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Acceptability of Antiretroviral Pre-exposure Prophylaxis from a Cohort of Sexually Experienced Young Transgender Women in Two U.S. Cities

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Abstract

Emtricitabine/tenofovir disoproxil fumarate as pre-exposure prophylaxis (PrEP) can prevent HIV infection among at-risk individuals, including young transgender women (YTW). We used baseline data from 230 HIV-uninfected YTW (ages 16–29 years) who were enrolled in Project LifeSkills during 2012–2015. We examined factors associated with perceived acceptability of PrEP use (mean score = 23.4, range 10.0–30.0). Participants were largely transgender women of color (67%) and had a mean age of 23 years (SD = 3.5). In an adjusted multiple linear regression model, PrEP interest (β = 3.7, 95% CI 2.2–5.2) and having a medical provider who meets their health needs (β = 2.9, 95% CI 1.3–4.4) was associated with higher PrEP acceptability scores, whereas younger age (21–25 vs 26–29 years) (β = –2.0, 95% CI − 3.6 to − 0.4) and reporting transactional sex in the past 4 months (β = − 1.5, 95% CI − 3.0 to − 0.1) was associated with lower PrEP acceptability scores (all p values < 0.05). Enhancing PrEP-related interventions by addressing the unique barriers to uptake among YTW of younger age or those with history of transactional sex could bolster PrEP acceptability for this population.

Resumen

Emtricitabine/tenofovir disoproxil fumarate como profilaxis preexposición (PrEP) puede prevenir VIH en personas con alto riesgo, incluyendo mujeres jóvenes transgénero (YTW). Usamos datos de línea base de 230 YTW sin infección por VIH inscritas en Project LifeSkills para examinar las variables asociadas con aceptabilidad de PrEP (promedio=23.4, intervalo=10.0-30.0). Participantes eran mayormente mujeres transgénero de color (67%) con edad promedia de 23 años (DE=3.5). En un modelo de regresión lineal múltiple, interés en PrEP (β=3.7, 95% CI = 2.2–5.2) y tener un proveedor de atención medica que cumple con sus necesidades (β=2.9, 95% CI =1.3–4.4) era asociado con mayor aceptabilidad de PrEP, mientras que una edad menor (21-25 vs 26-29 años) (β=–2.0, 95% CI=-3.6–-0.4) y sexo transaccional en los últimos cuatro meses (β=–1.5, 95% CI =-3.0–-0.1) era asociado con menor aceptabilidad. Se necesitan intervenciones acerca de PrEP para YTW, sobre todo aquellas que han ejercido trabajo sexual, para aumentar la aceptabilidad de PrEP para esta población.

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References

  1. Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22.

    Article  Google Scholar 

  2. Garofalo R, Osmer E, Sullivan C, Doll M, Harper G. Environmental, psychosocial, and individual correlates of HIV risk in ethnic minority male-to-female transgender youth. J HIV/AIDS Prev Child Youth. 2007;7(2):89–104.

    Article  Google Scholar 

  3. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.

    Article  Google Scholar 

  4. Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV infection in transgender adults and adolescents: results from the National HIV Surveillance System, 2009–2014. AIDS Behav. 2017;21(9):2774–83.

    Article  Google Scholar 

  5. White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31.

    Article  Google Scholar 

  6. Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC, Garofalo R, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–7.

    Article  Google Scholar 

  7. Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. JAIDS J Acquir Immune Defic Syndr. 2008;48(1):97–103.

    Article  Google Scholar 

  8. Wilson EC, Chen YH, Arayasirikul S, Fisher M, Pomart WA, Le V, et al. Differential HIV risk for racial/ethnic minority trans*female youths and socioeconomic disparities in housing, residential stability, and education. Am J Public Health. 2015;105(Suppl 3):e41–7.

    Article  Google Scholar 

  9. Garofalo R, Deleon J, Osmer E, Doll M, Harper GW. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. J Adolesc Health. 2006;38(3):230–6.

    Article  Google Scholar 

  10. Reback CJ, Fletcher JB. HIV prevalence, substance use, and sexual risk behaviors among transgender women recruited through outreach. AIDS Behav. 2014;18(7):1359–67.

    Article  Google Scholar 

  11. Silva-Santisteban A, Raymond HF, Salazar X, Villayzan J, Leon S, McFarland W, et al. Understanding the HIV/AIDS epidemic in transgender women of Lima, Peru: results from a sero-epidemiologic study using respondent driven sampling. AIDS Behav. 2012;16(4):872–81.

    Article  Google Scholar 

  12. Poteat T, Wirtz AL, Radix A, Borquez A, Silva-Santisteban A, Deutsch MB, et al. HIV risk and preventive interventions in transgender women sex workers. The Lancet. 2015;385(9964):274–86.

    Article  Google Scholar 

  13. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;2010(363):2587–99.

    Article  Google Scholar 

  14. Grant RM, Sevelius JM, Guanira JV, Aguilar JV, Chariyalertsak S, Deutsch MB. Transgender women in clinical trials of pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S226–9.

    Article  CAS  Google Scholar 

  15. Deutsch MB, Glidden DV, Sevelius J, Keatley J, McMahan V, Guanira J, et al. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. The lancet HIV. 2015;2(12):e512–9.

    Article  Google Scholar 

  16. Kelley CF, Kahle E, Siegler A, Sanchez T, Del Rio C, Sullivan PS, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.

    Article  Google Scholar 

  17. Liu A, Colfax G, Cohen S, Bacon O, Kolber M, Amico K, et al. editors. The spectrum of engagement in HIV prevention: proposal for a PrEP cascade. In: Proceedings of 7th International conference on HIV treatment and prevention adherence Florida: Miami Beach; 2012.

  18. Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, Mayer KH, Mimiaga M, Patel R, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS (London, England). 2017;31(5):731.

    Article  Google Scholar 

  19. Escudero DJ, Kerr T, Operario D, Socias ME, Sued O, Marshall BD. Inclusion of trans women in pre-exposure prophylaxis trials: a review. AIDS Care. 2015;27(5):637–41.

    Article  Google Scholar 

  20. Galindo GR, Ja’Nina JW, Hazelton P, Lane T, Steward WT, Morin SF, et al. Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci. 2012;7(1):116.

    Article  Google Scholar 

  21. Hoagland B, De Boni RB, Moreira RI, Madruga JV, Kallas EG, Goulart SP, et al. Awareness and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women in Brazil. AIDS Behav. 2016;21:1–10.

    Google Scholar 

  22. Sevelius JM, Deutsch MB, Grant R. The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. J Int AIDS Soc. 2016;19:21105.

    Article  Google Scholar 

  23. Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Global Public Health. 2016;11(7–8):1060–75.

    Article  Google Scholar 

  24. Yang D, Chariyalertsak C, Wongthanee A, Kawichai S, Yotruean K, Saokhieo P, et al. Acceptability of pre-exposure prophylaxis among men who have sex with men and transgender women in Northern Thailand. PLoS ONE. 2013;8(10):e76650.

    Article  CAS  Google Scholar 

  25. Garofalo R, Johnson AK, Kuhns LM, Cotten C, Joseph H, Margolis A. Life skills: evaluation of a theory-driven behavioral HIV prevention intervention for young transgender women. J Urban Health. 2012;89(3):419–31.

    Article  Google Scholar 

  26. Kuhns LM, Mimiaga MJ, Reisner SL, Biello K, Garofalo R. Project LifeSkills-a randomized controlled efficacy trial of a culturally tailored, empowerment-based, and group-delivered HIV prevention intervention for young transgender women: study protocol. BMC Public Health. 2017;17(1):713.

    Article  Google Scholar 

  27. Kuhns LM, Reisner SL, Mimiaga MJ, Gayles T, Shelendich M, Garofalo R. Correlates of PrEP indication in a multi-site cohort of young HIV-uninfected transgender women. AIDS Behav. 2016;20(7):1470–7.

    Article  Google Scholar 

  28. Restar AJ, Tocco JU, Mantell JE, Lafort Y, Gichangi P, Masvawure TB, et al. Perspectives on HIV pre-and post-exposure prophylaxes (PrEP and PEP) among female and male sex workers in Mombasa, Kenya: implications for integrating biomedical prevention into sexual health services. AIDS Educ Prev. 2017;29(2):141–53.

    Article  Google Scholar 

  29. Hosek S, Siberry G, Bell M, Lally M, Kapogiannis B, Green K, et al. Project PrEPare (ATN082): The acceptability and feasibility of an HIV pre-exposure prophylaxis (PrEP) trial with young men who have sex with men (YMSM). J Acquir Immune Defic Syndr (1999). 2013;62(4):447–56.

    Article  Google Scholar 

  30. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.

    Article  CAS  Google Scholar 

  31. Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2013;381(9883):2083–90.

    Article  Google Scholar 

  32. Mustanski B, Johnson AK, Garofalo R, Ryan D, Birkett M. Perceived likelihood of using HIV pre-exposure prophylaxis medications among young men who have sex with men. AIDS Behav. 2013;17(6):2173–9.

    Article  Google Scholar 

  33. George D, Mallery P. IBM SPSS Statistics 23 step by step: a simple guide and reference. New York: Routledge; 2016.

    Book  Google Scholar 

  34. Centers for Disease Control and Prevention. Update to Interim Guidance for Preexposure Prophylaxis (PrEP) for the Prevention of HIV Infection: PrEP for injecting drug users. MMWR Morb Mortal Wkly Rep. 2013;62(23):463–5.

    Google Scholar 

  35. Reisner SL, Bradford J, Hopwood R, Gonzalez A, Makadon H, Todisco D, et al. Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health. J Urban Health. 2015;92(3):584–92.

    Article  Google Scholar 

  36. Masvawure TB, Mantell JE, Tocco JU, Gichangi P, Restar A, Chabeda SV, et al. Intentional and unintentional condom breakage and slippage in the sexual interactions of female and male sex workers and clients in Mombasa, Kenya. AIDS Behav. 2018;22(2):637–48.

    Article  Google Scholar 

  37. Pettifor A, Nguyen NL, Celum C, Cowan FM, Go V, Hightow-Weidman L. Tailored combination prevention packages and PrEP for young key populations. J Int AIDS Soc. 2015;18(2S1).

  38. Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “Truvada Whores”. Am J Public Health. 2015;105(10):1960–4.

    Article  Google Scholar 

  39. Spieldenner A. PrEP whores and HIV prevention: the queer communication of HIV pre-exposure prophylaxis (PrEP). J Homosex. 2016;63(12):1685–97.

    Article  Google Scholar 

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Acknowledgements

We would like to thank the participants for their participation, the members of the LifeSkills study teams in Boston and Chicago for their contribution in this study, and Alberto Edeza for translation of the abstract into Spanish. This project was supported by award number R01MH094323 from the National Institute of Mental Health (NIMH; PIs: Drs. Garofalo and Mimiaga). Ms. Arjee Restar is supported by a National Institute of General Medical Sciences training grant (R25GM083270) and the Robert Wood Johnson Foundation Health Policy Research Scholars. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health or the Robert Wood Johnson Foundation.

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Authors and Affiliations

  1. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Arjee J. Restar, Adedotun Ogunbajo & Matthew J. Mimiaga

  2. Center for Health Equity Research, Brown University, Providence, RI, USA

    Arjee J. Restar, Adedotun Ogunbajo & Matthew J. Mimiaga

  3. Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Lisa Kuhns & Robert Garofalo

  4. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Lisa Kuhns & Robert Garofalo

  5. Division of General Pediatrics, Boston Children’s Hospital/Harvard University Medical School, Boston, MA, USA

    Sari L. Reisner

  6. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Sari L. Reisner

  7. The Fenway Institute, Fenway Health, Boston, MA, USA

    Sari L. Reisner & Matthew J. Mimiaga

  8. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Matthew J. Mimiaga

  9. Departments of Behavioral & Social Health Sciences and Epidemiology, Center for Health Equity Research, Brown University, Providence, RI, USA

    Matthew J. Mimiaga

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  1. Arjee J. Restar
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Correspondence to Matthew J. Mimiaga.

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Restar, A.J., Kuhns, L., Reisner, S.L. et al. Acceptability of Antiretroviral Pre-exposure Prophylaxis from a Cohort of Sexually Experienced Young Transgender Women in Two U.S. Cities. AIDS Behav 22, 3649–3657 (2018). https://doi.org/10.1007/s10461-018-2127-0

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