Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet HIV. 2020 Dec;7(12):e825-e834. doi: 10.1016/S2352-3018(20)30119-3. Epub 2020 Jul 2.
The South African national HIV plan recommends pre-exposure prophylaxis (PrEP) for transgender women, whose HIV prevalence estimates are as high as 25% in sub-Saharan Africa. The aim of this study was to explore PrEP awareness, uptake, and willingness, as well as associated barriers and facilitators, in order to inform PrEP implementation efforts with transgender women in South Africa.
Using a community-engaged, convergent parallel mixed methods design, trained local transgender women data collectors recruited 213 transgender women participants (aged >18 years, assigned male sex at birth, and identifying as a gender different from male), via network referral and word-of-mouth in Cape Town, East London, and Johannesburg. A subset of 36 transgender women also participated in qualitative in-depth interviews. Quantitative analyses included descriptive statistics and negative binomial regression models to assess correlates of PrEP willingness. Qualitative interviews were audio-recorded, transcribed verbatim, and coded. Thematic content analysis was used to identify key themes. Quantitative and qualitative data were integrated for interpretation.
Participants were recruited between June 1 and Nov 30, 2018. 57 (45%) of 127 HIV-negative participants were PrEP-aware and only 14 (11%) of 129 were currently taking PrEP. HIV-negative participants experiencing social (eg, violence, poverty) and interpersonal (eg, discrimination, low transgender women community connectedness) hardship reported PrEP awareness more frequently than HIV-negative transgender women who did not. Willingness to take PrEP was low, at 56 (55%) of 102, among HIV-negative participants who were not currently taking PrEP, and negatively associated with transgender women community connectedness (multivariable prevalence ratio 0·87; 95% CI 0·77-0·99). Barriers to PrEP included taking a daily pill, side-effects, and cost. Participants urged greater education and engagement of transgender women in PrEP implementation.
South Africa is poised to scale up PrEP services for transgender women. Dedicated transgender clinics are planned to provide comprehensive care, including PrEP, for transgender women. It is critical to ensure transgender women are aware of and have accurate information about PrEP, and that health-care sites are prepared to provide quality care for transgender women.
Gilead Sciences.
南非国家艾滋病规划建议为跨性别女性提供暴露前预防（PrEP），因为在撒哈拉以南非洲，跨性别女性的艾滋病感染率高达 25%。本研究旨在探讨 PrEP 的认知、采用和意愿，以及相关的障碍和促进因素，以便为南非跨性别女性的 PrEP 实施工作提供信息。
采用社区参与的、汇聚的平行混合方法设计，经过培训的当地跨性别女性数据收集员通过网络推荐和口口相传，在开普敦、东伦敦和约翰内斯堡招募了 213 名跨性别女性参与者（年龄>18 岁，出生时被指定为男性性别，并且认同自己的性别与男性不同）。其中一组 36 名跨性别女性还参加了定性深入访谈。定量分析包括描述性统计和负二项回归模型，以评估 PrEP 意愿的相关性。定性访谈进行了录音、逐字转录和编码。使用主题内容分析来确定关键主题。对定量和定性数据进行整合以进行解释。
参与者于 2018 年 6 月 1 日至 11 月 30 日期间招募。在 127 名 HIV 阴性参与者中，有 57 名（45%）对 PrEP 有认知，而在 129 名中仅有 14 名（11%）正在服用 PrEP。经历社会（如暴力、贫困）和人际（如歧视、与跨性别女性社区联系较少）困难的 HIV 阴性参与者比没有经历这些困难的 HIV 阴性跨性别女性更频繁地报告对 PrEP 的认识。在目前未服用 PrEP 的 102 名 HIV 阴性参与者中，仅有 56 名（55%）愿意服用 PrEP，而与跨性别女性社区联系较少的参与者的 PrEP 意愿呈负相关（多变量患病率比 0.87；95%CI 0.77-0.99）。PrEP 的障碍包括每天服用一片药、副作用和费用。参与者强烈要求对 PrEP 的实施进行更多的教育和参与。
南非准备扩大 PrEP 服务范围，为跨性别女性提供服务。计划设立专门的跨性别诊所，为跨性别女性提供全面护理，包括 PrEP。确保跨性别女性了解并获得关于 PrEP 的准确信息，以及医疗保健机构准备好为跨性别女性提供高质量的护理至关重要。
吉利德科学公司。
