Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City

Rael, Christine Tagliaferri; Martinez, Michelle; Giguere, Rebecca; Bockting, Walter; MacCrate, Caitlin; Mellman, Will; Valente, Pablo K.; Greene, George J.; Sherman, Susan G.; Footer, Katherine H.A.; D’Aquila, Richard T.; Carballo‐Diéguez, Alex

doi:10.1007/s10461-018-2102-9

Cited by 94 publications

(81 citation statements)

References 36 publications

(51 reference statements)

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“…Social stigma perceived and/or experienced by individuals at risk of HIV is a major barrier to PrEP use (Table 5). This may stem from historical stigma surrounding HIV/AIDS (both the disease itself and being a member of a group considered at risk, i.e., sexual, gender, racial and/or ethnic minority); for example, transgender women in one focus group had concerns that by taking PrEP they would be mistakenly identified as HIV-positive [50]. It may also be stigma relating specifically to PrEP.…”

Section: Social Stigma As a Barrier To Prep Uptakementioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.

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Section: Social Stigma As a Barrier To Prep Uptakementioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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“…At present, many existing PrEP navigation services support individuals in initiating PrEP (e.g., providing information on accessing medication assistance programs, answering questions about using PrEP, disseminating information on where to access PrEP, accompanying individuals to initial PrEP medical visit). This service should be expanded to include PrEP retention efforts after initiation, as some of the barriers or challenges to starting PrEP are the same for remaining on PrEP (e.g., lack or lapse of insurance, cost, side effects) [40][41][42][43]. Case management, which has been shown to be effective in managing HIV care, is another option to support PrEP users [44][45][46].…”

Section: A Need For Prep Support Servicesmentioning

confidence: 99%

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

et al. 2020

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Purpose Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen. Methods In-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data. Results Four themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence. Conclusions PrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.

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“…Patients also had a visceral response to the smaller size of 2DR pills and the ease of the 2DR regimen and this underscored their feeling that they were on a less toxic regimen and that their HIV disease was manageable and under control. Previous research has highlighted the importance of pill size in accepting new medications and adhering to them [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“It made me more confident that I have it under control”: Patient and provider perspectives on moving to a two-drug ART regimen in the United States and Spain

et al. 2020

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Background Two-drug regimens (2DR) to treat HIV infection have the potential to reduce long-term toxicity and increase therapeutic options for people living with HIV (PLHIV). Prior phase III trials, SWORD-1 and SWORD-2, as well as GEMINI-1 and GEMINI-2, have demonstrated that a dolutegravir-based 2DR is as effective as three-or four-drug regimens among virologically suppressed patients. Limited information exists, however, on patient and provider experiences with 2DR to inform roll-out and integration into routine clinical care. Methods We conducted 39 in-depth interviews with PLHIV currently on 2DR in the context of routine care and 8 of their clinical care providers in the United States (U.S.) and Spain. Participants included 33 male and 6 female PLHIV and 8 providers. Interview topics explored perceptions of and experiences with 2DR compared to prior anti-retroviral regimens (ARVs), side effects, patient satisfaction, and clinical performance. Interviews were audio-recorded, transcribed and analyzed using thematic content analysis. Results Participants viewed 2DR as a significant and positive advance, in terms of its ability to effectively treat HIV with reduced toxicity and essentially no reported side effects. Patients noted the central role providers played in the decision to switch to a 2DR regimen and, among U. S. participants, the importance of insurance coverage making this preferred option feasible.

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Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City

Cited by 94 publications

References 36 publications

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

“It made me more confident that I have it under control”: Patient and provider perspectives on moving to a two-drug ART regimen in the United States and Spain

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