Challenges and Opportunities for PrEP Uptake Among GBMSM in Puerto Rico

Track: Community Mobilization

Location: Fort Bend A, Level 2

Presenters:

HIV continues to disproportionally affect otherwise socially vulnerable populations. Globally, epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. In Puerto Rico (PR), an unincorporated territory of the USA, MSM represent 39% of all the new cases and is the only group in which HIV incidence has increased over the last decade. PrEP is changing the HIV prevention landscape; however, PR’s current political and economic crisis has limited the access to PrEP among those at increased risk for infection. Currently, PR is structurally unable to provide new resources to the HIV prevention response (e.g. PrEP) due to multiple factors including a $100 billion debt that represents nearly 70% of the GDP and a cap on funding for healthcare established by the USA Congress. Under these circumstances it is difficult to adequately respond to the HIV prevention needs in the island. Considering this scenario, community-based initiatives have been responding by assessing the needs of populations at increased risk of infection and incorporating best practices in the implementation of biomedical HIV prevention services.

This workshop will discuss the overall knowledge, awareness, and willingness to use PrEP among GBMSM in Puerto Rico. The panelists will also elaborate on the potential barriers for PrEP uptake, including stigma, misconceptions about its use and efficacy, missed opportunities during interactions with providers, costs, and other structural limitations.

The discussion will be framed around the importance of using community-based participatory research and mixed-methods research approaches as promising tools for the design of evidence-based interventions to reduce social inequities and increase the effectiveness of current and future HIV response strategies.

How a Urine PrEP Adherence Test Optimizes Support for Vulnerable Patient Populations

Track: Navigation, Retention and Re-engagement

Location: Sugarland, Level 3

Presenters:

Giffin Daughtridge, UrSure, Inc.

Karem Mounzer, Jonathan Lax Treatment Center

Adam Cohen

Over one million people are at high-risk of HIV infection in the US (CDC). Daily pre-exposure prophylaxis (PrEP) is 99% effective at preventing new HIV infections if taken consistently, however current adherence rates can be as low as 37% in certain populations (Serota et al, 2019). Self-reported adherence is a poor indicator of actual adherence (Hosek et al, 2017), and existing lab tests to measure adherence (e.g. hair follicle and dried blood spot) are expensive and difficult to implement.

We developed a urine test that measures the presence of TFV – one of the drug components of PrEP -using a liquid chromatography mass spectrometry (LC-MS/MS) method. This test is used to assess PrEP adherence at Philadelphia FIGHT Community Health Centers. Data was disaggregated by demographic to identify trends in adherence by sub-population. LC-MS/MS adherence rates were compared to self-reported adherence to assess concordance of objective adherence monitoring versus self-report.

A Blueprint for Implementing a PrEP Program - Making it Happen!

Track: Implementation Research

Location: Tanglewood, Level 3

Presenters:

Patricia Gallegos, Centro San Vicente

Rodolfo Castañeda, Centro San Vicente

Travis Cosban, Centro San Vicente

Gerado Anaya

In an effort to have a more active role in the fight against the HIV epidemic, Centro San Vicente (CSV), a faith-based Federally Qualified Health Center, began providing Pre-Exposure Prophylaxis (PrEP) services at its Be PrEPared! Clinic in June of 2018. This new PrEP clinic serves residents living in a Tri-State area, which includes El Paso County, Southern New Mexico, and Ciudad Juárez, Mexico. Multi-phase strategies used by CSV to initiate PrEP services will be presented, highlighting the following four key phases: 1. Pre-condition; 2. Pre-Implementation; 3. Implementation; and, 4. Maintenance and Evaluation. Participants will also learn about evidence-based implementation strategies that can be used to target people at very high risk for HIV as well as methods that can bolster stakeholder engagement. During the presentation, participants will hear perspectives from an administrator, a patient navigator, a physician, and a subject expert.

Bird's Eye View: Refining State-Wide PrEP Monitoring and Evaluation Plan

Track: Evaluation

Location: Memorial, Level 3

Presenter:

Simon Andrade, Texas Department of State Health Services

Sarah Norkin, Texas Department of State Health Services

This workshop examines the evolution of a pre-exposure prophylaxis (PrEP) monitoring and evaluation (M&E) plan. The initial plan addressed data collection and process measures at PrEP organizations funded by the Texas Department of State Health Services (DSHS). The development of a broader M&E plan offered the opportunity to address systemic goals and concerns that emerged during early environmental scans; and the development and implementation of integrated prevention/care plans and community-driven End the Epidemic (EtE) plans. The M&E plan uses the domains of supply, demand, and maintenance to delineate various activities and goals for increasing access, driving up demand, and removing barriers to continuing PrEP use. The work on the M&E plan has highlighted our understanding of strengths and limitations, such as access to relevant data and preliminary identification of the factors that drive demand for PrEP.

Community and Researchers Working Together

Location: Montgomery B, Level 2

This workshop will discuss the role of community in ending the epidemic. It will also provide an overview of the ACTG research network. It will include the following presentations:

Be the Generation: Mobilizing Communities to End the HIV/AIDS Epidemic

Track: Community Mobilization

Presenter:

Brian Minalga, The Legacy Project

Louis Shabkelford, Legacy Project

Jorge Benitiez, Columbia University

HIV prevention research is urgently needed and remains our best hope to finding safe and effective methods to prevent the spread of HIV. However, the benefits of HIV prevention research do not reach everyone equitably. Seventy percent of Americans on PrEP are white. A lower proportion of African Americans and Latinx people have reached viral suppression compared to white people with HIV (CDC). The future of HIV prevention depends on the ability of all communities to benefit from PrEP, TasP, and ongoing research in HIV prevention modalities such as microbicides and vaccines. Communities of color, transgender people, and men who have sex with men bear the greatest burden of HIV, but they are also the most valuable resource to ending the epidemic. This presentation will provide an overview of the Be the Generation project and how we’re mobilizing communities to end the HIV/AIDS epidemic through biomedical HIV prevention research engagement.

The Latest in HIV Treatment Research from ACTG

Track: Community Mobilization

Presenter:

Michael Stirratt, PhD, National Institute of Mental Health, Division of AIDS

David Hughes, CCRP, AIDS Clinical Trials Group (ACTG)

Russell Campbell, MA, Office of HIV/AIDS Network Coordination

Despite the great advances in the treatment of HIV infection, people living with HIV still take medications daily which represents a challenge for adherence and a constant reminder of their HIV status. The AIDS Clinical Trials Group (ACTG) has developed an agenda to evaluate new long acting treatment options. The study, ACTG 5359, will compare the efficacy, safety, and durability of two different strategies to treat participants with a history adherence challenges and control of their HIV infection: long-acting (LA) antiretroviral therapy (ART) with rilpivirine (RPV-LA) and cabotegravir (CAB-LA. ACTG researchers will provide detailed information regarding LA antiretroviral therapy, broadly neutralizing antibodies, and a review of ACTG 5359.

Two Blue Pills: Game changers or STD Makers, U=U and PrEP

Track: Navigation, Retention and Re-engagement

Location: Liberty, Level 2

Presenters:

Anthony Fox, DC Department of Health – HAHSTA

Kenneth Pettigrew, DC Department of Health

Terrence Payton, DC Department of Health

Thanks to U=U and PrEP, the chance of transmitting or acquiring HIV has been reduced to just about zero if medications are taken correctly.  That being said, why has the message and up take of both been so slow among men who have sex with men in communities of color? Have attitudes regarding these two strategies and STIs stalled efforts to get zero new HIV infections?  This presentation will allow conference participants to engage in a community discussion regarding how we can or cannot get to zero new infections using these two strategies and the implications they have regarding increased STIs.

Models of PrEP services

Location: Clear Lake, Level 3

This workshop will include the following presentations:

Individualized PrEP: Changing the Clinical Approach in NYS

Track: Clinical Provider Engagement

Presenter:

Lyn Stevens, New York State Department of Health AIDS Institute

As a cornerstone of HIV prevention, pre-exposure prophylaxis (PrEP) is strongly endorsed by New York State (NYS), which named PrEP a pillar of its initiative to end the HIV epidemic by 2020. Use of PrEP in NYS depends on increasing awareness of, access to, and utilization of PrEP among people disproportionately at risk of acquiring HIV and their healthcare providers. The NYS Department of Health AIDS Institute Clinical Guidelines Program develops and disseminates practical, evidence-based clinical guidelines to promote quality medical care. The PrEP for Sexual Health guideline provides recommendations for successful initiation and continuation of PrEP. NYS first issued PrEP guidance in 2014. It and guidelines that followed were used widely. The 2019 edition of the PrEP for Sexual Health guideline incorporates current scientific evidence and implementation strategies to increase PrEP use. Toward that end, the 2019 update addresses “on-demand” PrEP, same-day PrEP initiation, and individualized PrEP follow-up.

No PrEP Services Here…

Track: Service Provider Engagement

Presenter:

Teresa Springer, Wellness Services Inc.

PrEP has been marketed to at-risk populations as a miracle drug that helps to prevent HIV. There are commercials and ads placed in communities and HIV service organizations have been charged with screening and linkage to PrEP.  What happens in the smaller cities where there are no providers prescribing PrEP?  What happens when someone screens eligible and there is no one to link them to? Provider shortage and ignorance can be a major barrier to accessing PrEP in smaller towns and cities.  This workshop will explore this challenge and look at solutions to this ongoing issue.

Interdisciplinary PrEP Care Model at a University Setting ID Clinic-> The PrEP Desert: Interdisciplinary Care Model in the Wild West.

Track: Implementation Research

Presenters:

Cesar Egurrola, University of Arizona, Department of Medicine

Jai Smith, University of Arizona, Department of Medicine

Despite expansion and improvement of antiretroviral therapy and established efficacy of biomedical HIV prevention interventions such as PrEP and PEP, HIV incidence continues to rise. Access to PrEP care in southern Arizona was very limited up until 2013. To address this need, a comprehensive PrEP Clinical Care Model was designed and implemented at the Petersen HIV Clinics in Tucson, AZ. This program expanded beyond clinical care to include PrEP Navigation and Education, and option of linkage to specialized local pharmacies to maximize adherence and access to medication. The primary goal of this effort was facilitation of PrEP care by an interdisciplinary team including physicians, clinical pharmacists, and limited medical case management support. Workshop overview consists of program background, program design and implementation, PrEP patient panel snapshot, and recommendations for increased PrEP access based on lessons learned.

Crafting messages to Diagnose and Prevent HIV - Developing a social marketing strategy that works

Track: Training

Location: Montgomery A, Level 2

Presenters:

Krystle Sims-Cameron, 510Media, Oakland, California

Gary Naja-Riese, San Francisco Department of Public Health

Community-based HIV testing and PrEP are key components of the Diagnose and Prevent pillars of the plan to end the U.S. HIV epidemic. Ensuring that we are creating culturally relevant messages for populations that are not aware of or reluctant to test and/or use PrEP is critical if we are to advance the plan’s ambitious goals of preventing new HIV infections and achieving health equity. Krystle Sims-Cameron, a national social marketing leader, will guide participants through a structured approach to develop meaningful campaigns including: 1) how to solicit insights from communities to craft a strong message; 2) how to engage community through powerful collateral and targeted placement strategies; and 3) how to measure success. Following the workshop, attendees who will be creating or refining their local campaigns are invited to participate in an interactive 3-month learning collaborative hosted by Krystle and the HIV Prevention Capacity Building Assistance Program of the San Francisco Department of Public Health, getSFcba.

We're Not "Hard to Reach:” Black Women's Biomedical Ambassador Program

Track: Community Mobilization

Location: Harris, Level 2

Presenters:

Maya Merriweather, Black AIDS Institute

As the scientific community continues to make advances in biomedical interventions, disparities on who uses those interventions have become apparent. Many conversations around these disparities have put the impetus on communities that have been historically marginalized, calling young people, women, Black people, and other people of color “hard to reach.” In 2019, the Black Women’s Biomedical Ambassador Program was launched by the Black AIDS Institute, with an inaugural cohort of Black women who reflect the diversity of Black America: women from the South, women of trans experience, women for whom English is a second language, and women who are living with HIV. This cohort was trained on HIV education and tasked with bringing that education to their peers through social media.

PrEP, Latinos, and The South

Track: Community Mobilization

Location: Fort Bend B, Level 2

Presenters:

Judy Montenegro, Latino Commission on AIDS

Joaquín Carcano, Latino Commission on AIDS

The South represents the most diverse region in the US. The South accounts for 35% of LGBT population and has become a new destination for Latinx populations contributing to exponential growth, but it is also a region that continues to lack proper investment in health care and sexual health education. In 2016, the South accounted for more than half of all new HIV diagnoses in the US but only 30% of PrEP users lived in the South. Current data also shows that communities of color continue to have a low uptake of PrEP, especially amongst gay/bi/same gender loving men and trans individuals. These combined notions continue to make the South the epicenter of the HIV epidemic and will continue, unless there is an institutional investment by local counties, cities, and states. This workshop will share the results of a statewide poll of multiple southern states that gauge the knowledge of PrEP and support of individuals for local health departments to increase access to PrEP.