Transfeminine people reported the greatest willingness to try on-demand pre-exposure prophylaxis (PrEP) when asked about their willingness to start one of three PrEP options—daily oral (DO), on-demand, and long-acting injectable (LAPrEP)—as well as their preferences between these options, according to findings published in PLOS One.
“PrEP usage prevalence among transfeminine persons is estimated to be very low among transfeminine people in the US, ranging between 9% to 32% based on local estimates, and no national estimates of prevalence are available,” Duygu Islek Yaras, MD, PhD, MPH, and colleagues wrote. “Furthermore, among transfeminine persons who start PrEP, adherence and persistence are both relatively low, compromising PrEP’s protective efficacy.”
Dr. Yaras and colleagues surveyed HIV-negative transfeminine people about various formulations of PrEP and used log-binomial models to assess PrEP modality willingness and related sociodemographic and behavioral characteristics.
PrEP Preferences Based on Sociobehavioral Factors
The analysis included 2,657 transfeminine people not currently using PrEP. Slightly more than half of respondents (51%) reported a willingness to initiate at least one PrEP option.
The researchers reported that the highest willingness was for on-demand PrEP (42.6%), followed by DO (38.1%) and LA PrEP (27.1%). Among transfeminine people who indicated a willingness to initiate multiple types of PrEP, LA PrEP was ranked as the most preferred PrEP option (43.0%).
“Willingness to start on-demand PrEP was higher among participants who were 15-24 years, resided in the South, did not have health insurance, had more than one sex partner, and reported prior awareness of on-demand PrEP,” Dr. Yaras and colleagues wrote. “Willingness to use DO and LA PrEP was higher among those who had both private and public insurance, reported condomless anal sex, had more than one sex partner, and had used non-injection illicit drugs. Additional factors for DO and LA PrEP willingness was residing in the South and prior awareness of LA PrEP, respectively.”
Translating Study Findings to Clinical Settings
Transfeminine people reported a signifi cant interest in starting PrEP, the researchers noted, with preferences varying by sociobehavioral factors. Further, a signifi cant number of transfeminine people indicated that they were willing to change PrEP regimens or routes of administration. “Our data can be used to inform strategies to improve clinical PrEP services for transfeminine persons and perhaps increase overall uptake among transfeminine persons in the US,” Dr. Yaras and colleagues wrote.
