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PrEP Use and Adherence Among Transgender Patients.
Jae Downing1, Kimberly Yee2,3, Jae M Sevelius4
1Department of Health Policy and Management, OHSU-PSU School of Public Health, Portland, OR, USA.
AIDS and Behavior
|October 13, 2021
Summary
Transgender individuals, particularly those assigned male at birth, show higher PrEP use but lower adherence. Understanding gender identity is crucial for effective HIV prevention strategies and PrEP access.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Pre-exposure prophylaxis (PrEP) is a critical biomedical intervention for HIV prevention.
- Understanding PrEP uptake and adherence across diverse gender identities is essential for equitable HIV prevention.
- Previous research has often overlooked the specific needs and utilization patterns of transgender populations regarding PrEP.
Purpose of the Study:
- To estimate the prevalence of PrEP use among transgender and cisgender individuals in Oregon.
- To identify factors associated with high adherence to PrEP across different gender identities.
- To highlight the importance of considering gender identity in PrEP surveillance and healthcare practices.
Main Methods:
- A cross-sectional study analyzing Oregon Medicaid claims data from 2012 to 2019.
- Inclusion of 1555 individuals who used PrEP, categorized by gender identity (cisgender women/men, transgender assigned female at birth [AFAB], transgender assigned male at birth [AMAB]).
- Multivariable logistic regression was used to assess the association between gender identity and PrEP uptake or high adherence (proportion of days covered ≥ 0.80).
Main Results:
- PrEP use was highest among transgender individuals (AMAB: 546.8/10,000; AFAB: 226.5/10,000) compared to cisgender men (20.6/10,000) and women (2.6/10,000).
- High adherence to PrEP was significantly lower in AMAB individuals (72.6%) compared to cisgender women (86.0%) and cisgender men (82.2%).
- Enrollment records often misclassified gender identity, underscoring the need for gender-identity-inclusive data collection.
Conclusions:
- Significant disparities exist in PrEP use and adherence based on gender identity.
- Current surveillance and prescribing practices may not adequately address the needs of transgender individuals.
- Tailored PrEP outreach, education, and clinical management considering gender identity-unique risk factors are imperative for optimizing HIV prevention.
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