PrEP Adherence Lower Among Transgender Individuals Assigned Male at Birth

Transgender patients had the highest probability of pre-exposure prophylaxis (PrEP) use, but those assigned male sex at birth had significantly lower rates of high adherence compared with cisgender women and men. Researchers published their findings in AIDS and Behavior.

“There were significant differences in PrEP use and adherence by gender identity,” researchers wrote. “PrEP surveillance, outreach, and prescribing practices must consider gender identity-unique risk factors.”

For the study, researchers analyzed Oregon Medicaid claims for 1555 people who used PrEP between 2012 and 2019. Medical history and enrollment records were used to categorize patients into one of four gender identify categories: (1) cisgender women, (2) cisgender men, (3) transgender, assigned female sex at birth, and (4) transgender, assigned male sex at birth.

Per 10,000 people, the probability of PrEP use was highest in transgender groups: 546.8 in people assigned male sex at birth and 226.5 in people assigned female sex at birth, compared with 20.6 in cisgender men and 2.6 in cisgender women, according to the study.

High adherence, defined as at least 80% of days covered, occurred in just 72.6% of transgender people assigned male sex at birth, however. Comparatively, high adherence occurred in 86.0% of cisgender women and 82.2% of cisgender men.

“Among the 279 PrEP users with female on their enrollment record, 76 (27.2%) were assigned male sex at birth, while among the 1276 PrEP users with male on their enrollment record, 35 (2.7%) were assigned female sex at birth,” investigators pointed out. “This demonstrates the importance of surveillance methods that take gender identity into account in addition to sex assigned at birth.”

Reference:
Downing J, Yee K, Sevelius JM. PrEP use and adherence among transgender patients. AIDS Behav. 2022;26(4):1251-1259. doi:10.1007/s10461-021-03482-8