Same-day initiation of tenofovir alafenamide-based pre-exposure prophylaxis with drug-level feedback for transgender women in Uganda.
Andrew Mujugira, Rogers Nsubuga, Agnes Nakyanzi et al.
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In 30 seconds
This randomized controlled trial assessed the feasibility of same-day initiation of emtricitabine/tenofovir alafenamide (F/TAF) PrEP among 200 HIV-negative transgender women in Uganda. Despite a 100% initiation rate, adherence was low, with tenofovir detection in dried blood spots declining from 46% at 3 months to 31% at 12 months. Drug-level feedback did not significantly improve adherence.
Key findings
- Same-day initiation of F/TAF PrEP was achieved in 100% of participants.
- Tenofovir detection in urine was 79% at 3 months, declining to 70% by 12 months.
- No significant effect of drug-level feedback on PrEP adherence was observed (aIRR 1.06; 95% CI: 0.82-1.37).
- Factors associated with better adherence included never being harassed by police and higher monthly income.
Why it matters
Understanding the challenges of PrEP adherence in vulnerable populations, such as transgender women, is crucial for developing effective HIV prevention strategies. This study highlights the need for alternative PrEP formulations and tailored interventions to improve adherence.