Transgender women and transfeminine people (TWTFP) experience disproportionately high HIV prevalence, low HIV pre-exposure prophylaxis (PrEP) coverage, and negative healthcare experiences. Long-acting injectable PrEP (LAI-PrEP) and daily oral-PrEP are delivered under different healthcare interaction protocols. We examined the role of healthcare-related experiences on willingness and preference for LAI-PrEP among a U.S. nationwide sample of sexually active TWTFP aged 15+. Recruitment occurred between 6/2022 and 10/2023 via social media advertisements for a cross-sectional online sexual health survey. Analyses included past-year PrEP naïve TWTFP with no prior HIV diagnosis (N = 1648). Participants reported LAI-PrEP willingness and ranked PrEP modality preferences; recent healthcare-related experiences were explored as correlates, using adjusted multivariable Poisson regression with robust variance estimation. Among respondents, 26.3% were willing to use LAI-PrEP (n = 433/1648). Among participants willing to use LAI-PrEP and another modality (n = 390/433; 90.1%), 45.6% (n = 178/390) preferred LAI-PrEP. Discussing sexual health with a healthcare provider (HCP) was associated with increased LAI-PrEP willingness (adjusted prevalence ratio aPR = 1.34; 95% confidence interval CI = 1.12-1.60; p = 0.001); use of oral prescription medication (non-hormonal) was associated with decreased LAI-PrEP willingness (aPR = 0.60; 95% CI = 0.38-0.93; p = 0.022). No significant associations were found between healthcare-related experiences and LAI-PrEP preference. Given that most TWTFP who were willing to use LAI-PrEP were also willing to use oral-PrEP, but nearly half preferred LAI-PrEP, offering multiple PrEP modalities is essential to meet their needs. Associations between sexual health discussions and increased LAI-PrEP willingness highlight the importance of HCP engagement; initiatives which encourage HCPs to initiate LAI-PrEP conversations in supportive ways are crucial. Associations between oral prescription use and decreased LAI-PrEP willingness, coupled with null findings related to injection use, highlight the need for further investigation.
Glick et al. (Tue,) studied this question.