Correlates of pre-exposure prophylaxis amongst transgender women of color taking gender-affirming hormone therapy: Findings from the TURNNT cohort study.

Background: The Trying to Understand Relationships, Networks, and Neighborhoods Among Transgender Women of Color (TURNNT) Cohort Study provides a unique opportunity to identify correlates of PrEP use amongst transgender women of color taking gender-affirming hormone therapy (GAHT). Methods: We analyzed baseline data from the TURNTT Cohort Study, restricting our sample to those taking GAHT. We examined individual, interpersonal, and structural characteristics in association with current PrEP use using bivariate and multivariable models. Results: Healthcare factors played a critical role amongst those reporting GAHT use, with lower provider knowledge of transgender care and poor access to gender-affirming services associated with decreased likelihood of PrEP use; e.g., participants with only "okay" or "poor" access had 45% lower likelihood of PrEP use than those with "great" or "good" access (aPR = 0.55; 95% CI: 0.32-0.95). Gender and sexuality-related factors also predicted inequities, as individuals identifying with an additional gender (e.g., femme non-binary) had 70% lower likelihood of PrEP use than those identifying solely as transgender women (aPR = 0.30; 95% CI: 0.13-0.72), and those reporting higher sexual risk behaviors (such as having 6+ partners in the past six months) had more than double the likelihood of PrEP use compared to those with 0-1 partner (aPR = 2.28; 95% CI: 1.10-4.75). Conclusions: The findings suggest that both individual sociodemographic characteristics as well as interpersonal and structural healthcare-related characteristics play a significant role in shaping PrEP use among transgender women of color taking GAHT. This highlights the need for multilevel interventions that address structural and interpersonal determinants of health access to promote equity in HIV prevention.