Preexposure prophylaxis care continuum among transgender women at a patient-centered preexposure prophylaxis program in Atlanta, Georgia

Aldredge, Amalia; Roth, Grant; Vaidya, A.S.; Duarte, Ana Paula; Kundu, Suprateek; Zheng, Ziduo; Smith, Bradley L.; Lora, Meredith; Gruen, Judah K; Sheth, Anandi N.; Sales, Jessica M.; Cantos, Valeria D

doi:10.1097/qad.0000000000002788

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…Many socio‐structural drivers of high HIV incidence among transgender women are also barriers to engagement in the HIV prevention cascade [ 3 , 4 , 5 , 6 ]. Observational data on longitudinal PrEP engagement among transgender women are limited [ 7 , 8 ], but data from clinical cohorts suggest that PrEP persistence among transgender women is low [ 9 , 10 ]. A daily, oral PrEP demonstration study with multiple sites in Latin America conducted from 2018 to 2021, ImPrEP, found less than half of transgender women remained on PrEP 52 weeks after initiation [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study

Cooney,

Saleem,

Stevenson

et al. 2023

J Int AIDS Soc.

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IntroductionTransgender women in the United States experience high HIV incidence and suboptimal Pre‐exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women.MethodsUsing a sequential, explanatory, mixed‐methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow‐up 24 months; interquartile range 15–36). Cox regression models assessed predictors of initiation and discontinuation. In‐depth interviews were conducted among 18 participants, including life history calendars to explore key events and experiences surrounding discontinuations. Qualitative and quantitative data were integrated to generate typologies of discontinuation, inform meta‐inferences and facilitate the interpretation of findings.Results21.8% (n = 286) of participants reported taking PrEP at one or more study visits while under observation. We observed 139 PrEP initiations over 2127 person‐years (6.5 initiations/100 person‐years, 95% CI: 5.5–7.7). Predictors of initiation included identifying as Black and PrEP indication. The rate of initiation among those who were PrEP‐indicated was 9.6 initiations/100 person‐years (132/1372 person‐years; 95% CI: 8.1–11.4). We observed 138 PrEP discontinuations over 368 person‐years (37.5 discontinuations/100 person‐years, 95% CI: 31.7–44.3). Predictors of discontinuation included high school education or less and initiating PrEP for the first time while under observation. Four discontinuation typologies emerged: (1) seroconversion following discontinuation; (2) ongoing HIV acquisition risk following discontinuation; (3) reassessment of HIV/STI prevention strategy following discontinuation; and (4) dynamic PrEP use coinciding with changes in HIV acquisition risk.ConclusionsPrEP initiation rates were low and discontinuation rates were high. Complex motivations to stop using PrEP did not consistently correspond with HIV acquisition risk reduction. Evidence‐based interventions to increase PrEP persistence among transgender women with ongoing acquisition risk and provide HIV prevention support for those who discontinue PrEP are necessary to reduce HIV incidence in this population.

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Section: Introductionmentioning

confidence: 99%

PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study

Cooney,

Saleem,

Stevenson

et al. 2023

J Int AIDS Soc.

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show abstract

“…There are limited data on patterns of PrEP use over time in the United States (US), which limits our understanding of how patients are adhering and persisting to PrEP and where interventions may be useful, at both individual and structural levels. 9,[17][18][19][20] We sought to explore patterns of PrEP use over the first year after initiation specifically among racial/ethnic minority patients of all genders to inform future interventions for these population. Furthermore, we examined patient characteristics and experiences at baseline and over follow-up that differed between PrEP use patterns.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…1,2 To maximize prevention, individuals must take PrEP consistently enough to remain biologically protected, which is measured by adherence, and long enough while potentially exposed to HIV to be protected, which is measured by persistence. 3,4 Adherence and persistence metrics have been inconsistently reported 5,6 but the literature suggests many patients stop using PrEP relatively soon after initiation, particularly among ciswomen and transwomen and racial/ethnic minorities [6][7][8][9][10][11][12][13][14][15][16][17] ; better adherence and persistence are therefore needed to end the HIV epidemic. However, there are also patients who can successfully use PrEP for extended periods of time.…”

Section: Introductionmentioning

confidence: 99%

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Long-term HIV Pre-exposure Prophylaxis Trajectories Among Racial & Ethnic Minority Patients: Short, Declining, & Sustained Adherence

Pyra

Brewer

Rusie

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: HIV pre-exposure prophylaxis (PrEP) requires continued use at an effective dosage to reduce HIV incidence. Data suggest early PrEP drop-off among many populations. We sought to describe PrEP use over the first year among racial and ethnic minority patients in the US.Setting: Racial and ethnic minority patients initiating PrEP at a federally qualified health center in Chicago, IL.Methods: Using electronic health records, we determined the adherence ($6 weekly doses) trajectories over the first year of PrEP use and compared baseline and time-varying patient characteristics. Results:From 2159 patients, we identified 3 PrEP use trajectories.Sustained use was the most common (40%) trajectory, followed by short use (30%) and declining use (29%). In adjusted models, younger age, Black race, as well as gender, sexual orientation, insurance status at baseline, and neighborhood were associated with trajectory assignment; within some trajectories, insurance status during follow-up was associated with odds of monthly adherence ($6 weekly doses).Conclusion: Among racial and ethnic minorities, a plurality achieved sustained PrEP persistence. Access to clinics, insurance, and intersectional stigmas may be modifiable barriers to effective PrEP persistence; in addition, focus on younger users and beyond gay, cismale populations are needed.

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Prevention-effective adherence trajectories among transgender women indicated for PrEP in the United States: a prospective cohort study

Cooney

Reisner

Saleem

et al. 2022

Annals of Epidemiology

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Preexposure prophylaxis care continuum among transgender women at a patient-centered preexposure prophylaxis program in Atlanta, Georgia

Cited by 3 publications

References 23 publications

PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study

PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study

Long-term HIV Pre-exposure Prophylaxis Trajectories Among Racial & Ethnic Minority Patients: Short, Declining, & Sustained Adherence

Prevention-effective adherence trajectories among transgender women indicated for PrEP in the United States: a prospective cohort study

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