The University of Miami Rapid Access Wellness Clinic, established in 2018, delivers same-day HIV prevention and sexual health services through one fixed site and mobile unit at five Miami-Dade locations. In April 2023, the clinic began offering doxycycline post-exposure prophylaxis (DoxyPEP) to reduce bacterial sexually transmitted infections (STIs). We evaluated changes in STI incidence before and after DoxyPEP initiation. We conducted a retrospective cohort study using clinical data from September 2018 to April 2025. For each client prescribed DoxyPEP, the post-DoxyPEP period began on the day of the first DoxyPEP prescription. The pre-DoxyPEP period extended from first recorded visit to the day before initiation. Incident cases of chlamydia and gonorrhea were identified via positive nucleic acid amplification test from urine, oral, or rectal samples. Early syphilis was diagnosed using positive/increased rapid plasma reagin (RPR) titer and clinical evaluation/adjudication of stage. Person-time was calculated for each period, and incidence rates were expressed per 100 person-years. Poisson regression models were fit separately for each STI, with event count as the outcome, log-person-time as the offset, and a binary pre/post indicator as the predictor. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were derived. Among 750 DoxyPEP recipients included, 87.9% identified as men who have sex with men, 63.6% as White, 76.0% as Hispanic or Latino, and 88.8% as male. The mean number of sexual partners reported in the past year was 8.7 (SD = 15.0). During the observation period, there were 304 chlamydia, 528 gonorrhea, and 189 early syphilis instances. Chlamydia incidence was 48% lower post-DoxyPEP (IRR = 1.48; 95% CI: 1.18–1.88; p < 0.001). Gonorrhea incidence increased by 33% post-DoxyPEP (IRR = 0.75; 95% CI: 0.63–0.88; p < 0.001). Early syphilis incidence did not significantly differ (IRR = 1.09; 95% CI: 0.82–1.47; p = 0.54). DoxyPEP appeared to reduce chlamydia incidence among individuals at risk in our cohort; the observed increase in gonorrhea underscores the need for continued surveillance. This real-world evaluation highlights the need for additional data regarding the impact of DoxyPEP in community-based sexual health programs. Susanne Doblecki-Lewis, MD, MSPH, Aspire Scientific: Medical writing support|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Medical writing support|Merck, Inc.: Grant/Research Support

Background:Timely and accurate estimates of HIV incidence are essential for program monitoring and planning clinical studies. Real-world evidence from electronic medical records (EMRs) in sexual health clinics may provide a pragmatic alternative to resource-intensive surveys and surveillance.Setting:We conducted a retrospective cohort study across 5 health centers in the United States, South Africa, and Thailand to assess the feasibility of estimating HIV incidence using EMR data.Methods:Clients aged 16-64 years assigned male at birth who reported ever having sex with someone assigned male at birth and had at least 1 HIV test between July 1, 2022, and December 31, 2023, were included. Deidentified data were extracted and subcohorts created considering 1 versus more than 1 HIV test during the study period. Incidence rates were calculated within the multiple-test (MT) cohort using person-time at risk; diagnosis proportions were calculated for all cohorts.Results:All sites met data quality thresholds for essential demographic and clinical variables. A total of 25,801 clients were included. Diagnosis proportions in single-test cohorts were higher (2.9%-12.6%) than in MT cohorts (0%-0.53%). Incidence rates among MT cohorts ranged from 0.22 to 0.72 per 100 person-years, substantially lower than expected, likely due to PrEP use and selection bias toward health-engaged clients.Conclusion:EMR-based HIV incidence estimation is feasible but limited by data variability and selection bias thus incidence estimates from MT cohorts may not reflect true community incidence. Diagnoses data may be used for incidence modeling where there is sufficient sample size.

Sexually minoritized men (SMM) experience sexual minority stress, a product of exposure to prejudice, discrimination, and heterosexism. This study sought to identify the latent profiles of sexual minority stress among SMM with HIV who use methamphetamine and to examine the correlates associated with profile membership. A cross-sectional examination of 104 participants in San Francisco self-reported their experiences with sexual minority stress. A latent profile analysis was used to characterize the underlying "profiles" or subgroups of participants. ANOVA and Chi-square analysis were used to examine sociodemographic characteristics, psychological health, substance use, and HIV-related health associated with each profile. Participants' mean age was 43 years old (SD = 9); most identified as Black, Hispanic, or Other racial and ethnic identities (57%), and had been diagnosed with HIV for 13 years (SD = 9) on average. Our findings revealed four distinct profiles: (1) High Concealment, Moderate Prejudice Events, (2) Low Concealment, High Prejudice Events, (3) Low Sexual Minority Stress, and (4) High Sexual Minority Stress. Members of the High Sexual Minority Stress profile had the highest mean addiction severity scores and the greatest endorsement of feelings of shame and guilt. Notably, each profile had clinically significant PTSD and depression scores, even among those who experienced stressful events to a lesser extent. Our findings suggest that sexual minority stress plays a critical role in substance use and mental health outcomes. Additional research is needed to elucidate the other facets of stress in SMM that use substances.

BACKGROUND:In Miami-Dade County, high HIV incidence rates and suboptimal uptake of HIV prevention strategies, such as pre-exposure prophylaxis (PrEP), underscore significant gaps in community HIV awareness and service accessibility. Novel interventions leveraging community-based participatory research (CBPR) and peer-driven distribution mechanisms offer potential solutions for increasing engagement with HIV testing and preventive services, yet few existing interventions are culturally tailored or systematically integrated into local contexts. This study aimed to develop and refine a culturally sensitive, peer-distributed at-home HIV self-test (HIVST) and prevention information intervention called Test-to-PrEP, to address specific needs within Miami-Dade's diverse populations. METHODS:A CBPR approach was employed, incorporating iterative community stakeholder engagement through a purposely selected, diverse 10-member advisory panel. Members included representatives from local HIV prevention organizations, academic experts, and community advocates reflecting key populations affected by HIV, notably Hispanic/Latino men who have sex with men (MSM), Black women, and immigrants. Development activities included structured weekly meetings, thematic analysis of qualitative panel discussions, and literature reviews to identify intervention gaps and opportunities for optimization. Materials were pretested among PrEP clients, incorporating feedback into intervention revisions. Training for intervention distributors utilized a standardized "Train-the-Trainer" module to promote fidelity and scalability. RESULTS:Key outputs included the development of gender- and sexual orientation-neutral educational materials (a six-page prevention booklet and discreetly packaged self-test kits), a culturally and linguistically adapted data collection survey available via QR code, and refined training procedures emphasizing distributor preparedness and self-efficacy. Thematic analysis revealed critical community preferences for neutral and inclusive messaging, privacy considerations in materials packaging, and systematic distributor-recipient linkage to enhance traceability and accountability. Pilot feedback affirmed the perceived quality, cultural acceptability, and broad accessibility of the developed materials. CONCLUSIONS:The CBPR-informed Test-to-PrEP intervention demonstrates an innovative, scalable model for improving accessibility and acceptability of HIV self-testing and prevention information in high-incidence communities. Results underscore the importance of inclusive, culturally sensitive intervention design, systematic training approaches, and rigorous community collaboration to optimize health services delivery. Future implementation studies are ongoing to quantitatively evaluate the intervention's effectiveness on HIV testing uptake, PrEP initiation, and subsequent clinical service utilization.

Objective:This longitudinal study aimed to examine the associations of sexual minority stress and outness with leukocyte telomere length across time among sexually minority men (SMM) with HIV who use methamphetamine. Methods:A sample of 91 SMM with HIV with biologically confirmed recent methamphetamine use completed measures of sexual minority stress and outness at the baseline visit in a randomized controlled trial. Telomere length was measured over 15 months using extracted leukocyte DNA Statistical analyses were performed using bivariate analyses and generalized estimation equations to examine the independent association between baseline outness and leukocyte telomere length, adjusting for chronological age and recent stimulant use. Results:Greater outness was significantly associated with longer telomere length (estimate = 0.008; CI: 0.001-0.008) after adjusting for chronological age and stimulant use. There was no evidence that stimulant use, intervention assignment, or race/ethnicity moderated the association between outness and greater leukocyte-telomere length. Sexual minority stress was not significantly associated with leukocyte-telomere length. Conclusion:Findings are among the first to demonstrate that greater outness is associated with slower biological aging in SMM. Further research is needed to elucidate the bio-behavioral mechanisms linking outness and greater leukocyte-telomere length.

BACKGROUND:In Miami-Dade County Florida (Miami), the rate of newly diagnosed HIV per 100,000 population is four times the national rate with a large majority of transmission due to male-to-male sex. Latinx men are prescribed HIV preventative medication (PrEP) at a lower rate than White individuals; as such, efforts are being made by community health organizations to engage Latinx men who have sex with men (LMSM) in PrEP promotion programs. The objective of this study is to characterize the features, strengths, and weaknesses of the implementation of a PrEP promotion program (DiversiPrEP) at three community based organization (CBO) locations across Miami-Dade and Broward Counties. METHODS:All 30 staff members were invited via e-mail to participate; 11 staff participated in semi-structured interviews were conducted by two authors to assess implementation of the DiversiPrEP program with questions mapped to the Consolidated Framework for Implementation Research (CFIR). We used directed content analysis to analyze qualitative data. RESULTS:All staff members self-identified as male and 82% (9 of the 11) identified as Hispanic/Latino. Facilitators to providing PrEP services included: 1) individualized counseling for the PrEP process; 2) providing inviting community-focused spaces with staff who reflect the demographics of the priority population; and 3) hiring non-medical staff that bridge the gap as a translator of both medical and administrative issues. Negative influences on implementation included: 1) federal funding restrictions on lab and testing costs that hinder the ability of the CBO to provide no-cost testing to clients; and 2) finding ways to advertise services to LMSM that may not already be familiar with the CBO. CONCLUSIONS:CBO administrative staff provide actionable policy and implementation recommendations for offering culturally tailored PrEP services in other LMSM communities. CBO can reduce PrEP service barriers by acting as intermediaries for navigation of the healthcare system and deferring costs to the clients through federal and state funding programs.

Disparities in Latinx sexual minority men (LSMM) pre-exposure prophylaxis (PrEP) initiation and adherence demonstrate the need for innovative strategies to improve outcomes along the PrEP Care Continuum. The purpose of this study was to examine physical and virtual risk venue co-attendance among LSMM of varying stages of PrEP use living in South Florida, an Ending the HIV Epidemic (EHE) priority jurisdiction. Venue co-attendance may be leveraged to support equitable dissemination and implementation (D&I) of HIV and drug use preventive interventions to LSMM. Ninety-four LSMM completed surveys on PrEP use and identified physical and virtual sexual and drug risk venues (where men seek sex partners and/or have sex or access or use drugs). Bivariate analyses examined differences in demographics and venue endorsement by PrEP status. Exponential random graph models examined endorsement of venues by PrEP status. One-mode projection visualizations portray the structure of venue co-attendance networks by PrEP status. Participants identified 49 physical and virtual sexual and drug risk venues. A homophily effect of PrEP status on venue endorsement was identified for both sexual and drug risk venues. Network size and density differed by PrEP status and whether the venue was identified as a sexual or drug risk location. Online dating apps, bars, and saunas had the highest centrality in each network type suggesting their potential role in implementing preventive programming. This study identified specific sexual and drug risk venues that may be leveraged to both disseminate targeted PrEP and harm reduction information and to implement interventions to improve PrEP uptake and adherence among LSMM living in EHE priority jurisdictions.

Background: Barriers to Pre-exposure prophylaxis (PrEP) access have limited its reach to priority populations. Community-based mobile clinics have potential to broaden PrEP engagement. We aim to compare reach and persistence for mobile and fixed clinic settings.Methods: This observational cohort study analyzed data from 1896 clients engaged through our fixed or mobile clinic from August 2018 to March 2023. Services were offered at no cost to clients. The same staff and package of barrier-lowering strategies was deployed across sites. Chi‐square and Fisher's exact test or the Kruskal–Wallis test were used to test for differences in characteristics across sites as well as across services sought. Demographics for our cohorts were compared with those experiencing new HIV diagnoses in MDC in 2021. Kaplan–Meier curves were generated to evaluate persistence on PrEP and in care. Cox proportional hazards models were used to evaluate risk factors for discontinuation of PrEP or clinic care by 48 weeks by gender, race, ethnicity, insurance status, and site.Findings: The mobile clinic engaged a higher proportion of cisgender women, Black clients, and older clients compared with the fixed setting. Uninsured individuals, males, and those who initiated services in the mobile clinic were more likely to continue PrEP (HR:1.20, p=0.01; HR:2.02, p<0.01; HR:1.68, p<0.01, respectively). Persistence did not differ by race or ethnicity. Interpretation: A mobile clinic strategy for PrEP engagement can increase reach to key populations underrepresented in HIV prevention care in MDC. Persistence in PrEP was increased for the mobile clinic cohort, suggesting an additional benefit to this modality beyond the other barrier-lowering strategies employed in our fixed and mobile clinics.Funding: National Institute of Allergy and Infectious Disease, Florida Department of Health.Declaration of Interest: Receipt of research funding to my institution for clinical trials (not related to this work) from Gilead Sciences and Merck. There are no other competing interests.Ethical Approval: The University of Miami’s Institutional Review Board (IRB) reviewed the data collection and analysis plan and determined that this demonstration project did not qualify as human subject research.

Introduction: Barriers to pre-exposure prophylaxis (PrEP) access have limited its reach to priority populations. Community-based mobile clinics have potential to broaden PrEP engagement. We evaluated reach and persistence for fixed and mobile clinic cohorts in Miami-Dade County, Florida. Methods: This observational cohort study analysed data from 1896 clients engaged through our fixed or mobile clinic from August 2018 to March 2023. Services were offered at no cost to clients. The same staff and package of barrier-lowering strategies was deployed across fixed and mobile clinic sites. Chi-square and Fisher's exact test or the Kruskal-Wallis test were used to test for differences in characteristics across sites as well as across services sought. Kaplan-Meier curves were generated to evaluate persistence on PrEP and in care, defined as completion of at least one clinic visit (including PrEP prescribing, for PrEP persistence, or for any reason, for persistence in care) within 24 weeks of the prior visit. Cox proportional hazards models were used to evaluate risk factors for discontinuation of PrEP or clinic care by 48 weeks by gender, race, ethnicity, insurance status and site. Results: The fixed and mobile clinics reached 781 and 1109 clients, respectively, during the study period. The median client age was 35 years; the majority (70.4%) of clients were cisgender men, identified as Hispanic/Latino (62.5%) and were men who have sex with men (54.5%). The mobile clinic extended reach to a higher proportion of cisgender women (32.1% mobile vs. 12.9% for fixed clinic), Black clients (34.5% vs. 13.1%) and older clients (median 37 vs. 33 years) compared with the fixed setting. Uninsured individuals, men and those who initiated services in the mobile clinic were more likely to continue PrEP to 48 weeks (HR: 1.20, p = 0.01; HR: 2.02, p<0.01; HR: 1.68, p<0.01, respectively). Persistence did not differ by race or ethnicity. Conclusions: A mobile clinic strategy for PrEP engagement can increase reach to key populations underrepresented in HIV prevention care including cisgender women and Black clients. Persistence in PrEP was increased for the mobile clinic cohort, suggesting an additional benefit to this modality beyond other barrier-lowering strategies employed in our fixed and mobile clinics.

Despite the availability of pre-exposure prophylaxis (PrEP), Latino sexual minority men (LSMM) continue to experience disparities in PrEP uptake and subsequently, HIV vulnerability. Social network norms are an underutilized solution to increase PrEP uptake. We used a peer influence model (network autocorrelation model) to examine the role of social network descriptive norms (i.e., actual behaviors) surrounding PrEP use. A total of 11 sociocentric networks of 13 friends (n = 143 LSMM) were recruited into our study from 2018 to 2019 in South Florida. Most participants were in PrEP pre-contemplation (n = 44), and almost one-third of our sample were using PrEP (n = 38). Three network autocorrelation models were estimated using an empirically informed Bayesian analysis. We found a positive association between participants' Motivational PrEP Cascade (MPC) position and their network members' (friends') cascade position based on three different measures of connection even when accounting for PrEP knowledge: friendship (ρ = 0.22; 95% CIa = 0.01-0.42), emotional closeness (ρ = 0.24; 95% CI = 0.03-0.44), and frequency of interaction (ρ = 0.22; CI = 0.03-0.42). Our findings highlight that an individual's progress in the MPC may be influenced by their network members' progress in the MPC, suggesting that LSMM using PrEP may serve as role models to their peers for PrEP use due to descriptive norms. Our findings further suggest that PrEP interventions for LSMM along the MPC can be implemented at the social network level.

Little is known about polydrug use among Latino seasonal farmworkers. This cross-sectional study with male Latino seasonal workers (LSWs) living in South Florida categorized distinct classes of drug use and then characterized each drug use typology by demographic, structural, and psychological factors.One hundred and twenty-five male LSWs were recruited during community events using convenience sampling between July 2019-March 2020. Latent class analysis was conducted by leveraging measures of self-reported use of nine drugs in the past year (sedatives, cannabis, stimulants, heroin, opioids, cocaine, PCP, hallucinogens, and inhalants). Correlates of latent class membership were examined using 3-step categorical latent variable logistic regression. Analyses were performed using Mplus version 8 and SAS 9.4.Four drug use classes were identified, male LSWs who exhibited: 1) use of illegal opioids only (n = 32); 2) concurrent cannabis and cocaine use (n = 75); 3) concurrent sedative and cannabis use (n = 13); and 4) high concurrent drug use (n = 5). About 84.7% of the sample reported use of at least one drug in the past 12 months. LSWs who identified as White and were married or in a stable relationship were likely to only use illegal opioids. LSWs with less than high school education and self-reported good to excellent health were more likely to use cannabis and cocaine. Men with moderate to severe anxiety and self-reported bad health were classified as engaging in sedative and cannabis co-use. Survivors of physical abuse were more commonly classified as people using high concurrent substances relative to non-abused men among the four classes.This pilot study suggests the presence of heterogeneity in polydrug use classes among LSWs in South Florida.

BACKGROUND:DiversiPrEP is a culturally-tailored PrEP program for LMSM offered in South Florida. DiversiPrEP navigates LMSM through their PrEP journey, including education, deciding if PrEP is relevant for them, payment, and accessing/maintaining PrEP use. DiversiPrEP includes five ERIC strategies (Increase Demand, Promote Adaptability, Alter Client Fees, Intervene with Clients to Enhance Uptake and Adherence, and Tailor Strategies). DESCRIPTION:Photovoice was used to conduct five two-part focus groups with LMSM (n = 12) and Non-LMSM (n = 12). In the first session, trainers provided guidance on selecting and contextualizing photos to generate CFIR themes. Then, participants captured photos that embodied their lived experiences accessing PrEP. In the second session, using SHOWeD, participants discussed photos, identifiedhow photos relate to culturally relevant issues. Triangulation approaches compared/contrasted themes between LMSM and Non-LMSM. RESULTS:Five central themes emerged around barriers and facilitators to PrEP services: 1) the need for normalizing PrEP messages within the MSM community, 2) the need for normalizing PrEP messages outside the MSM community, 3) the need for expanding PrEP knowledge, 4) different motivations for using PrEP, and 5) the presence of structural barriers that limit PrEP access. This study compared similarities and differences of barriers and facilitators to PrEP use between Latino/a and non-Latino/a MSM. Similarities included the built environment (outer setting) as a barrier, the need for normalizing PrEP messaging within and outside of the MSM community, and the need to expand PrEP knowledge. Differences between Latino/a and non-Latino/a MSM were found in assessing the motivation and personal drivers (inner setting) for initiating PrEP associated with how participants viewed their responsibilities to self or others. CONCLUSIONS:Photovoice with focus groups identified CFIR constructs that can guide the large-scale implementation of a client-centered PrEP service model with telehealth for both Latino/a and non-Latino/a MSM. Implementing client-centered accessible PrEP programs is an essential step to promoting sexual-health equity.

Abstract Background Black and Latina transgender women (BLTW) have the highest HIV rates among transgender women (Black: 62%, Latinx: 35%). PrEP-GAT is an EHE grant which evaluated barriers and facilitators to engagement in PrEP and gender affirming therapy (GAT) services and the use of friendship networks to promote these interventions. Methods Participants were recruited through the University of Miami’s GenWell Service, which provides bundled PrEP and GAT. This study has two components: qualitative and social networks. Qualitative component: 20 in-depth interviews focused on barriers and facilitators to PrEP and GAT services using Consolidated Framework for Implementation Research (CFIR) constructs. Data was analyzed using thematic analysis. Social network component: 27 social network-based interviews identified friendship dynamics that could promote conversations and encouragement to engage with PrEP and GAT. Analysis included multilevel logistic regression using R and network visualizations using UCINET. Results Qualitative Component. Barriers to accessing PrEP and GAT services included cost, need for Spanish-language materials, bias, stigma, and discrimination. Facilitators included access to telehealth, mobile services, pharmacists, and co-located PrEP-GAT services. BLTW were not comfortable disclosing their HIV status due to HIV stigma. “HIV clinics” discouraged individuals from seeking services. Social network component: most participants were using GAT (75%), and more than half reported lifetime PrEP use (56%). Bivariate analysis: having a Latinx friend, a friend who shared GAT status, and higher emotional closeness were associated with future conversations about PrEP and GAT (p< 0.05). Multilevel model: emotional closeness was associated with future conversations about PrEP and GAT (p=0.02). Conclusion Mental health, legal, employment and housing services are needed to meet BLTW access to PrEP. Social network approaches can identify key individuals in BLTW friendship networks to promote and disseminate information about PrEP and GAT. Future Directions: Future research will determine whether bundled PrEP-GAT, social network support, and telehealth is effective to increase BLTW’s engagement in these services. Disclosures Susanne Doblecki Lewis, MD, MSPH, FIDSA, Gilead Sciences: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support

Background: HIV self-testing (HIVST) can increase the reach of HIV testing. Preexposure prophylaxis (PrEP) clients may be ideal distributors of HIVST kits and PrEP information within their social networks. This study uses the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate the distribution of HIVST bundled with PrEP information (“Test-to-PrEP” kits) among egocentric friendship networks of PrEP users. Methods: The study was conducted in Miami from November 2021 to March 2022. Enrolled PrEP clients (egos; n = 100) were offered Test-to-PrEP kits for distribution. Egos and Test-to-PrEP kit users completed brief online surveys. Descriptive statistics are reported for participants, their reported network members, and users of the Test-to-PrEP kits. Logistic and Poisson regression assessed the relationship between characteristics of egos, alters, and the distribution of Test-to-PrEP kits. Results: The 100 enrolled egos reported a total of 414 alters. Participants received 293 Test-to-PrEP kits for distribution with 47 of the 100 participants distributing at least 1 kit. Of those who scanned the quick-response code and responded to the survey, 16.2% reported no previous HIV test and 38.5% reported no prior knowledge of PrEP; 32.5% reported interest in distributing Test-to-PrEP kits, 3 successfully distributed kits, and 2 initiated PrEP. Conclusions: An approach using PrEP clients' social networks can disseminate HIVST bundled with PrEP information to critical populations including individuals lacking knowledge of PrEP or who have never been tested for HIV. Future studies will assess whether this use of network effects can increase reach and efficiency of HIV testing and PrEP information distribution.

Despite the increasing availability of pre-exposure prophylaxis (PrEP), Latinx men who have sex with men (LMSM) are not receiving PrEP-related information. To understand the influence of LMSM sexual networks on PrEP-related conversations and encouragement to use PrEP, this cross-sectional egocentric network study characterized the PrEP-related communication of 130 LMSM egos with 507 sexual partners (alters). Participants were recruited using respondent-driven sampling methods from a Miami-Dade County community-health organization. Egocentric-level data were collected from 2018-2019 and analyzed using multilevel modeling. Of egos, 30% reported using PrEP. Closeness between participants and sexual partners played a role in PrEP conversation and encouragement. Participants believed they would have less success convincing sexual partners to use PrEP if partners were older. Participants perceived higher likelihood to talk about PrEP or success in encouraging alters to use PrEP if, relative to meeting sexual partners on Grindr, they met at a friend's party, gay-centric community event, or school/work. Given that increased closeness and in-person sexual partner meeting venues are associated with PrEP information dissemination and encouragement, social network-based interventions can capitalize on PrEP navigators who run network visualizations, and with this information develop a longitudinal plan to increase PrEP conversation and encouragement as needed for each network.

Objective: To determine the feasibility, acceptability, and implementation of a HIV self-test (HIVST) program through PrEP clients' social and sexual networks. Background: HIV testing is critical for treatment and prevention engagement. HIVST kits can overcome barriers to testing. A negative result is an opportunity to provide PrEP information. We describe implementation factors associated with engaging current Mobile PrEP (MP) clients to distribute HIVST kits and PrEP information through their networks. Setting: Community venues in Miami-Dade County, Florida. Methods: A baseline survey collected network information and explored distribution plans for offering HIVST kits. A follow-up survey evaluated use and distribution. A logic model describes the process of implementation and evaluation. Up to 4 Ora-Quick HIV ST kits were offered to 81 MP clients. A brief training included resources for posttest engagement. Results: Forty-four percent of the kits were reported as distributed. Of 81 MP clients offered kits, 50 (62%) accepted. In a follow-up survey, 77% of MP clients distributed at least 1 kit. Fifty-six (86%) social network members were Latino, and 9 (14%) were Black. Three of 4 MP clients engaged in PrEP discussions (77%) with SN members. Reported reasons for HIVST kit use included convenience, confidentiality, privacy concerns, and discomfort with going to a testing site. MP clients reported that kit distribution was affected by the COVID-19 pandemic. Conclusion: HIV ST kits allowed PrEP users to engage others in their social and sexual networks for HIV testing and information regarding PrEP. Work to scale-up this intervention is underway.

Abstract Background HIV testing allows care engagement of people living with HIV and PrEP for those who test negative. Social network strategy (SNS) interventions may facilitate distribution of HIV self-test (ST) kits to individuals who do not routinely test for HIV. The University of Miami pre-exposure prophylaxis (PrEP) program offers low-barrier PrEP/HIV prevention services through mobile and static clinics in Miami-Dade County. Current PrEP clients may be ideal distributors of HIV ST kits and PrEP information within their social networks. Methods Study activities occurred in Miami from November 2021 to March 2022. At PrEP visits, participants (n = 96) were given Ora-Quick oral fluid ST kits for distribution to their social network members. Participant surveys included demographics, feelings of closeness to network members, history of PrEP conversations, and intention for future PrEP conversations. Descriptive statistics included mean and range for continuous variables and frequencies for categorical variables. Network visualizations were constructed using UCINet and NetDraw. Bivariate and regression analysis, conducted in R, assessed the relationship between demographic characteristics of the client and the proportion of network members who discussed PrEP and plan to discuss PrEP in the future between and across networks. Results A network visualization displays clients (n=96) and their social networks (n=426). Clients and network members were a majority male (84.7%) and of Hispanic/Latinx ethnicity (78.8%). Within and between network analysis indicated that networks differed significantly in reported closeness and frequency of PrEP discussions (F = 2.97; p-value 0.01, F = 17.45; p < 0.03, respectively). Age and average reported closeness of the ego were independently and jointly associated with an increase in the likelihood of future PrEP conversations (estimate = 0.02; p-value < 0.01; estimate = 0.24; p –value < 0.01, respectively). Figure 1:PrEP Discussion & Closeness Node color reflects PrEP discussion and node size reflects client reported closeness Conclusion We demonstrate the feasibility of disseminating HIV ST kits and PrEP information through SNS. Emotionally closely linked networks, with similar characteristics (i.e., age) may be most effective for this SNS strategy. Disclosures Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.

Latinx seasonal farmworkers are essential workers and are at elevated risk for SARS-CoV-2 in the United States. Risk factors for SARS-CoV-2 are unique to this population and include crowded living conditions, isolated social networks, and exploitative working environments. The circumstances and cultural values of Latinx seasonal farmworkers pose a unique challenge to public health authorities working to contain the spread of SARS-CoV-2. This community is in dire need of urgent public health research to identify opportunities to prevent SARS-CoV-2 transmission: social network methods could be the solution. Using previously collected and new information provided by a team of experts, this commentary provides a brief description of Latinx seasonal farmworker disparities that affect tracking and treating SARS-CoV-2 in this important group, the challenges introduced by SARS-CoV-2, and how social network approaches learned from other infectious disease prevention strategies can address these disparities.