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PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study.

Publication ,  Journal Article
Cooney, EE; Saleem, HT; Stevenson, M; Aguayo-Romero, RA; Althoff, KN; Poteat, TC; Beckham, SW; Adams, D; Radix, AE; Wawrzyniak, AJ; Cannon, CM ...
Published in: J Int AIDS Soc
December 2023

INTRODUCTION: Transgender women in the United States experience high HIV incidence and suboptimal Pre-exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women. METHODS: Using a sequential, explanatory, mixed-methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow-up 24 months; interquartile range 15-36). Cox regression models assessed predictors of initiation and discontinuation. In-depth interviews were conducted among 18 participants, including life history calendars to explore key events and experiences surrounding discontinuations. Qualitative and quantitative data were integrated to generate typologies of discontinuation, inform meta-inferences and facilitate the interpretation of findings. RESULTS: 21.8% (n = 286) of participants reported taking PrEP at one or more study visits while under observation. We observed 139 PrEP initiations over 2127 person-years (6.5 initiations/100 person-years, 95% CI: 5.5-7.7). Predictors of initiation included identifying as Black and PrEP indication. The rate of initiation among those who were PrEP-indicated was 9.6 initiations/100 person-years (132/1372 person-years; 95% CI: 8.1-11.4). We observed 138 PrEP discontinuations over 368 person-years (37.5 discontinuations/100 person-years, 95% CI: 31.7-44.3). Predictors of discontinuation included high school education or less and initiating PrEP for the first time while under observation. Four discontinuation typologies emerged: (1) seroconversion following discontinuation; (2) ongoing HIV acquisition risk following discontinuation; (3) reassessment of HIV/STI prevention strategy following discontinuation; and (4) dynamic PrEP use coinciding with changes in HIV acquisition risk. CONCLUSIONS: PrEP initiation rates were low and discontinuation rates were high. Complex motivations to stop using PrEP did not consistently correspond with HIV acquisition risk reduction. Evidence-based interventions to increase PrEP persistence among transgender women with ongoing acquisition risk and provide HIV prevention support for those who discontinue PrEP are necessary to reduce HIV incidence in this population.

Duke Scholars

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Published In

J Int AIDS Soc

DOI

EISSN

1758-2652

Publication Date

December 2023

Volume

26

Issue

12

Start / End Page

e26199

Location

Switzerland

Related Subject Headings

  • United States
  • Transgender Persons
  • Sexually Transmitted Diseases
  • Prospective Studies
  • Pre-Exposure Prophylaxis
  • Male
  • Humans
  • Homosexuality, Male
  • HIV Infections
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Cooney, E. E., Saleem, H. T., Stevenson, M., Aguayo-Romero, R. A., Althoff, K. N., Poteat, T. C., … American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group, . (2023). PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study. J Int AIDS Soc, 26(12), e26199. https://doi.org/10.1002/jia2.26199
Cooney, Erin E., Haneefa T. Saleem, Meg Stevenson, Rodrigo A. Aguayo-Romero, Keri N. Althoff, Tonia C. Poteat, S Wilson Beckham, et al. “PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study.J Int AIDS Soc 26, no. 12 (December 2023): e26199. https://doi.org/10.1002/jia2.26199.
Cooney EE, Saleem HT, Stevenson M, Aguayo-Romero RA, Althoff KN, Poteat TC, et al. PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study. J Int AIDS Soc. 2023 Dec;26(12):e26199.
Cooney, Erin E., et al. “PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study.J Int AIDS Soc, vol. 26, no. 12, Dec. 2023, p. e26199. Pubmed, doi:10.1002/jia2.26199.
Cooney EE, Saleem HT, Stevenson M, Aguayo-Romero RA, Althoff KN, Poteat TC, Beckham SW, Adams D, Radix AE, Wawrzyniak AJ, Cannon CM, Schneider JS, Haw JS, Rodriguez AE, Mayer KH, Beyrer C, Reisner SL, Wirtz AL, American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group. PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study. J Int AIDS Soc. 2023 Dec;26(12):e26199.

Published In

J Int AIDS Soc

DOI

EISSN

1758-2652

Publication Date

December 2023

Volume

26

Issue

12

Start / End Page

e26199

Location

Switzerland

Related Subject Headings

  • United States
  • Transgender Persons
  • Sexually Transmitted Diseases
  • Prospective Studies
  • Pre-Exposure Prophylaxis
  • Male
  • Humans
  • Homosexuality, Male
  • HIV Infections
  • Female