{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:09:49Z","timestamp":1791508189436,"version":"4.3.4"},"reference-count":68,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Patient Care and STDs"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and\/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.<\/jats:p>","DOI":"10.1089\/apc.2021.0236","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T15:25:06Z","timestamp":1654874706000},"page":"236-248","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":108,"title":["Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review"],"prefix":"10.1177","volume":"36","author":[{"given":"Madeline","family":"Dang","sequence":"first","affiliation":[{"name":"Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayden I.","family":"Scheim","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Teti","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine G.","family":"Quinn","sequence":"additional","affiliation":[{"name":"Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meagan","family":"Zarwell","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew E.","family":"Petroll","sequence":"additional","affiliation":[{"name":"Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith J.","family":"Horvath","sequence":"additional","affiliation":[{"name":"Department of Psychology, San Diego State University, San Diego, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1316-3920","authenticated-orcid":false,"given":"Steven A.","family":"John","sequence":"additional","affiliation":[{"name":"Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303578"},{"key":"e_1_3_3_3_2","unstructured":"Flores AR Herman JL Gates GJ et al. How Many Adults Identify as Transgender in the United States?. Los Angeles CA: T.W. Institute; 2016."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304727"},{"key":"e_1_3_3_5_2","unstructured":"Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States 2014. A Clinical Practice Guideline. 2014. Available at: https:\/\/www.sfdph.org\/dph\/files\/newsMediadocs\/2014PR\/PrEPguidelines2014.pdf (Last accessed April6 2022)."},{"key":"e_1_3_3_6_2","unstructured":"Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States\u20142017 Update: A Clinical Practice Guideline. 2018. Available at: https:\/\/www.cdc.gov\/hiv\/pdf\/risk\/prep\/cdc-hiv-prep-guidelines-2017.pdf (Last accessed April6 2022)."},{"key":"e_1_3_3_7_2","unstructured":"US Food and Drug Administration. FDA approves first medication to reduce HIV risk. 2012. Available at: https:\/\/wayback.archiveit.org\/7993\/20170406045106\/https:\/\/www.fda.gov\/ForConsumer\/ConsumerUpdates\/ucm311821.htm (Last accessed April6 2022)."},{"key":"e_1_3_3_8_2","unstructured":"US Food and Drug Administration. FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. 2019. Available at: https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic (Last accessed April6 2022)."},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001555"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-015-0850-2"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2019.0049"},{"key":"e_1_3_3_12_2","unstructured":"Centers for Disease Control and Prevention. HIV infection risk prevention and testing behaviors among transgender women\u2014National HIV Behavioral Surveillance 7 U.S. Cities 2019\u20132020. HIV Surveillance Special Report 27. 2021. Available at: https:\/\/www.cdc.gov\/hiv\/pdf\/library\/reports\/surveillance\/cdc-hiv-surveillance-special-report-number-27.pdf (Last accessed April6 2022)."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25539"},{"key":"e_1_3_3_14_2","unstructured":"Centers for Disease Control and Prevention. HIV Surveillance Report 2018 (Updated). Vol. 31. 2020. 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