{"doi":"10.1016/j.annepidem.2022.03.016","title":"Prevention-effective adherence trajectories among transgender women indicated for PrEP in the United States: a prospective cohort study","abstract":"PURPOSE: Adherence to pre-exposure prophylaxis (PrEP) during periods of PrEP-indication (i.e., prevention-effective adherence) is critical for preventing HIV. We sought to describe factors associated with prevention-effective adherence trajectories among transgender women (TW) to inform PrEP implementation strategies. METHODS: Using data from The LITE American Cohort (n = 728), we performed group-based multi-trajectory modeling (GBMTM) to identify clusters of TW with similar trajectories of PrEP adherence and indication, and sociodemographic, biobehavioral, and structural correlates of each trajectory. RESULTS: We identified five trajectories: (1) consistent indication/no PrEP (15.3%), (2) initial indication/no PrEP (47.1%), (3) declining indication/discontinued PrEP (9.5%), (4) consistent indication/PrEP adherent (18.5%), and (5) increasing indication/initiated PrEP (9.6%). TW diagnosed with an STI were more likely to follow a consistent indication/no PrEP trajectory compared to consistent indication/PrEP adherent trajectory (adjusted Relative Risk Ratio [aRRR], 2.54; 95% confidence interval [CI], 1.16-5.57). TW who experienced homelessness were more likely to follow PrEP discontinuation and initiation trajectories relative to PrEP adherence (aRRR, 2.71; 95% CI, 1.10-6.70 and 2.83; 95% CI, 1.13-7.05, respectively). CONCLUSIONS: Over a quarter of TW followed trajectories suggestive of prevention-effective adherence, while 15% did not initiate PrEP despite consistent indication. Findings highlight missed opportunities for PrEP engagement at STI diagnosis and suggest structural interventions addressing housing instability may improve prevention-effective adherence among TW.","journal":"Annals of Epidemiology","year":2022,"id":242271,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":38,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9195,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":277262,"name":"Sari L. Reisner","orcid":"0000-0001-7868-4746","position":1,"is_corresponding":false},{"id":298108,"name":"Haneefa T. Saleem","orcid":"0000-0002-6085-0635","position":2,"is_corresponding":false},{"id":240243,"name":"Keri N. Althoff","orcid":"0000-0002-5068-6595","position":3,"is_corresponding":false},{"id":332955,"name":"S. Wilson Beckham","orcid":null,"position":4,"is_corresponding":false},{"id":394769,"name":"Asa Radix","orcid":"0000-0001-9611-4181","position":5,"is_corresponding":false},{"id":873294,"name":"Christopher M. Cannon","orcid":null,"position":6,"is_corresponding":false},{"id":697886,"name":"Jason S. Schneider","orcid":"0000-0002-6265-0370","position":7,"is_corresponding":false},{"id":231203,"name":"J. Sonya Haw","orcid":"0000-0003-3405-8609","position":8,"is_corresponding":false},{"id":426539,"name":"Allan Rodríguez","orcid":"0000-0001-9477-3327","position":9,"is_corresponding":false},{"id":697885,"name":"Andrew J. Wawrzyniak","orcid":"0000-0002-1780-0966","position":10,"is_corresponding":false},{"id":284815,"name":"Tonia Poteat","orcid":"0000-0001-6541-3787","position":11,"is_corresponding":false},{"id":305156,"name":"Kenneth H. Mayer","orcid":"0000-0001-7460-733X","position":12,"is_corresponding":false},{"id":241510,"name":"Chris Beyrer","orcid":"0000-0003-0665-9124","position":13,"is_corresponding":false},{"id":394627,"name":"Andrea L. Wirtz","orcid":"0000-0002-2063-1534","position":14,"is_corresponding":false},{"id":460624,"name":"Erin E. Cooney","orcid":"0000-0001-9563-1822","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T00:23:05.485568Z","pmid":"35398255","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}