Abstract
BackgroundTransgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM.MethodsParticipants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically.ResultsFifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services.ConclusionWhile MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.
Highlights
The World Health Organization (WHO) recommends pre-exposure prophylaxis (PrEP) to be offered to all populations at increased risk for HIV acquisition
Any TFV-DP was detected in 62.5% (5/8) of Transgender women (TGW) vs. 14.7% of men who have sex with men (MSM) (5/34, p = 0.01)
Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM
Summary
The World Health Organization (WHO) recommends pre-exposure prophylaxis (PrEP) to be offered to all populations at increased risk for HIV acquisition. Among 76 MSM who reported PrEP use and had Tenofovir Diphosphate (TFV-DP) determined 6–12 months after PrEP initiation, only 11 (14.5%) had protective TFV-DP concentrations in blood plasma corresponding with 4 tablets a week [7]. To our knowledge, this is the only study that has reported PrEP protective levels in MSM in SSA, and no study has reported PrEP protective levels among TGW in SSA. Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM
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