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

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.

Predictors of Event-Driven Regimen Choice in Current PrEP Users and Sexual Behavior Characteristics of MSM Receiving Sexual Health Services in New York City.

While daily PrEP is undeniably effective, broad-based adoption remains low. Non-daily PrEP modalities, like event-driven PrEP (ED PrEP), offer an efficient way to deliver PrEP's protection to priority populations. We carried out an at-home survey with patients receiving sexual health services in a LGBTQ-clinic in New York (n = 147). Participants answered questions on ED PrEP awareness and preferences, sexual behavior, and sexual preparatory practices. Only 50% of our sample were aware of ED PrEP, about 30% met eligibility for ED PrEP, and 35% chose ED PrEP as a good HIV prevention option for them. In a robust Poisson model (n = 128), endorsement of ED PrEP as a good prevention choice was significantly more common in participants who were uninsured, preferred taking PrEP only when needed, and those who had concerns about side-effects. Furthermore, participants reported many sexual behaviors patterns and preparatory practices compatible with use of ED PrEP.

RESUMEN: Si bien la PrEP diaria es innegablemente efectiva, la adopción generalizada sigue siendo baja. Las modalidades de PrEP no diarias, como la PrEP impulsada por eventos (ED PrEP), ofrecen una manera eficiente de brindar protección de PrEP a las poblaciones prioritarias. Realizamos una encuesta a domicilio con pacientes que recibían servicios de salud sexual en una clínica LGBTQ en Nueva York (n = 147). Los participantes respondieron preguntas sobre su conocimiento y sus preferencias de la ED PrEP, su comportamiento sexual, y sus prácticas de preparación sexual. Solo el 50% de nuestra muestra conocía la ED PrEP, alrededor del 30% cumplía con los requisitos para la ED PrEP, y el 35% eligió ED PrEP como una buena opción de prevención del HIV para ellos. En un modelo robusto de Poisson (n = 128), la aprobación de la ED PrEP como una buena opción de prevención fue significativamente más común en los participantes que no tenían seguro, preferían tomar la PrEP solo cuando era necesario, y aquellos que tenían preocupaciones sobre los efectos secundarios. Además, los participantes informaron muchos patrones de comportamiento sexual y prácticas preparatorias compatibles con el uso de ED PrEP.