Paltin D, Prescott M, Ma J, Yeager S, Ham L, Serrano S, Narez J, Delgado J, Burke L, Gouaux B, Beckwith M, Morris S R, Moore D J, Montoya J L
San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
University of California, San Diego, CA, USA.
AIDS Behav. 2025 Jul 11. doi: 10.1007/s10461-025-04810-y.
Despite known benefits of Motivational Interviewing (MI) for medication adherence, its effectiveness in supporting pre-exposure prophylaxis (PrEP) adherence among transgender and nonbinary (TGNB) populations remains underexplored. This study applies mixed-methods analysis to understand PrEP adherence among TGNB individuals who received a daily individualized text-message intervention and phone-based MI for non-adherence to PrEP. Individuals who did not respond to three consecutive messages were identified as potential MI recipients. We had three objectives: (1) examine psychosocial differences between participants who needed MI (MI Indicated group; n = 81) versus those who did not (MI Not Indicated group; n = 48), (2) assess whether Health Belief Model (HBM) constructs were associated with PrEP adherence, and (3) identify adherence barriers and facilitators. This secondary analysis builds on primary intervention outcomes published in Morris et al. (J Acquire Immune Defic Syndr 91:453-459, 2022). We conducted multivariable linear regression on psychosocial measures and PrEP adherence, and inductive qualitative analysis on a subset of participants who completed at least one MI session (n = 60). Results were deductively mapped onto HBM constructs. Significant differences emerged between MI groups in HBM constructs, with the MI Indicated group reporting higher perceived HIV risk, stress, depressive symptoms, and poorer coping and self-efficacy. Findings highlight the need for personalized interventions to support PrEP adherence, mental health, and HIV risk perception among TGNB individuals. Future adherence interventions may benefit from assessing and addressing HBM constructs. To support the Ending the HIV Epidemic initiative, it is critical to enhance access to facilitators and mitigate barriers to PrEP adherence for this population.
尽管动机性访谈（MI）对药物依从性有已知的益处，但其在支持跨性别和非二元性别（TGNB）人群的暴露前预防（PrEP）依从性方面的有效性仍未得到充分探索。本研究采用混合方法分析，以了解接受每日个性化短信干预和基于电话的MI以解决PrEP不依从问题的TGNB个体的PrEP依从性情况。连续三次未回复信息的个体被确定为潜在的MI接受者。我们有三个目标：（1）检查需要MI的参与者（MI指征组；n = 81）与不需要MI的参与者（非MI指征组；n = 48）之间的心理社会差异，（2）评估健康信念模型（HBM）结构是否与PrEP依从性相关，以及（3）确定依从性障碍和促进因素。这项二次分析基于Morris等人（《获得性免疫缺陷综合征杂志》91:453 - 459, 2022）发表的主要干预结果。我们对心理社会测量指标和PrEP依从性进行了多变量线性回归，并对至少完成一次MI疗程的一部分参与者（n = 60）进行了归纳定性分析。结果被演绎性地映射到HBM结构上。MI组在HBM结构上出现了显著差异，MI指征组报告的感知HIV风险、压力、抑郁症状更高，应对能力和自我效能更差。研究结果强调了需要个性化干预来支持TGNB个体的PrEP依从性、心理健康和HIV风险感知。未来的依从性干预可能会受益于评估和解决HBM结构问题。为了支持“终结艾滋病流行”倡议，加强这一人群获得促进因素的机会并减轻PrEP依从性障碍至关重要。
