Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

What Can Urine Tell Us About Medication Adherence?

Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study

A second decade of PrEP.

Pre-exposure Prophylaxis Uptake, Adherence, and Persistence: A Narrative Review of Interventions in the U.S.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Purpose: High levels of human immunodeficiency virus (HIV) prevalence and inconsistent condom use among transgender women in India highlight the need for additional effective HIV prevention methods like preexposure prophylaxis (PrEP). We examined the extent of and factors influencing willingness to use PrEP among trans women in India. Methods: Between June and August 2017, we conducted a cross-sectional survey among 360 trans women recruited through community-based organizations in six cities. We assessed PrEP knowledge, condom use, attitudes toward PrEP (after providing information on PrEP), preferences in PrEP pricing and access venues, discrimination experiences, and the likelihood of using PrEP. Logistic regression analyses were conducted. Results: Participants' median age was 26 years; 50.7% had not completed high school, and 24.8% engaged in sex work. Only 17.1% reported having heard of PrEP before the survey, and 80.6% reported that they would definitely use PrEP. Trans women in sex work had 28 times higher odds of reporting willingness to use PrEP than those not in sex work (adjusted odds ratio [aOR]=28.9, 95% confidence interval [CI]=8.79-95.16, p<0.001). When compared with trans women who did not experience discrimination, the odds of reporting willingness to use PrEP was lower among trans women who had experienced discrimination from health care providers (aOR=0.25, 95% CI=0.06-0.97, p=0.04) and family members (aOR=0.08, 95% CI=0.05-0.14, p<0.001). Conclusion: Willingness to use PrEP was high among trans women, especially those in sex work, despite identified barriers (e.g., discrimination experiences). To promote PrEP uptake among at-risk trans women, the steps needed are as follows: increasing awareness about PrEP; providing easy-to-understand information on PrEP's effectiveness, side effects and interactions between PrEP and hormones; training health care providers on PrEP and cultural competency; and reducing stigmas related to PrEP use and HIV. PrEP implementation research projects to identify effective PrEP delivery strategies are urgently needed to reduce the disproportionate HIV burden among trans women in India.

Uptake of PrEP for HIV slow among MSM

Although there is substantial momentum to scale up preexposure prophylaxis (PrEP) for HIV prevention in adolescent girls and young women (AGYW) at risk of HIV acquisition, this key population has demonstrated difficulty in sustained PrEP use. Despite being a user-controlled and discreet prevention option, effective oral PrEP use requires a series of complex daily decisions in the life of the PrEP user. In this review, we describe how the number of decisions AGYW have to execute for effective and continued PrEP use may potentially be reduced by providing simplified, integrated, differentiated sexual and reproductive health services that include PrEP, and introducing a choice of PrEP products, including less frequently dosed, longer acting and/or multipurpose prevention technology (MPT) products. PrEP uptake and effective use are enhanced when AGYW experience PrEP service delivery channels as convenient, integrated with their other sexual and reproductive health needs and matching their experiences (including limited autonomy) and lifestyle. Longer acting or less frequently dosed PrEP products or MPTs may reduce the cognitive burden associated with prevention decision-making and is, therefore, likely more suitable for the majority of AGYW who struggle with daily pill adherence. In the scaling up of HIV prevention for AGYW, implementers are encouraged to consider both PrEP products and PrEP delivery outlet preferences. Understanding and responding to AGYW's different needs will allow for preferred PrEP delivery outlets and choice in PrEP products, leading to a greater likelihood of effective PrEP use in this key population.

IntroductionMen who have sex with men (MSM) and transgender women (TGW) are at increased risk for acquiring HIV, but there are limited HIV incidence data for these key populations in Africa. Understanding HIV prevalence and incidence provides important context for designing HIV prevention strategies, including pre‐exposure prophylaxis (PrEP) programmes. We describe HIV prevalence, awareness of HIV infection, HIV incidence and associated factors for a cohort of MSM and TGW in Cape Town and Port Elizabeth, South Africa.MethodsFrom 2015 to 2016, MSM and TGW in Cape Town and Port Elizabeth were enrolled and prospectively followed for 12 months, receiving a comprehensive package of HIV prevention services. HIV testing was conducted at baseline and at follow‐up visits (targeted for three, six and twelve months). All HIV‐negative PrEP‐eligible participants were offered PrEP enrolment during the first four months of study participation. We determined HIV prevalence among participants at baseline, and incidence by repeat screening of initially HIV‐negative participants with HIV tests at three, six and twelve months.ResultsAmong 292 participants enrolled, HIV prevalence was high (43%; 95% CI: 38 to 49) and awareness of HIV status was low (50%). The 167 HIV‐negative participants who were followed prospectively for 144.7 person‐years; nine incident HIV infections were documented. Overall annual incidence was 6.2% (CI: 2.8 to 11.8) and did not differ by city. Annual HIV incidence was significantly higher for younger (18 to 19 years) MSM and TGW (MSM: 21.8% (CI: 1.2 to 100); TGW: 31.0 (CI: 3.7, 111.2)). About half of participants started PrEP during the study; the annual incidence of HIV among 82 (49%) PrEP starters was 3.6% (CI: 0.4, 13.1) and among those who did not start PrEP was 7.8% (CI: 3.1, 16.1).ConclusionsHIV incidence was high among MSM and TGW in the context of receiving a comprehensive package of prevention interventions and offering of PrEP. PrEP uptake was high; the observed incidence of HIV in those who started PrEP was about half the incidence of HIV in those who did not. Future implementation‐oriented studies should focus on decisions to start and continue PrEP for those at highest risk, including young MSM.

Cost and cost-effectiveness of an HIV pre-exposure prophylaxis (PrEP) programme for high-risk men who have sex with men in England: results of a static decision analytical model

Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study

The HIV pre-exposure prophylaxis (PrEP) Impact Trial demonstrated the feasibility and effectiveness of PrEP in England, providing critical evidence to inform national commissioning. Using trial data, we assess regional variation in delivery and examine how service provision differences impacted outcomes across the PrEP Prevention Care Continuum (PPCC) (ie, those at risk of HIV acquisition, those eligible for PrEP, PrEP uptake and coverage). We assessed PPCC outcomes among HIV-negative men who have sex with men (MSM) attending trial sexual health services (SHS) from October 2017 to February 2020. Outcomes were stratified by SHS region (London, Outside London) and MSM throughput, defined as the mean annual number of MSM attendees, to approximate differences in service structure and provision based on attendee composition. HIV incidence per 100 person-years was calculated for SHS in and outside of London, restricted to those with ≥2 visits during the study period. Across 157 trial SHS, 165 270 MSM attended during the study period, of whom 20 349 were enrolled in the trial. HIV incidence was calculated among 102 842 MSM, including 17 770 trial participants. PrEP uptake ranged from 42% to 92%, and coverage from 16% to 31%, varying by MSM throughput strata and consistently higher among London SHS. HIV incidence was significantly lower in trial participants (London: 0.07 (95% CI 0.04 to 0.14); Outside London: 0.22 (0.13 to 0.36)) versus non-trial attendees (London: 0.98 (0.88 to 1.10); Outside London: 0.93 (0.82 to 1.04)). This analysis supports ongoing enhancements to PrEP delivery across England. Findings highlight the success of varied service models, including those not traditionally focused on MSM populations. High HIV seroconversions among individuals without clear markers of risk for HIV acquisition support the need for broader, less restrictive PrEP access, aligned with recent updates to national guidance. To evaluate the long-term impact of PrEP on HIV and sexually transmitted infection (STI) incidence, consistent, high-quality data reporting to national surveillance remains essential.

Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.

HIV pre-exposure prophylaxis in men who have sex with men and transgender women: a secondary analysis of a phase 3 randomised controlled efficacy trial