ArticleJournal of the International AIDS Society2023
PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study.
Article in Journal of the International AIDS Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Doxycycline Post-exposure Prophylaxis Awareness and Use Among Transgender Women in San Francisco, 2023-2024: Assessment One Year After Release of Health Department Guidance.AIDS and behavior · 2026Article
- PrEP and PEP: awareness, use, and preferences among Latina immigrant transgender women in the Washington DC metropolitan area.AIDS care · 2026Article
- The Role of Healthcare-Related Experiences in Willingness and Preference for Long-Acting Injectable PrEP (LAI-PrEP) Among Transfeminine People in the United States.AIDS and behavior · 2026Article
- Persistence on Oral HIV Pre-Exposure Prophylaxis Among Key Populations at a Centre in Buenos Aires: A Survival Analysis of a Real-World Cohort.Journal of the International AIDS Society · 2026Article
- Longitudinal Analysis of Substance Use as a Predictor PrEP Use and Adherence Among Young Transgender Women and Nonbinary Individuals.AIDS and behavior · 2026Article
- HIV Prevention Patterns Among a Population-Based Sample of HIV Negative Young Women in Eswatini.AIDS and behavior · 2026Article
- HIV Preexposure Prophylaxis Utilization and Reasons for Never Using Preexposure Prophylaxis Among Transfeminine Persons in the United States: Findings From the Transgender Women's Internet Survey and Testing (TWIST) Study.Open forum infectious diseases · 2026Article
- Intensive longitudinal follow-up of cisgender and transgender women engaged in sex work during the three months following initiation of daily oral PrEP: A series of case-studies with mixed-method assessments.PLOS global public health · 2026Article
- PrEP Use Among Black Transgender Women: A Qualitative Study on Barriers to PrEP Use and the Power and Promise of Community.Archives of sexual behavior · 2025Article
- Preference for Long-Acting Injectable PrEP Compared With Daily Oral PrEP Among Transgender Women in the U.S.: Findings From a Multisite Cohort.AJPM focus · 2025Article
- Multi-level correlates of oral pre-exposure prophylaxis discontinuation among English and Spanish-speaking transgender women of color in New York City: The TURNNT cohort study.International journal of transgender health · 2025Article
- Article
- Infections Following Gender-Affirming Vaginoplasty: A Single-Center Experience.Open forum infectious diseases · 2024Article
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Authors and funding
19 authors.
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Abstract
introductionTransgender women in the United States experience high HIV incidence and suboptimal Pre-exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women.
methodsUsing a sequential, explanatory, mixed-methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow-up 24 months; interquartile range 15-36). Cox regression models assessed predictors of initiation and discontinuation. In-depth interviews were conducted among 18 participants, including life history calendars to explore key events and experiences surrounding discontinuations. Qualitative and quantitative data were integrated to generate typologies of discontinuation, inform meta-inferences and facilitate the interpretation of findings.
results21.8% (n = 286) of participants reported taking PrEP at one or more study visits while under observation. We observed 139 PrEP initiations over 2127 person-years (6.5 initiations/100 person-years, 95% CI: 5.5-7.7). Predictors of initiation included identifying as Black and PrEP indication. The rate of initiation among those who were PrEP-indicated was 9.6 initiations/100 person-years (132/1372 person-years; 95% CI: 8.1-11.4). We observed 138 PrEP discontinuations over 368 person-years (37.5 discontinuations/100 person-years, 95% CI: 31.7-44.3). Predictors of discontinuation included high school education or less and initiating PrEP for the first time while under observation. Four discontinuation typologies emerged: (1) seroconversion following discontinuation; (2) ongoing HIV acquisition risk following discontinuation; (3) reassessment of HIV/STI prevention strategy following discontinuation; and (4) dynamic PrEP use coinciding with changes in HIV acquisition risk.
conclusionsPrEP initiation rates were low and discontinuation rates were high. Complex motivations to stop using PrEP did not consistently correspond with HIV acquisition risk reduction. Evidence-based interventions to increase PrEP persistence among transgender women with ongoing acquisition risk and provide HIV prevention support for those who discontinue PrEP are necessary to reduce HIV incidence in this population.
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