Brief Report: Transgender Women and Preexposure Prophylaxis Care: High Preexposure Prophylaxis Adherence in a Real-World Health Care Setting in New York City

Abstract

Background: Transgender women and trans feminine individuals (TGW/TFI) are a high priority population for the provision of HIV preexposure prophylaxis (PrEP) care within the United States, but there is limited research that focuses specifically on PrEP adherence within this population.Setting: Observational study of patients prescribed PrEP at a community-based health center. Methods:We enrolled 100 TGW/TFI PrEP patients at a community health center during clinic visits. Adherence data were collected at 3 time points, using self-report surveys, patient interviews, and urine assays measuring tenofovir. Data were summarized descriptively. Results:The sample was diverse in age, race/ethnicity, and socioeconomic characteristics. Participants demonstrated strong PrEP adherence; at least 80% of the sample reported 90% or greater adherence at each time point. Concordance between self-report and urine assay was high. Among patients who reported taking PrEP within the past 48 hours, 82%-92% had detectable urine tenofovir. However, many patients reported PrEP stop periods of 4 or more days (28%-39% per time point).Conclusions: Our data highlight TGW/TFI's capacity to adhere to daily PrEP and sustain PrEP use over time. The concordance between patient self-report and urine TFV levels suggest that providers can trust patient reports of PrEP adherence behavior and support the use of adherence conversations in clinical settings, without the need for point of care biological monitoring. Findings also underscore the importance of continued attention to drivers of PrEP stops at the patient, clinic, and systems levels and the development of strategies that support sustained PrEP use.

Urine tenofovir testing for real‐time PrEP adherence feedback: a qualitative study involving transgender women in Uganda

“…Other studies conducted among those on antiretroviral treatment in South Africa [ 19 ] and female PrEP users in Kenya [ 18 ] confirmed the acceptability of the urine test. Our research findings align with these studies and a similar one involving 100 TGW and men prescribed PrEP in the United States, which reported a strong correlation between self‐reported adherence to PrEP and the detection of tenofovir in urine samples [ 34 ]. Our finding of initially negative emotions and distrust in POC urine testing underscores the importance of tailored adherence counselling.…”

A cross-sectional analysis of psychosocial and structural barriers and facilitators associated with PrEP use among a sample of transgender women in Chicago, IL

“…Limited findings herein suggest that among those taking PrEP very recently (last month), adherence was high. Similarly in a prior study among trans women taking PrEP, there was evidence of high adherence, but also intermittent stoppage over time [ 19 ].…”

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

“…At the clinic-level, a select few US- and international-based demonstration projects have shown some promising successes in implementing the integration of gender-affirming care with PrEP services, with the majority primarily designed to increase PrEP uptake among transfeminine adults in community-based health clinic settings. For example, researchers at Callen Lorde Community Health Center in New York City, an LGBTQ-focused health center that specializes in the integration of PrEP, gender-affirming care, as well as insurance and payment services, recently published a longitudinal study that showed PrEP adherence was high (greater than 90%) at 3 and 6 months after initiation both in self-report and urine assay data collection among 80% of the 100 enrolled transfeminine patients [ 51 ]. In Atlanta, a patient-centered PrEP program designed with a co-located gender clinic offering affordable comprehensive primary care, gender-affirming hormone, and mental health services showed high rates of linkage to PrEP care, prescription, and initiation among transfeminine participants.…”