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    API Wellness: Tri Do

    Tri City: Zettie Page

    SFDPH: PrEP-T: Advancing PrEP Delivery in the Transgender Community

    Al Liu, Principal Investigator (San Francisco Department of Public Health)

    Transgender people are a population at high risk for HIV acquisition, with transwomen having a 34 times greater odds of being HIV-infected than all reproductive age adults in the US, and emerging data showing potential risk among transmen. Pre-exposure prophylaxis (PrEP), a daily pill taken during periods of potential HIV risk, has been shown to be highly effective for men who have sex with men and heterosexual couples, reducing new infections by >90% when taken daily. Although data with the transgender population is limited, we believe that daily PrEP will also substantially lower HIV risk in transwomen and men. Although few transgender persons have enrolled in PrEP studies, adherence to daily pill-taking among transwomen was low in one study. Low adherence is a problem because studies have demonstrated that if pill-taking is low, PrEP efficacy is also low. Despite the intensity of the HIV epidemic among trans persons and the potential of PrEP to reduce new infections, no transgender-specific interventions to provide PrEP support have been tested in the US. Culturally relevant and comprehensive intervention strategies that reach and engage transgender people are critically needed to maximize the impact of PrEP in the transgender community.

    Using the trans-specific Model of Gender Affirmation and a Patient Centered Medical Home approach, we will develop and evaluate a comprehensive PrEP education, access, and support package (PrEP-T) for HIV negative transwomen and transmen in the San Francisco Bay Area (SFBA). We will begin by getting input from transpersons and their healthcare providers to inform development of the PrEP delivery model and intervention components. We will launch a broad social marketing campaign that is trans-specific to increase knowledge about PrEP. Based on our prior work highlighting the importance of providing services within gender-affirming environments, we will integrate PrEP delivery and support into the 4 largest trans-specific clinics in the SFBA that provide culturally-competent care, including hormone provision. Intervention components will build upon our prior work and may include a sexual risk assessment tool, online education, SMS-based adherence reminders/support, and peer navigators. We will enroll 250 transwomen and transmen, with a particular focus on transwomen and people of color who are at high risk, to determine the acceptability of the tools, PrEP uptake and pill-taking, most useful support strategies, and measure any negative effects of PrEP use. The long-term goal of this project is to develop a successful PrEP delivery and support model that can be scaled up to increase PrEP uptake and adherence among at-risk transgender women in the US.

    The San Francisco Department of Public Health (SFDPH) and collaborating community-based partners (Asian & Pacific Islander Wellness Center and Tri City Health Center) will work together to fight the HIV epidemic in California by meeting the need for PrEP in transgender-specific health clinics in San Francisco Bay Area. The PrEP-T project will improve access to PrEP in the transgender community by combining state of the art PrEP implementation science, world renowned transgender health services and a professional and tailored approach to our SFBA transgender PrEP social marketing campaign.