Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review

Dang, Madeline; Scheim, Ayden I.; Teti, Michelle; Quinn, Katherine; Zarwell, Meagan; Petroll, Andrew E.; Horvath, Keith J.; John, Steven A.

doi:10.1089/apc.2021.0236

Cited by 38 publications

(28 citation statements)

References 58 publications

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“…1,10 Systemic discrimination within the healthcare system impedes access, adherence, and compliance with social and biomedical interventions to prevent HIV infection, including HIV pre-exposure prophylaxis (PrEP). 11 As one example, from 2014-2015, 35.6% of US transgender women and 31.6% of transgender men reported having ever had an HIV test in their lifetime, which was numerically similar to the prevalence of HIV testing for cisgender, heterosexual adults (35.2%). 12 In addition to confounders that prevent access to care, there are additional barriers to recruiting and enrolling TGD people in HIV-focused research, including research and medical mistrust, fear of mistreatment, and concerns about safety, exploitation, and confidentiality.…”

Section: Language In This Reviewmentioning

confidence: 83%

“…18 Although not all TGD people choose to access hormone therapies, based on the 2015 US Transgender Health Survey, which was a non-probability survey of ~30,000 TGD adults, nearly 80% of respondents wanted to take hormone therapy at some point in their lives. 19 Because TGD people accessing hormone therapy may prioritize gender affirming hormone treatment over PrEP, 9,11,20 integrated HIV care and clinical medical gender affirmation management (including hormone therapy) can serve as the "bedrock of gender-affirmative health care." 5 Researchers observed that active hormone therapy use was associated with 1.5 higher odds of linkage to HIV primary care (P = 0.04), 2.04 higher odds of retention in HIV care (P < 0.001), and 1.89 higher odds of viral suppression (P < 0.001) for transgender women living with HIV relative to transgender women not using hormones.…”

Section: Importance Of Hiv Pharmacology Research In Transgender Medicinementioning

confidence: 99%

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Inclusion of Transgender and Gender Diverse People in Phase III Trials: Examples from HIV Pharmacologic Prevention Studies

Cirrincione

Grieve

Holloway

et al. 2022

Clin Pharma and Therapeutics

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Although at least 25 million adults are transgender worldwide, few phase III clinical trials have enrolled transgender and gender diverse (TGD) people. HIV is the only therapeutic area to include TGD people intentionally in phase III randomized clinical trials during the development of certain newer HIV pharmacologic prevention interventions. Pharmacologic assessments for HIV prevention efficacy in TGD populations are important, as there may be specific considerations for product use and potential interactions with hormone therapies. Herein, we summarize ongoing and completed phase III HIV trials that included TGD people as part of the study population, we examine investigators’ strategies for recruiting and engaging TGD priority populations in these phase III trials, and we comment on the implications of these studies for prioritizing TGD populations in clinical pharmacology research within the phase III clinical trial landscape.

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Section: Language In This Reviewmentioning

confidence: 83%

Section: Importance Of Hiv Pharmacology Research In Transgender Medicinementioning

confidence: 99%

Inclusion of Transgender and Gender Diverse People in Phase III Trials: Examples from HIV Pharmacologic Prevention Studies

Cirrincione

Grieve

Holloway

et al. 2022

Clin Pharma and Therapeutics

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“…Similarly, 26.1% of the transgender men recruited on the internet from October 2017 to May 2018 ever reported PrEP use [ 40 ]; yet, these findings were not disaggregated by current or prior PrEP use and are similar to our study’s 23.4% (133/569) who reported ever being prescribed PrEP. Further efforts are needed to target barriers to PrEP uptake, such as reducing potential misconceptions about interactions with gender-affirming therapy, establishing trusting relationships between medical institutions and transgender patients, and reducing PrEP stigma negatively affecting PrEP knowledge and attitudes as thematically organized by a systematic review of the literature [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study

John

Sizemore

Jimenez

et al. 2022

JMIR Public Health Surveill

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Background HIV disproportionately affects sexual minority men (SMM) in the United States. Objective We sought to determine past HIV postexposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among a web-based sample of cisgender and transgender men who have sex with men. Methods In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other web-based venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP use and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use with PEP and PrEP use, as well as the association between past PEP use and current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at P<.001, given the large sample size; 99.9% CIs are reported. Results Prior PEP use was reported by 11.28% (7108/63,015) of the participants, with current or prior PrEP use reported by 21.95% (13,832/63,015) and 8.12% (5118/63,015), respectively. Nearly half (3268/7108, 46%) of the past PEP users were current PrEP users, and another 39.9% (2836/7108) of the participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (relative risk ratio [RRR] 23.53, 99.9% CI 14.03-39.46) and prior PrEP use (RRR 52.14, 99.9% CI 29.39-92.50). Compared with White men, Black men had higher prevalence of past PEP use and current PrEP use, Latino men had higher prevalence of PEP use but no significant difference in PrEP use, and those identifying as another race or ethnicity reported higher prevalence of past PEP use and lower current PrEP use. Past PEP use and current PrEP use were highest in the Northeast, with participants in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race by past PEP use with current PrEP use was found (RRR 0.57, 99.9% CI 0.37-0.87), indicating that Black men who previously used PEP were less likely to report current PrEP use. Participants who reported recent club drug use were significantly more likely to report past PEP use and current or prior PrEP use than those without recent club drug use. Conclusions PrEP use continues to be the predominant HIV prevention strategy for SMM compared with PEP use. Higher rates of past PEP use and current PrEP use among Black SMM are noteworthy, given the disproportionate burden of HIV. Nonetheless, understanding why Black men who previously used PEP are less likely to report current PrEP use is an important avenue for future research.

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“…Research shows other health priorities such as hormone therapy take precedence over services like PrEP for some trans women (9,10). Programs and health communication strategies that group trans women in programs for men who have sex with men have also contributed to low PrEP uptake, as they do not center the unique needs and concerns of trans women (9).…”

Section: Introductionmentioning

confidence: 99%

“Entre Nosotras:” A qualitative evaluation of a peer-led PrEP project for transgender Latinas

Zamudio-Haas

Koester

Venegas

et al. 2023

Preprint

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Background: Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx project staff led intervention development, which aimed to increase access to HIV prevention services, including PrEP. Methods: This paper engages qualitative methods to describe and evaluate how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of participant observation of intervention activities and recorded field notes. We analyzed qualitative data engaging a content analysis approach and used Dedoose to code transcripts. Results: Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support “entre nosotras” (“between us women/girls”). The combination of these factors contributed to the intervention’s success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcomed and “en casa/ at home” in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. Peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. Conclusions: Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.

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Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review

Cited by 38 publications

References 58 publications

Inclusion of Transgender and Gender Diverse People in Phase III Trials: Examples from HIV Pharmacologic Prevention Studies

Inclusion of Transgender and Gender Diverse People in Phase III Trials: Examples from HIV Pharmacologic Prevention Studies

The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study

“Entre Nosotras:” A qualitative evaluation of a peer-led PrEP project for transgender Latinas

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