Prep Utilization Among Young Transgender Women, Transgender Men, and MSM in an Urban Community-Based Setting
Dankerlui D, Connolly M, Joseph C, Eljallad T, and Dodard-Friedman I. Prep Utilization Among Young Transgender Women, Transgender Men, and MSM in an Urban Community-Based Setting.
J Sex Transm Dis
Background Little is known about factors influencing HIV pre-exposure prophylaxis (PrEP) utilization among young urban transgender women (TW), transgender men (TM) and men who have sex with men (MSM), who are disproportionately affected by HIV. This prospective pilot study explores PrEP adherence and persistence among these traditionally underserved communities in primary care clinics located in community centers serving LGBTQ youth. Methods To examine factors related to PrEP outcomes, we established a cohort of PrEP-eligible young TW, TM and MSM at two clinics located in LGBTQ community centers and followed participants monthly. We measured tenofovir diphosphate levels at 12 weeks to assess adherence, defined as having a value >700 fmol/punch. Persistence was defined as picking up 2 refills during 12 weeks of follow up. Multivariate analysis will be used to describe associations between demographic, behavioral, social, and clinical characteristics and outcomes. Results Of the 50 participants, 25 were TW, 6 TM and 19 MSM. ~75% were African American, ~10% white and ~5% Hispanic/Latino; average age 24.18. Results to date shows 27% adherence and 55% persistence. Taking hormones at baseline was inversely related to PrEP persistence, Relative Risk=0.67 (0.39-1.15) p=0.14. The trend is similar for adherence, RR=0.65 (0.20-2.1), p=0.48. Conclusion Combining gender affirming hormones and PrEP in community spaces for LGBTQ youth is a novel approach to engage a traditionally hard-to-reach population. While initial data shows low PrEP outcomes, the relatively high number of patients remaining in care (84%) demonstrates an opportunity to improve adherence and clinical outcomes. We observed that integrating hormone therapy with PrEP administration did not positively impact outcomes, suggesting that other factors (e.g. homelessness, trauma) are important. These findings indicate the need to develop interventions designed to address these factors while continuing to integrate PrEP with gender affirming services .