{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T13:12:37Z","timestamp":1782997957635,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["P30MH136919"],"award-info":[{"award-number":["P30MH136919"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transfeminine persons in the United States face a high burden of human immunodeficiency virus (HIV), yet national data on preexposure prophylaxis (PrEP) use remain limited. We examined PrEP utilization, adherence, and persistence and reasons for never using PrEP among a national sample of transfeminine persons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sexually active transfeminine persons aged \u226515 years without HIV were recruited online through the Transgender Women's Internet Survey and Testing (TWIST) Study, a national cross-sectional survey conducted between June 2023 and October 2024. Multivariable Poisson regression was used to estimate adjusted prevalence ratios for characteristics associated with current PrEP use. Reasons for never using PrEP were examined descriptively by age group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1656 participants, 6% were currently using PrEP and 86% had never used PrEP. Among current users (n = 96), 94% used oral PrEP and 6% used long-acting injectable (LA) PrEP. Among the 32 participants who reported using &amp;lt;30 daily PrEP doses in the past 30 days, 25% indicated that they were using event-driven (on-demand) PrEP, taking it only when they anticipated having sex. In multivariable models, current PrEP use was higher among participants aged \u226540 years, Black participants, and participants reporting a sexually transmitted infection diagnosis, multiple sexual partners, illicit drug use, or prescribed medication use. Common reasons for never using PrEP among participants aged 15\u201324 years included insurance-related privacy and disclosure concerns and transportation barriers, while among participants aged \u226525 years, reasons included loss of insurance, side-effect concerns, and monogamous partnerships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PrEP uptake among transfeminine persons remains low, with distinct age-specific barriers. Tailored interventions are needed. LA PrEP may help address challenges related to adherence and disclosure, particularly among younger individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag073","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:28:47Z","timestamp":1771331327000},"source":"Crossref","is-referenced-by-count":1,"title":["HIV Preexposure Prophylaxis Utilization and Reasons for Never Using Preexposure Prophylaxis Among Transfeminine Persons in the United States: Findings From the Transgender Women\u2019s Internet Survey and Testing (TWIST) Study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-2320","authenticated-orcid":false,"given":"Duygu","family":"Islek","sequence":"first","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Baral","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Public Health, Johns Hopkins University , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna A","family":"Caldwell","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L","family":"Glick","sequence":"additional","affiliation":[{"name":"Community Health Science and Policy, Health Sciences Center, Louisiana State University , New Orleans, Louisiana ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irah","family":"Lucas","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8495-5039","authenticated-orcid":false,"given":"Supriya","family":"Sarkar","sequence":"additional","affiliation":[{"name":"ViiV Healthcare , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Ragone","sequence":"additional","affiliation":[{"name":"ViiV Healthcare , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemiek","family":"de Ruiter","sequence":"additional","affiliation":[{"name":"ViiV Healthcare , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariah","family":"Valentine-Graves","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Winter","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vani","family":"Vannappagari","sequence":"additional","affiliation":[{"name":"ViiV Healthcare , Durham, North Carolina ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"2026030912314509000_ofag073-B1","doi-asserted-by":"crossref","first-page":"e308","DOI":"10.1016\/S2352-3018(23)00008-5","article-title":"HIV incidence and mortality in transgender women in the eastern and southern USA: a multisite cohort study","volume":"10","author":"Wirtz","year":"2023","journal-title":"Lancet HIV"},{"key":"2026030912314509000_ofag073-B2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.15585\/mmwr.su7301a2","article-title":"National HIV Behavioral Surveillance Among Transgender Women Study Group. 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