Background Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy, but it is unclear how best to deliver PrEP to key populations. Drawing upon a cross-sectional survey of transgender women (TW) in Detroit, USA, and experience of a PrEP clinic that serves this population, this manuscript describes the following: (1) the risk profile of Detroit TW; (2) the proportion of TW with at least one PrEP indication; and (3) perceptions of and experiences with PrEP among TW in Detroit. Methods: Between August 2017 and March 2018, 126 TW completed an online PrEP survey. Survey responses were summarised using descriptive statistics and multivariable relative risk regression. Results: Among participants who reported a negative or unknown HIV status (76% of all participants), 56% reported risk behaviour(s) consistent with PrEP indication guidelines, 17% reported currently taking PrEP and another 4% reported discontinued PrEP use. Among participants who met an indication for PrEP but were not currently taking PrEP, 64% indicated that they were not interested in taking PrEP. Approximately 60% of participants who were not currently taking PrEP reported that they would be more likely to take PrEP if it were provided at a clinic that also provided hormone replacement therapy. Conclusions: Although a substantial proportion of TW in our survey were on PrEP, interest in PrEP among high-risk TW who were not taking it was low. Specialised clinical infrastructure that is responsive to the specific needs of TW may be needed to expand PrEP to this oftentimes marginalised and high-risk population.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are disproportionately affected by HIV, and young transgender women (YTW) are especially impacted. The purpose of this small demonstration project was to measure pre-exposure prophylaxis (PrEP) adherence in a community-based clinic for LGBTQ youth in which PrEP services are integrated with gender-affirming care. Of the 50 enrolled participants, 38 had a serum drug assay performed after three or more months and 26% of those had laboratory evidence of highly protective levels of medication. Low adherence highlights the need for culturally tailored follow-up efforts and assistance with the structural barriers to health experienced by LGBTQ youth, especially YTW.

Background Rates of reported early syphilis in Alaska increased over 300% between 2015 and 2018, with cases concentrated in men who have sex with men (MSM) that reside in the Anchorage/Mat-Su region. To better understand the epidemic, we surveyed at-risk Alaskan MSM about their syphilis knowledge, attitudes, and practices using a paper-and webbased survey. MSM were recruited through several avenues, including advertisements on two, popular geosocial-networking apps for gay, bisexual, and other MSM. We report on the relative efficiency in recruiting men through two different geosocial-networking apps. Methods The geosocial-networking apps (App A and App B) were selected based on key-informant interviews. Identical ad text and imagery promoting the survey ran on each app for two weeks. The total number of times the ads were displayed (impressions), number of times users clicked on an ad (clicks), mean clickthrough rate (CTR; clicks/impressions), and costs for advertising on the two apps were estimated and compared. Results App A had a total of 28,642 impressions, and 904 clicks (daily range: 5-191). The mean CTR for App A was 5.45, at a cost of $0.32/click. App B had a total of 681 impressions, and 57 clicks. The mean CTR for App B was 8.37, at a cost of $12.28/click. Of 119 survey responses, 59 (50%) were online surveys, of which 32 (54%) reported hearing about the survey through the geosocial-networking apps ad. Conclusion Recruiting MSM for surveys and prevention interventions through mobile apps is productive and may be costefficient. However, not all apps produce the same results. In our survey, App B was over 38 times more costly per click than App A. Programs should routinely explore the effectiveness and associated costs with utilization of app-based advertising. Disclosure No significant relationships.