Preference for Long-Acting Injectable PrEP Compared With Daily Oral PrEP Among Transgender Women in the U.S.: Findings From a Multisite Cohort.
Erin E Cooney, Sari L Reisner, Tonia C Poteat, Asa E Radix, Kenneth H Mayer, Chris Beyrer, Meg Stevenson, Rodrigo A Aguayo-Romero, Jason S Schneider, Andrew J Wawrzyniak, Christopher M Cannon, Carolyn A Brown, Leigh Ragone, Vani Vannappagari, Andrea L Wirtz, American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group
Author Information
Erin E Cooney: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sari L Reisner: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Tonia C Poteat: Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, North Carolina.
Asa E Radix: Callen-Lorde Community Health Center, New York, New York.
Kenneth H Mayer: The Fenway Institute, Fenway Health, Boston, Massachusetts.
Chris Beyrer: Duke Global Health Institute, Duke University, Durham, North Carolina.
Meg Stevenson: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Rodrigo A Aguayo-Romero: Whitman-Walker Institute, Washington, District of Columbia.
Jason S Schneider: Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Andrew J Wawrzyniak: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.
Christopher M Cannon: Whitman-Walker Institute, Washington, District of Columbia.
Carolyn A Brown: ViiV Healthcare, Durham, North Carolina.
Leigh Ragone: ViiV Healthcare, Durham, North Carolina.
Vani Vannappagari: ViiV Healthcare, Durham, North Carolina.
Andrea L Wirtz: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Introduction: Pre-exposure prophylaxis (PrEP) use among transgender women in the U.S. has not reached levels optimal to change the trajectory of the HIV epidemic owing to multilevel barriers. Long-acting injectable PrEP received Food and Drug Administration approval in 2021 and may potentially address some of the barriers experienced in initiating and adhering to daily oral PrEP (e.g., pill fatigue, medication storage). However, preferences for long-acting injectable PrEP compared with daily oral PrEP have not been well studied among transgender women. Methods: The authors analyzed data collected from transgender women not living with HIV in eastern and southern U.S. in 2020-2022. Using multivariable Poisson regression with robust standard errors, the authors estimated prevalence ratios and 95% CIs for factors associated with preference for long-acting injectable PrEP. Results: The study sample (N=789) was racially and ethnically diverse, with 42.6% identifying as Black, Latina, and/or multiracial and 12% using daily oral PrEP. Fifty-eight percent preferred long-acting injectable PrEP to daily oral PrEP. In multivariable regression analyses, preference for long-acting injectable PrEP was associated with residence in Midwest (reference group=Northeast, adjusted prevalence ratio=1.33; 95% CI=1.10, 1.60), current PrEP indications (adjusted prevalence ratio=1.14; 95% CI=1.01, 1.30), and history of gender-affirming hormone injection (adjusted prevalence ratio=1.36; 95% CI=1.18, 1.57). Conclusions: Transgender women may prefer long-acting injectable PrEP to daily oral PrEP, especially those with current PrEP indications and experience with gender-affirming hormone injections. Increasing availability and access to long-acting injectable PrEP may improve PrEP uptake in transgender women, particularly in combination with other interventions to reduce multilevel PrEP barriers.
