Factors associated with long‐term HIV pre‐exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

Abstract

Introduction The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.

Prevención, diagnóstico y tratamiento del VIH en niños y jóvenes de Latinoamérica.

“…Añaden que el acceso a pruebas de VIH es un buen método, por lo tanto, los programas de prevención deben de dirigirse a emplearla, ya que en la actualidad es escasa en todo Latinoamérica. Konda y col. (Konda et al, 2022). También sugieren y señalan a la prEP como medida profiláctica segura y eficiente.…”

Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: a discrete choice experiment in Brazil

“…Some of the recruited participants could have also been enrolled in other studies within the ImPrEP Project, a transnational project in Latin America to generate evidence on PrEP among MSM and TGW. 39 , 43 , 44 The DCE used the infrastructure of other studies under the umbrella of the ImPrEP study for data collection but had its own training of interviewers and protocols. Participation in the DCE did not influence the other studies.…”

Long-Acting Injectable Cabotegravir for HIV Preexposure Prophylaxis Among Sexual and Gender Minorities: Protocol for an Implementation Study

“…PrEP Brasil, a daily oral PrEP demonstration study, found that although 74% of all participants had protective concentrations of tenofovir diphosphate at week 48, young participants and TGW participants had decreasing rates of protective drug concentrations throughout the study [ 14 ]. In addition, data from the ImPrEP study, which aimed to evaluate the feasibility of same-day PrEP initiation for MSM and TGW within the public health contexts of Brazil, Mexico, and Peru, identified lower PrEP adherence among TGW and individuals aged ≤30 years [ 15 , 16 ].…”

“…Owing to user adherence challenges, PrEP has not decreased HIV incidence among some population, particularly among populations with higher susceptibility (youth, racial and ethnic minorities, and TGW) [ 17 - 20 ]. Although HIV incidence in the ImPrEP study population was relatively low (0.85/100 person-years), it was higher among TGW, participants from Peru, those aged 18 to 30 years, Black or mixed-race participants, and those who were nonadherent to daily oral PrEP [ 15 , 16 ]. These disproportionately worse outcomes reinforce the potential of PrEP agents that do not require daily or planned oral dosing to increase their effective use among the most susceptible populations.…”