Jowanna Malone1, Sari L Reisner2,3,4, Erin E Cooney5, Tonia Poteat6, Christopher M Cannon7, Jason S Schneider8, Asa Radix9, Kenneth H Mayer10,11, J Sonya Haw12, Keri N Althoff1, Andrew J Wawrzyniak13, Chris Beyrer14, Andrea L Wirtz1. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. 3. Department of Medicine, Harvard Medical School, Boston, MA. 4. Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Boston, MA. 5. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 6. Department of Social Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC. 7. Research, Whitman-Walker Institute, Washington, DC. 8. School of Medicine, Emory University, Atlanta, GA. 9. School of Medicine, New York University, New York, NY. 10. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 11. Fenway Community Health Center, The Fenway Institute, Boston, MA. 12. Division of Endocrinology, Metabolism, and Lipids, School of Medicine, Emory University, Atlanta, GA. 13. University of Miami Miller School of Medicine, Miami, FL and. 14. Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abstract
INTRODUCTION: Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood. METHODS: This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women-specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum. RESULTS: PrEP indication prevalence using transgender women-specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk. CONCLUSIONS: These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
INTRODUCTION: Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood. METHODS: This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women-specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum. RESULTS: PrEP indication prevalence using transgender women-specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk. CONCLUSIONS: These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
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