Departments of Epidemiology, and Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
School of Public Health, Yale University, New Haven, CT, USA.
Sci Rep. 2024 Oct 8;14(1):23482. doi: 10.1038/s41598-024-72920-z.
Integrating gender-affirming care with biomedical HIV prevention could help address the disproportionate HIV risk experienced by transgender and nonbinary (trans) adults. This discrete choice experiment assesses and identifies the most important programming factors influencing the decisions of trans adults to use injectable long-acting HIV pre-exposure prophylaxes (LA-PrEP). From March to April 2023 n = 366 trans adults in Washington state chose between four different choice profiles that presented hypothetical programs (each comprised of 5 attributes with 4 levels). We analyzed ranked choice responses using a mixed rank-ordered logit model for main effects. Respondents preferred to receive LA-PrEP from a gender-affirming care provider and a co-prescription for both oral and injectable hormones. Trans adults strongly favored 12-month protection and injection in the upper arm. No strong preferences emerged surrounding the type of health facility offering the gender-affirming LA-PrEP program. Our findings show that integrating and leveraging gender-affirming health systems, inclusive of medical services such as hormone therapy, with HIV biomedical products like LA-PrEP is strongly preferred and influential to trans adults' decision to use LA-PrEP. Leveraging choice-based design experiments provides informative results for optimizing gender-affirming LA-PrEP programming tailored to trans adults.
将性别肯定护理与生物医学 HIV 预防相结合，可以帮助解决跨性别和非二进制（跨性别）成年人不成比例的 HIV 风险。这项离散选择实验评估并确定了影响跨性别成年人决定使用注射长效 HIV 暴露前预防（LA-PrEP）的最重要的编程因素。2023 年 3 月至 4 月，华盛顿州的 366 名跨性别成年人在四个不同的选择方案中进行选择，这些方案提出了假设性的方案（每个方案由 5 个属性和 4 个级别组成）。我们使用混合排序对数模型对主要影响因素进行了排名选择响应分析。受访者更喜欢从性别肯定护理提供者那里获得 LA-PrEP，并同时开出口服和注射用激素。跨性别成年人强烈倾向于 12 个月的保护和上臂注射。在提供性别肯定 LA-PrEP 项目的卫生机构类型方面，没有出现强烈的偏好。我们的研究结果表明，将包括激素治疗在内的医疗服务在内的性别肯定健康系统与 HIV 生物医学产品（如 LA-PrEP）相结合并加以利用，是跨性别成年人决定使用 LA-PrEP 的强烈偏好和影响因素。利用基于选择的设计实验为优化针对跨性别成年人的性别肯定 LA-PrEP 编程提供了有价值的结果。
