Background
The anticipated approval of lenacapavir for HIV pre-exposure prophylaxis (PrEP) may present an opportunity to better address inequitable PrEP implementation among priority populations in the United States (US). We examined potential preferences for long-acting PrEP methods among transgender and gender-diverse (TGD) adults in the US.
Methods
From April to June 2022, we conducted an online survey with 304 HIV-negative TGD adults in the US. After presenting a brief description of five PrEP methods, participants were asked to rank their most preferred PrEP methods. Logistic regression was used to examine participant characteristics associated with preferring injectable PrEP every 6 months over the other four methods. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals.
Results
Overall, 295 (97%) participants ranked method preferences: median age was 24 years [interquartile range 21—29]; 221 (75%) were assigned female sex at birth; 69 (24%) were assigned male sex at birth; 159 (54%) transmasculine, 96 (33%) nonbinary, 40 (14%) transfeminine; 169 (57%) non-Latine White, 44 (15%) Latine, 33 (11%) non-Latine Black, 49 (17%) non-Latine another race; and 63 (21%) reported current or prior PrEP use. Participants’ preferred PrEP methods were monthly oral pill (33%), annual implant (28%), injection every six months (22%), daily oral pill (13%), and injection every two months (4%). The primary outcome, ranking injectable PrEP every 6 months as the most preferred PrEP method, was significantly associated with non-Latine Black race/ethnicity (adjusted odds ratio, aOR: 2.77 [95% CI 1.10, 6.98]) and Latine ethnicity (aOR: 2.39 [95% CI 1.10, 5.18]; both p-values < 0.05. Age, sex assigned at birth, current gender identity, PrEP status, condomless sex, known HIV-positive sexual partner, and sexual partner with unknown HIV status in the past six months were not significantly associated with the primary outcome.
Conclusions
PrEP injection every two months was rarely selected as the most preferred method; and non-Latine Black and Latine individuals had higher odds of reporting that an injectable PrEP method administered every six months was their most preferred PrEP method. Future research should prioritize the development of implementation strategies that bolster comprehensive low-barrier PrEP services for non-Latine Black and Latine TGD adults, particularly TGD individuals for whom daily oral PrEP and injectable cabotegravir every two months are not desirable.