Prevention-effective adherence trajectories among transgender women indicated for PrEP in the United States: a prospective cohort study

Cooney, Erin E.; Reisner, Sari L.; Saleem, Haneefa; Althoff, Keri N.; Beckham, S. Wilson; Radix, Asa; Cannon, Christopher M.; Schneider, Jason; Haw, J. Sonya; Rodríguez, Allan; Wawrzyniak, Andrew J.; Poteat, Tonia; Mayer, Kenneth H.; Beyrer, Chris; Wirtz, Andrea L.

doi:10.1016/j.annepidem.2022.03.016

Cited by 18 publications

(21 citation statements)

References 31 publications

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“…In conclusion, our work supports the evidence that many PrEP users try and are often able to align their HIV prevention with their sexual exposures. 19,[23][24][25][26][27][28] In addition, it highlights the importance of establishing habits in PrEP use and in removing barriers, such as cost and access, to improve PrEP use and STI testing, particularly as cases continue to rise. Continuing to remove these barriers and reaching out to those who have stopped PrEP can help address the current HIV and STI epidemic that remains as pandemic mitigations have disappeared.…”

Section: Discussionmentioning

confidence: 99%

Changes in HIV Prevention and Sexual Experiences During the COVID-19 Pandemic: A Mixed-Methods Study

Pyra¹,

Kline

Taylor

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: STI and HIV services and infection rates were affected during the COVID-19 pandemic, because of changes in access to health care and individual behavior. Understanding how individuals made decisions around prevention and sexual activities during different phases of the pandemic is useful to addressing the rising rates of STIs and HIV. Setting: Federally-qualified health center focused on sexual and gender minority health, Chicago IL, 2021. Methods: Patients with a history of PrEP use who were contacted by the PrEP retention team as part of standard care were invited to complete an online survey. A subset of survey participants were then contacted to complete one-on-one interviews. Participants were asked about two distinct periods: November 2020 to January 2021 and February to June 2021. Results: From the 356 survey participants (mostly young, insured, and experienced with PrEP), more than half maintained their number of sex partners during the early pandemic and most also maintained PrEP use; during the later pandemic; most reported more or the same number of sex partners and almost all maintained PrEP use. From interviews, we identified diverse and changing experiences regarding sexual practices throughout the pandemic; whereas many participants changed PrEP use in accordance with sexual practices, many others maintained PrEP use as a habit. COVID-19 prevention was also a factor in sexual activities, particularly prevaccination. Conclusion: Many PrEP users try to align their HIV prevention with their sexual exposures and establish PrEP as a long-term habit. Removing financial and access barriers is important to improve PrEP use and STI testing.

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Section: Discussionmentioning

confidence: 99%

Changes in HIV Prevention and Sexual Experiences During the COVID-19 Pandemic: A Mixed-Methods Study

Pyra¹,

Kline

Taylor

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…These diffuse structural factors negatively impact access to care. 7,11,[13][14][15][16]18,19,[26][27][28][29]31,34,40,41,45,79,80,87 Ways to overcome these challenges These disparities and social constructs limit the diffusion of medical advancement in many ways; overcoming them will require resources and political will beyond the conversation of increasing PrEP access. Focusing on future novel PrEP access and structural changes to the process of PrEP development may ultimately extend to overcoming some of these other challenges as well.…”

Section: Challengesmentioning

confidence: 99%

“…8,66,76 Transgender women and transgender men are also frequently excluded and lack access. 51,77 –80 Often there is disproportionate inclusion of participants not reflective of populations at highest risk. For example, Black individuals made up only 8.6% of the iPrEx study 1 sample, despite the excess HIV risk seen among Black MSM.…”

Section: Disparities and Social Constructsmentioning

confidence: 99%

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Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

Magnus,

Yellin,

Langlands

et al. 2023

The Journal of Medicine Access

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HIV prevention with antiretroviral medication in the form of pre-exposure prophylaxis (PrEP) offers a critical tool to halt the HIV pandemic. Barriers to PrEP access across drug types, formulations, and delivery systems share remarkable commonalities and are likely to be generalizable to future novel PrEP strategies. Appreciation of these barriers allows for planning earlier in the drug-development pathway rather than waiting for the demonstration of efficacy. The purpose of this article is to propose a core set of considerations that should be included in the drug-development process for future PrEP interventions. A literature synthesis of key barriers to PrEP uptake in the United States was conducted to elucidate commonalities across PrEP agents and delivery methods. Based on the published literature, we divided challenges into three main categories of structural barriers: (1) provider and clinic characteristics; (2) cost considerations; and (3) disparities and social constructs, with potential solutions provided for each. Pragmatic strategies for examining and overcoming these barriers before future PrEP regulatory approval are recommended. If these strategies are considered well before the time of commercial availability, the potential for PrEP to interrupt the HIV pandemic will be greatly enhanced.

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“… Prior reporting of the fundamental data in dissertations or conference papers (Akinola et al, 2021; Cooney et al, 2022; Malone et al, 2021; Peitzmeier et al, 2021; Poteat et al, 2020; Wirtz, Mayer, et al, 2019; Wirtz, Poteat, et al, 2019; Wirtz et al, 2021). …”

mentioning

confidence: 99%

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

Sherman,

Higgins,

Balthazar

et al. 2023

J of Nursing Scholarship

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IntroductionExisting literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co‐occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.Design/MethodsPartial least square path modeling followed by response‐based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)‐based TW (N = 1418; 46.2% White non‐Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post‐traumatic stress and psychological distress).ResultsThe final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.ConclusionOur findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co‐occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real‐world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti‐racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.Clinical RelevanceThis study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post‐traumatic stress disorder and psychological distress. Specifically, interventions should take an anti‐racist approach and would benefit from incorporating social support‐building activities.

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Prevention-effective adherence trajectories among transgender women indicated for PrEP in the United States: a prospective cohort study

Cited by 18 publications

References 31 publications

Changes in HIV Prevention and Sexual Experiences During the COVID-19 Pandemic: A Mixed-Methods Study

Changes in HIV Prevention and Sexual Experiences During the COVID-19 Pandemic: A Mixed-Methods Study

Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

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