Pre-exposure prophylaxis (PrEP) uptake and retention in care in a group of transgender women at high risk of HIV: a French cohort of follow-up.

INTRODUCTION

Despite high HIV prevalence rates among trans women (TW), few preventive interventions have targeted this population.

METHODS

We described sociodemographic and clinical data from a cohort of TW followed up for pre-exposure prophylaxis (PrEP) at the Sexual Health Clinic of Bichat hospital in Paris between 2016 and 2023, via a multidisciplinary community-led PrEP programme.The total number of TW starting PrEP and having ongoing follow-up each year was assessed. We described retention in care at 3, 6 and 12 months and median time of follow-up. Incidence of PrEP discontinuation was calculated using Poisson regression.

RESULTS

Between January 2016 and December 2023, 209 TW have been followed up for PrEP at Bichat Hospital, with a median age of 36 years and mostly originating from South America (79.4%, 166/209). Seventy-four per cent of TW (155/209) were sex workers and 53.6% (112/209) had regular health insurance. Most of TW were on daily PrEP (94.3 %, 197/209).The total number of TW followed-up for PrEP per year increased from 17 in 2016 to 129 in 2023. Median time of follow-up was 10.3 months and incidence of PrEP discontinuations was 58.2 (CI 95% 49.51 to 68.57) per 100 persons-year. Retention in care at 6 and 12 months was, respectively, 62% and 38% for users who started PrEP in 2016 and 81% and 31% for those who started in 2022. Seven per cent of TW (13/190) experienced adverse events, leading to PrEP discontinuation in 10/190 cases. Two cases of HIV seroconversion were reported, both in TW who had stopped PrEP for gastrointestinal intolerance.

CONCLUSIONS

Our multidisciplinary reach-out community-led PrEP programme has increased PrEP access among our cohort of TW. Rates of retention in such a prevention programme of care remained poor. More interventions are needed to analyse PrEP barriers and improve retention in care for this specific population.