PrEP awareness and engagement among transgender women in South Africa: a cross-sectional, mixed methods study.

Abstract:

BACKGROUND:The South African national HIV plan recommends pre-exposure prophylaxis (PrEP) for transgender women, whose HIV prevalence estimates are as high as 25% in sub-Saharan Africa. The aim of this study was to explore PrEP awareness, uptake, and willingness, as well as associated barriers and facilitators, in order to inform PrEP implementation efforts with transgender women in South Africa. METHODS:Using a community-engaged, convergent parallel mixed methods design, trained local transgender women data collectors recruited 213 transgender women participants (aged >18 years, assigned male sex at birth, and identifying as a gender different from male), via network referral and word-of-mouth in Cape Town, East London, and Johannesburg. A subset of 36 transgender women also participated in qualitative in-depth interviews. Quantitative analyses included descriptive statistics and negative binomial regression models to assess correlates of PrEP willingness. Qualitative interviews were audio-recorded, transcribed verbatim, and coded. Thematic content analysis was used to identify key themes. Quantitative and qualitative data were integrated for interpretation. FINDINGS:Participants were recruited between June 1 and Nov 30, 2018. 57 (45%) of 127 HIV-negative participants were PrEP-aware and only 14 (11%) of 129 were currently taking PrEP. HIV-negative participants experiencing social (eg, violence, poverty) and interpersonal (eg, discrimination, low transgender women community connectedness) hardship reported PrEP awareness more frequently than HIV-negative transgender women who did not. Willingness to take PrEP was low, at 56 (55%) of 102, among HIV-negative participants who were not currently taking PrEP, and negatively associated with transgender women community connectedness (multivariable prevalence ratio 0·87; 95% CI 0·77-0·99). Barriers to PrEP included taking a daily pill, side-effects, and cost. Participants urged greater education and engagement of transgender women in PrEP implementation. INTERPRETATION:South Africa is poised to scale up PrEP services for transgender women. Dedicated transgender clinics are planned to provide comprehensive care, including PrEP, for transgender women. It is critical to ensure transgender women are aware of and have accurate information about PrEP, and that health-care sites are prepared to provide quality care for transgender women. FUNDING:Gilead Sciences.

journal_name

Lancet HIV

journal_title

The lancet. HIV

authors

Poteat T,Malik M,van der Merwe LLA,Cloete A,Adams D,Nonyane BAS,Wirtz AL

doi

10.1016/S2352-3018(20)30119-3

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

e825-e834

issue

12

eissn

2405-4704

issn

2352-3018

pii

S2352-3018(20)30119-3

journal_volume

7

pub_type

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    authors: Iwuji CC,Orne-Gliemann J,Larmarange J,Balestre E,Thiebaut R,Tanser F,Okesola N,Makowa T,Dreyer J,Herbst K,McGrath N,Bärnighausen T,Boyer S,De Oliveira T,Rekacewicz C,Bazin B,Newell ML,Pillay D,Dabis F,ANRS 12249 Tas

    更新日期:2018-03-01 00:00:00

  • Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study.

    abstract:BACKGROUND:As HIV incidence and mortality continue to increase in eastern Europe and central Asia, particularly among people who inject drugs (PWID), it is crucial to effectively scale-up opioid agonist therapy (OAT), such as methadone or buprenorphine maintenance therapy, to optimise HIV outcomes. With low OAT coverag...

    journal_title:The lancet. HIV

    pub_type: 杂志文章

    doi:10.1016/S2352-3018(19)30373-X

    authors: Tan J,Altice FL,Madden LM,Zelenev A

    更新日期:2020-02-01 00:00:00