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TransPrEP: Results from the Pilot Study of a Social Network-Based Intervention to Support PrEP Adherence Among Transgender Women in Lima, Peru

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Abstract

We conducted a pilot randomized controlled trial of a social network-based intervention to promote PrEP adherence among transgender women (TW) in Lima, Peru. We enrolled 89 TW from six social networks and cluster-randomized them 1:1 to standard of care (n = 44) or the TransPrEP intervention (n = 45). Core workshops discussed strategies to support PrEP adherence and defined group adherence objectives. Maintenance workshops discussed participants’ experiences taking PrEP and collective adherence goals. At 3-month follow-up, we evaluated 40 participants and obtained 29 hair samples for tenofovir level measurements. Though no significant differences were observed, 36.4% (4/11) of participants of TransPrEP participants and 10.0% (1/10) of control participants had tenofovir levels > 0.023 ng/mg, consistent with ≥ 4 doses per week. 81.8% (9/11) of intervention and 40.0% (4/10) of control participants had any detectable tenofovir in their hair. Pilot assessment of our network-based intervention suggested a trend towards improved PrEP adherence, measured objectively, for TW in Peru.

Resumen

Realizamos un estudio piloto controlado y aleatorizado de una intervención basada en redes sociales para promover la adherencia al PrEP en mujeres transgénero (MT) de Lima, Perú. Enrolamos a 89 MT de 6 redes sociales y las aleatorizamos por grupos a razón 1:1 al estándar de atención como control (n = 44) o a la intervención TransPrEP (n = 45). En los talleres centrales se discutieron estrategias para respaldar la adherencia al PrEP y se definieron los objetivos de adherencia del grupo. En los talleres de mantenimiento se discutieron las experiencias de los participantes al tomar PrEP y los objetivos de adherencia colectiva. A los 3 meses de seguimiento, evaluamos a 40 participantes y obtuvimos 29 muestras de cabello para medir el nivel de tenofovir. Aunque no se observaron diferencias significativas, el 36.4% (4/11) de los participantes de TransPrEP y el 10.0% (1/10) de los participantes del grupo control tenían niveles de tenofovir> 0.023 ng/mg, congruente con 4 o más dosis por semana. El 81.8% (9/11) del grupo de intervención y el 40.0% (4/10) de los participantes de control tenían tenofovir detectable en el cabello. La evaluación piloto de nuestra intervención basada en redes sugiere una tendencia hacia una mejor adherencia al PrEP, medida objetivamente, para las MT en Perú.

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References

  1. Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global epidemiology of HIV infection and related syndemics affecting transgender people. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S210–9.

    PubMed  PubMed Central  Google Scholar 

  2. Vaitses Fontanari AM, Zanella GI, Feijo M, Churchill S, Rodrigues Lobato MI, Costa AB. HIV-related care for transgender people: a systematic review of studies from around the world. Soc Sci Med. 2019;230:280–94.

    PubMed  Google Scholar 

  3. Baral SD, Poteat T, Stromdahl 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.

    PubMed  Google Scholar 

  4. Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016;388(10042):412–36.

    PubMed  PubMed Central  Google Scholar 

  5. Luz PM, Veloso VG, Grinsztejn B. The HIV epidemic in Latin America: accomplishments and challenges on treatment and prevention. Curr Opin HIV AIDS. 2019;14(5):366–73.

    PubMed  PubMed Central  Google Scholar 

  6. Barrington C, Wejnert C, Guardado ME, Nieto AI, Bailey GP. Social network characteristics and HIV vulnerability among transgender persons in San Salvador: identifying opportunities for HIV prevention strategies. AIDS Behav. 2012;16(1):214–24.

    PubMed  Google Scholar 

  7. Bastos FI, Bastos LS, Coutinho C, et al. HIV, HCV, HBV, and syphilis among transgender women from Brazil: assessing different methods to adjust infection rates of a hard-to-reach, sparse population. Medicine. 2018;97:S16–24.

    PubMed  PubMed Central  Google Scholar 

  8. Bautista CT, Sanchez JL, Montano SM, et al. Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men. Sex Transm Infect. 2004;80(6):498–504.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Grinsztejn B, Jalil EM, Monteiro L, et al. Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro. Brazil Lancet HIV. 2017;4(4):e169–76.

    PubMed  Google Scholar 

  10. Silva-Santisteban A, Eng S, de la Iglesia G, Falistocco C, Mazin R. HIV prevention among transgender women in Latin America: implementation, gaps and challenges. J Int AIDS Soc. 2016;19(3 Suppl 2):20799.

    PubMed  PubMed Central  Google Scholar 

  11. Clark JL, Konda KA, Silva-Santisteban A, et al. Sampling methodologies for epidemiologic surveillance of men who have sex with men and transgender women in Latin America: an empiric comparison of convenience sampling, time space sampling, and respondent driven sampling. AIDS Behav. 2014;18(12):2338–48.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Sanchez J, Lama JR, Kusunoki L, et al. HIV-1, sexually transmitted infections, and sexual behavior trends among men who have sex with men in Lima, Peru. J Acquir Immune Defic Syndr. 2007;44(5):578–85.

    PubMed  Google Scholar 

  13. Silva-Santisteban A, Raymond HF, Salazar X, 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.

    PubMed  Google Scholar 

  14. Tabet S, Sanchez J, Lama J, et al. HIV, syphilis and heterosexual bridging among Peruvian men who have sex with men. AIDS. 2002;16(9):1271–7.

    PubMed  Google Scholar 

  15. Castillo R, Konda KA, Leon SR, et al. HIV and sexually transmitted infection incidence and associated risk factors among high-risk MSM and male-to-female transgender women in Lima, Peru. J Acquir Immune Defic Syndr. 2015;69(5):567–75.

    PubMed  PubMed Central  Google Scholar 

  16. Brennan J, Kuhns LM, Johnson AK, 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.

    PubMed  PubMed Central  Google Scholar 

  17. Clark J, Salvatierra J, Segura E, et al. Moderno love: sexual role-based identities and HIV/STI prevention among men who have sex with men in Lima, Peru. AIDS Behav. 2013;17(4):1313–28.

    PubMed  PubMed Central  Google Scholar 

  18. Lake JE, Clark JL. Optimizing HIV prevention and care for transgender adults. AIDS. 2019;33(3):363–75.

    PubMed  Google Scholar 

  19. Operario D, Nemoto T. HIV in transgender communities: syndemic dynamics and a need for multicomponent interventions. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S91–3.

    PubMed  PubMed Central  Google Scholar 

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

    PubMed  Google Scholar 

  21. Satcher MF, Segura ER, Silva-Santisteban A, Sanchez J, Lama JR, Clark JL. Partner-level factors associated with insertive and receptive condomless anal intercourse among transgender women in Lima, Peru. AIDS Behav. 2017;21(8):2439–51.

    PubMed  PubMed Central  Google Scholar 

  22. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Deutsch MB, Glidden DV, Sevelius J, et al. HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial. Lancet HIV. 2015;2(12):e512–9.

    PubMed  PubMed Central  Google Scholar 

  24. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Mayer KH, Grinsztejn B, El-Sadr WM. Transgender people and hiv prevention: what we know and what we need to know, a call to action. J Acquir Immune Defic Syndr. 2016;72(Suppl 3):S207–9.

    PubMed  PubMed Central  Google Scholar 

  26. Grinsztejn B, Hoagland B, Moreira RI, et al. Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study. Lancet HIV. 2018;5(3):e136–45.

    PubMed  Google Scholar 

  27. Hoagland B, Moreira RI, De Boni RB, et al. High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project. J Int AIDS Soc. 2017;20(1):21472.

    PubMed  PubMed Central  Google Scholar 

  28. Cottrell ML, Prince HMA, Schauer AP, et al. Decreased tenofovir diphosphate concentrations in a transgender female cohort: implications for human immunodeficiency virus preexposure prophylaxis. Clin Infect Dis. 2019;69(12):2201–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Hiransuthikul A, Janamnuaysook R, Himmad K, et al. Drug-drug interactions between feminizing hormone therapy and pre-exposure prophylaxis among transgender women: the iFACT study. J Int AIDS Soc. 2019;22(7):e25338.

    PubMed  PubMed Central  Google Scholar 

  30. Shieh E, Marzinke MA, Fuchs EJ, et al. Transgender women on oral HIV pre-exposure prophylaxis have significantly lower tenofovir and emtricitabine concentrations when also taking oestrogen when compared to cisgender men. J Int AIDS Soc. 2019;22(11):e25405.

    PubMed  PubMed Central  Google Scholar 

  31. D’Avanzo PA, Bass SB, Brajuha J, et al. Medical mistrust and PrEP perceptions among transgender women: a cluster analysis. Behav Med. 2019;45(2):143–52.

    PubMed  Google Scholar 

  32. Deutsch MB. Pre-exposure prophylaxis in trans populations: providing gender-affirming prevention for trans people at high risk of acquiring HIV. LGBT Health. 2018;5(7):387–90.

    PubMed  Google Scholar 

  33. Longino A, Montano MA, Sanchez H, et al. Increasing PrEP uptake and adherence among MSM and TW sex workers in Lima, Peru: what and whom do different patients trust? AIDS Care. 2020;32(2):255–60.

    PubMed  Google Scholar 

  34. Perez-Brumer A, Silva-Santisteban A, McLean S, et al. “Como conejillo de indias”: critical role of medical and research mistrust in acceptability of PrEP among transgender women in Lima, Peru. Durban: International AIDS Society; 2016.

    Google Scholar 

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

    PubMed  Google Scholar 

  36. Soares F, MacCarthy S, Magno L, et al. Factors associated with PrEP refusal among transgender women in Northeastern Brazil. AIDS Behav. 2019;23(10):2710–8.

    PubMed  Google Scholar 

  37. Clark JL, Perez-Brumer AG, Reisner SL, et al. Social network organization, structure, and patterns of influence within a community of transgender women in Lima, Peru: implications for biomedical HIV prevention. AIDS Behav. 2020;24(1):233–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Maiorana A, Kegeles S, Salazar X, Konda K, Silva-Santisteban A, Caceres C. “Proyecto Orgullo”, an HIV prevention, empowerment and community mobilisation intervention for gay men and transgender women in Callao/Lima. Peru Glob Public Health. 2016;11(7–8):1076–92.

    PubMed  Google Scholar 

  39. Mehrotra ML, Rivet Amico K, McMahan V, et al. The Role of Social Relationships in PrEP Uptake and Use Among Transgender Women and Men Who Have Sex with Men. AIDS Behav. 2018. https://doi.org/10.1007/s10461-018-2151-0.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Moriarty KE, Segura ER, Gonzales W, Lake JE, Cabello R, Clark JL. Assessing sexually transmitted infections and HIV risk among transgender women in Lima, Peru: beyond behavior. LGBT Health. 2019;6(7):370–6.

    PubMed  PubMed Central  Google Scholar 

  41. Pollock L, Silva-Santisteban A, Sevelius J, Salazar X. “You should build yourself up as a whole product”: transgender female identity in Lima. Peru Glob Public Health. 2016;11(7–8):981–93.

    PubMed  Google Scholar 

  42. Perez-Brumer AG, Reisner SL, McLean SA, et al. Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru. J Int AIDS Soc. 2017;20(1):21462.

    PubMed  PubMed Central  Google Scholar 

  43. Reisner SL, Perez-Brumer AG, McLean SA, et al. Perceived barriers and facilitators to integrating HIV prevention and treatment with cross-sex hormone therapy for transgender women in Lima, Peru. AIDS Behav. 2017;21(12):3299–311.

    PubMed  PubMed Central  Google Scholar 

  44. Silva-Santisteban A, Salazar X, Pollock L, Villayzan J, Caceres CF. When identity claims: risky processes of body modification among the male to female transgender population of Lima, Peru. XVIII International AIDS Conference. Vienna, 2010 [abstract MOAD0306].

  45. Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the information, motivation and behavioral skills model of antiretroviral therapy adherence. AIDS Care. 2005;17(6):661–73.

    CAS  PubMed  Google Scholar 

  46. Centola D. Complex contagions and the weakness of long ties. Am J Soc. 2007;3:702–34.

    Google Scholar 

  47. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–73.

    PubMed  Google Scholar 

  48. Granovetter MS. The strength of weak ties. Am J Soc. 1973;78(6):1360–80.

    Google Scholar 

  49. Granovetter MS. The strength of weak ties: a network theory revisited. Soc Theory. 1983;1:201–33.

    Google Scholar 

  50. Rogers EM. Diffusion of innovations. 5th ed. New York, NY: Free Press; 2003.

    Google Scholar 

  51. Safren SA, Otto MW, Wortg JL. Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cognit Behav Pract. 1999;6:332–41.

    Google Scholar 

  52. Baxi SM, Liu A, Bacchetti P, et al. Comparing the novel method of assessing PrEP adherence/exposure using hair samples to other pharmacologic and traditional measures. J Acquir Immune Defic Syndr. 2015;68(1):13–20.

    CAS  PubMed  Google Scholar 

  53. Liu AY, Yang Q, Huang Y, et al. Strong relationship between oral dose and tenofovir hair levels in a randomized trial: hair as a potential adherence measure for pre-exposure prophylaxis (PrEP). PLoS ONE. 2014;9(1):e83736.

    PubMed  PubMed Central  Google Scholar 

  54. 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(7):21105.

    PubMed  PubMed Central  Google Scholar 

  55. Agot K, Taylor D, Corneli AL, et al. Accuracy of self-report and pill-count measures of adherence in the FEM-PrEP clinical trial: implications for future HIV-prevention trials. AIDS Behav. 2015;19(5):743–51.

    PubMed  Google Scholar 

  56. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne effect: a randomised, controlled trial. BMC Med Res Methodol. 2007;7:30.

    PubMed  PubMed Central  Google Scholar 

  57. Gandhi M, Bacchetti P, Spinelli MA, et al. Brief Report: validation of a urine tenofovir immunoassay for adherence monitoring to PrEP and ART and establishing the cutoff for a point-of-care test. J Acquir Immune Defic Syndr. 2019;81(1):72–7.

    PubMed  PubMed Central  Google Scholar 

  58. Castillo-Mancilla JR, Zheng JH, Rower JE, et al. Tenofovir, emtricitabine, and tenofovir diphosphate in dried blood spots for determining recent and cumulative drug exposure. AIDS Res Hum Retroviruses. 2013;29(2):384–90.

    CAS  PubMed  PubMed Central  Google Scholar 

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Funding

Funding was provided by the National Institute of Mental Health NIH/NIMH (Grant No. R34 MH104072) to JLC, MM and SR.

Author information

Authors and Affiliations

  1. UCLA Geffen School of Medicine, Los Angeles, CA, USA

    Jesse Clark & Kathleen Moriarty

  2. The Fenway Institute, Boston, MA, USA

    Sari Reisner, Matthew Mimiaga & Kenneth H. Mayer

  3. Boston Children’s Hospital, Boston, MA, USA

    Sari Reisner

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Amaya Perez-Brumer

  5. Feminas, Lima, Peru

    Leyla Huerta

  6. Epicentro, Lima, Peru

    Hugo Sanchez

  7. Asociacion Civil Impacta Salud y Educacion, Lima, Peru

    Maria Mamani Luque & Javier R. Lama

  8. University of California, San Francisco, CA, USA

    Hideaki Okochi & Monica Gandhi

  9. Instituto de Estudios de Salud Sexual y Derechos Humanos, Lima, Peru

    Ximena Salazar

  10. Brown University School of Public Health, Providence, RI, USA

    Matthew Mimiaga

  11. Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Universidad Nacional San Marcos, Lima, Peru

    Jorge Sanchez

  12. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

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  1. Jesse Clark
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  2. Sari Reisner
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  11. Jorge Sanchez
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Correspondence to Jesse Clark.

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The authors have no financial or proprietary interests in any material discussed in this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All study procedures were approved by the UCLA Office for Human Research Participant Protection (IRB #16-001418) and Asociacion Civil Impacta Salud y Educacion´s Comite Institucional de Bioetica (Certificate #0089-2014-CE) and registered with www.clinicaltrials.gov (NCT02710032) prior to any participant enrollment.

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Clark, J., Reisner, S., Perez-Brumer, A. et al. TransPrEP: Results from the Pilot Study of a Social Network-Based Intervention to Support PrEP Adherence Among Transgender Women in Lima, Peru. AIDS Behav 25, 1873–1883 (2021). https://doi.org/10.1007/s10461-020-03117-4

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