Abstract Body

Background:

Long-acting injectable (LAI) PrEP is a highly efficacious HIV prevention tool. Among communities with high HIV burden, such as transgender women (TW) in the United States (US), uptake among those at risk of acquiring HIV could potentially reduce new infections and contribute to Ending the HIV Epidemic efforts. However, a lack of data on LAI PrEP interest among TW in the US has limited scientific understanding of the potential impact of LAI PrEP scale-up on new infections within TW communities. Thus, our objective was to identify correlates of interest in LAI PrEP among a large sample of TW.

Methods:

Data were drawn from the LITE cohort, which followed TW with risk factors for HIV acquisition in the eastern and southern US. Participants who completed 12-month surveys between March 2019 and September 2021 (corresponding to the period between establishing LAI PrEP efficacy and prior to FDA approval) were asked about their interest in using LAI PrEP. We estimated crude and adjusted prevalence ratios for LAI PrEP interest with sociodemographic characteristics, healthcare access indicators, prior PrEP experience, and PrEP indication correlates using Poisson regression with robust variance.

Results:

Among 867 TW, 23% reported they were very interested in LAI PrEP, 22% somewhat interested, 19% neutral, 7% somewhat uninterested, 12% very uninterested, and 16% unsure. In the adjusted model, interest in LAI PrEP (somewhat or very interested) was more common among TW who identified as Black, college-educated TW, and TW indicated for PrEP based on CDC guidelines (Figure). LAI PrEP interest was also more common among adherent users of oral PrEP and those who had discontinued oral PrEP, compared to PrEP-naïve participants. There were no statistically significant differences in LAI PrEP interest for young adults ages 18-24 years compared to those >=25 years, those who identified as Latina/x, and those who were publicly insured or uninsured compared to those privately insured.

Conclusions:

Interest in LAI PrEP among TW in the eastern and southern US varied by several demographic and clinical characteristics. Increased interest in LAI PrEP among Black TW, those who were PrEP indicated, and those who had previously discontinued oral PrEP underscores the need to increase LAI PrEP access for TW who express interest. Efforts to increase awareness of and access to LAI PrEP among young TW and Latina/x TW are needed to ensure equitable scale-up among TW most impacted by HIV.