Richard Gray

This late breaker abstract session focused on factors related to oral and injectable PrEP use such as confirmatory testing, use preferences, adherence disparities, and the increased risk of other STIs. Data was presented from clinical trials and implementation studies of women, men who have sex with men, and transgender women.

The first two presentations focused on results from the HPTN 084 trial of injectable cabotegravir (CAB) in women. Mina Hosseinipour presented results for the testing algorithm used in the trial focusing on the issues around false positive results. Two rapid POC tests were able to correctly confirm HIV diagnosis though the PPV was lower for CAB due to its high efficacy. Sinead Delany-Moretlwe then presented results related to the choices and preferences of women participants related to using injectable cabotegravir or oral PrEP. CAB was chosen by 78% of women with the main reason related to liking/not liking injections or the taking of pills. The following presentation by Lucilene Freitas described results from the ImPrEP study which assessed same day oral PrEP delivery to men who have sex with men and transgender women in public health systems in Latin America. Focusing on data from Brazil there were clear racial disparities in HIV incidence with black and pardo participants having a higher incidence and lower oral PrEP adherence. In the final presentation Jore Gallardo Cartagena showed using data from the AMP (HVTN 704/HPTN 085) trial and a post-hoc analysis there was a higher incidence of bacterial STIs among participants on PrEP.

Oral PrEP scale-up and the introduction of highly efficacious injectable long-acting PrEP requires public health programs and systems to adapt and be able to offer a broad range of PrEP options that align with the preferences and experiences of individuals. Providing more choice and tailoring PrEP interventions will maximize uptake and help improve equity. There is a need to ensure accurate diagnosis of HIV infections to minimize the consequences of false positive results and PrEP programs will need to incorporate STI prevention. Discrimination and structural barriers that prevent access to any form of PrEP must continue to be addressed.