Universidad Peruana Cayetano Heredia

Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

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dc.contributor.author Konda, Kelika A.
dc.contributor.author Torres, Thiago S.
dc.contributor.author Marino, Gabriela
dc.contributor.author Ramos, Alessandra
dc.contributor.author Moreira, Ronaldo, I
dc.contributor.author Leite, Iuri C.
dc.contributor.author Cunha, Marcelo
dc.contributor.author Jalil, Emilia M.
dc.contributor.author Hoagland, Brenda
dc.contributor.author Guanira, Juan, V
dc.contributor.author Benedetti, Marcos
dc.contributor.author Pimenta, Cristina
dc.contributor.author Vermandere, Heleen
dc.contributor.author Bautista-Arredondo, Sergio
dc.contributor.author Vega-Ramirez, Hamid
dc.contributor.author Veloso, Valdilea G.
dc.contributor.author Caceres Palacios, Carlos Fernando
dc.contributor.author Grinsztejn, Beatriz
dc.contributor.author ImPrEP Study Grp
dc.date.accessioned 2022-11-15T23:04:42Z
dc.date.available 2022-11-15T23:04:42Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/12616
dc.description.abstract Introduction: The HIV epidemic continues to disproportionately impact Latin-American transgender women (TGW). We assessed factors associated with long-term pre-exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods: HIV-negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow-up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long-term PrEP engagement (3+ follow-up visits in 52 weeks) and complete self-reported adherence (no missed pills in the past 30 days) during follow-up. For both outcomes, we constructed multivariable models controlling for country, socio-demographics, sexual behaviour, substance use, STIs and self-reported adherence at 4 weeks (long-term engagement outcome only). Results: From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed-race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person-years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long-term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown-HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self-reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP-related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions: Although TGW were willing to enrol in ImPrEP, long-term PrEP engagement and complete self-reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans-specific interventions supporting oral PrEP and exploring long-acting PrEP strategies for TGW. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartofseries Journal of the International AIDS Society
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject pre-exposure prophylaxis en_US
dc.subject transgender persons en_US
dc.subject HIV en_US
dc.subject Latin America en_US
dc.subject medication adherence en_US
dc.subject public health en_US
dc.title Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1002/jia2.25974
dc.relation.issn 1758-2652


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