PrEP Care Continuum Among Certain Patient Populations in the United States

There is an increased need for PrEP uptake among transgender women, men who have sex with men, and transgender women of color in the United States.

The results of 2 studies presented at the virtual Conference on Retroviruses and Opportunistic Infections highlighted an increased need for pre-exposure prophylaxis (PrEP) uptake among transgender women, men who have sex with men (MSM), and transgender women of color in the United States.

Transgender women in the United States have a disproportionate burden of HIV, and PrEP is an effective way to prevent acquisition among adherent users. However, data are lacking regarding the PrEP care continuum among transgender women and factors associated with PrEP indication.

The Leading Innovation for Transgender Women’s Health and Empowerment (LITE) study1 recruited a multisite cohort of transgender women from the United States. Participants received testing for sexually transmitted infections, including HIV, and a sociobehavioral survey at baseline. Investigators found that 39% of the 751 participants were indicated for PrEP with non-Hispanic black participants having a higher prevalence of being PrEP indicated. The data also showed that having any kind of self-perceived HIV risk was associated with higher indication, whereas having some college or more education was associated with lower PrEP indication. Among transgender women indicated for PrEP, adherent use was 14%.

Investigators also noted that more than one-third of transgender women not living with HIV at baseline were indicated for PrEP. In a separate study,2 undertaken as part of the THRIVE project, investigators found that though patients may be HIV negative, MSM of color had similar percentages of referral and linkage to PrEP as white MSM, and fewer were actually prescribed PrEP. They also found that the percentage of transgender women of color who received referrals and linkage to PrEP was less than that of MSM of color at all steps of the continuum.

These results came from a cohort of 10,422 HIV-negative MSM and 1009 transgender women enrolled in THRIVE from September 2015 through March 2019. Investigators estimated the percentage of participants included at each step of the PrEP care continuum. While their results showed that the THRIVE demonstration project expanded access to PrEP services for MSM and transgender women of color, increases in measures that “support PrEP uptake among MSM and [transgender women] of color are needed to improve the PrEP care continuum for these populations.” Investigators also found that challenges exist in prescribing PrEP to younger (age < 30 years) MSM of color.

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Taken together these studies show that overall uptake and adherence among PrEP-indicated individuals were low and improved uptake, specifically among transgender women and MSM of color, is needed. This is especially true because PrEP indication is higher in these groups but the proportions of these individuals included at each stage of the care continuum is lower as are the numbers actually being prescribed PrEP.


  1. Malone JR, Reisner S, Wirtz AL. PrEP indication and care continuum among transgendered women in the United States. Poster presented at: CROI 2020; March 8-11, 2020; Boston, MA. Accessed March 19, 2020
  2. Iqbal K, Zhu W, Dominguez KL, Tanner M, Henny KD, Hoover KW. PrEP continuum of care among MSM and TGW of color in the THRIVE demonstration project. Poster presented at: CROI 2020; March 8-11, 2020; Boston, MA. Accessed March 19, 2020.