Storholm Erik D, Nacht Carrie L, Opalo Chloe, Flynn Risa, Murtaugh Kimberly Ling, Marroquin Mariana, Baumgardner Mika, Dopp Alex R
School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
RAND, Santa Monica, CA, USA.
J Community Health. 2025 Apr 21. doi: 10.1007/s10900-025-01468-4.
Transgender and nonbinary (TGNB) individuals are disproportionately impacted by HIV, particularly those who identify as racial/ethnic minorities and those who are socioeconomically disadvantaged. Pre-exposure prophylaxis (PrEP) is a highly effective medication to prevent HIV infection, but many TGNB individuals encounter barriers to PrEP uptake and adherence that limit fully realized preventive benefits. We developed PrEP Well, a multicomponent community-led program, to scale and sustain comprehensive PrEP services from a TGNB-led community organization that provides gender-affirming healthcare and social services. We used implementation science frameworks to evaluate initial program outcomes and contextual influences on program implementation. Preliminary data from August 2022 through January 2024 showed promising implementation and effectiveness outcomes. During that time, 113 primarily low-resourced TGNB clients were educated about PrEP and received an HIV test, of whom 60 (53%) attended a visit with a provider and received a PrEP prescription. At 30-day follow-up, urinalysis confirmed uptake of PrEP among 50 (83%) of the clients prescribed PrEP. At 90-day follow-up, 43 (72%) demonstrated continued use of PrEP and 40 (67%) showed protective levels of PrEP adherence. Qualitative interviews and surveys indicated that clients, staff, and leadership viewed the PrEP Well program as highly acceptable, feasible, and sustainable (including willingness to address persistent implementation barriers). Referral patterns and rates of PrEP uptake suggested increasing integration of PrEP Well into the TGNB community center over time. The PrEP Well program demonstrates the potential for TGNB communities to address HIV inequities by integrating community-led HIV prevention services with gender-affirming healthcare in TGNB-specific health centers.
跨性别者和非二元性别者（TGNB）受艾滋病毒的影响尤为严重，特别是那些被认定为少数种族/族裔以及社会经济地位不利的人群。暴露前预防（PrEP）是预防艾滋病毒感染的一种高效药物，但许多TGNB个体在获取和坚持使用PrEP方面遇到障碍，这限制了预防效益的充分实现。我们开发了“PrEP Well”项目，这是一个由社区主导的多组件项目，旨在扩大并持续提供全面的PrEP服务，该项目由一个TGNB主导的社区组织负责实施，该组织提供性别肯定性医疗保健和社会服务。我们运用实施科学框架来评估项目的初始成果以及对项目实施的背景影响。2022年8月至2024年1月的初步数据显示出了良好的实施情况和成效。在此期间，113名主要资源匮乏的TGNB客户接受了PrEP教育并接受了艾滋病毒检测，其中60人（53%）就诊并获得了PrEP处方。在30天随访时，尿液分析证实50名（83%）开具PrEP处方的客户已开始服用PrEP。在90天随访时，43人（72%）持续使用PrEP，40人（67%）的PrEP依从性达到了保护水平。定性访谈和调查表明，客户、工作人员和领导层认为“PrEP Well”项目非常可接受、可行且可持续（包括愿意解决持续存在的实施障碍）。转诊模式和PrEP获取率表明，随着时间的推移，“PrEP Well”项目越来越融入TGNB社区中心。“PrEP Well”项目展示了TGNB社区通过将社区主导的艾滋病毒预防服务与TGNB特定健康中心的性别肯定性医疗保健相结合来解决艾滋病毒不平等问题的潜力。
