Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study

• Published in: Journal of the International AIDS Society Vol. 25; no. 3; pp. e25896 - n/a
• Main Authors: Jalil, Emilia M., Torres, Thiago S., Luz, Paula M., Monteiro, Laylla, Moreira, Ronaldo I., Castro, Cristiane R. V., Leite, Iuri da C., Cunha, Marcello, Cássia Elias Estrela, Rita, Ramos, Michelle, Hoagland, Brenda, Wagner Cardoso, Sandra, Anderson, Peter, Veloso, Valdilea G., Wilson, Erin, Grinsztejn, Beatriz
• Format: Journal Article
• Language: English
• Published: Switzerland John Wiley & Sons, Inc 01.03.2022; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; adherence; AIDS; Anti-HIV Agents - therapeutic use; Antigens; Behavior; Binge drinking; Brazil; Care and treatment; Central Nervous System Stimulants - therapeutic use; Disease prevention; Drug dosages; Female; Gender identity; Hepatitis B; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; Homosexuality, Male; hormones; Human immunodeficiency virus; Humans; Infections; Laboratories; Male; Mass spectrometry; Medical tests; Medication Adherence; Mental health; Patient compliance; Pre-Exposure Prophylaxis; PrEP; prevention; Prophylaxis; Retention; Risk taking; Scientific imaging; Sexual behavior; Statistics; Syphilis; Transgender people; Transgender Persons; transgender women; Women patients; Brazil; United States > US; Rio de Janeiro Brazil; PrEP; HIV; hormones; adherence; prevention; transgender women
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25896

Introduction We aimed to evaluate daily oral pre‐exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non‐attendance and low PrEP adherence in a Brazilian trans‐specific 48‐week study (PrEParadas). Methods We enrolled transgender women (TGW) engaging in high‐risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p‐value<0.10 in the univariate analysis. Results From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non‐attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18–24 (adjusted odds ratio [aOR] = 8.76, 95% CI: 2.09–36.7) and 25–34 years (aOR = 6.79, 95% CI: 1.72–26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37–18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30–34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94–47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16–0.88). No participant seroconverted over the course of the study. Conclusions Although high PrEP retention can be achieved in a gender‐affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale‐up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.