An built-in HIV prevention technique will increase PrEP adherence amongst transgender girls

Researchers from the HIV Prevention Trials Community (HPTN) offered outcomes from HPTN 091 (“I Am Research”) on the HIVR4P 2024 convention in Lima, Peru. The research examined the acceptability and feasibility of an built-in, multicomponent technique to enhance day by day uptake and adherence to oral HIV pre-exposure prophylaxis (PrEP) in transgender girls in a randomized instant versus delayed design.

The built-in care technique included the availability of gender-affirming hormone remedy (GAHT) and shared structured peer well being navigation (PHN) periods, as effectively as oral PrEP. Contributors within the deferred arm acquired case administration and referral to GAHT. As soon as individuals reached week 26, all of them acquired the built-in care technique. The first end result measured at week 26 confirmed an enhance in PrEP uptake and inspiring ranges of PrEP adherence; Nevertheless, PrEP uptake and adherence ranges had been comparable between research arms.

“Common peer help and provision of entry to GAHT and different wanted providers in each research arms seemingly resulted in an enhance in PrEP engagement amongst research individuals, highlighting the pressing want for this help on this inhabitants.”

Dr. AS Tonia Poteat, professor at Duke College College of Nursing

The research concerned 304 transgender girls ages 18 and older at four U.S. HPTN analysis websites (Houston, Recent York, Philadelphia, and San Francisco) and one Brazilian web site (Rio de Janeiro). Contributors had been randomized 1:1 to the instant or delayed intervention arm. US individuals in each research arms had been supplied Truvada® (tenofovir/emtricitabine) or Descovy® (emtricitabine and tenofovir alafenamide) for HIV PrEP from enrollment. Contributors in Brazil had been supplied Truvada®, akin to the nationally permitted and accessible PrEP product. Apretude® (cabotegravir) was not accessible on the time of research initiation and was due to this fact not included as one among the PrEP choices.

At enrollment, individuals within the instant intervention arm acquired GAHT and co-located structured PHN. Contributors within the deferred intervention arm acquired exterior GAHT and case administration till week 26 after which crossed over to the built-in technique. The first research end result was PrEP uptake and adherence assessed at week 26, with adherence outlined as taking four or extra tablets per week based mostly on tenofovir detection in dried blood spots.

“Transgender girls maintain one among the very best HIV prevalence charges of any inhabitants, but proceed to maintain problem accessing and adhering to PrEP,” mentioned Dr. Wafaa El-Sadr, co-principal investigator of HPTN, director of ICAP and professor of epidemiology and medication at Columbia College in Recent York. “Tailor-made methods tailor-made to the distinctive wants of this inhabitants are important to addressing this problem.”

At enrollment, 11 p.c of individuals self-reported utilizing PrEP and 42 p.c reported utilizing GAHT. At week 26, PrEP exercise within the instant and delayed research arms was 85 p.c and 87 p.c, respectively. PrEP adherence based mostly on dried blood spot outcomes was confirmed for 50 and 51 p.c of individuals, respectively. Retention was comparatively excessive in each research arms (84 p.c and 87 p.c, respectively).

“Significant engagement with the transgender group by offering peer case administration and entry to wanted providers was considerable to growing PrEP engagement amongst all research individuals,” mentioned Dr. Myron Cohen, co-principal investigator of the HPTN and director of the Institute for World Well being on the College of North Carolina at Chapel Hill. “This strategy affords a path to decreasing HIV an infection on this inhabitants.”