The PrEP cascade in a sample of HIV-negative or unknown status adolescent and young adult transgender women in Peru

Background: Transgender women are a key population in the HIV epidemic globally, including in Peru. This cross-sectional epidemiological study characterized the pre-exposure prophylaxis (PrEP) cascade in adolescent and young adult transgender women in Peru to inform roll-out of early HIV prevention efforts. Methods: Between February-July 2022, a community-recruited sample of HIV-negative or status unknown young transgender women (n = 140) in Peru completed a socio-behavioral survey and biological testing for HIV and bacterial STIs. Logistic regression models estimated the association of sociodemographic, healthcare, and behavioral factors to PrEP indication and willingness. Results: Median age was 22 years (range = 16-24 years); 65.7% reported sex work and 28.6% homelessness. Overall, 45.7% had a PrEP indication based on past 6 months HIV behavioral risk profiles. In a multivariable model, sex work (aRR = 2.27; 95% CI = 1.24-4.17) and homelessness (aRR = 1.27; 95% CI = 1.00-1.60) were associated with PrEP indication. More than one-third (38.6%) had never been HIV tested; 25.3% were tested >1 year ago. Only 34.3% heard of daily oral PrEP, 8.6% reported ever PrEP use, and 5.0% current PrEP use. Nearly half (49.3%) reported willingness to take daily oral PrEP. In a multivariable model, younger age was associated with increased willingness to use PrEP (aRR = 0.92; 95% CI = 0.87-0.98). Highest ranked PrEP preferences were a daily oral pill (35.7%), implant (32.1%), and injection by a provider (10.0%). Conclusions: PrEP indication and willingness were high in this sample, but HIV testing and PrEP uptake were low. Findings highlight opportunities for age-responsive and contextually-relevant interventions to increase HIV prevention among young transgender women in Peru.