TY - JOUR
T1 - PrEP Use and Adherence Among Transgender Patients
AU - Downing, Jae
AU - Yee, Kimberly
AU - Sevelius, Jae M.
N1 - Funding Information:
Research reported in this publication was supported by National Institute on Minority Health and Health Disparities (3R01MD011212-0S31 [Administrative Supplement to 1R01MD011212], PI McConnell), the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (K12HD043488, PI Downing), and the National Institute on Drug Abuse (K24 DA051328, PI Sevelius).
Funding Information:
JD and KY contributed substantially to the design, analysis, interpretation, and composition of this study. JS contributed critical revisions to this study. All authors agree to be accountable for the accuracy and integrity of this study. Research reported in this publication was supported by National Institute on Minority Health and Health Disparities (3R01MD011212-0S31 [Administrative Supplement to 1R01MD011212], PI McConnell), the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (K12HD043488, PI Downing), and the National Institute on Drug Abuse (K24 DA051328, PI Sevelius). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/4
Y1 - 2022/4
N2 - This cross-sectional study used 2012 to 2019 Oregon Medicaid claims to estimate the prevalence of PrEP use and identify determinants of high adherence across transgender and cisgender men and women. Gender identity (cisgender woman/man; transgender, assigned female sex at birth [AFAB]; transgender, assigned male sex at birth [AMAB]) was based on medical history and enrollment records. Proportion of days covered ≥ 0.80 was considered high adherence to PrEP. The association between gender identity and PrEP uptake or high adherence was estimated using multivariable logistic regression. 1555 PrEP users, including 171 (11.0%) cis women, 1171 (75.3%) cis men, 67 (4.3%) AFAB, and 146 (9.4%) AMAB individuals, were included. The probability of PrEP use per 10,000 people was highest in transgender groups (AMAB 546.8, 95% CI 462.4–631.3; AFAB 226.5, 95% CI 173.4–279.6), followed by cisgender men (20.6, 95% CI 19.4, 21.8) and women (2.6, 95% CI 2.2, 3.0). High adherence was significantly lower in AMAB recipients (72.6%) than cisgender women (86.0%) and cisgender men (82.2%). Among the 279 PrEP users with female on their enrollment record, 76 (27.2%) were AMAB, while among the 1276 PrEP users with male on their enrollment record, 35 (2.7%) were AFAB. This demonstrates the importance of surveillance methods that take gender identity into account in addition to sex assigned at birth. There were significant differences in PrEP use and adherence by gender identity. PrEP surveillance, outreach, and prescribing practices must consider gender identity-unique risk factors.
AB - This cross-sectional study used 2012 to 2019 Oregon Medicaid claims to estimate the prevalence of PrEP use and identify determinants of high adherence across transgender and cisgender men and women. Gender identity (cisgender woman/man; transgender, assigned female sex at birth [AFAB]; transgender, assigned male sex at birth [AMAB]) was based on medical history and enrollment records. Proportion of days covered ≥ 0.80 was considered high adherence to PrEP. The association between gender identity and PrEP uptake or high adherence was estimated using multivariable logistic regression. 1555 PrEP users, including 171 (11.0%) cis women, 1171 (75.3%) cis men, 67 (4.3%) AFAB, and 146 (9.4%) AMAB individuals, were included. The probability of PrEP use per 10,000 people was highest in transgender groups (AMAB 546.8, 95% CI 462.4–631.3; AFAB 226.5, 95% CI 173.4–279.6), followed by cisgender men (20.6, 95% CI 19.4, 21.8) and women (2.6, 95% CI 2.2, 3.0). High adherence was significantly lower in AMAB recipients (72.6%) than cisgender women (86.0%) and cisgender men (82.2%). Among the 279 PrEP users with female on their enrollment record, 76 (27.2%) were AMAB, while among the 1276 PrEP users with male on their enrollment record, 35 (2.7%) were AFAB. This demonstrates the importance of surveillance methods that take gender identity into account in addition to sex assigned at birth. There were significant differences in PrEP use and adherence by gender identity. PrEP surveillance, outreach, and prescribing practices must consider gender identity-unique risk factors.
KW - Adherence
KW - Differential misclassification
KW - Medicaid
KW - Pre-exposure prophylaxis (PrEP)
KW - Transgender
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UR - http://www.scopus.com/inward/citedby.url?scp=85117019898&partnerID=8YFLogxK
U2 - 10.1007/s10461-021-03482-8
DO - 10.1007/s10461-021-03482-8
M3 - Article
C2 - 34643827
AN - SCOPUS:85117019898
SN - 1090-7165
VL - 26
SP - 1251
EP - 1259
JO - AIDS and Behavior
JF - AIDS and Behavior
IS - 4
ER -