“By Us, for Us”: Qualitative Insights to Inform Implementation of Comprehensive Pre-Exposure Prophylaxis Services in a Trans Community Center

Abstract

Transgender/nonbinary (TGNB) persons in the United States are disproportionately affected by HIV and have relatively low uptake and persistence of pre-exposure prophylaxis (PrEP). A collaborative research team aimed to design comprehensive PrEP services for a TGNB-led and serving community organization in Los Angeles. The objective of this qualitative study was to understand the perspectives of TGNB healthcare providers and TGNB community members on the design of the PrEP program. Semi-structured interviews were conducted with TGNB community members (n= 30; 11 Spanish-speaking and 19 English-speaking) and providers and staff (n= 10). All interviews were analyzed using rapid analysis to identify salient themes relevant to program development and implementation. Participants highlighted four themes for successful program implementation. First, “by us, for us” captured the importance of TGNB representation in PrEP-related education, outreach, and navigation, highlighting the necessity of TGNB community members as staff and healthcare providers. Second, the PrEP program must recognize and address the socioeconomic oppression of the TGNB community and provide economic and social support. Third, participants felt a “one-stop shop” in a trusted setting was needed, where the PrEP program should be integrated with other comprehensive, gender-affirming medical (e.g., hormone therapy and primary care) and social services (e.g., legal, mental health, and housing). Finally, client retention and the sustainability of the PrEP program hinges on collaborative, community-led implementation. These interviews suggested four key themes that informed the development and implementation of a PrEP program that is TGNB community-led, client-centered, and delivered in a trusted and gender-affirming space.