| Author | Konda, Kelika A. | |
| Author | Torres, Thiago S. | |
| Author | Mariño, Gabriela | |
| Author | Ramos, Alessandra | |
| Author | Moreira, Ronaldo I. | |
| Author | Leite, Iuri C. | |
| Author | Cunha, Marcelo | |
| Author | Jalil, Emilia M. | |
| Author | Hoagland, Brenda | |
| Author | Guanira, Juan V. | |
| Author | Benedetti, Marcos | |
| Author | Pimenta, Cristina | |
| Author | Vermandere, Heleen | |
| Author | Bautista-Arredondo, Sergio | |
| Author | Vega-Ramirez, Hamid | |
| Author | Veloso, Valdiléa G. | |
| Author | Caceres, Carlos F. | |
| Author | Grinsztejn, Beatriz | |
| Access date | 2022-12-11T13:50:43Z | |
| Available date | 2022-12-11T13:50:43Z | |
| Document date | 2022 | |
| Citation | KONDA, Kelika A. et al. Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study. Journal of the International AIDS Society, v. 25, n. 5, p. 47-59, Oct. 2022. | en_US |
| ISSN | 1758-2652 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/55909 | |
| Language | eng | en_US |
| Publisher | Wiley | en_US |
| Rights | open access | en_US |
| Title | Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study | en_US |
| Type | Article | en_US |
| DOI | 10.1002/jia2.25974 | |
| Abstract | Introduction: The HIV epidemic continues to disproportionately impact Latin-American transgender women (TGW). We assessed factors associated with long-term pre-exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods: HIV-negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow-up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long-term PrEP engagement (3+ follow-up visits in 52 weeks) and complete self-reported adherence (no missed pills in the past 30 days) during follow-up. For both outcomes, we constructed multivariable models controlling for country, socio-demographics, sexual behaviour, substance use, STIs and self-reported adherence at 4 weeks (long-term engagement outcome only). Results: From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18-24 years, 67.8% were mixed-race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person-years (95% confidence interval [CI]: 0.76-4.38). Almost half of TGW (48.6%) had long-term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88-4.63]) and was inversely associated with reporting CAS with unknown-HIV partner (aOR:0.52 [95%CI:0.34-0.81]), migration (aOR:0.54 [95%CI:0.34-0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14-0.53]). Self-reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10-2.34]) compared to those aged 25-34 and those with >secondary education (aOR:1.55 [95%CI:1.10-2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21-0.41]) or reporting PrEP-related adverse effects (aOR:0.63 [95%CI:0.42-0.92]). Conclusions: Although TGW were willing to enrol in ImPrEP, long-term PrEP engagement and complete self-reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans-specific interventions supporting oral PrEP and exploring long-acting PrEP strategies for TGW. | en_US |
| Affilliation | Universidad Peruana Cayetano Heredia. Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDA. Lima, Peru. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Universidad Peruana Cayetano Heredia. Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDA. Lima, Peru. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Universidad Peruana Cayetano Heredia. Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDA. Lima, Peru. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Ministério da Saúde. Brasília, DF, Brasil. | en_US |
| Affilliation | Instituto Nacional de Salud Pública. Cuernavaca, Mexico. | en_US |
| Affilliation | Instituto Nacional de Salud Pública. Cuernavaca, Mexico. | en_US |
| Affilliation | Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz. Mexico City, Mexico. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Universidad Peruana Cayetano Heredia. Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDA. Lima, Peru. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Subject | HIV | en_US |
| Subject | Latin America | en_US |
| Subject | Medication adherence | en_US |
| Subject | Pre-exposure prophylaxis | en_US |
| Subject | Public health | en_US |
| Subject | Transgender persons | en_US |
| xmlui.metadata.dc.subject.ods | 03 Saúde e Bem-Estar | |
| xmlui.metadata.dc.subject.ods | 05 Igualdade de gênero | |
