Background: Pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention among transgender women (transwomen) with good adherence, but its implementation is challenging, especially in low-and-middle-income countries (LMIC). We aimed to describe PrEP uptake and early adherence in PrEParadas study.
Methods: PrEParadas is a Brazilian trans-specific PrEP demonstration project. Inclusion criteria were: assigned as male at birth, self-identification as transwomen, aged 18+ years, HIV-negative and high-risk sexual behavior. Procedures included HIV viral load to evaluate acute viral infection (AVI). We calculated medication possession ratio (MPR) at the week 4 post-enrollment visit, which has been shown as a good measure for adherence. Predictors of low adherence (defined as MPR< 1) were evaluated using logistic regression model. At week 4, dried blood spots were also collected; TDF levels will be presented.
Results: We assessed 318 transwomen for participation; 271 were potentially eligible and 130 were offered PrEP between August 2017 December 2018 (PrEP uptake: 48.0%). Among those enrolled (N=130), eligibility was determined by: condomless anal sex in the last 6 months (63.1%), sexually transmitted infection diagnosis in the last 12 months (24.6%), HIV-positive partner in the last 30 days (3.9%), and transactional sex in the last 6 months (40.0%). Median age was 30 years (IQR:23-37). Twenty-three (17.7%) had < 8 years of schooling. Out of 130, 89.2% returned at week 4, with no indication of AVI; only 22 transwomen had low adherence. Adjusted odds ratio indicated that transwomen with limited schooling (OR=3.9,95%CI:0.8-18.4) and those not living in own or rented housing (OR=2.3, 95%CI:0.8-6.4) were more likely to have lower adherence.
Conclusions: Although a hard-to-engage group, transwomen had good uptake and adequate adherence levels in a LMIC study. More vulnerable transwomen had the worst adherence levels and deserve tailored strategies for PrEP delivery.

Flowchart of PrEParadas Study
[Flowchart of PrEParadas Study]