TY - JOUR
T1 - Prevention-effective adherence trajectories among transgender women indicated for PrEP in the United States
T2 - a prospective cohort study
AU - American Cohort To Study HIV Acquisition Among Transgender Women (LITE) Study Group
AU - Cooney, Erin E.
AU - Reisner, Sari L.
AU - Saleem, Haneefa T.
AU - Althoff, Keri N.
AU - Beckham, S. Wilson
AU - Radix, Asa
AU - Cannon, Christopher M.
AU - Schneider, Jason S.
AU - Haw, J. Sonya
AU - Rodriguez, Allan E.
AU - Wawrzyniak, Andrew J.
AU - Poteat, Tonia C.
AU - Mayer, Kenneth H.
AU - Beyrer, Chris
AU - Wirtz, Andrea L.
N1 - Publisher Copyright:
© 2022
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - Group-based multi-trajectory modeling
KW - HIV prevention
KW - Pre-exposure prophylaxis
KW - Transgender women
KW - United States
UR - http://www.scopus.com/inward/record.url?scp=85129625368&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85129625368&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2022.03.016
DO - 10.1016/j.annepidem.2022.03.016
M3 - Article
C2 - 35398255
AN - SCOPUS:85129625368
SN - 1047-2797
VL - 70
SP - 23
EP - 31
JO - Annals of epidemiology
JF - Annals of epidemiology
ER -