Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations

Abstract

Purpose of Review Pre-exposure prophylaxis (PrEP) represents one of the most effective methods of prevention for HIV, but remains inequitable, leaving many transgender and nonbinary (trans) individuals unable to benefit from this resource. Deploying community-engaged PrEP implementation strategies for trans populations will be crucial for ending the HIV epidemic. Recent Findings While most PrEP studies have progressed in addressing pertinent research questions about gender-affirming care and PrEP at the biomedical and clinical levels, research on how to best implement gender-affirming PrEP systems at the social, community, and structural levels remains outstanding. Summary The science of community-engaged implementation to build gender-affirming PrEP systems must be more fully developed. Most published PrEP studies with trans people report on outcomes rather than processes, leaving out important lessons learned about how to design, integrate, and implement PrEP in tandem with gender-affirming care. The expertise of trans scientists, stakeholders, and trans-led community organizations is essential to building gender-affirming PrEP systems.

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

“…Implementation efforts are ongoing to expand PrEP delivery by increasing the number of PrEP providers and diversifying PrEP delivery models (e.g. telemedicine services, pharmacy-based services and delivery in primary care practices) [3,27,52,73,74,80,109,110].…”

“…Key findings included high rates of PrEP awareness, an overwhelming preference for PrEP services without cost-sharing, a strong preference for PrEP services bundled with GAHT services and differential preferences in PrEP provision locations between PrEP-naïve and PrEP-experienced respondents. Community-engaged implementation and qualitative research conducted by and in collaboration with trans community stakeholders and researchers are needed to obtain a nuanced understanding of the PrEPrelated needs and preferences among this diverse priority population [3]. Future implementation efforts should consider how models of PrEP delivery for next-generation PrEP may impact scale-up among current and potential trans-PrEP users and prioritize strategies that address the complex factors impeding equitable PrEP delivery, which is a public health priority.…”

“…Social, structural and systemic barriers, including social marginalization, stigma and structural oppression, sustain inequitable HIV pre-exposure prophylaxis (PrEP) care con-tinuum outcomes in the United States among transgender and gender-diverse (trans) populations, which include communities of transfeminine, transmasculine, nonbinary and other gender-diverse individuals whose gender identity or expression differ from cultural expectations [1][2][3][4][5]. The U.S.…”

“…In light of these recommendations, tailored implementation strategies to achieve equitable PrEP delivery for trans populations are needed [3,13]. Regrettably, implementation studies rarely enrol trans participants in numbers sufficient to yield reliable estimates-transfeminine participants are often subsumed into study cohorts comprised predominantly of cisgender sexual minority men, while transmasculine and nonbinary individuals are rarely enrolled at all [13][14][15][16][17][18] Limited inclusion of trans participants in implementation research will hinder efforts to develop strategies that are salient and relevant to trans individuals who might otherwise benefit from PrEP due to their current sexual practices or personalized HIV prevention needs and preferences [3,13,15,19]. However, prior research with trans participants across other fields of research may inform this work.…”

Multilevel Factors Impacting PrEP Engagement Among Young Gay Men and Young Transgender Women in Thailand: A Qualitative Analysis

“… 47 , 48 This supports the need for tailored, youth-focused programs to facilitate PrEP adherence. 4 , 14 Differentiated service delivery of PrEP through youth-friendly clinics with peer educator involvement should include trans-specific spaces that provide gender-affirming care and integrate PrEP with hormone therapy and other sexual health services, 49 – 51 such as the Tangerine Community Health Clinic in Bangkok, 6 as well as gay-affirmative clinics serving YMSM.…”