(P127) A DIGITAL SYNDEMIC APPROACH TO POSITIVE RECTAL STIS AND HIV PREVENTION IN COMMUNITIES OF COLOR

Background:
Contracting HIV increases by 300% in individuals with rectal chlamydia or gonorrhea. Given the urgent need for HIV prevention in individuals that can be met through Pre-Exposure Prophylaxis (PrEP), Healthvana, a digital client engagement platform, in collaboration with AIDS Healthcare Foundation, an HIV prevention provider, initiated a messaging program as part of clients’ routine care. Following a positive rectal chlamydia or gonorrhea result, clients were immediately presented with a pleasure- or risk-based question asking whether they would like to start PrEP.

Methods:
Between May and December 2023, 400 clients at a Los Angeles AHF clinic tested positive for rectal chlamydia or gonorrhea and received their results via Healthvana's platform. They were notified of their positive status and randomly assigned to receive either a pleasure-based message highlighting PrEP's role in enhancing sexual confidence or a risk-based message emphasizing its effectiveness in reducing HIV risk. Those who clicked “Yes” (options: Yes/No/Already on PrEP) to start PrEP were contacted within 2-3 days for an initiation appointment.

Results:
Out of 400 clients messaged, 50 showed interest in PrEP, with 24 declining and 316 not responding (excluding 10 already on PrEP). Pleasure-based messages yielded higher engagement (21% vs. 16%) and more affirmative responses (75% vs. 56%) compared to risk- based messages, leading to more PrEP prescriptions (40% vs. 29%). Among the 41 respondents who shared demographic details, 52% were from Communities of Color, with 48% of these receiving PrEP prescriptions.

Conclusion:
Automatically identifying good PrEP candidates through a syndemic approach, based on positive tests for rectal STIs, aids in HIV prevention and helps connect clients with PrEP. Our work also suggests that focusing less on risk may boost engagement in sexual health. Moreover, this model has shown how technology can mitigate access barriers for communities of color, who represented a majority of the contacted clients.