Erin E Cooney1, Sari L Reisner2, Haneefa T Saleem3, Keri N Althoff4, S Wilson Beckham5, Asa Radix6, Christopher M Cannon7, Jason S Schneider8, J Sonya Haw8, Allan E Rodriguez9, Andrew J Wawrzyniak10, Tonia C Poteat11, Kenneth H Mayer12, Chris Beyrer4, Andrea L Wirtz4. 1. Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD. Electronic address: Ecooney2@jhmi.edu. 2. Fenway Health, The Fenway Institute, Boston, MA; Brigham and Women's Hospital, Division of Endocrinology, Diabetes, and Hypertension, Boston, MA; Harvard Medical School, Department of Medicine, Boston, MA; Harvard TH Chan School of Public Health, Department of Epidemiology, Boston, MA. 3. Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD. 4. Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD. 5. Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD. 6. Callen-Lorde Community Health Center, New York, NY. 7. Whitman-Walker Institute, Washington, DC. 8. Emory University, School of Medicine, Atlanta, GA. 9. University of Miami Miller School of Medicine, Division of Infectious Diseases, Department of Medicine, Miami, FL. 10. University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL. 11. University of North Carolina School of Medicine, Center for Health Equity Research, Chapel Hill, NC. 12. Fenway Health, The Fenway Institute, Boston, MA; Harvard Medical School, Department of Medicine, Boston, MA.
Abstract
PURPOSE: Adherence to pre-exposure prophylaxis (PrEP) during periods of PrEP-indication (i.e., prevention-effective adherence) is critical for preventing HIV. We sought to describe factors associated with prevention-effective adherence trajectories among transgender women (TW) to inform PrEP implementation strategies. METHODS: Using data from The LITE American Cohort (n = 728), we performed group-based multi-trajectory modeling (GBMTM) to identify clusters of TW with similar trajectories of PrEP adherence and indication, and sociodemographic, biobehavioral, and structural correlates of each trajectory. RESULTS: We identified five trajectories: (1) consistent indication/no PrEP (15.3%), (2) initial indication/no PrEP (47.1%), (3) declining indication/discontinued PrEP (9.5%), (4) consistent indication/PrEP adherent (18.5%), and (5) increasing indication/initiated PrEP (9.6%). TW diagnosed with an STI were more likely to follow a consistent indication/no PrEP trajectory compared to consistent indication/PrEP adherent trajectory (adjusted Relative Risk Ratio [aRRR], 2.54; 95% confidence interval [CI], 1.16-5.57). TW who experienced homelessness were more likely to follow PrEP discontinuation and initiation trajectories relative to PrEP adherence (aRRR, 2.71; 95% CI, 1.10-6.70 and 2.83; 95% CI, 1.13-7.05, respectively). CONCLUSIONS: Over a quarter of TW followed trajectories suggestive of prevention-effective adherence, while 15% did not initiate PrEP despite consistent indication. Findings highlight missed opportunities for PrEP engagement at STI diagnosis and suggest structural interventions addressing housing instability may improve prevention-effective adherence among TW.
PURPOSE: Adherence to pre-exposure prophylaxis (PrEP) during periods of PrEP-indication (i.e., prevention-effective adherence) is critical for preventing HIV. We sought to describe factors associated with prevention-effective adherence trajectories among transgender women (TW) to inform PrEP implementation strategies. METHODS: Using data from The LITE American Cohort (n = 728), we performed group-based multi-trajectory modeling (GBMTM) to identify clusters of TW with similar trajectories of PrEP adherence and indication, and sociodemographic, biobehavioral, and structural correlates of each trajectory. RESULTS: We identified five trajectories: (1) consistent indication/no PrEP (15.3%), (2) initial indication/no PrEP (47.1%), (3) declining indication/discontinued PrEP (9.5%), (4) consistent indication/PrEP adherent (18.5%), and (5) increasing indication/initiated PrEP (9.6%). TW diagnosed with an STI were more likely to follow a consistent indication/no PrEP trajectory compared to consistent indication/PrEP adherent trajectory (adjusted Relative Risk Ratio [aRRR], 2.54; 95% confidence interval [CI], 1.16-5.57). TW who experienced homelessness were more likely to follow PrEP discontinuation and initiation trajectories relative to PrEP adherence (aRRR, 2.71; 95% CI, 1.10-6.70 and 2.83; 95% CI, 1.13-7.05, respectively). CONCLUSIONS: Over a quarter of TW followed trajectories suggestive of prevention-effective adherence, while 15% did not initiate PrEP despite consistent indication. Findings highlight missed opportunities for PrEP engagement at STI diagnosis and suggest structural interventions addressing housing instability may improve prevention-effective adherence among TW.
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