Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California

Ogunbajo, Adedotun; Storholm, Erik D.; Ober, Allison J.; Bogart, Laura M.; Reback, Cathy J.; Flynn, Risa; Lyman, Phoebe; Morris, Sheldon R.

doi:10.1007/s10461-021-03159-2

Cited by 72 publications

(102 citation statements)

References 37 publications

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“…Three qualitative studies were identified that found depression to be a barrier to PrEP access. A study conducted in southern CA with 30 TGW found that mental health concerns were identified as barriers to PrEP care [ 48 ]. Similarly, another study conducted in southern CA with 37 individuals, the majority of whom were transgender, identified that mental disorder symptoms made PrEP access difficult [ 49 ].…”

Section: Depressionmentioning

confidence: 99%

“…PrEP adherence was a lower priority compared to mental health symptoms. Of note, some participants indicated that taking their PrEP on schedule was a way for them to positively cope with mental health symptoms [ 48 ].…”

Section: Depressionmentioning

confidence: 99%

“…However, there was no association between anxious symptoms and adherence to medical visits [ 63 ]. Similarly, qualitative findings from a study involving 30 TGW in southern CA revealed reports that mental health conditions including anxiety decreased individuals’ motivation to take PrEP, making adherence difficult [ 48 ]. Importantly, however, some participants indicated that taking PrEP was a way in which they coped with mental health conditions [ 48 ].…”

Section: Anxietymentioning

confidence: 99%

See 2 more Smart Citations

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

Miller

Harrison

Sanasi-Bhola

2021

IJERPH

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Men who have sex with men and transgender women in the United States are at increased risk for HIV and may benefit from pre-exposure prophylaxis (PrEP), a once-a-day pill to prevent HIV. Due to stigma and discrimination, sexual and gender minority (SGM) populations are also at risk for depression and anxiety. This scoping review sought to identify literature addressing relationships between the PrEP care continuum, depression, and anxiety among SGM individuals and others at high risk for HIV. We conducted a systematic review of four databases (i.e., PubMed, PsycInfo, Web of Science, Google Scholar) and identified 692 unique articles that were screened for inclusion criteria, with 51 articles meeting the final inclusion criteria. Data were extracted for key study criteria (e.g., geographic location, participant demographics, study design, main findings). Results suggest that while depression and anxiety are not associated with PrEP awareness or willingness to use, they can be barriers to seeking care and to PrEP adherence. However, empirical studies show that taking PrEP is associated with reductions in anxiety. Findings suggest the need to implement mental health screenings in PrEP clinical care. In addition, addressing systemic and structural issues that contribute to mental health disorders, as well as PrEP-related barriers, is critical.

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Section: Depressionmentioning

confidence: 99%

Section: Depressionmentioning

confidence: 99%

Section: Anxietymentioning

confidence: 99%

See 1 more Smart Citation

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

Miller

Harrison

Sanasi-Bhola

2021

IJERPH

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“…2 HIV preexposure prophylaxis (PrEP) presents an opportunity to address this disparity; however, there is a considerable lack of research on PrEP with this population. [4][5][6][7][8] Existing research has predominantly focused on documenting facilitators and barriers to PrEP uptake among TGW/TFI, including PrEP awareness, attitudes, acceptability, and eligibility. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Few studies in the United States have included a substantial sample of TGW/TFI on PrEP, 8,10 and none have closely examined dynamics over time of real-world PrEP use (ie, in the absence of research incentive or intervention).…”

Section: Introductionmentioning

confidence: 99%

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

Starbuck

Golub

Klein

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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.

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“…8,9 Negative opinions of PrEP fueled by misinformation, such as side effects occurring that are not associated with PrEP, presented an additional barrier. 10 PrEP was also associated with promotion of risk, HIV-related stigma, and promiscuity. 11 Previous experiences of discrimination in health care is the most notable barrier to PrEP for trans communities.…”

Section: Introductionmentioning

confidence: 97%

Expanding the Pie–Differentiated PrEP Delivery Models to Improve PrEP Uptake in the San Francisco Bay Area

Wilson

Turner

Sanz-Rodriguez

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Pre-exposure prophylaxis (PrEP) uptake among trans people to date has been low. Recommendations implemented in San Francisco to offer PrEP with feminizing hormones have not led to improvement of PrEP uptake in trans communities. New delivery models may be needed. The aim of this study was to examine whether a PrEP-only clinic was more likely to serve trans people at highest risk of HIV than trans-affirming primary care clinics.Methods:Participants were recruited between 2017 and 2019 as part of a PrEP demonstration project in the San Francisco Bay Area. Survey data including sociodemographics, HIV-related risk behavior, barriers to PrEP, and self-reported PrEP adherence were collected at baseline, 3 months, and 6 months for all participants. Bivariable Poisson regression models were used to examine differences between participants in the primary care clinics and PrEP-only clinic delivered to participants.Results:Baseline survey data were collected from 153 participants. Those with a higher number of sexual partners were significantly more likely to use the PrEP-only clinic rather than the primary care clinics. Participants with higher perceived HIV risk and those who engaged in sex work were also more likely to use the PrEP-only clinic compared with the primary care clinic. Medical mistrust was higher at baseline among participants of the PrEP-only clinic. PrEP adherence was not significantly different by delivery model. Few participants identified PrEP barriers, such as interactions with feminizing hormones, to be determinants of PrEP uptake.Conclusions:A PrEP-only delivery model could improve PrEP uptake and may better meet the needs of trans people who could most benefit from PrEP.

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Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California

Cited by 72 publications

References 37 publications

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

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

Expanding the Pie–Differentiated PrEP Delivery Models to Improve PrEP Uptake in the San Francisco Bay Area

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