Oral PrEP Use by Transgender Men in Uganda: A Multi-method Evaluation

Area of Science:

• Global Health
• Public Health
• Transgender Health

Background:

• HIV pre-exposure prophylaxis (PrEP) use remains understudied in transgender men within sub-Saharan Africa.
• Understanding PrEP adherence and associated factors is critical for effective HIV prevention strategies in this key population.

Purpose of the Study:

• To assess PrEP uptake, adherence, and related factors among transgender men in sub-Saharan Africa.
• To explore the lived experiences influencing PrEP use and adherence in this demographic.

Main Methods:

• A prospective cohort study enrolled 75 transgender men, followed for 12 months with social media recruitment.
• In-depth interviews and point-of-care urine tenofovir assays were used to assess knowledge, testing, service access, and adherence.
• Inductive content analysis was applied to qualitative data.

Main Results:

• The study observed a 48% PrEP uptake and moderate adherence, with urine tenofovir positivity increasing over time.
• Key themes included societal rejection, economic exclusion, challenges with adherence, and the role of urine testing in facilitating conversations.
• Low HIV/STI prevalence (HBV, HIV, syphilis, chlamydia, trichomonas) was noted.

Conclusions:

• Competing priorities significantly impacted PrEP adherence among transgender men in sub-Saharan Africa.
• This study highlights the need for integrated HIV prevention, sexual healthcare, and mental health services for this population.
• Tailored interventions addressing social and economic factors are essential to improve PrEP adherence.