HIV Pre-exposure Prophylaxis Continuum of Care Among Transgender Individuals in an Integrated Health care System

• Type of Material: Article
• Authors: J. Carlo Hojilla, Kaiser Permanente Northern California; Leo B. Hurley, Kaiser Permanente Northern California; Julia L. Marcus, Harvard Medical School; Derek D. Satre, Kaiser Permanente Northern California; Michael J. Silverberg, Kaiser Permanente Northern California; Eve F. Zaritsky, Harvard Pilgrim Health Care Institute; Darios Getahun, Kaiser Permanente Northern California; Michael Goodman, Emory University; Jonathan E. Volk, Kaiser Permanente San Francisco Medical Center
• Language: English
• Date: 2022-03-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000002853
• Title of Journal or Parent Work: JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
• Volume: 89
• Issue: 3
• Start Page: E35
• End Page: E38
• Grant/Funding Information: This study was supported by the Kaiser Permanente Northern California Community Benefit Research Program, the National Institute on Drug Abuse (T32 DA007250 to JCH), the National Institute of Allergy and Infectious Diseases (K01 AI122853 to JLM), the National Institute on Alcohol Abuse and Alcoholism (K24 AA025703 to DDS), and the Patient Centered Outcome Research Institute (Contract AD-12-11-4532 to MG).
• Keywords: Science & Technology; INFECTION; Life Sciences & Biomedicine; GAY; Infectious Diseases; Immunology
• Research Categories: Health Sciences, Immunology

Abstract

Effective HIV preexposure prophylaxis (PrEP) use requires that individuals are linked to care and screened for PrEP eligibility, receive a prescription, initiate PrEP, and sustain use during periods of HIV risk. This series of crucial steps (linkage to care, prescribing, initiation, and persistence) has been described as the PrEP continuum of care, which provides a framework for evaluating gaps in PrEP delivery.1 Little is known about the PrEP continuum of care in transgender individuals. Research evaluating PrEP uptake in transgender populations has been primarily based on self-reported surveys,2-4 which are limited by social desirability or recall bias.5,6 Several studies have examined PrEP delivery across various settings, but these have predominantly involved men who have sex with men (MSM),7-9 in part because of the low number of transgender individuals enrolled in demonstration projects and the lack of systematic collection of transgender status in clinical cohorts.10 In this study, we evaluated attrition at each step of the PrEP continuum of care and characterized HIV infections in a cohort of transgender individuals in Kaiser Permanente Northern California (KPNC), a large integrated healthcare delivery system.