PEC0604
Share
 
Title
Pre-exposure prophylaxis among Brazilian transwomen: Retention and adherence in 48 weeks follow-up of PrEParadas study
Presenter
Emilia Jalil
Authors
E. Jalil * (1), R. Moreira (1), I. Leite (2), T. Torres (1), C. Castro (1), L. Monteiro (1), A.C. Ferreira (1), D. Santos (1), M. Pedrosa (1), P. Leite (1), V. Cattani (1), L. Kamel (1), C. Jalil (1), E. Carvalheira (1), M.D. Gomes (1), B. Hoagland (1), R. Estrela (1), P. Anderson (3), L. Bushman (3), A. Liu (4), S. Wagner (1), V. Veloso (1), B. Grinsztejn (1,1), PrEParadas Study Team
Institutions
(1) FIOCRUZ, INI, Rio de Janeiro, Brazil, (2) FIOCRUZ, ENSP, Rio de Janeiro, Brazil, (3) University of Colorado, Boulder, United States, (4) UCSF, San Francisco, United States

BACKGROUND: Transgender women are disproportionately affected by HIV in Latin America. Although efficacious, PrEP adherence is a major issue among transwomen. PrEParadas is a demonstration study tailored for transwomen aiming to assess oral PrEP uptake, safety and adherence among transwomen at high risk for HIV in Rio de Janeiro, Brasil.
METHODS: HIV-negative transwomen, aged 18+ years, who reported 1+risk criteria (condomless anal sex in the last 6 months, sexually transmitted infection diagnosis in the last 12 months, transactional sex in the last 6 months, HIV-infected partner in the last 30 days) were enrolled and followed at 4 weeks and quarterly thereafter for 48 weeks. HIV viral load and dried blood spots (DBS) were collected at all follow-up visits. Anal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were assessed at w0 and w48. PrEP retention was defined by attendance of w48 visit; PrEP adherence was evaluated by measuring tenofovir diphosphate concentrations in dried blood spots (DBS) at all follow-up visits. We used GEE logistic regression to identify factors associated with high adherence (defined as TFV concentration in DBS correspondent to 4+ doses/week).
RESULTS: 130 transwomen initiated PrEP between Aug-2017 and Dec-2018, 109 (83.8%) were retained at w48. Anal CT and NG prevalence remained similar at w0 and w48 (CT: 7.7% and 8.3%, p=0.79; NG: 9.4% and 8.3%, p=0.88). Overall proportion of high PrEP adherence across all study visits was 57.0% (52.2% at w48). In the univariate analysis, black (OR=0.39 [95%CI:0.17-0.92]) and younger transwomen (OR=0.36 [95%CI:0.16-0.79] had a lower chance of high PrEP adherence across the study but did not remain significant in the adjusted model. Transwomen with high PrEP adherence at w4 had a higher chance of high adherence across the study (aOR=13.90, [95%CI: 6.30-30.87]). There were no HIV seroconversions during follow-up.
CONCLUSIONS: Even in a gender-affirming setting, achieving high PrEP adherence among transwomen remains a challenge, despite high retention, especially for those young and black. Strategies to support early PrEP adherence and to increase knowledge of PrEP as a self-empowering HIV prevention tool may contribute to longer-term PrEP adherence in that highly-vulnerable population.