Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California

Abstract

Black and Latinx transgender women in the United States (U.S.) are at disproportionately high risk for HIV. Although HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection, uptake and persistence (i.e., ability to continue taking PrEP over time) can be a challenge for Black and Latinx transgender women due to myriad social and structural forces. In this qualitative study, we present unique data on the facilitators of PrEP persistence from Black and Latinx transgender women who initiated PrEP and exhibited varying levels of persistence during a demonstration project in Southern California. PrEP persistence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels on dried blood spot (DBS) samples collected at weeks 12 and 48. Informed by the socioecological framework, we conducted and analyzed interviews using qualitative content analysis to determine themes on the facilitators of PrEP persistence. Individual-level facilitators included the use of reminders, having high individual-level HIV risk perception, feeling empowered to take PrEP, and reporting having improved peace of mind and mental health because of taking PrEP. Interpersonal/Community-level facilitators included feeling motivation to prevent HIV in the community, motivation to prevent HIV in the context of sex work, and having high community-level risk perception. Structural-level facilitators included having positive experiences in affirming healthcare settings and having PrEP visits combined with other gender-related healthcare visits. Interventions aiming to increase PrEP uptake and persistence among Black and Latinx transgender women in the U.S. should harness the multiple levels of support exhibited by those who were able to start and persist on PrEP in the face of the myriad social and structural barriers.

Keywords:

• Transgender women
• health equity
• PrEP persistence
• medication adherence
• HIV prevention

Acknowledgements

This project was funded by grant R21DA044073 from the National Institute on Drug Abuse. Drs. Storholm and Reback acknowledge additional support from the National Institute of Mental Health (P30MH58107). Dr. Morris was funded by the parent study PrEP Linkage, Adherence & Pharmacology in Transgender Persons (PR15-SD-021) from the California HIV/AIDS Research Program. Findings from this study have informed Strategies for Implementing PrEP Services in a TG Community Center (H21IS3484), a California HIV/AIDS Research Program-funded project that is currently implementing gender-affirming PrEP service at the Los Angeles Transgender Wellness Center. The authors would like to thank the participants of the study as well as Chloe Opalo, Alvy Rangel, and Andrew Stieber without whom this study would not have been possible.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse under grant R21DA044073; the National Institute of Mental Health under grant P30MH58107; and the California HIV/AIDS Research Program under grant PR15-SD-021. Findings from this study have informed Strategies for Implementing PrEP Services in a Trans Community Center a California HIV/AIDS Research Program-funded project (H21IS3484; PI Storholm), that is currently implementing culturally appropriate, comprehensive, and gender affirming PrEP services at the Los Angeles Wellness Center.