Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color

Abstract

We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48 h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22 years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility, reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.

Resumen

Nuestro objetivo fue descubrir los obstáculos y facilitadores de la adherencia al profilaxis de pre-exposición al VIH (PrEP) en hombres jóvenes y mujeres transgénero que tienen sexo con hombres (YMSM/TW) y quienes son minorías étnicas. La adherencia, a corto plazo y sostenida, se midió mediante la concentración de tenofovir en la orina y las prescripciones completadas en la farmacia. La adherencia óptima se definió basado en una concentración de tenofovir en la orina consistente con el uso de PrEP en las ultimas 48 horas y prescripciones completadas en la farmacia consistentes con ≥ 4 dosis por semana. Los participantes completaron entrevistas semiestructuradas que exploraron los obstáculos y facilitadores de la adherencia. Los participantes (n = 31) fueron principalmente afroamericanos (68%), con una edad media de 22 años (SD: 1.8) y 48% obtuvieron adherencia óptima. Participantes discutieron varios obstáculos, incluyendo el estigma, acceso limitado a los sistemas de salud, los efectos secundarios asociados a PrEP, competencia con otras prioridades, y la baja percepción del riesgo de VIH. Los facilitadores incluyeron apoyo social, acceso al sistema de salud, recordatorios/rutinas, alta percepción de riesgo de VIH y agencia personal. Nuestros hallazgos identifican oportunidades para mejorar la adherencia al PrEP en estas poblaciones a través de intervenciones, incluyendo la activación de salud y cambios en la percepción del riesgo al VIH en estas comunidades.

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Acknowledgements

Dr. Koenig is an Advisory Board member for Gilead Sciences. No other authors have conflicts of interest to disclose. Funding: Wood: NIMH F32MH111341; P30 AI 045008, Center for AIDS Research Pilot Award; P30 MH 097488, Penn Mental Health AIDS Research Center Pilot Award. Dowshen: NIMH K23MH102128.

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Correspondence to Sarah Wood.

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Wood, S., Gross, R., Shea, J.A. et al. Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color. AIDS Behav 23, 2719–2729 (2019). https://doi.org/10.1007/s10461-019-02502-y

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Keywords

  • HIV prevention
  • Pre-exposure prophylaxis
  • Social support
  • Adherence