Among transgender women, PrEP initiation was low and discontinuation was high, with reasons for cessation that did not correspond with HIV risk, according to results published in JIAS. Andrea Wirtz, PhD, and colleagues examined PrEP initiation and discontinuation among 1,312 transgender women. Less than one-quarter (21.8%) reported taking PrEP at one or more study visits. There were 139 PrEP initiations over 2,127 person years (6.5 initiations/100 person years). Predictors of starting PrEP included identifying as Black and having a PrEP indication. The rate of initiation among those with a need for PrEP was 9.6 initiations/100 person years (132/1,372 person years). During 368 person years, there were 138 PrEP discontinuations (37.5 discontinuations/100 person years). Predictors of discontinuation included having a high school education or less and starting PrEP for the first time during the study. The researchers identified four discontinuation typologies: seroconversion after cessation; ongoing HIV risk after cessation; reassessment of HIV/STI prevention strategy after cessation; and dynamic PrEP use coinciding with changes in HIV risk.
