Amalia Aldredge

Long-acting cabotegravir/rilpivirine supports virologic suppression among people with HIV (PWH) facing adherence challenges. In two large U.S. cohorts(n=1,070), 96% of viremic PWH achieved virologic suppression at a 4-week median. However, blips/failure were more frequent among PWH initiating with viremia, underscoring the need for careful monitoring and optimization of long-acting treatment.

Background: People with HIV (PWH) with viremia despite oral antiretroviral therapy (ART) can achieve viral suppression (VS) using long-acting (LA)-ART. Scaling this approach has lagged, especially in the highest HIV burden areas. Methods: We performed a retrospective review of PWH who initiated LA-ART (cabotegravir/rilpivirine [CAB/RPV] ± lenacapavir [LEN] ± ibalizumab [IBA]) with viremia (≥50 c/mL) at a Ryan White-funded program in the urban South between 14 April 2021 and 31 August 2024. Among PWH who received ≥3 LA-CAB/RPV injections through end of follow-up (31 December 2024), achieving VS (200 c/mL [n = 2]; 50–200 c/mL [n = 2]). Of 645 LA-CAB/RPV injections (500 Q4wk; 145 Q8wk), 635 (98%) were administered on-time; all LEN (43/43) and IBA (37/37) administrations occurred on-time. Conclusions: In the largest southern US cohort of PWH with viremia initiating LA-ART, 92% achieved VS despite significant barriers to care and disease burden, underscoring LA-ART as a tool to help achieve Ending the HIV Epidemic goals.

Background: There is an ongoing syndemic of HIV and sexually transmitted infections (STIs) in the United States, particularly among men who have sex with men (MSM). We have increasingly effective and diverse measures of prevention, including various types of pre-exposure prophylaxis (PrEP) for HIV prevention and doxycycline postexposure prophylaxis (doxyPEP) for STI prevention. As options expand, we need to understand how to use a combination of these strategies and other supports for MSM to best curb the syndemic. Objective: We designed a patient-preference trial to understand patient preferences for PrEP and doxyPEP, how preferences may change over time, and methods for preventing premature discontinuation of PrEP. Methods: We enrolled HIV-negative MSM in metropolitan Atlanta, Georgia. Participants could elect to take PrEP (daily or on-demand), doxyPEP, both, or neither, along with app-based support to evaluate for risk factors of discontinuation or behavioral changes that might affect their choice of prevention methods. Participants were able to switch prevention methods at any time. Oral PrEP and doxyPEP users are currently being offered quarterly in-person or at-home HIV, syphilis, gonorrhea, and chlamydia testing along with opportunities for motivational interviewing. Results: We enrolled individuals from November 2021 to September 2023. Among 240 participants, the median age was 30 (IQR 25-35), 63% (n=150) self-identified as non-Hispanic Black, and 69% (n=166) were insured. Most participants (n=144, 60%) elected to take daily PrEP plus doxyPEP, with a smaller proportion taking on-demand PrEP plus doxyPEP (n=34, 14%) or daily PrEP without doxyPEP (n=33, 14%). Conclusions: We designed an ongoing study to evaluate the preferences for PrEP and doxyPEP among MSM in metropolitan Atlanta. Enrollment was completed in 22 months and included a diverse cohort of MSM that will be followed longitudinally to evaluate prevention preferences over time. At baseline, most participants preferred to take a combination of daily PrEP and doxyPEP for HIV and STI prevention. Trial Registration: Clinicaltrials.gov NCT05072093; https://clinicaltrials.gov/study/NCT05072093 International Registered Report Identifier (IRRID): DERR1-10.2196/56096

BACKGROUND There is an ongoing syndemic of HIV and sexually transmitted infections (STIs) in the United States, particularly among men who have sex with men (MSM). We have increasingly effective and diverse measures of prevention, including various types of pre-exposure prophylaxis (PrEP) for HIV prevention and doxycycline postexposure prophylaxis (doxyPEP) for STI prevention. As options expand, we need to understand how to use a combination of these strategies and other supports for MSM to best curb the syndemic. OBJECTIVE We designed a patient-preference trial to understand patient preferences for PrEP and doxyPEP, how preferences may change over time, and methods for preventing premature discontinuation of PrEP. METHODS We enrolled HIV-negative MSM in metropolitan Atlanta, Georgia. Participants could elect to take PrEP (daily or on-demand), doxyPEP, both, or neither, along with app-based support to evaluate for risk factors of discontinuation or behavioral changes that might affect their choice of prevention methods. Participants were able to switch prevention methods at any time. Oral PrEP and doxyPEP users are currently being offered quarterly in-person or at-home HIV, syphilis, gonorrhea, and chlamydia testing along with opportunities for motivational interviewing. RESULTS We enrolled individuals from November 2021 to September 2023. Among 240 participants, the median age was 30 (IQR 25-35), 63% (n=150) self-identified as non-Hispanic Black, and 69% (n=166) were insured. Most participants (n=144, 60%) elected to take daily PrEP plus doxyPEP, with a smaller proportion taking on-demand PrEP plus doxyPEP (n=34, 14%) or daily PrEP without doxyPEP (n=33, 14%). CONCLUSIONS We designed an ongoing study to evaluate the preferences for PrEP and doxyPEP among MSM in metropolitan Atlanta. Enrollment was completed in 22 months and included a diverse cohort of MSM that will be followed longitudinally to evaluate prevention preferences over time. At baseline, most participants preferred to take a combination of daily PrEP and doxyPEP for HIV and STI prevention. CLINICALTRIAL Clinicaltrials.gov NCT05072093; https://clinicaltrials.gov/study/NCT05072093 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/56096

HIV prevention in women is imperative to end the HIV epidemic in the US. However, pre-exposure prophylaxis (PrEP) uptake in this population has been low, and innovative and feasible approaches are needed. The Title X Family Planning Program provides federal funding for sexual health services and HIV prevention to low income or uninsured individuals. We sought to increase PrEP awareness and reduce barriers to providing PrEP for women in Atlanta. We designed, implemented, and evaluated educational tools (trainings, resources, and technical assistance) for staff at Title X clinics on topics relevant for PrEP care for cisgender women. Comparison of pre- and post-training 5-point Likert scale evaluations of ability to meet training objectives for the Overview of PrEP and PrEP for Clinicians Trainings. Two-sample Satterthwaite t-tests comparing pre- and post-training scores were significantly different by individual objective, for each training, and overall (all pMelissa Kottke, MD, MPH, MBA, HRA Pharma: Advisor/Consultant|Organon: Grant/Research Support