PEC0692
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BACKGROUND: Transgender Women (TGW) are a key population in the worldwide HIV epidemic. While Pre-exposure prophylaxis (PrEP) is recommended by the WHO to prevent HIV acquisition among individuals at substantial risk, including TGW, PrEP uptake among TGW globally has been low. ImPrEP is a PrEP demonstration study to assess the feasibility providing daily oral PrEP to MSM and TGW at risk for HIV in Brazil, Mexico and Peru. We explore baseline characteristics associated with early engagement of enrolled TGW
METHODS: This analysis includes all individuals who self-define as TGW enrolled in ImPrEP. Early engagement was defined as returning for the first follow-up visit within 15-60 days of enrollment. Data were collected on socio-demographics, factors associated with HIV acquisition (i.e. condomless anal sex), and past use of Pre or Post-exposure prophylaxis. Enrollees were tested for syphilis and anal STIs (Neisseria Gonorrhea and Chlamydia Trachomatis). In bivariate analysis, the effect of each covariate was estimated controlling by country, covariates significant at 10% were selected for the multivariate analysis.
RESULTS: Until December 1st, 2019, ImPrEP enrolled 480 TGW (235, 49.0% from Peru; 184, 38.3% from Brazil; and 61, 12.7% from Mexico), who were on average 29 years-old (IQR:24-37). The majority completed only secondary education (71.0%). In the past 6 months, their median number of sex partners was 20 (IQR: 5-100); 89.6% reported condomless anal sex; 4.6% reported sex with an HIV positive partner; and 68.5% reported sex work. Baseline prevalence for syphilis, anal NG and anal CT were 18.1%(95%CI:14.4%-22.2%), 14.7%(95%CI:11.2%-18.9%) and 17.8%(95%CI:13.9%-22.2%), respectively. Early engagement was achieved by 71.1% of TGW. Having greater than secondary education was independently associated with a higher chance of early engagement among TGW (aOR2.42, 95%CI1.37-4.29).

N (% with early engagement)
OR* (95% CI)
adjusted by country
p-value
aOR (95% CI)
p-value
Country
Brazil
Mexico
Peru
183 (77.6)
23 (88.5)
137 (63.4)
Ref.
2.21 (0.63-7.74)
0.50 (0.32-0.78)
-
0.210
0.002
Ref.
2.27 (0.63-8.18)
0.61 (0.34-1.08)
-
0.210
0.009
Age (years)
18-24
25-34
35+
115 (68.7)
181 (69.1)
129 (76.0)
0.59 (0.33-1.06)
0.58 (0.34-0.98)
Ref.
0.080
0.040
-
0.67 (0.37-1.24)
0.60 (0.34-1.03)
Ref.
0.200
0.060
-
Educational level
'¤Secondary
Post-secondary
308 (65.9)
116 (84.5)
Ref.
2.63 (1.50-4.62)
-
0.001
Ref.
2.42 (1.37-4.29)
-
0.020
Reason to visit ImPrEP site
Looking for PrEP
Others
272 (77.2)
153 (60.1)
1.70 (1.00-2.91)
Ref.
0.050
-
1.66 (0.96-2.88)
Ref.
0.070
-
Number of male sex partners, last 3 months (divided at the median)
'¤20
>20
213 (71.8)
212 (70.3)
Ref.
0.87 (0.57-1.34)
-
0.52


Sex workers
Yes
No
300 (69.7)
125 (74.4)
0.78 (0.48-1.26)
Ref.
0.32
-


Condomless sexual intercourse with HIV+ partner(s)
Yes
No
Don´t know
20 (85.0)
138 (74.6)
267 (68.2)
1.39 (0.37-5.20)
Ref.
0.68 (0.43-1.10)
0.620
-
0.110


Marijuana
Yes
No
112 (67.0)
313 (72.5)
0.68 (0.43-1.10)
Ref.
0.080
-
0.70 (0.42-1.17)
-
0.180
-
Cocaine
Yes
No
74 (64.9)
351 (72.4)
0.62 (0.36-1.07)
Ref.
0.090
-
0.82 (0.46-1.47)
-
0.510
-

CONCLUSIONS: Greater efforts to improve early retention to PrEP among TGW should be undertaken to improve their PrEP continuation, especially among TGW with lower education.