Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD.
Fenway Health, The Fenway Institute, Boston, MA; Brigham and Women's Hospital, Division of Endocrinology, Diabetes, and Hypertension, Boston, MA; Harvard Medical School, Department of Medicine, Boston, MA; Harvard TH Chan School of Public Health, Department of Epidemiology, Boston, MA.
Ann Epidemiol. 2022 Jun;70:23-31. doi: 10.1016/j.annepidem.2022.03.016. Epub 2022 Apr 6.
Adherence to pre-exposure prophylaxis (PrEP) during periods of PrEP-indication (i.e., prevention-effective adherence) is critical for preventing HIV. We sought to describe factors associated with prevention-effective adherence trajectories among transgender women (TW) to inform PrEP implementation strategies.
Using data from The LITE American Cohort (n = 728), we performed group-based multi-trajectory modeling (GBMTM) to identify clusters of TW with similar trajectories of PrEP adherence and indication, and sociodemographic, biobehavioral, and structural correlates of each trajectory.
We identified five trajectories: (1) consistent indication/no PrEP (15.3%), (2) initial indication/no PrEP (47.1%), (3) declining indication/discontinued PrEP (9.5%), (4) consistent indication/PrEP adherent (18.5%), and (5) increasing indication/initiated PrEP (9.6%). TW diagnosed with an STI were more likely to follow a consistent indication/no PrEP trajectory compared to consistent indication/PrEP adherent trajectory (adjusted Relative Risk Ratio [aRRR], 2.54; 95% confidence interval [CI], 1.16-5.57). TW who experienced homelessness were more likely to follow PrEP discontinuation and initiation trajectories relative to PrEP adherence (aRRR, 2.71; 95% CI, 1.10-6.70 and 2.83; 95% CI, 1.13-7.05, respectively).
Over a quarter of TW followed trajectories suggestive of prevention-effective adherence, while 15% did not initiate PrEP despite consistent indication. Findings highlight missed opportunities for PrEP engagement at STI diagnosis and suggest structural interventions addressing housing instability may improve prevention-effective adherence among TW.
在有预防指征（即有效预防依从性）期间坚持使用暴露前预防（PrEP）对于预防 HIV 至关重要。我们旨在描述与跨性别女性（TW）的有效预防依从轨迹相关的因素，以为 PrEP 实施策略提供信息。
使用来自 LITE 美国队列（n=728）的数据，我们进行了基于群组的多轨迹建模（GBMTM），以识别 PrEP 依从性和指征具有相似轨迹的 TW 群组，并确定每个轨迹的社会人口统计学、生物行为学和结构相关性。
我们确定了五个轨迹：（1）持续指征/无 PrEP（15.3%），（2）初始指征/无 PrEP（47.1%），（3）指征减少/停止 PrEP（9.5%），（4）持续指征/PrEP 依从性（18.5%）和（5）指征增加/开始 PrEP（9.6%）。与持续指征/PrEP 依从性轨迹相比，诊断出性传播感染（STI）的 TW 更有可能遵循持续指征/无 PrEP 轨迹（调整后的相对风险比 [aRRR]，2.54；95%置信区间 [CI]，1.16-5.57）。经历过无家可归的 TW 更有可能遵循 PrEP 停药和启动轨迹，而不是 PrEP 依从性（aRRR，2.71；95%CI，1.10-6.70 和 2.83；95%CI，1.13-7.05）。
超过四分之一的 TW 遵循了提示有效预防依从性的轨迹，而 15%的 TW 尽管有持续指征，但仍未开始使用 PrEP。这些发现突出了在 STI 诊断时错过 PrEP 参与的机会，并表明解决住房不稳定的结构性干预措施可能会提高 TW 的有效预防依从性。
