Perspectives on PrEP/PEP Integration in Telehealth Gender-Affirming Care: A Survey of Clients From a National Telehealth Platform.

BACKGROUND

Transgender individuals face disproportionate HIV burden yet experience significant barriers to accessing biomedical HIV prevention. We assessed awareness, experience, and willingness among trans adults to use pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) when integrated with telehealth-delivered gender-affirming hormone care (GAC).

METHODS

We conducted a cross-sectional survey of clients receiving GAHC via a national subscription-based telehealth platform between October 2023 and January 2024. Using stratified sampling to ensure inclusion of transgender men (TGM) and those residing in rural areas, we assessed PrEP/PEP awareness, prior use, barriers, and willingness to use these services if recommended by their GAC provider. Multivariable logistic regression identified factors associated with stated willingness (yes/no).

RESULTS

Among 387 respondents (from 2506 survey invitations, 15.4% response rate), 54.8% identified as transgender women (TGW), 45% were between the ages of 18 and 25, and 74% identified as white, and 13% resided in rural areas. Pre-exposure prophylaxis awareness was moderate among TGW (56%) and TGM (69%), while PEP awareness was 24% among TGW and 31% among TGM. Only 2% of TGW were using PrEP (0% of TGM), and 0% had used PEP. Despite limited prior utilization, 67% expressed willingness to use PrEP and 66% willingness to use PEP if recommended by their GAC provider. Public insurance (vs private) and self-reported HIV worry (vs not worried) were associated with willingness to use both PrEP (public insurance: aOR 3.64, P = .022; HIV worry: aOR 2.57, P = .002) and PEP (public insurance: aOR 3.48, P = .032; HIV worry: aOR 2.41, P = .004). Prior awareness of PEP was also associated with willingness to use it (aOR 2.06, 95% CI 1.08-3.94, P = .030).

CONCLUSIONS

Among clients of a subscription-based telehealth platform, stated acceptability of integrated PrEP/PEP services was high regardless of gender identity or geography. Limited awareness, cost concerns, and the large gap between awareness and utilization require further attention to realize the potential benefits of biomedical HIV prevention integration into telehealth GAC.