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Publication Profiles

Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study

Citation

Andrzejewski J, Pines HA, Morris S, et al. Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study. Int J Environ Res Public Health. 2024;21(2):133. doi:10.3390/ijerph21020133

Implementation stage:

Sustainment

Implementation outcomes reported:

Penetration

Continuum target addressed:

PrEP persistence

Geography:

San Diego County-CA, Los Angeles County-CA

Study Participant Classification:

Recipients of care

Plain Language Objectives

The researchers examined why some transgender women stayed in PrEP care for 24 weeks while others did not, combining trial data with interviews about work, drug use, housing, and gender-affirming services.

Plain Language Abstract

Transgender women experience major HIV inequities and specific barriers to staying in pre-exposure prophylaxis, or PrEP, care. Researchers first analyzed trial data from 170 transgender women who received oral PrEP, then interviewed 15 PrEP-experienced women to explain the patterns. Participants not retained at 24 weeks more often reported sex work (18% versus 7%) and substantial or severe drug use (18% versus 8%). Interviews showed that drug use could disrupt PrEP, often alongside sex work. Women doing “survival sex work” described unstable housing and drug use that made retention difficult, while women in other forms of sex work reported fewer problems. Participants not retained also reported gender-affirming hormone use less often (56% versus 71%). Interviewees prioritized gender-affirming services but described benefits when hormone and PrEP care were available together. Quantitative findings were observational and interviews reflect individual experiences, so they do not prove causation. The authors concluded that women facing survival-related instability may need additional, integrated support.

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