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Author Notes:

Ms. Erin Cooney, 615 N. Wolfe St, Office E5035, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA, +1 401-595-3436. Email: ecooney2@jhmi.edu

ALW and SLR conceived of the LITE cohort, secured funding, and led the overall project. EEC designed the analysis plan, wrote all statistical analysis code, produced all tables and figures, and wrote the first draft. EEC, ALW and SLR had full access to all data in the study, have verified the underlying data, and accept responsibility to submit for publication. ALW, SLR, HTS, KNA, SWB, TCP, CB, and KHM provided substantive input on study design and aided in interpretation of findings. EEC, ALW, and SLR obtained ethics approvals. ALW, AR, CC, JSS, JSH, AER, AJW, SLR, and KHM led study implementation at each site. ALW, SLR, HTS, KNA, SWB, TCP, and CB reviewed and edited the manuscript. All authors were involved in design and conceptual development and reviewed and approved the final manuscript.

The authors thank the transgender women who took part in this study. This study would not have been possible without their participation. The authors also acknowledge the work of the entire American Cohort To Study HIV Acquisition Among Transgender Women team: Andrea Wirtz (multiple PI; Johns Hopkins University (JHU)); Sari Reisner (multiple PI; Harvard University); Keri Althoff (JHU); Chris Beyrer (JHU); James Case (JHU); Erin Cooney (JHU); Oliver Laeyendecker (JHU); Megan Stevenson (JHU); Elizabeth Humes (JHU); Jeffrey Herman (JHU); Tonia Poteat (University of North Carolina); Kenneth Mayer (Fenway Health); Asa Radix (Callen-Lorde Community Health Center); Christopher Cannon (Whitman-Walker Institute); Jason Schneider (Emory University and Grady Hospital); Sonya Haw (Emory University and Grady Hospital); Allan Rodriguez (University of Miami); Andrew Wawrzyniak (University of Miami); the incredible research teams at each study site; and the LITE Community Advisory Board, including the following individuals: Sherri Meeks, Flora Marques, Sydney Shackelford, Nala Toussaint, and SaVanna Wanzer and those who have remained anonymous.

We declare no competing interests.

Subjects:

Research Funding:

EEC is supported by a predoctoral fellowship from the National Institute of Mental Health (F31MH124582).

The LITE study is jointly supported by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the National Institute of Child Health and Human Development of the National Institutes of Health under Award Number UG3/UH3AI133669 (ALW and SLR).

Research reported in this publication was also supported by HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), Washington, DC, Department of Health.

The LITE study is also appreciative of support from the CFAR at partner institutions, including JHU (P30AI094189), Emory University (P30AI050409), Harvard University (P30AI060354), DC CFAR (P30AI117970), and the University of Miami (P30AI073961).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or HAHSTA.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Pre-exposure prophylaxis
  • Transgender women
  • HIV prevention
  • Group-based multi-trajectory modeling
  • United States
  • PREEXPOSURE PROPHYLAXIS PREP
  • HIV PREVENTION
  • MEN
  • SEX
  • RISK

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

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Journal Title:

ANNALS OF EPIDEMIOLOGY

Volume:

Volume 70

Publisher:

, Pages 23-31

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Purpose: Adherence to pre-exposure prophylaxis (PrEP) during periods of PrEP-indication (i.e., prevention-effective adherence) is critical for preventing HIV. We sought to describe factors associated with prevention-effective adherence trajectories among transgender women (TW) to inform PrEP implementation strategies. Methods: Using data from The LITE American Cohort (n = 728), we performed group-based multi-trajectory modeling (GBMTM) to identify clusters of TW with similar trajectories of PrEP adherence and indication, and sociodemographic, biobehavioral, and structural correlates of each trajectory. Results: We identified five trajectories: (1) consistent indication/no PrEP (15.3%), (2) initial indication/no PrEP (47.1%), (3) declining indication/discontinued PrEP (9.5%), (4) consistent indication/PrEP adherent (18.5%), and (5) increasing indication/initiated PrEP (9.6%). TW diagnosed with an STI were more likely to follow a consistent indication/no PrEP trajectory compared to consistent indication/PrEP adherent trajectory (adjusted Relative Risk Ratio [aRRR], 2.54; 95% confidence interval [CI], 1.16–5.57). TW who experienced homelessness were more likely to follow PrEP discontinuation and initiation trajectories relative to PrEP adherence (aRRR, 2.71; 95% CI, 1.10–6.70 and 2.83; 95% CI, 1.13–7.05, respectively). Conclusions: Over a quarter of TW followed trajectories suggestive of prevention-effective adherence, while 15% did not initiate PrEP despite consistent indication. Findings highlight missed opportunities for PrEP engagement at STI diagnosis and suggest structural interventions addressing housing instability may improve prevention-effective adherence among TW.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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