Uptake, Retention, and Adherence to Pre-exposure Prophylaxis (PrEP) in TRIUMPH: A Peer-Led PrEP Demonstration Project for Transgender Communities in Oakland and Sacramento, California

Abstract

Background:TRIUMPH (Trans Research–Informed communities United in Mobilization for the Prevention of HIV) was a community-led, transgender-specific pre-exposure prophylaxis (PrEP) demonstration project at 2 community-based clinical sites in California. TRIUMPH used peer health education, community mobilization, and clinical integration of PrEP with hormone therapy to promote PrEP knowledge and acceptability. The goal of this study was to evaluate PrEP uptake, retention, and adherence among TRIUMPH participants and examine site-based differences.Methods:Eligible participants were adult transgender and gender diverse people interested in PrEP. Participants were seen at baseline and at 1, 3, 6, 9, and 12 months for PrEP provision, clinical visits, and HIV testing. PrEP uptake was defined as dispensation of PrEP, PrEP retention was defined as proportion of expected visits completed among those who initiated PrEP, and PrEP adherence was assessed by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models quantified the association of variables with PrEP outcomes.Results:TRIUMPH enrolled 185 participants; the median age was 28 years (interquartile range: 23–35), 7% was Black, and 58% was Latinx. PrEP uptake was as follows: 78% in Oakland and 98% in Sacramento; 91% among trans women, 96% among trans men, and 70% among nonbinary participants. Almost half (47%) rarely/never believed about HIV, and 42% reported condomless sex act in the past 3 months. Participants who reported higher numbers of sex partners were more likely to be retained and adherent; other predictors of adherence included not having a primary partner and not experiencing violence in the past 3 months.Conclusions:This community-led, trans-specific PrEP demonstration project documents high levels of PrEP initiation in a young transgender and gender diverse cohort at risk of HIV acquisition.

Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California

“…This finding is consistent with studies that have found that receiving quality, affirming health services in a welcoming and trans-friendly environment was associated with increased engagement in sexual health services 42 and where trans clients can connect and derive support from one another as well as from their providers. 64,65 Gender affirmation 43 and healthcare empowerment 66 have been shown to moderate the deleterious impact that trans-related discrimination has on rates of viral suppression among Black and Latinx TGW with HIV. 67 Guidelines for gender-affirming care of trans and non-binary people include ensuring a safe and welcoming environment by utilizing a patient's gender identity, and taking a gender-affirming approach for any physical exams.…”

Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California

“…Future PrEP interventions for TGNB should consider adding behavioral content that bolsters coping skills and strengthens social support for PrEP as these appear to be promising targets for increasing uptake and persistence on PrEP among TGNB persons. However, it is important to note that these interventions must be delivered within gender-affirming healthcare and prevention services settings in order to be maximally effective at bolstering PrEP engagement among TGNB persons [4,88,89].…”

“…Violence against transgender and non-binary (TGNB) persons (persons whose gender identity differs from the sex they were assigned at birth) has deleterious effects on the health and wellbeing of TGNB persons including increasing HIV risk [1][2][3]. While little is currently known about the impact of gender-based violence (GBV) on engagement in HIV prevention behaviors such as pre-exposure prophylaxis (PrEP) among TGNB persons, a recent study found PrEP use 1 3 to be negatively associated with recent experience of violence generally [4]. TGNB persons experience violence on the basis of their gender expression, gender identity, gender nonconformity, and/or their perceived sexual orientation [1].…”

HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community‐based survey

“…Conversely, gender affirmation, the process of recognizing and supporting a TNB person's gender, is associated with engagement in HIV care and viral suppression [16] and uptake of biomedical HIV prevention [12,17].…”

“…Quantitative studies have shown negative associations between anti‐trans stigma and HIV care access [ 14 ], whereas qualitative studies have identified how intersecting anti‐trans and HIV stigma limit trans women's access to HIV prevention/care [ 15 ]. Conversely, gender affirmation, the process of recognizing and supporting a TNB person's gender, is associated with engagement in HIV care and viral suppression [ 16 ] and uptake of biomedical HIV prevention [ 12 , 17 ].…”