Mentored Scientist Award

Transgender women in Latin America are at highest risk for HIV infection. In Brazil, transgender women comprise <1% of the national population, but bear a disproportionate burden of HIV, with estimates as high as 32%—up to 80 times the prevalence among cisgender women and double the prevalence among men who have sex with men. Brazil has been a leader in HIV prevention in the Latin American region, making daily oral PrEP available through their national system, Sistema Unico de Saude, at zero cost since 2018. However, uptake among priority populations, including transgender women, is low. Recent data suggest that <5% of current PrEP users are transgender women, and that among transgender women engaged in PrEP, retention is <50%. Novel biomedical HIV prevention strategies—long-acting injectable and event-driven PrEP—were recently approved for use in Brazil, however, implementation is not yet underway. These novel PrEP modalities have the potential to overcome existing barriers to PrEP uptake and continuation among transgender women, that are currently attributed to low uptake of daily oral PrEP. However, there is a dearth of information on factors that influence uptake and preferences for delivery of these alternate PrEP approaches among transgender women, including delivery setting, provider prescribing, and support strategies. The proposed RAP research will fill these gaps in knowledge by exploring individual-, interpersonal-, and health system-level opportunities and challenges for optimizing PrEP delivery, with focus on newly approved biomedical HIV prevention strategies (LAI and ED PrEP) among TGW in Brazil. Aim 1 will explore individual and interpersonal factors influencing TGW’s interest for LAI- and ED-PrEP uptake and preferences for delivery settings, prescribing practices, and support strategies. Aim 2 will explore providers’ willingness, ability, and resources needed to prescribe LAI and ED PrEP to transgender women, and explore settings and strategies for PrEP prescribing and delivery that could be integrated into Brazil’s primary care system. Findings from Aims 1 and 2 will be integrated and used to develop recommendations that optimize PrEP service delivery to meet the HIV prevention needs of transgender women in Brazil. This research will be mentored by UCSF- and Brazil-based mentors and will lay the groundwork for a future K01 proposal that will support Dr. Zamudio-Haas goals of becoming an independent HIV investigator.