P424 High prevalence and incidence of bacterial STIs in young women at high risk of HIV prior to PrEP scale-up in kenya

Background Young women account for more than half of new HIV infections in sub-Saharan Africa and are a target population for HIV pre-exposure prophylaxis (PrEP). Although it protects against HIV acquisition, PrEP lacks protection against bacterial sexually transmitted infections (STIs). High rates of STIs have been reported among PrEP-using men who have sex with men (MSM) in high income countries. STI rates among African adolescent girls and young women (AGYW) have not been well-described. Methods POWER is a multi-site PrEP implementation science project among AGYW aged 16–25 in Kisumu, Kenya (beginning August 2017) as well as South Africa; we describe results from the Kenyan cohort here. At enrollment, participants are offered PrEP; follow-up visits are at month-one and then quarterly for 36 months with STI testing at enrollment before PrEP initiation and every 6 months. Urine samples were tested for Chlamydia trachomatis and Neisseria gonorrhoeae by nucleic acid amplification (NAAT) and participants with infections returned to the research site for treatment. Results To date, 708 Kenyan women have enrolled in POWER with 17% prevalence of C. trachomatis and 8% of N. gonorrhoeae at enrollment. Among the 65 women with 6-month follow-up in Kenya; the incidence of C. trachomatis and N. gonorrhoeae were 40.0 and 12.3 per 100 person-years. Conclusion In a PrEP scale-up cohort among Kenyan AGYW, STI prevalence and incidence were very high, which predict substantial morbidity. These STI rates are comparable to those seen among PrEP-using MSM in the US after years of rising rates; Kenya has had only early PrEP roll-out and thus these findings are largely prior to community delivery of PrEP. It is not yet known if STI rates will increase among with PrEP use in Kenya, and PrEP roll-out programs provide a crucial opportunity to address both HIV and STI epidemics simultaneously. Disclosure No significant relationships.