Overall peer support and providing access to gender-affirming hormone therapy (GAHT) and other needed services likely lead to an increase in HIV pre-exposure prophylaxis (PrEP) engagement among transgender women, highlighting the critical need for these supports in this population.
This is according to a study that examined the acceptability and feasibility of an integrated multicomponent strategy to enhance daily oral HIV PrEP uptake and adherence among transgender women in a randomized immediate versus deferred design.
The study enrolled 304 transgender women aged 18 and older at four US HIV Prevention Trials Network (HPTN) research sites (Houston, New York, Philadelphia, and San Francisco) and one Brazil site (Rio de Janeiro). Participants were randomized 1:1 to the immediate versus deferred intervention arm. US participants in both study arms were offered Truvada (tenofovir/emtricitabine) or Descovy (emtricitabine and tenofovir alafenamide) for HIV PrEP starting at enrollment. Participants in Brazil were offered Truvada, in keeping with the nationally approved and available PrEP product. Apretude (cabotegravir) was unavailable at the time of the study’s initiation and, therefore, not included as one of the PrEP options.
At enrollment, participants in the immediate intervention arm received GAHT and co-located structured PHN. Participants in the deferred intervention arm received external GAHT and case management up to Week 26, then transitioned to the integrated strategy afterward. PrEP uptake and adherence were evaluated as the primary study outcome at week 26, with adherence defined as taking four or more pills per week based on tenofovir detection in dried blood spots.
“Transgender women have one of the highest HIV prevalence of any population yet continue to struggle to access and adhere to PrEP,” said Dr. Wafaa El-Sadr, HPTN co-principal investigator. “Tailoring strategies to address the unique needs of this population is critical to addressing this challenge.”
At enrollment, 11% of participants self-reported PrEP use, and 42% reported GAHT use. At week 26, PrEP uptake was 85% and 87% in the immediate and deferred study arms, respectively. PrEP adherence based on dried blood spot results was confirmed for 50% and 51% of the participants, respectively. Retention was comparably high in both study arms (84% and 87%, respectively).
“Meaningful involvement of the transgender community through the provision of peer-delivered case management and access to needed services was important to increasing PrEP engagement among all study participants,” said Dr. Myron Cohen, HPTN co-principal investigator. “This approach offers a path to reducing HIV acquisition in this population.”
