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Background: Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM) are significantly less likely than white MSM to initiate pre-exposure prophylaxis (PrEP). A peer-driven intervention (PDI) may be an effective approach to addressing this disparity. In this study, we explored community member perspectives of a PDI to promote PrEP uptake among B/AA and H/L MSM. Methods: We conducted semi-structured interviews with B/AA and H/L HIV-negative MSM between August 2018 and October 2019 in Rhode Island, USA. Participants reported their perspectives and recommendations for a PDI. Data from participant responses were thematically analysed. Results: Of 15 MSM, the median age was 25 years (interquartile range: 22, 33). The majority identified as B/AA (53.3%), H/L (66.7%), and having a college education or above (53.3%). Most participants viewed a PDI positively and were willing to learn and promote PrEP among their peers. Participants identified and supported several potential intervention components, such as education about the benefit of PrEP, emphasising prevention-effective dosing, and clarifying no prevention effect towards other sexually transmitted infections. They preferred in-person meetings to electronic communication. Preferred characteristics of peer educators included compassion, good communication skills, and enthusiasm about PrEP. Conclusions: This in-depth qualitative interview suggested that a PDI approach is promising in promoting PrEP uptake, as it could deliver culturally appropriate education and encourage PrEP uptake via peer influence among B/AA and H/L MSM. Peer approach is effective in promoting health among hard-to-reach populations. This study aims to explore the feasibility of implementing a peer approach for improving pre-exposure prophylaxis (PrEP) use among Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM). Study findings will be used to develop a peer approach for a real-world implementation. Participants were interviewed for their perspectives on such a peer approach, including willingness to disseminate PrEP knowledge and potential barriers to initiating PrEP. [ABSTRACT FROM AUTHOR]

Background: Vaccines are effective in preventing Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy defined as delay of acceptance or refusal of the vaccine is a major barrier to effective implementation. Methods: Participants were recruited statewide through an English and Spanish social media marketing campaign conducted by a local news station during a one-month period as vaccines were becoming available in Rhode Island (from December 21, 2020 to January 22, 2021). Participants completed an online survey about COVID-19 vaccines and vaccine hesitancy with constructs and items adopted from the Health Belief Model. Results: A total of 2,007 individuals completed the survey. Eight percent (n = 161) reported vaccine hesitancy. The sample had a median age of 58 years (interquartile range [IQR]: 45, 67), were majority female (78%), White (96%), Non-Hispanic (94%), employed (58%), and reported an annual individual income of $50,000 (59%). COVID-19 vaccine hesitancy was associated with attitudes and behaviors related to COVID-19. A one unit increase in concern about COVID-19 was associated with a 69% (Adjusted Odds Ratio: 0.31, 95% CI: 0.26–0.37) decrease in vaccine hesitancy. A one-level increase in the likelihood of getting influenza vaccine was associated with a 55% (AOR: 0.45 95% CI: 0.41–0.50) decrease in vaccine hesitancy. Conclusions: COVID-19 vaccine hesitancy was relatively low in a state-wide survey in Rhode Island. Future research is needed to better understand and tailor messaging related to vaccine hesitancy. [ABSTRACT FROM AUTHOR]

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Retention in HIV pre-exposure prophylaxis (PrEP) care is critical for effective PrEP implementation. Few studies have reported long-term lost to follow-up (LTFU) and re-engagement in PrEP care in the United States. Medical record data for all cisgender patients presenting to the major Rhode Island PrEP clinic from 2013 to 2019 were included. LTFU was defined as no PrEP follow-up appointment within 98 days. Re-engagement in care was defined as individuals who were ever LTFU and later attended a follow-up appointment. Recurrent event survival analysis was performed to explore factors associated with PrEP retention over time. Of 654 PrEP patients, the median age was 31 years old [interquartile range (IQR): 25, 43]. The majority were male (96%), White (64%), non-Hispanic (82%), and insured (97%). Overall, 72% patients were ever LTFU and 27% of those ever LTFU re-engaged in care. Female patients were 1.37 times [crude hazard ratio (cHR): 1.37; 95% confidence interval (CI): 0.86–2.18] more likely to be LTFU than male patients, and a 1-year increase in age was associated with a 1% lower hazard of being LTFU (cHR: 0.99; CI: 0.98–0.99). Being either heterosexual (aHR: 2.25, 95% (CI): 1.70–2.99] or bisexual (aHR: 2.35, 95% CI: 1.15–4.82) was associated with a higher hazard of loss to follow-up compared with having same-sex partners only. The majority of PrEP users were LTFU, especially at the first 6 months of PrEP initiation. Although a significant number were re-engaged in care, targeted interventions are needed to improve retention in PrEP care. This study characterized the natural projection of loss to follow-up and re-engagement in HIV PrEP care using a longitudinal clinic cohort data and explored associated factors for guiding future interventions to improve retention in PrEP care. [ABSTRACT FROM AUTHOR]

Illicit substance use poses a significant public health challenge in the United States. Certain populations are disproportionately impacted by substance use disorders. Men who have sex with men (MSM) have been shown to be three to four times more likely to report substance use compared to the general population. MSM also make up a disproportionate number of new cases of STIs. The impact of substance use disorders on STI and HIV infection risk has been well documented among this vulnerable population. Understanding the intersection of substance use and sexual risk is important to design effective interventions to reduce substance use and risk of STIs. However, little is known about the relationship between venues used to arrange sexual encounters including hook-up apps and substance use. This study describes the demographics and social network characteristics of MSM who presented to an STI clinic in Rhode Island including reported substance use and the primary hook-up venues used for meeting sexual partners. The results show that individuals using online venues to meet sexual partners were more likely to report substance use, indicating the possible utility of interventions using social media to address the unique vulnerability of STI and HIV infection for substance using MSM. [ABSTRACT FROM AUTHOR]

Background Pre-exposure prophylaxis (PrEP) in the form of daily tenofovir disoproxil fumarate (TDF/FTC) is a potentially transformative tool to prevent HIV infection. However, PrEP scale-up in the United States has been slow and difficult to evaluate comprehensively. All payer claims databases (APCDs) are large datasets that contain information on medical and pharmaceutical claims from most public and private payers in each state, and provide an unusual opportunity to evaluate statewide PrEP implementation efforts. Methods We used 2012–2017 data from Rhode Island's APCD and developed an algorithm to identify individuals prescribed TDF/FTC for PrEP. We compared APCD PrEP data to electronic medical record (EMR) data at the largest dedicated PrEP program in the state, and to other comprehensive pharmaceutical claims data (AIDSVu.org). We calculated the PrEP-to-Need ratio (PnR) based on annual HIV incidence, and used multivariable logistic regression to predict ZIP code-level PrEP use, and specialty of prescribing provider (primary care vs. infectious disease). Results The Rhode Island APCD included insurance claims for 917,633 individuals (87% of the Rhode Island population). PrEP use increased substantially in Rhode Island over the 5-year period, from 13 to 331 prescriptions between 2012 and 2017, with 546 total users during this time period. Users were predominantly male (89%) and privately insured (69.1%), and concentrated in Providence County (71.5%). The PnR ratio increased from 0.2 to 4.0 from 2012–2017. Compared with AIDSVu and EMR Data, the APCD underestimated the number of PrEP users in Rhode Island, but improved over time in documenting users. Infectious diseases specialists had 8.4 times the odds (95% CI: 5.4 to 12.9) of being a PrEP prescriber compared with primary care providers. A total of 2.6% of infectious disease specialists were PrEP prescribers compared with 0.33% of PCPs. The proportion of Black or Hispanic individuals in a ZIP-code was not a significant predictor of PrEP use. Conclusion APCDs offer an innovative approach to evaluate statewide PrEP implementation comprehensively. Engaging PCPs in PrEP implementation is critical to improve overall uptake among populations most at-risk. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Men who have sex with men are disproportionately impacted by HIV in the United States and may benefit most from pre-exposure prophylaxis (PrEP). However, differences may exist between men who only have sex with men (MSM) and men who have sex with both men and women (MSMW). MSMW may experience more barriers to accessing PrEP and may act as a potential bridge population for transmitting HIV to female sex partners. Differences in PrEP awareness and use between MSM and MSMW are unknown. Methods We evaluated all MSM and MSMW presenting to the Rhode Island Sexually Transmitted Diseases (STD) clinic and PrEP clinic from 2013–2017. Demographics and behavioral information were reviewed. Bivariate analyses were performed to present distributions of demographic and behavioral characteristics by sexual behavior. Logistic regression was conducted to explore associations between PrEP awareness/use and sexual behavior. Confounding variables were identified using the directed acyclic graphs (DAGs) and a priori. Results Of 1,795 male individuals, 84% (1,504) were MSM, and 16% (291) were MSMW. The median age of our study population was 29 (interquartile range [IQR]: 23–42). When compared with MSM, MSMW were more likely to be non-White (33% vs. 28%), uninsured (54% vs.46%), self-report more sexual partners in the past 12 months (median 6 [IQR: 3–9]: vs. 4 [IQR:2–10]), use intranasal cocaine (21% vs. 12%), and engage in selling (6% vs. 2%) or buying sex (12% vs. 4%, all P < 0.05). MSMW were also less likely to have a previous HIV test (77% vs. 89%) compared with MSM. MSMW were 59% (adjusted odds ratio [aOR]: 041, 95% confidence interval [CI]: 0.31–0.55) less likely to be aware of PrEP and 17% (aOR: 0.83, 95% CI: 0.41–1.66) less likely to report ever using PrEP after adjusting for age, race/ethnicity, and self-reported HIV risk. Conclusion Despite engaging in higher risk behaviors, MSMW were significantly less likely to be aware of or use PrEP compared with MSM. Future PrEP interventions are needed to target this potentially high-risk bridge population. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Sexually transmitted disease (STD) rates continue to rise in the United States (US). Over half of all new STDs occur in adolescents and young adults (AYA). Few studies have evaluated how sexual behaviors such as number of partners or condom use may contribute to this increase. We aimed to determine the association of sexual behaviors and condom use with STD incidence over time among AYA. Methods We reviewed all AYA ages 13–26 years attending a public STD clinic in Rhode Island from 2013–2017. We reviewed demographic and behavioral data including age, gender identity, risk group, race, ethnicity, insurance status, sexual behaviors, substance use, self-reported STD/HIV diagnosis (lifetime, past year), condom use, and HIV/STD testing results. We report proportions in 2013 and 2017, and performed trend analyses (Cocharn-Armitage test for categorical variables and Kruskal–Wallis trend test for continuous variables) to determine trends over time. Results A total of 3,822 AYA visited the clinic during the study time period. An increasing trend was observed for: multiple (≥5) partners (29% of AYA in 2013 vs. 38% in 2017, P < 0.001), self-reported past year and lifetime STD diagnosis (12 vs. 21%, P < 0.001 and 19 vs. 33%, P < 0.001, respectively), and lab-documented diagnosis of any STD (15 vs. 25%, P < 0.001), syphilis (2 vs. 5%, P = 0.006), any chlamydia (11 vs. 20%, P = 0.001), and any gonorrhea (3 vs. 8%, P = 0.008). A decreasing trend was observed for: white race (66% in 2013 vs. 43% in 2017, P < 0.001), uninsured (73 vs. 53%, P < 0.001), condomless sex during oral as well as vaginal/anal sex (22 vs. 10%, P = 0.001 and 16 vs. 8%, P = 0.001, respectively), and self-reported HIV diagnosis (2.5% to 0.9%, P = 0.016). Conclusion Among AYA, risk behaviors such as condomless sex and multiple partners increased significantly from 2013–2017, which may be contributing to an increase in STDs. Increased public health efforts are needed to promote education and other interventions to address behaviors associated with STD transmission. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Medical record data was extracted from a sexually transmitted infection (STI) clinic in Providence, Rhode Island to characterize trends in Neisseria gonorrhoeae (GC) infection and explore risk factors. Of 16,601 clinical encounters, 6% (n=991) tested GC positive: 5.28 GC case rate (per 100 encounters) in the first two years of data collection (2015-2016) and 7.04 in the last two years (2020-2021). Analysis suggested a single linear trend line over time (p<.05). Overall, in more recent years, patients were older and more like to identify as male, Black, and Hispanic/Latino, as well as to have reported a previous STI, current symptoms, and specific risk behaviors. GC-positive patients in 2020-2021 were older and more like to identify as female and Black compared to 2015-2016. Lower rates of condom use were especially salient among female patients. These findings may reflect GC trends in the community.

We developed a testing program for severe acute respiratory syndrome coronavirus 2 in an urban Latinx neighborhood in Providence, Rhode Island, USA. Approximately 11% of Latinx participants (n = 180) tested positive. Culturally tailored, community-based programs that reduce barriers to testing help identify persons at highest risk for coronavirus disease.

Coronavirus disease 2019 is responsible for a global pandemic and has impacted health care accessibility and delivery. Clinic data were reviewed for an STI clinic from September 2019 to May 2020. A significant decrease in rates of STI visits and treatments during the coronavirus disease 2019 pandemic was observed.

Purpose: Preexposure prophylaxis (PrEP) in the form of daily emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) is effective for preventing HIV infection. Implementation has been limited by an inability to systematically evaluate uptake and use. All-Payer Claims Databases (APCDs) provide an opportunity to evaluate population-level PrEP implementation., Methods: We used 2012-2017 data from Rhode Island's APCD and developed an algorithm to identify individuals prescribed FTC/TDF for PrEP. We describe PrEP implementation by patient demographics and provider type and mapped PrEP implementation across ZIP codes. We compared APCD data to electronic medical record data and comprehensive pharmaceutical claims data (AIDSVu.org)., Results: The Rhode Island APCD represented approximately 87% of the state's population. PrEP use increased 31-fold from 2012 to 2017. Users were predominantly privately insured, male, and concentrated in Providence County (76.6%). Infectious diseases providers had 3.2 times the odds of being a PrEP prescriber compared to primary care providers. Compared to other pharmaceutical and electronic medical record data, the APCD underestimated the number of PrEP users in Rhode Island but improved in capturing users over time., Conclusions: APCDs are a useful data source for characterizing PrEP use across a state. There is a need to increase PrEP prescribing among primary care providers, especially in areas with underserved populations., (Copyright © 2020 Elsevier Inc. All rights reserved.)