{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:42:10Z","timestamp":1792410130089,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T00:00:00Z","timestamp":1646611200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006506","name":"Minist\u00e9rio da Sa\u00fade","doi-asserted-by":"publisher","award":["#01\/2013 BRA\/K57"],"award-info":[{"award-number":["#01\/2013 BRA\/K57"]}],"id":[{"id":"10.13039\/501100006506","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We aimed to evaluate daily oral pre\u2010exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non\u2010attendance and low PrEP adherence in a Brazilian trans\u2010specific 48\u2010week study (PrEParadas).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We enrolled transgender women (TGW) engaging in high\u2010risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with <jats:italic>p<\/jats:italic>\u2010value&lt;0.10 in the univariate analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non\u2010attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18\u201324 (adjusted odds ratio [aOR] = 8.76, 95% CI: 2.09\u201336.7) and 25\u201334 years (aOR = 6.79, 95% CI: 1.72\u201326.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37\u201318.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race\/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30\u201334.5) and had a borderline association with Black colour\/race (aOR = 6.72, 95% CI: 0.94\u201347.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16\u20130.88). No participant seroconverted over the course of the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although high PrEP retention can be achieved in a gender\u2010affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale\u2010up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25896","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T20:04:37Z","timestamp":1646683477000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6017-5660","authenticated-orcid":false,"given":"Emilia M.","family":"Jalil","sequence":"first","affiliation":[{"name":"National Institute of Infectious Diseases Evandro Chagas Fiocruz  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-601X","authenticated-orcid":false,"given":"Thiago S.","family":"Torres","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases Evandro Chagas Fiocruz  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9746-719X","authenticated-orcid":false,"given":"Paula M.","family":"Luz","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases Evandro Chagas Fiocruz  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laylla","family":"Monteiro","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases Evandro Chagas Fiocruz  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronaldo I.","family":"Moreira","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases Evandro Chagas Fiocruz  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiane R. 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