Latesha Elopre, MD, Merck: Grant/Research Support

P-950. Pre-Exposure Prophylaxis Education for Internal Medicine Residents (PRIMER)

Abstract Background Pre-exposure prophylaxis (PrEP) for HIV is a safe and effective strategy for HIV prevention among high-risk patient groups. Despite consistent experimental and real-world data showing benefit, PrEP is underutilized. There is a dearth of non-specialized providers engaging in PrEP services. The purpose of this project is to increase knowledge and prescribing of PrEP among a cohort of internal medicine (IM) residents. Methods A 3 hour interactive education session was provided to the IM residents of the University of Connecticut Categorical Internal Medicine Residency. Baseline knowledge was assessed with a pre-training survey. This survey was repeated up within six months to assess for a change in PrEP knowledge and prescribing. Results The pre-intervention (pre) survey was completed by 39 IM residents. The post-intervention (post) survey was completed by 25 IM residents from the same cohort. 4 participants from the post group were excluded as they had not completed a pre survey. Similar proportions indicated PrEP awareness pre- and post-intervention 97.4% and 100%, respectively. There was a numeric increase in the proportion of respondents reporting knowledge of PrEP indications from 69.2% pre to 85.7% post. Similar proportions reported prescribing PrEP 15.4% pre and 14.3% post. Those who had prescribed PrEP reported providing it to only 1-5 patients. When assessing for paired differences among a sub-set of participants who had both pre- and post scores, general knowledge of PrEP significantly improved. General knowledge scores averaged 8.6% pre and 22.6% post (p-value 0.001). Of the five general knowledge questions – testing individual domains -- the mean differences between pre and post scores were: 0.6 (95% CI 0.3-1.0), 0.2 (0.04-0.4), 0.05 (-0.1-0.2), 0.2 (0.007-0.4), 0.05 (-0.05-0.1), and 0.3 (0.08-0.5), respectively. Indicating that in all but 2 domains the 95% confidence interval did not include 0. Conclusion Among a cohort of IM residents from a mid-sized, university-based program, general PrEP knowledge was low despite widespread awareness. Knowledge was improved following an educational session; however, prescribing did not increase. Other barriers besides knowledge likely impact the likelihood of generalists, and in particular learners, to prescribe PrEP. Disclosures All Authors: No reported disclosures

P-509. Impact of an Innovative Educational Initiative Using Community-Based Organization Partnerships to Reach Young Adults at Risk for HIV

Abstract Background Young adults (YA) are particularly vulnerable to acquiring HIV due to low self-perceived risk, low rates of HIV testing, and lack of knowledge/awareness about pre-exposure prophylaxis (PrEP). Methods Between 3/23 – 8/23, six education sessions for YAs were conducted in the Southeastern U.S. by local healthcare professionals (HCPs) along with community-based organizations (CBOs) in non-clinical settings (e.g. college campuses, breweries). Pre- and post-surveys were administered, with follow-up surveys 3 weeks later. A scale-up education toolkit was disseminated to HCPs nationwide. Results A total of 264 YAs participated in the education sessions (mean age: 24 years; 85% female; 54% Caucasian; 87% heterosexual) with 29% previously tested for HIV and 21% who previously discussed PrEP with a HCP. YA’s knowledge of different forms of PrEP improved significantly (38% pre- vs. 96% post-activity; p < 0.001) as did their confidence in protecting themselves from acquiring HIV (55% pre vs. 93% post; p < 0.001). In addition, awareness of local resources for HIV testing improved from 60% to 93% (p < 0.001) with a significant increase in YAs who stated they were likely to get tested for HIV (26% pre vs. 63% post, p < 0.001). Seventy-five HCPs and CBO leaders also participated. Interestingly, there was a disconnect between CBO/HCPs’ perceptions of barriers to HIV/STI testing compared to YAs’ reported challenges (Fig 1). All providers stated they were likely/very likely to organize another session. A follow-up survey of HCPs (N = 10) found they helped 58 YAs access HIV testing and 33 access PrEP since the education, with 70% of HCPs using the materials during 1:1 counseling with YAs, suggesting sustainability of the resources. HCPs (N = 867) who reviewed the toolkit had improvements in their confidence in differentiating between PrEP options and identifying who would benefit from each approach (p < 0.001) and counseling YAs about PrEP (p < 0.001). Conclusion Providing HIV prevention education to YAs in informal, community settings increases reach to those who may not have these discussions with their HCPs during regular visits. This type of educational initiative, which includes partnering with CBOs, is scalable and sustainable. Disclosures Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant Kelly E. Pillinger, PharmD, AHFS: Contractor

P-964. Case-Based Learning Outcomes for Pre-Exposure Prophylaxis Education for the Preventative Medicine Plus One Maternal Health Track

Abstract Background As HIV prevention methods continue to develop with new agents added for Pre-Exposure Prophylaxis (PrEP). Prep uptake has remained low among US women since its approval in 2012. One major barrier to increasing PrEP uptake remains lack of knowledge of PrEP among patients and providers and lack of access to PrEP care in regions with high HIV prevalence. This study aims to increase PrEP knowledge and medical competence among Maternal Health Track Preventive Medicine residents at a single academic center in Southern California. Pre-Test and Post-Test Scores and % Improvement A pre-test was given at the start of each module. The same questions were made into a post-test after the curriculum was completed. Open and closed book portions were offered, and the % improvement was recorded. Methods Three Preventative Medicine Fellows from Family Medicine and Obstetrics and Gynecology backgrounds enrolled in multidisciplinary curriculum involving women’s health. A series of twelve case-based lectures were completed from July 2023 through December 2023. Each four-hour session included a pre-test, lecture, and a problem-based learning module. Simultaneous, they provided direct care for women in a combined clinic for PrEP and HIV care weekly for 3-6 months. In March 2024, the pre-test questions were combined into 47 post-test questions. Results Two of the three fellows had improvement in the closed book portion of the exam with a mean improvement of 9.5%. However, all of them had significant improvement for the open book exam with an average improvement of 16.2%. This suggests that although the memory retention of the material can wane with time, the ability to use resources to address clinically challenging questions has been strengthened. Of note, the questions were designed to simulate the American Academy of HIV Medicine (AAHIV) certification exam, which is an open-book test. Conclusion The combination of lectures, self-assessments, case-based discussions, and clinical experience has enhanced the fellows’ knowledge of PrEP care for women based on the improvement of exam scores after the curriculum. This will enhance their ability to provide multidisciplinary preventative care for women in underserved areas. Disclosures Kristin A. Carr, MD, Preventive Medicine Plus One Maternal Health Track: Grant/Research Support

P-978. Internal Medicine Resident Perceptions of the Barriers to and Facilitators of Optimal Inpatient Care of Persons who Inject Drugs: A Mixed Methods Study

Abstract Background Harm reduction counseling and HIV pre- and post-exposure prophylaxis (PrEP and PEP) can prevent infectious complications among persons who inject drugs (PWID). Hospitalizations are opportunities to provide these services, though these interventions occur infrequently for PWID admitted to our hospital. Little is known about internal medicine resident (IMR) perceptions of these interventions in the inpatient setting despite their frontline role in patient care in our institution. Methods In our mixed methods study we describe IMR perceptions of HIV prevention interventions and harm reduction counseling among PWID admitted to the University of Wisconsin Hospital. We conducted a survey examining current practices and perceptions. We explored the barriers and facilitators to optimizing these practices through semi-structured interviews. Transcripts were analyzed via consensus coding using the Systems Engineering Initiative for Patient Safety (SEIPS) model as a guiding conceptual framework. This framework describes the interactions of five components of complex work systems and their individual and overlapping influence on patient outcomes: 1) organization, 2) person, 3) physical environment, 4) task, and 5) technology and tools. Results 59 IMRs responded to the survey (58% response rate). Residents report offering HIV-PrEP or HIV-PEP to PWID at low frequency; 56% never offer PrEP and 64% never offer PEP. 20% or fewer IMRs report offering PrEP or PEP at least some of the time. IMRs report a high degree of importance and appropriateness of HIV prevention interventions; however, the majority lack comfort, familiarity, or competence in how to counsel patients or prescribe PrEP or PEP (Table 1). 15 residents participated in interviews, all of whom identified barriers and facilitators to these interventions relevant to each component of the work system (Figure 1). Conclusion Despite recognizing the importance of HIV prevention services, including PrEP, PEP and harm reduction counseling, IMRs lack knowledge and comfort to do so. Barriers to optimal care span all components of the work system. Facilitators to optimal care and next steps include educational initiatives and EMR-based interventions with assessment of impact. Disclosures Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support

P-508. Opportunities for Prep Prescription At Two Urban Academic Healthcare Institutions

Abstract Background Pre-exposure prophylaxis (PrEP) use for HIV prevention remains unequal across groups vulnerable to HIV. Reasons for inequalities include both individual and healthcare level factors. We sought to understand opportunities for prescribing PrEP at two urban academic healthcare institutions in Chicago, Illinois. Methods We analyzed electronic medical record data from both institutions including persons >18 years of age with >1 negative HIV test between 1/1/2015-12/31/2021 who had indications for PrEP. Data included demographics, social history, medications, sexually transmitted infections (STI), and encounters. Indications for PrEP included STI with gonorrhea, chlamydia, and/or active syphilis infection or injection drug use (IDU). Eligible encounters were those within six months after an STI, or as long as IDU was documented. We categorized encounters as inpatient, emergency department (ED), primary care, infectious disease (ID), obstetrics and gynecology/women’s health (OBGYN) and other outpatient settings. Results In total, 9644 persons contributed 53031 encounters that resulted in 941 people with PrEP prescriptions. The two healthcare institutions had differing patient demographics, institution A had more 18-24 year olds (58.3% vs 31.3%), more African Americans (83.8% vs 27.9%), and more women (65.7% vs 46.3%). Institution B had more White (40.6% vs 7.1%) and Hispanic persons (14.0% vs 4.2%), and more men who have sex with men (MSM) (15.2% vs 3.3%). Institution A had more eligible encounters in the ED (30.8% vs 7.3%) as well as in infectious disease, inpatient, OBYGN, and primary care settings. Institution B had more eligible encounters in other outpatient settings (67.7% vs 18.7%). Institution B accounted for the majority of PrEP prescriptions (89.1%). Conclusion Institution A contained persons historically underrepresented in PrEP prescriptions, while institution B had more encounters in other outpatient settings where ]PrEP prescriptions commonly occur. These factors are likely to be responsible for our findings. Future work will examine associations between these factors and the likelihood of PrEP prescriptions in a combined as well as institution specific models. Disclosures Jessica Ridgway, MD, Gilead Sciences: Expert Testimony Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant

P-172. Assessment of the HIV Case Epidemiological Surveillance System in Sughd Region, Tajikistan, 2024 year

Abstract Background In recent times, the HIV epidemic has emerged as a major challenge in contemporary healthcare, leading to the demise of 40.4 million individuals globally. Across the timeline of the ailment, fatalities have been recorded, and the spread of the virus persists worldwide, Tajikistan included, where over 10.5 thousand cases have been documented. This study aimed to evaluate the efficiency of the HIV surveillance system, which stands as a pivotal strategy in combating HIV/AIDS. Methods Between February and March 2024, we conducted a descriptive evaluation study of the existing surveillance system using the CDC's methodology. The analysis covered data from the AIDS Centre and three health centers in Khujand, including a survey of 33 health workers to assess aspects of surveillance such as flexibility, timeliness, sensitivity, predictive positive value, cost, and overall effectiveness. Results According to the decision of the Government of the Republic of Tajikistan, from 2012 to 2022, 12 AIDS centers were organized in the cities and districts of the region. However, to date, the infrastructure of these centres has not yet been fully developed. Also, 30% of commission blood samples are collected with a delay. The sensitivity of the system has reached 91%, which means that 91% of the estimated number of people living with HIV are detected by surveillance. The positive predictive value is 78%, indicating the probability that the reported case is indeed consistent with a real case of HIV. The cost of confirming an HIV diagnosis per person was $19.94. Also, the cost of antiretroviral therapy per month ranges from US$3.78 to US$23.94, which remains cost-effective, while HIV prevention costs US$3.06. In the region, HIV testing coverage increased by 1.2 times and reached 13.9% in 2023 compared to previous years, which led to a decrease in the mortality rate by 1% and indicates the effectiveness of the system. Conclusion The system shows potential for further improvement and adaptation. Improved strategies need to be implemented to increase timeliness and flexibility in responses to epidemiological changes. Particular attention should be paid to optimizing logistics processes and expanding infrastructure to achieve higher standards in HIV diagnosis and treatment. Disclosures All Authors: No reported disclosures

P-511. Missed Opportunities for Pre-Exposure Prophylaxis Initiation in Hospitalized Persons with Opioid Use Disorder and Infectious Diseases

Abstract Background Hospitalizations are increasing among persons with opioid use disorder (OUD) secondary to overdose as well as infections. Hospital settings are a reachable moment not only to offer treatment for OUD and co-occurring infections, but also to offer HIV testing and link to antiretroviral therapy to treat and prevent HIV. Pre-exposure prophylaxis (PrEP) prevents HIV acquisition through both sharing injection drug use equipment and condomless sexual intercourse. Unfortunately, few persons who use drugs including those with OUD are offered PrEP. This descriptive analysis sought to examine patients’ knowledge and attitude about PrEP to better understand if PrEP initiation at time of hospital contact could be used as a way to increase PrEP uptake in patients with OUD.Figure 1.Participants’ perceived risk of HIV on hospital discharge. Methods A retrospective data analysis was performed from the ongoing parent study, Project COMMIT (Coordinated Medical Treatment of Opioid Use Disorder and Infectious Disease). Adult patients (N = 144) hospitalized with bacterial, viral, or fungal infection with moderate to severe OUD were recruited upon admission to hospital and randomized 1:1 to either: 1) infectious disease management of OUD with long-acting injectable buprenorphine vs. 2) treatment as usual. Of the 144, 73 participants who did not report HIV infection, completed a supplemental questionnaire assessing beliefs in PrEP. Basic demographic information, sexual and HIV risk factors, and opioid use risk factors and beliefs about PrEP were reported as frequencies and percentages. Results When exploring HIV risk behavior in the past 30 days, 46 (63%) used injection drugs, 26 (35.6%) had condomless sex, 3 (4.1%) knew of their sexual partner being HIV positive or of unknown status, and 12 (16.4%) shared works. Of the 73 who completed the survey, 29 (39.7%) had never heard of PrEP, and none (n=0, 0.0%) had taken PrEP before. When asked about perceived risk of HIV, on a 4-point scale (high, medium, low or no risk), a majority of participants 64 (87.7%) thought they had no or low risk of HIV infection. Conclusion This study identified the need for increased education about risk for HIV and PrEP among people who use drugs and attention to acute hospitalization as a reachable moment for engaging them in HIV prevention care. Disclosures Sheela Shenoi, MD MPH, Merck Pharmaceuticals: Stocks/Bonds (Private Company) Frances Levin, MD, Aelis Pharmaceuticals: Grant/Research Support|Indivior: Medication for Research|Major League Baseball: Advisor/Consultant|NCATS: Grant/Research Support|NIDA: Grant/Research Support|NYSPI: Salary Support|SAMSHA: Grant/Research Support|US World Meds: Grant/Research Support Edward Nunes, MD, Alkermes: Advisor/Consultant|Alkermes: donated medication or digital therapeutics|Braeburn: donated medication or digital therapeutics|Camurus: Advisor/Consultant|Camurus: donated medication or digital therapeutics|Chess Health: donated medication or digital therapeutics|Indivior: Advisor/Consultant|Indivior: donated medication or digital therapeutics|Pear Therapeutics: Advisor/Consultant|Pear Therapeutics: donated medication or digital therapeutics Alain H. Litwin, MD, MPH, MS, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Merck Pharmaceuticals: Advisor/Consultant Sandra Ann Springer, MD, Alkermes Inc: Honoraria|Alkermes Inc: In kind study drug donation for NIH sponsored research|Indivior Pharmaceutical company: In kind study drug donation for NIH sponsored research

P-1424. Patient Experiences at Month 6 after Initiation of Cabotegravir Long-Acting (CAB LA) for PrEP in the First Male Gender Concordant Implementation Science Trial (PILLAR) in the US

Abstract Background Little is known outside of registrational clinical trials about patient experiences on CAB LA, the first long-acting injectable regimen for HIV prevention. We report real-world experiences and outcomes of men at month 6 (M6) after initiating CAB LA in the US. Methods PILLAR is a Phase 4 gender-concordant implementation science trial assessing integrating CAB LA at 17 clinics for men who have sex with men (MSM) and transgender men (TGM). MSM and TGM completed surveys at baseline (BL) and M6 on experiences and implementation outcomes. A purposeful sample of men completed interviews about their experiences. Results 201 men enrolled and initiated CAB LA from May 2022-August 2023, 186 (93%) and 159 (79%) completed BL and M6 surveys, respectively; of these, 45 men completed interviews at M6. Table 1 presents BL demographics. At BL,15-29% of men reported experiencing stigma and anxiety on oral PrEP (Table 2). At M6, 0-1% of CAB LA users reported stigma and anxiety concerns. At BL, 53-54% oral PrEP users reported concerns about forgetting to take and running out of PrEP. At M6, 2-7% of CAB LA users concerns were forgetting or missing injection visits. Interviewees noted CAB LA reduced stress and fear of missing PrEP, while offering confidence of protection. High acceptability of CAB LA increased from BL to M6 [mean acceptability: 4.4 (SD:0.69) vs. 4.6 (SD:0.61)] and feasibility remained high [mean feasibility: 4.4 (SD:0.74) vs 4.4 (SD:0.75)]. Interviewees noted CAB LA was convenient for their life. Though 45% reported injection site reactions, majority (86%) returned to daily activities the same day. Few were bothered by injection pain (8%) and reported that pain decreased over subsequent injections. At M6, 80-92% of survey respondents reported flexible scheduling by clinics as useful to supporting CAB LA use, which was also expressed by most interviewees. Among men who received transportation to visits, had injection reminders and had virtual appointments, over 80% rated them useful. Conclusion M6 results show that MSM and TGM report no to little PrEP stigma and anxiety concerns while on CAB LA and that it is feasible and acceptable in their lives. Flexible and virtual appointments and transportation support are helpful while on injectable PrEP. Disclosures Nanlesta Pilgrim, PhD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee William M. Valenti, MD, FIDSA, Gilead Sciences: Grant/Research Support|Gilead Sciences: Stocks/Bonds (Public Company)|ViiV Healthcare: Grant/Research Support Bo Li, PhD, GSK: Employee Alison Gaudion, PhD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Deanna Merrill, PharmD, MBA, AAHIVP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Patrick Daniele, MS, GSK: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Larissa Stassek, MPH, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Travel support Riya Moodley, FCP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Toyin Nwafor, MD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Katherine L. Nelson, PhD, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Kimberley Brown, PharmD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Maggie Czarnogorski, MD MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee

P-506. Improving HIV Pre-exposure Prophylaxis (PrEP) among Transgender Individuals

Abstract Background Due to numerous structural factors, transgender (TG) individuals are disproportionately affected by HIV in the United States. Prioritizing PrEP for this population remains a priority. In 2020, only an estimated 3% of TG individuals were taking PrEP. However, one study showed that TG women who had access to gender-affirming care were more likely to discuss PrEP use with their healthcare provider. This study aims to evaluate PrEP prescription patterns among TG individuals seen in our integrated infectious disease and gender-affirming care practice. Methods We conducted a retrospective chart review for all patients who were prescribed PrEP from January 1st, 2022 to December 31st, 2023 at our institution. Data from 2017 to 2023 was collected to evaluate the frequency of PrEP prescriptions over time. Results Two hundred and five total individuals were prescribed PrEP in 2022-2023 at our institution. Of these, 125 (61.0%) patients identified as male, 33 (16.1%) as female, 42 (20.5%) as TG female, 6 (2.9%) as TG male, and 3 (1.5%) as nonbinary. Of the 48 TG patients, 19 (39.6%), 18 (37.5%), and 13 (27.1%) were Black, Latinx, or White, respectively. Out of 48 TG patients, 32 (66.7%) were new to PrEP at our institution compared to 98 (47.8%) of all patients prescribed PrEP (p< 0.01). Thirty-four TG individuals (70.8%) remained on PrEP by the end of the study period, compared to 130/205 of all patients prescribed PrEP (63.4%; p=0.22). Linear regression indicated an increase in prescription rates in TG patients from 2017 to 2023 (R2 = 0.86). Conclusion At our institution, gender-affirming care integrated within an infectious disease practice led to higher levels of PrEP uptake and persistence for a marginalized TG patient population. Improving access to high-quality gender-affirming care is an essential component of HIV prevention programs with the goals of ending the HIV epidemic and ensuring equitable access to services. Disclosures Shobha Swaminathan, MD, Viiv Healthcare: Advisor/Consultant

P-959. Evaluation of Online Medical Education to Improve Pre-Exposure Prophylaxis (PrEP) Knowledge and Competency among Providers

Abstract Background Pre-exposure prophylaxis (PrEP) use for HIV prevention remains low among Black women in the U.S. compared to their need. Barriers to uptake include provider discomfort prescribing PrEP to this group. We sought to evaluate the impact of medical education on providers’ knowledge and attitudes toward PrEP among Black women. Methods Providers at two community health centers in Florida and Illinois participated in a live, online PrEP training and completed an online pre- and post-test. The training lasted 45-60 minutes and included didactic and interactive content to equip providers with the clinical knowledge for prescribing PrEP (e.g., indications/side effects, PrEP during pregnancy/breast-feeding, maintenance of therapy) while building their competency discussing PrEP with Black women (e.g., culturally-competent and “health-based” rather than “risk-based” scripts). The test evaluated objective knowledge of PrEP, attitudes toward PrEP and discussing PrEP with/prescribing PrEP to Black women, and likelihood of prescribing PrEP in the future. Data were analyzed descriptively. Results Nineteen providers completed the pre-test and fifteen providers completed the post-test. Most were physicians or nurse practitioners (68%, 13/19 and 80%, 12/15, respectively) and female (63%, 12/19 and 60%, 9/15, respectively). In the pre-test, 32% (6/19) of participants thought that pregnant women should not use PrEP; 100% (15/15) of post-test participants understood that PrEP was safe during pregnancy. In terms of discussing PrEP with Black women, originally 53% (10/19) of participants rated their comfort level as “Poor” or “Fair”, which fell to 13% (2/15) after the training. In the pre-test, 47% (9/19) of participants rated their comfort level in prescribing PrEP to Black women as “Poor” or “Fair”, which decreased to 20% (3/15) in the post-test. When asked how likely they were to prescribe PrEP to a Black woman within the next 6 months, 42% (8/19) of participants stated “Likely or “Very Likely” which increased to 80% (12/15) after the training. Conclusion Knowledge of PrEP, comfort discussing PrEP with Black women, and intention to prescribe PrEP all improved post-education. Additional data is needed to evaluate the long-term impact of the training on PrEP uptake among Black women. Disclosures Jessica Ridgway, MD, Gilead Sciences: Expert Testimony

P-1458. The Implementation Science Coordination Initiative (ISCI) for evidence-based HIV services: supporting implementation in practice

Abstract Background The Ending the HIV Epidemic (EHE) Initiative was launched in 2019 to address implementation problems related to HIV interventions. In alignment with EHE, the National Institutes of Health supported research projects focusing on implementation science (IS), or the scientific examination of strategies to overcome barriers to and improve effective implementation of HIV-related interventions. The result is a growing IS knowledge base. The Implementation Science Coordination Initiative (ISCI) at Northwestern University has developed a suite of tools and resources for providers for practice communities to improve implementation and uptake of HIV prevention, testing, and treatment using IS. Methods We will describe tools, projects, and programs available to clinicians to support implementation of evidence-based HIV interventions in practice including that have been developed over from 2020-2024. Results ISCI maintains a literature review dashboard for that summarizes ongoing systematic reviews of the HIV implementation science literature. It includes common barriers and facilitators to evidence-based HIV interventions, interventions to support patients, and implementation strategies for practitioners and clinics. Literature is filterable along various dimensions so that users can quickly review literature relevant to their setting and patient population. See Figure 1. ISCI provides two training opportunities for practitioners interested in learning about IS and innovative tools that can be applied to real-world practice. The IS Navigation Practitioner Page is an online, freely available self-paced curriculum. The Practitioner-Oriented Implementation Science Education (POISE) Training Program is a mix of in-person and remote training over a 5-month period leveraging IS to support implementation in one’s practice setting. The Best Practices Project identifies and disseminates implementation strategies for evidence-based HIV interventions with the best evidence. We accomplish this through a review process and then develop a mix of resources to support use of implementation strategies in practice, which are freely accessible on the ISCI webpage Conclusion There are a number of resources available to support evidence-based HIV services. Disclosures Brian Mustanski, PhD, Hologic: Grant/Research Support

P-1899. Improvement in Provider Experiences from Baseline to Month 12 with Integrating Cabotegravir Long-Acting (CAB LA) for PrEP into Care in an Implementation Science Trial (PILLAR)

Abstract Background Real world clinical experience with CAB LA, the first long-acting injectable medication for HIV prevention, might be helpful to alleviate provider implementation concerns. We evaluate changes in healthcare providers (HCPs) CAB LA implementation outcomes over 12 months. Methods PILLAR (ClinicalTrials.gov # NCT05374525) is a Phase IV randomized controlled trial conducted at 17 sites in the US. Sites were randomized 2:1 to dynamic (standard + enhanced support) and routine implementation (standard support). HCPs providing PrEP services were enrolled and completed surveys at month (M) 1, M4, and M12. Change across six CAB LA domains was assessed: 1) acceptability (4 items); 2) feasibility (4 items); 3) resources needed to implement (4 items); 4) fidelity to dosing and administration (6 items); 5) scheduling and patient management (5 items); and 6) patient adoption and adherence (6 items). Results 86 HCPs enrolled between April-October 2022 completed M1 surveys; 80 and 81 HCPs completed M4 and M12 surveys, respectively. HCPs reported high levels of acceptability and feasibility of CAB LA at M1 (mean scale scores≥4.4), M4 (mean scale scores≥4.1), and M12 (mean scale scores≥4.3) across both arms; change from BL to M12 between arms was not significant. Across timepoints, HCPs reported reduced concerns in implementing CAB LA except risk of drug resistance due to non-adherence (Table 1). Concerns related to resources needed to implement CAB LA reduced by an average of 51% between M1 and M12. Staff needed per week to implement CAB LA reduced (M1: 4.4 vs. M12: 3.8) while the number of CAB LA patients clinics could manage per week increased (M1: >25=22% vs. M12: >25=63%) (Table 2). Concerns about scheduling and managing patients, fidelity to dosing and administration, and patients’ adoption and adherence reduced by an average of 42%, 46% and 32%, respectively, between M1 and M12. Drug resistance concerns rose by 7%. A higher proportion of HCPs in the dynamic arm reported less concerns about resourcing and fidelity to dosing and administration than HCPs in the routine arm. Conclusion HCPs confidence delivering CAB LA improved as early as M4 and continued through M12. Use of available implementation tools (e.g., guidance documents) support CAB LA implementation. Disclosures Taimur H. Khan, MD MPH, ViiV Healthcare/GSK: Grant/Research Support Linda Mercado, PA-C, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Gilead: Institution-samples; lunches for staff; travel support|Janssen: Institution-samples, lunches for staff|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria|ViiV Healthcare: Institution-samples; lunches for staff; travel support Bo Li, PhD, GSK: Employee Katherine L. Nelson, PhD, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Lisa Petty, MT(ASCP), GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Michael Acquadro, PhD, GSK: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Nicola Barnes, MA, GSK: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant William Lenderking, PhD, Gilead: Advisor/Consultant Neelima Jain, PhD, GSK: Employee|GSK: Stocks/Bonds (Public Company) Heidi Swygard, MD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Todd McKeon, PharmD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Annemiek de Ruiter, MBBS FRCP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Maggie Czarnogorski, MD MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Nanlesta Pilgrim, PhD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee

213. Electronic Visit (E-visit) Use for Sexually Transmitted Infection (STI) Testing in a Large Integrated Healthcare System

Abstract Background To improve access to sexually transmitted infection (STI) and HIV prevention services, Kaiser Permanente Northern California (KPNC), an integrated healthcare system, launched a sexual health electronic visit (E-visit) in February 2022. This E-visit allows users to self-order STI testing and other sexual health services through the healthcare patient portal. Methods We conducted a retrospective cohort study to characterize E-visit use for STI testing among all persons who had STI testing within KPNC from February 13, 2022 to December 31, 2023. We compared demographic factors of persons requesting STI testing via the E-visit with those who accessed STI services via conventional pathways. We used log-binomial regression to assess factors associated with E-visit use and compared STI test positivity among persons who used the E-visit versus those who used conventional pathways. Results Of the 773,884 persons who underwent STI testing, 120,064 (16%) used the sexual health E-visit and 653,820 (84%) used conventional pathways. Younger persons were more likely to use the E-visit, with persons aged 18-24 years being the most likely to use the E-visit (adjusted prevalence ratio [aPR] 1.61 [95% CI 1.58, 1.64] compared with persons aged 35-44 years) (Table 1). Compared with white persons, black persons were more likely to use the E-visit (aPR 1.48 [95% CI 1.45, 1.5]). Men were more likely than women to use the E-visit (aPR 1.12 [95% CI 1.11, 1.14). Use was similar across socioeconomic status. Persons with HIV were less likely to use the E-visit (aPR 0.51 [95% CI 0.48-0.55]), whereas those with prior or current HIV pre-exposure prophylaxis use were more likely (aPRs 1.48 [95% CI 1.37, 1.6] and 2.0 [95% CI 1.94, 2.05], respectively). Test positivity was higher for E-visit testing compared with conventional pathways for urogenital chlamydia (4.6% vs. 2.1%; p < 0.0001), urogenital gonorrhea (0.9% vs. 0.5%; p < 0.0001), rectal chlamydia (5.6% vs 4.0% p < 0.0001), and pharyngeal chlamydia (2.0% vs 1.3%, p < 0.0001) (Table 2). Conclusion The KPNC sexual health E-visit is used by individuals at risk for STIs, including younger and black persons, with higher test positivity for urogenital gonorrhea and chlamydia, rectal chlamydia, and pharyngeal chlamydia. Disclosures All Authors: No reported disclosures

Men’s voices on Long-acting Pre-Exposure Prophylaxis (LA PrEP) delivery modalities: Acceptability and Preferences among Cis-gender men and men who have sex with men in South Africa

Introduction: In sub-Saharan Africa (SSA), cisgender men—in particular men who have sex with women (MSW) and, to a lesser degree, men who have sex with men (MSM)—are often under-represented in HIV prevention research, despite their own HIV risk and role in transmission cycles. As HIV prevention research on long-acting pre-exposure prophylaxis (LA PrEP) options expands in SSA, it is essential to engage these populations to ensure their acceptability. We investigated perceptions of implants and intramuscular injectables as LA PrEP delivery among MSW and MSM. Methods: In-depth interviews were conducted between October 2020 and March 2021with 40 MSW (n=20) and MSM (n=20), aged 18-35 years, self-reported as HIV-negative, sexually-active, and residing in resource-restricted communities in Cape Town and Johannesburg, South Africa. We explored factors influencing LA PrEP attitudes. Data analysis followed a thematic framework approach. Results: MSW and MSM found LA PrEP administration modes more acceptable than daily oral PrEP because they offered longer-lasting protection while reducing frequent clinic visits for refills. MSW voiced hesitancy around the use of ‘foreign products’, fearing infertility and congenital-disabilities in their future children. Both subgroups acknowledged the convenience of implants with long-dosing duration, but injections were deemed to be more discreet and familiar. Both groups described Implant use as potentially stigmatizing, with a greater chance of causing tissue scarring from insertion and removal procedures. Conclusions: Evidence relating to men’s engagement in HIV prevention and acceptable modalities of HIV prevention is limited. We found that both groups were enthusiastic about LA PrEP, informing the development of our subsequent clinical study to provide further insight into using placebo versions of LA PrEP and future implementation of LA PrEP options. One-Sentence Summary: LA PrEP acceptability and preference among men

Understanding the PrEP Care Continuum for Adults: Health Care Providers' Perspectives on Barriers, Facilitators, and Missed Opportunities.

Pre-exposure prophylaxis (PrEP) is an effective strategy in reducing HIV transmission, yet its uptake remains suboptimal. Health care providers play a vital role in facilitating PrEP access and care. This qualitative study explores health care providers' perspectives on the oral PrEP care continuum for adults, emphasizing barriers, facilitators, and missed opportunities in PrEP implementation. Drawing on interviews with 18 primary care providers in New York State, our research investigates multi-level factors influencing PrEP awareness, initiation, and management. Findings reveal significant barriers at the patient level, such as low awareness, stigma, and misconceptions about HIV risk. Provider-level challenges include knowledge gaps, discomfort in discussing sexual health, and logistical constraints. Structural factors such as insufficient infrastructure and high costs impede consistent PrEP management. Facilitators identified include proactive provider-patient communication, educational resources, and workflow integration strategies. Subgroup analyses highlight variations in attitudes based on provider demographics and experience. Younger and female providers are more proactive in discussing PrEP, while older and male providers often perceive it as less relevant. Nurses emphasize patient education and trust-building, contrasting with physicians' focus on logistical challenges. Providers experienced in prescribing PrEP view it as a valuable prevention tool, while nonprescribers report hesitancy and limited familiarity. Discrepancies in patient-perceived versus actual HIV risk, as well as provider assumptions about patient candidacy for PrEP, underscore the need for routine, stigma-free discussions about HIV prevention. This study emphasizes the importance of targeted provider training, system-level support, and inclusive policies to enhance PrEP uptake. Addressing these barriers and leveraging facilitators can advance public health efforts, fostering equitable and effective HIV prevention strategies.

Perspectives and experiences regarding pre-exposure prophylaxis (PrEP) in a community sample of Veterans with unhealthy alcohol use: overall and across sexual orientation and gender identity

BackgroundUnhealthy alcohol use is an independent, modifiable risk factor for HIV, but limited research addresses alcohol use and HIV prevention synergistically. Groups that experience chronic stigma, discrimination, and/or other marginalization, such as sexual and gender minoritized groups, may have enhanced HIV risk related to unhealthy alcohol use. We described awareness of and experiences with pre-exposure prophylaxis (PrEP) among a community sample of Veterans reporting unhealthy alcohol use (relative to those without), overall and across self-reported sexual orientation and gender identity.MethodsUsing data collected from a national online survey of Veterans recruited via Facebook ads, community organizations, and listservs, we assessed variation in four PrEP outcomes (knowledge, experience, willingness, and conversations with doctors) across patterns of unhealthy alcohol use among all respondents reporting any lifetime drinking (n = 1,041) and then within sexual orientation and gender identity groups using Chi-square or Fisher’s exact tests.ResultsAmong 1,041 eligible Veterans, 440 (42%) screened positive for unhealthy alcohol use. Veterans with unhealthy alcohol use were not more likely to have heard of PrEP (58.2% vs. 55.4%, p = 0.37), but trended toward more likely to have taken PrEP (7.5% vs. 5.0%, p = 0.09), to be willing to take PrEP (30.5% vs. 27.6%, p = 0.06), and to have spoken with a doctor about PrEP (11.4% vs. 7.7%, p = 0.04). Those with heavy episodic drinking also trended toward higher prevalence of PrEP awareness (60.0% vs. 54.6%, p = 0.09), and were more likely to have taken PrEP (8.3% vs. 4.7%, p = 0.02), to be willing to use PrEP (34.6% vs. 25.5%, p < 0.01), and to have had conversations with doctors about PrEP (12.7% vs. 7.2%, p < 0.01). Similar patterns were observed for severe unhealthy alcohol use and past-year frequent heavy episodic drinking. Generally, sexual/gender minoritized Veterans with unhealthy alcohol use reported more PrEP-affirming responses than those without but associations with unhealthy alcohol use were similar.ConclusionsUnhealthy alcohol use was prevalent, particularly among Veterans with minoritized sexual orientation/gender identity, but not clearly linked to increased PrEP-literacy and use despite its known status as an HIV risk factor. Across groups, > 25% of individuals were willing to take PrEP. Interventions targeting both alcohol use and HIV prevention should capitalize on this.

HIV service use among minoritized racial and ethnic transgender and gender non-conforming youth in the U.S South: a qualitative investigation

ABSTRACT Transgender youth are disproportionately affected by HIV, particularly minoritized youth in the US south. To understand HIV service use among transgender youth, we interviewed 25 young racial and ethnic minority clients of four southern community-based HIV service organizations (CBOs), and CBO staff (n = 12), about service access and use. Participants were assigned male at birth and identified as female (n = 8), transgender (n = 11) or gender-fluid or nonbinary (n = 6). The majority were Black/African American or mixed race; four were Hispanic or Latino/a. Most were unemployed; nearly half were unstably housed or homeless during the prior year. Four service types were each used by approximately two-thirds of participants: counseling/support, HIV/STD testing/education, pre-exposure prophylaxis education/prescriptions, and transgender-related medical services (primarily hormone provision). Just over a quarter used social services (e.g., housing, employment). Key facilitators to service use included a non-stigmatizing CBO atmosphere, and easy and convenient access. Poor access (e.g., inconvenient hours, location), lack of transportation or parking, social service needs, and lack of money were barriers. Qualitative reports highlighted unmet social service needs, particularly housing, especially for those without HIV. To reduce disparities, HIV prevention for racial and ethnic minoritized transgender youth should simultaneously address hormone provision, HIV risk reduction and social service needs.

Policy Recommendations to Support Equitable Access to Long-Acting Injectables for Human Immunodeficiency Virus Prevention and Treatment: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association.

Long-acting injectables (LAIs) for HIV prevention and treatment could dramatically improve health outcomes and health equity for people with HIV and those who could benefit from pre-exposure prophylaxis. Despite widespread acceptability and demand by providers and potential users of LAIs, implementation has been extremely limited since the introduction of cabotegravir/rilpivirine, the first LAI for HIV treatment, in January 2021, and long-acting cabotegravir, the first LAI for HIV prevention, in December 2021. We report results of a provider survey, conducted by the HIV Medicine Association, which identified LAI implementation barriers related to health insurance processes, staffing and administrative support, drug costs and acquisition, and access for individuals who are uninsured. We provide policy recommendations to address those barriers and facilitate broad and equitable access to LAIs for HIV prevention and treatment, which will be necessary to achieve the goals of the US Ending the HIV Epidemic initiative.

To what extent are digital health interventions targeting HIV care cascade among mobile populations feasible, acceptable, and effective? A mixed methods systematic review protocol

IntroductionHuman mobility is associated with an increased risk of HIV acquisition and disengagement from HIV care, leading to poorer health outcomes among highly mobile individuals compared to less mobile individuals. Mobile individuals, broadly defined as those who temporally, seasonally, or permanently move from one place to another for voluntary or involuntary reasons, face many challenges in accessing HIV care services. These challenges include logistical difficulties, interruptions in HIV care continuity, and limited access to services across different locations, which together hinder timely testing, treatment initiation, and viral suppression. Digital health interventions offer flexible approaches that can adjust to the mobile individual’s location to improve HIV care engagement and health outcomes for this underserved and hard-to-reach population. However, evidence on the feasibility, acceptability, and efficacy of digital health interventions across the HIV care cascade among mobile populations has not yet been appraised.ObjectivesWe seek to synthesize empirical evidence on the feasibility, acceptability, and efficacy of digital health interventions targeting the HIV care cascade among mobile populations.MethodsWe will conduct a mixed methods systematic review of peer reviewed studies published between 1 January 2010 and 31 July 2024 that evaluated digital health interventions targeting the HIV care cascade among mobile populations. We will search PubMed, Web of Science, and EBSCOhost (Academic Search Premier, Africa-Wide information, CINAHL, Health Source: Nursing/Academic Edition, APA PsycInfo, APA PsycArticles) electronic databases. Bibliographies of retrieved studies will also be reviewed for relevant citations. Only studies published in English language and involved a digital health intervention, report an outcome related to the HIV care cascade, and involve mobile populations either partially or completely will be included. Two reviewers will independently screen titles and abstracts against the inclusion criteria, followed by full text screening for eligible articles. In case of disagreements, consensus will be sought from a third reviewer. Data synthesis will follow the Joanne Briggs Institute’s convergent segregated approach. If sufficient quantitative studies with comparable outcome measures are available, a meta-analysis will be performed.DiscussionThis review will address a critical evidence gap by consolidating data on digital health interventions’ feasibility, acceptability, and efficacy across the HIV care cascade among mobile populations. The results will inform the development of tailored digital health interventions to enhance HIV care delivery and health outcomes for this hard-to-reach population, supporting global HIV prevention and treatment goals.Systematic review registrationThis protocol is registered on PROSPERO (CRD42024528122).