Using stated preference methods to design gender-affirming long-acting PrEP programs for transgender and nonbinary adults.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
08 10 2024
08 10 2024
Historique:
received:
18
02
2024
accepted:
11
09
2024
medline:
9
10
2024
pubmed:
9
10
2024
entrez:
8
10
2024
Statut:
epublish
Résumé
Integrating gender-affirming care with biomedical HIV prevention could help address the disproportionate HIV risk experienced by transgender and nonbinary (trans) adults. This discrete choice experiment assesses and identifies the most important programming factors influencing the decisions of trans adults to use injectable long-acting HIV pre-exposure prophylaxes (LA-PrEP). From March to April 2023 n = 366 trans adults in Washington state chose between four different choice profiles that presented hypothetical programs (each comprised of 5 attributes with 4 levels). We analyzed ranked choice responses using a mixed rank-ordered logit model for main effects. Respondents preferred to receive LA-PrEP from a gender-affirming care provider and a co-prescription for both oral and injectable hormones. Trans adults strongly favored 12-month protection and injection in the upper arm. No strong preferences emerged surrounding the type of health facility offering the gender-affirming LA-PrEP program. Our findings show that integrating and leveraging gender-affirming health systems, inclusive of medical services such as hormone therapy, with HIV biomedical products like LA-PrEP is strongly preferred and influential to trans adults' decision to use LA-PrEP. Leveraging choice-based design experiments provides informative results for optimizing gender-affirming LA-PrEP programming tailored to trans adults.
Identifiants
pubmed: 39379446
doi: 10.1038/s41598-024-72920-z
pii: 10.1038/s41598-024-72920-z
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
23482Informations de copyright
© 2024. The Author(s).
Références
Flores, A. R., Herman, J., Gates, G. J. & Brown, T. N. How Many Adults Identify as Transgender in the United States? Vol. 13 (Williams Institute, 2016).
Becasen, J. S., Denard, C. L., Mullins, M. M., Higa, D. H. & Sipe, T. A. Estimating the prevalence of HIV and sexual behaviors among the US Transgender population: A systematic review and meta-analysis, 2006–2017. Am. J. Public Health109, E1–E8. https://doi.org/10.2105/Ajph.2018.304727 (2019).
doi: 10.2105/Ajph.2018.304727
pubmed: 30496000
pmcid: 6301428
Schulden, J. D. et al. Rapid HIV testing in transgender communities by community-based organizations in three cities. Public Health Rep.123, 101–114 (2008).
pubmed: 19166094
pmcid: 2567010
doi: 10.1177/00333549081230S313
Restar, A. J. (2023). Gender-affirming care is preventative care. The Lancet Regional Health–Americas, 24.
Scheim, A. I. & Travers, R. Barriers and facilitators to HIV and sexually transmitted infections testing for gay, bisexual, and other transgender men who have sex with men. AIDS Care29, 990–995 (2017).
pubmed: 28027664
doi: 10.1080/09540121.2016.1271937
Sevelius, J. “There’s no pamphlet for the kind of sex I have”: HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. J. Assoc. Nurses AIDS Care20, 398–410 (2009).
pubmed: 19732698
pmcid: 2785444
doi: 10.1016/j.jana.2009.06.001
Murray, M. et al. In Conference on Retroviruses and Opportunistic Infections (CROI) 22–25.
Hope, T. J. & Marrazzo, J. M. A shot in the arm for HIV prevention? Recent successes and critical thresholds. AIDS Res. Hum. Retrovir.31, 1055–1059 (2015).
pubmed: 26486613
pmcid: 4651048
doi: 10.1089/aid.2015.0310
Schlesinger, E. et al. A tunable, biodegradable, thin-film polymer device as a long-acting implant delivering tenofovir alafenamide fumarate for HIV pre-exposure prophylaxis. Pharm. Res.33, 1649–1656 (2016).
pubmed: 26975357
pmcid: 4892981
doi: 10.1007/s11095-016-1904-6
Johnson, L. M. et al. Characterization of a reservoir-style implant for sustained release of tenofovir alafenamide (TAF) for HIV pre-exposure prophylaxis (PrEP). Pharmaceutics11, 315 (2019).
pubmed: 31277461
pmcid: 6680758
doi: 10.3390/pharmaceutics11070315
Gatto, G. et al. In Proceedings of the Conference on Retrovirusus and Opportunistic Infections (CROI).
US Food and Drug Administration..Sunlenca/Lenacapavir Receives FDA Approval as a First-in-Class, Twice-Yearly Treatment Option for People Living With Multi-Drug Resistant HIV. (2022). Retrieved from Available at: https://www.gilead.com/news-and-press/press-room/press-releases/2022/12/sunlenca-lenacapavir-receives-fda-approval-as-a-firstinclass-twiceyearly-treatment-option-for-people-living-with-multidrug-resistant-hiv .
Landovitz, R. J. et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N. Engl. J. Med.385, 595–608 (2021).
pubmed: 34379922
pmcid: 8448593
doi: 10.1056/NEJMoa2101016
US Food Drug Administration (FDA). FDA approves first injectable treatment for HIV pre-exposure prevention. Updated December 2021. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention .
Centers for Disease Control and Prevention. HIV Testing, Prevention and Care for Transgender People. Available at: https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/prevention-and-care-data.html (2021).
Centers for Disease Control and Prevention. HIV infection, risk, prevention, and testing behaviors among transgender women—National HIV Behavioral Surveillance, 7 US cities, 2019–2020. HIV Surveill. Spec. Rep.27, 15 (2021).
Roy Paladhi, U., Katz, D. A., Farquhar, C. & Thirumurthy, H. Using behavioral economics to support PrEP adherence for HIV prevention. Curr. HIV AIDS Rep.19, 409–414 (2022).
pubmed: 36044119
doi: 10.1007/s11904-022-00624-y
Linnemayr, S. HIV prevention through the lens of behavioral economics (draft). J. Acquir. Immune Defic. Syndr.68, e61 (2015).
pubmed: 25559597
pmcid: 4334696
doi: 10.1097/QAI.0000000000000499
Galarraga, O. & Sosa-Rubi, S. G. Conditional economic incentives to improve HIV prevention and treatment in low-income and middle-income countries. Lancet HIV6, e705–e714. https://doi.org/10.1016/S2352-3018(19)30233-4 (2019).
doi: 10.1016/S2352-3018(19)30233-4
pubmed: 31578955
pmcid: 7725432
Galárraga, O. et al. We must invest in behavioural economics for the HIV response. Nat. Hum. Behav.7, 1241–1244 (2023).
pubmed: 37463988
doi: 10.1038/s41562-023-01664-z
Celum, C. L. et al. Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: A randomized trial. J. Int. AIDS Soc.23, e25636 (2020).
pubmed: 33247553
pmcid: 7695999
doi: 10.1002/jia2.25636
Mishra, A. et al. Strengthening HIV and HIV co-morbidity care in low-and middle-income countries: Insights from behavioural economics to improve healthcare worker behaviour. J. Int. AIDS Soc.26, e26074 (2023).
pubmed: 37012895
pmcid: 10071072
doi: 10.1002/jia2.26074
Team Behavioural Insights. East. Four Simple Ways to Apply Behavioural Insights. Available at: https://www.bi.team/publications/east-four-simple-ways-to-apply-behavioural-insights/ (2024).
McGrady, M. E., Pai, A. L. & Prosser, L. A. Using discrete choice experiments to develop and deliver patient-centered psychological interventions: A systematic review. Health Psychol. Rev.15, 314–332 (2021).
pubmed: 31937184
doi: 10.1080/17437199.2020.1715813
Wulandari, L. P. L. et al. Preferences for pre-exposure prophylaxis for HIV: A systematic review of discrete choice experiments. EClinicalMedicine51, 101507 (2022).
pubmed: 35844771
pmcid: 9284393
doi: 10.1016/j.eclinm.2022.101507
Beckham, S. W., Crossnohere, N. L., Gross, M. & Bridges, J. F. Eliciting preferences for HIV prevention technologies: A systematic review. Patient Patient Cent. Outcomes Res.14, 151–174 (2021).
doi: 10.1007/s40271-020-00486-9
US Food and Drug Administration. FDA Approves First Injectable Treatment for HIV Pre-Exposure Prevention. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention (2021).
US Food and Drug Administration. Sunlenca/Lenacapavir Receives FDA Approval as a First-in-Class, Twice-Yearly Treatment Option for People Living With Multi-Drug Resistant HIV. Available at: https://www.gilead.com/news-and-press/press-room/press-releases/2022/12/sunlenca-lenacapavir-receives-fda-approval-as-a-firstinclass-twiceyearly-treatment-option-for-people-living-with-multidrug-resistant-hiv (2022).
Clark, M. D., Determann, D., Petrou, S., Moro, D. & de Bekker-Grob, E. W. Discrete choice experiments in health economics: A review of the literature. Pharmacoeconomics32, 883–902 (2014).
pubmed: 25005924
doi: 10.1007/s40273-014-0170-x
Veldwijk, J., Lambooij, M. S., de Bekker-Grob, E. W., Smit, H. A. & de Wit, G. A. The effect of including an opt-out option in discrete choice experiments. PloS One9, e111805 (2014).
pubmed: 25365169
pmcid: 4218820
doi: 10.1371/journal.pone.0111805
Bech, M., Kjaer, T. & Lauridsen, J. Does the number of choice sets matter? Results from a web survey applying a discrete choice experiment. Health Econ.20, 273–286 (2011).
pubmed: 20143304
doi: 10.1002/hec.1587
de Bekker-Grob, E. W., Donkers, B., Jonker, M. F. & Stolk, E. A. Sample size requirements for discrete-choice experiments in healthcare: A practical guide. Patient Patient Cent. Outcomes Res.8, 373–384 (2015).
doi: 10.1007/s40271-015-0118-z
Giergiczny, M., Dekker, T., Hess, S. & Chintakayala, P. K. Testing the stability of utility parameters in repeated best, repeated best-worst and one-off best-worst studies. Eur. J. Transp. Infrastruct. Res. https://doi.org/10.18757/EJTIR.2017.17.4.3209 (2017).
doi: 10.18757/EJTIR.2017.17.4.3209
Huls, S. P., Lancsar, E., Donkers, B. & Ride, J. Two for the price of one: If moving beyond traditional single-best discrete choice experiments, should we use best-worst, best-best or ranking for preference elicitation?. Health Econ.31, 2630–2647 (2022).
pubmed: 36102864
pmcid: 9826006
doi: 10.1002/hec.4599
Hole, A. DCREATE: Stata module to create efficient designs for discrete choice experiments (2017).
Carlsson, F. & Martinsson, P. Design techniques for stated preference methods in health economics. Health Econ.12, 281–294 (2003).
pubmed: 12652515
doi: 10.1002/hec.729
Hauber, A. B. et al. Statistical methods for the analysis of discrete choice experiments: A report of the ISPOR conjoint analysis good research practices task force. Value Health19, 300–315 (2016).
pubmed: 27325321
doi: 10.1016/j.jval.2016.04.004
Chetty-Makkan, C. M. et al. Youth preferences for HIV testing in South Africa: Findings from the Youth Action for Health (YA4H) study using a discrete choice experiment. AIDS Behav.25, 182–190 (2021).
pubmed: 32607914
doi: 10.1007/s10461-020-02960-9
Ghijben, P., Lancsar, E. & Zavarsek, S. Preferences for oral anticoagulants in atrial fibrillation: A best–best discrete choice experiment. Pharmacoeconomics32, 1115–1127 (2014).
pubmed: 25027944
doi: 10.1007/s40273-014-0188-0
Galárraga, O. et al. iSAY (incentives for South African youth): Stated preferences of young people living with HIV. Soc. Sci. Med.265, 113333 (2020).
pubmed: 32896799
pmcid: 7738405
doi: 10.1016/j.socscimed.2020.113333
Operario, D. & Restar, A. Gender-affirmative systems needed for PrEP implementation. Lancet HIV7, e799–e800 (2020).
pubmed: 32622371
doi: 10.1016/S2352-3018(20)30191-0
Minalga, B. et al. Research on transgender people must benefit transgender people. Lancet399, 628 (2022).
pubmed: 35151395
doi: 10.1016/S0140-6736(21)02806-3
Sevelius, J. M., Deutsch, M. B. & Grant, R. The future of PrEP among transgender women: The critical role of gender affirmation in research and clinical practices. J. Int. AIDS Soc.19, 21105 (2016).
pubmed: 27760683
pmcid: 5071750
doi: 10.7448/IAS.19.7.21105
Restar, A. et al. Mapping community-engaged implementation strategies with transgender scientists, stakeholders, and trans-led community organizations. Curr. HIV/AIDS Rep.20, 160–169 (2023).
pubmed: 37012537
pmcid: 10071255
doi: 10.1007/s11904-023-00656-y
Thompson, H. M., et al. First they came for us all: responding to anti-transgender structural violence with collective, community-engaged, and intersectional health equity research and advocacy. Health Educ. Behav.51(1), 5–9 (2024).
pubmed: 37746726
doi: 10.1177/10901981231201146
Thaler, R. H. & Sunstein, C. R. Nudge: The Final Edition (Yale University Press, 2021).
Lelutiu-Weinberger, C., English, D. & Sandanapitchai, P. The roles of gender affirmation and discrimination in the resilience of transgender individuals in the US. Behav. Med.46, 175–188 (2020).
pubmed: 32787726
doi: 10.1080/08964289.2020.1725414
Feldman, J. L., Luhur, W. E., Herman, J. L., Poteat, T. & Meyer, I. H. Health and health care access in the US transgender population health (TransPop) survey. Andrology9, 1707–1718 (2021).
pubmed: 34080788
pmcid: 8613303
doi: 10.1111/andr.13052
Scheim, A. I., Baker, K. E., Restar, A. J. & Sell, R. L. Health and health care among transgender adults in the United States. Annu. Rev. Public Health43, 503–523 (2022).
pubmed: 34882432
doi: 10.1146/annurev-publhealth-052620-100313
Hiransuthikul, A. et al. Drug-drug interactions between feminizing hormone therapy and pre-exposure prophylaxis among transgender women: The iFACT study. J. Int. AIDS Soc.22, e25338 (2019).
pubmed: 31298497
pmcid: 6625338
doi: 10.1002/jia2.25338
Cattani, V. B. et al. Impact of feminizing hormone therapy on tenofovir and emtricitabine plasma pharmacokinetics: A nested drug–drug interaction study in a cohort of Brazilian transgender women using HIV pre-exposure prophylaxis. J. Antimicrob. Chemother.77, 2729–2736 (2022).
pubmed: 35815666
pmcid: 9525093
doi: 10.1093/jac/dkac229
Grant, R. M. et al. Sex hormone therapy and tenofovir diphosphate concentration in dried blood spots: Primary results of the interactions between antiretrovirals and transgender hormones study. Clin. Infect. Dis.73, e2117–e2123 (2021).
pubmed: 32766890
doi: 10.1093/cid/ciaa1160
Morris, E. et al. Characteristics associated with pre-exposure prophylaxis discussion and use among transgender women without HIV infection—National HIV Behavioral Surveillance Among Transgender Women, seven urban areas, United States, 2019–2020. MMWR Morb. Mortal. Wkly. Rep.73(1), 9–20 (2024).
Pinto, R. M., Berringer, K. R., Melendez, R. & Mmeje, O. Improving PrEP implementation through multilevel interventions: A synthesis of the literature. AIDS Behav.22, 3681–3691 (2018).
pubmed: 29872999
pmcid: 6208917
doi: 10.1007/s10461-018-2184-4
Melendez, R. M. & Pinto, R. M. HIV prevention and primary care for transgender women in a community-based clinic. J. Assoc. Nurses AIDS Care20, 387–397 (2009).
pubmed: 19732697
pmcid: 3534725
doi: 10.1016/j.jana.2009.06.002
Restar, A. et al. Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults. Humanit. Soc. Sci. Commun.9, 1–11 (2022).
Kennedy, C. E. et al. Self-administration of gender-affirming hormones: A systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex. Reprod. Health Matters29, 2045066 (2022).
pmcid: 8942532
doi: 10.1080/26410397.2022.2045066
Rael, C. T. et al. Transgender women’s concerns and preferences on potential future long-acting biomedical HIV prevention strategies: The case of injections and implanted medication delivery devices (IMDDs). AIDS Behav.24, 1452–1462 (2020).
pubmed: 31654172
pmcid: 7181384
doi: 10.1007/s10461-019-02703-5
U.S. Food and Drug Administration. FDA approves first injectable treatment for HIV pre-exposure prevention. FDA. gov. (2021).
Li, D. H. et al. Determinants of implementation for HIV pre-exposure prophylaxis based on an updated Consolidated Framework for Implementation Research: A systematic review. JAIDS J. Acquir. Immune Defic. Syndr.90, S235–S246 (2022).
pubmed: 35703776
doi: 10.1097/QAI.0000000000002984
Salinas-Rodríguez, A. et al. Preferences for conditional economic incentives to improve pre-exposure prophylaxis adherence: A discrete choice experiment among male sex workers in Mexico. AIDS Behav.26, 833–842 (2022).
pubmed: 34453239
doi: 10.1007/s10461-021-03443-1
de Aguiar Pereira, C. C. et al. Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: A discrete choice experiment in Brazil. Lancet Reg. Health Am.19, 100432 (2023).
Galárraga, O. & Sosa-Rubí, S. G. Conditional economic incentives to improve HIV prevention and treatment in low-income and middle-income countries. Lancet HIV6, e705–e714 (2019).
pubmed: 31578955
pmcid: 7725432
doi: 10.1016/S2352-3018(19)30233-4
Operario, D., Kuo, C., Sosa-Rubí, S. G. & Gálarraga, O. Conditional economic incentives for reducing HIV risk behaviors: Integration of psychology and behavioral economics. Health Psychol.32, 932 (2013).
pubmed: 24001243
pmcid: 4118666
doi: 10.1037/a0032760
Galárraga, O., Genberg, B. L., Martin, R. A., Barton Laws, M. & Wilson, I. B. Conditional economic incentives to improve HIV treatment adherence: Literature review and theoretical considerations. AIDS Behav.17, 2283–2292 (2013).
pubmed: 23370833
pmcid: 3688660
doi: 10.1007/s10461-013-0415-2