<mods:mods xmlns:mods="http://www.loc.gov/mods/v3" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-7.xsd"><mods:titleInfo><mods:title>The association between healthcare system interactions and PrEP usage among transgender and gender nonconforming adults in Massachusetts and Rhode Island</mods:title></mods:titleInfo><mods:typeOfResource authority="primo">dissertations</mods:typeOfResource><mods:name type="personal"><mods:namePart>Rofe, Kara</mods:namePart><mods:role><mods:roleTerm type="text">creator</mods:roleTerm></mods:role></mods:name><mods:name type="personal"><mods:namePart>Pearlman, Deborah</mods:namePart><mods:role><mods:roleTerm type="text">Reader</mods:roleTerm></mods:role></mods:name><mods:name type="personal"><mods:namePart>Hughto, Jaclyn</mods:namePart><mods:role><mods:roleTerm type="text">Advisor</mods:roleTerm></mods:role></mods:name><mods:name type="corporate"><mods:namePart>Brown University. School of Public Health</mods:namePart><mods:role><mods:roleTerm type="text">sponsor</mods:roleTerm></mods:role></mods:name><mods:originInfo><mods:copyrightDate>2022</mods:copyrightDate></mods:originInfo><mods:physicalDescription><mods:extent>v, 28 p.</mods:extent><mods:digitalOrigin>born digital</mods:digitalOrigin></mods:physicalDescription><mods:note type="thesis">Thesis (M. P. H.)--Brown University, 2022</mods:note><mods:genre authority="aat">theses</mods:genre><mods:abstract>Background: Transgender and gender nonconforming (TGNC) adults are disproportionately impacted by HIV. Despite the high efficacy of pre-exposure prophylaxis (PrEP) to prevent HIV, research suggests that PrEP is underutilized among TGNC people. Research is needed to identify which subgroups of at-risk TGNC people are not utilizing PrEP.&#13;
Methods: In 2019, a survey assessing PrEP knowledge and use, healthcare experiences, sexual risk behavior and demographics was administered to 600 TGNC adults in Massachusetts and Rhode Island in-person and online. For the current analysis, the sample was restricted to HIV-negative individuals who had reported one or more HIV risk behaviors, including having sexual contacts with six or more people in the past 6 months, engaging in condomless sex in the past 6 months, having a lifetime history of STIs, and engaging in sex work in the past year, resulting in an analytic sample of n=166. An age-adjusted multivariable logistic regression model tested the association between condomless sex in the past 6 months, lifetime history of STIs, accessing HIV prevention services in the past 12 months and the outcome: lifetime non-utilization of PrEP.&#13;
Findings: The mean age of this high HIV-risk sample of TGNC adults was 30.8 years old (SD=10.0) and 81.9% were White non-Hispanic. Overall, 31.3% were trans feminine, 24.7% were trans masculine, and 44.0% were non-binary. PrEP awareness was high (80.7%) but few had a history of taking PrEP (14.5%). In the age-adjusted multivariable model, not accessing HIV prevention services in the past 12 months months (aOR=21.14, 95% CI=6.43, 69.49), never having an STI (aOR=3.10, 95% CI= 1.02, 9.39), and engaging in condomless anal or vaginal sex in the past 6 months (aOR=3.84, 95% CI= 1.12, 13.14) were associated with the increased odds of never having used PrEP. &#13;
Conclusion: This study represents the first to our knowledge to quantitatively assess factors associated with not using PrEP in a multistate sample of TGNC adults who are HIV negative and at-risk for the virus. The findings extend a body of evidence documenting the lack of PrEP usage among TGNC adults. The low number of at-risk TGNC people who used PrEP indicates the need for structural and clinical interventions to increase PrEP access among this population.</mods:abstract><mods:subject><mods:topic>Pre-exposure prophylaxis</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/01015324"><mods:topic>Medicine, Preventive</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/01076117"><mods:topic>Preventive health services</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/01765239"><mods:topic>Transgender people</mods:topic></mods:subject><mods:subject><mods:topic>LGBT health</mods:topic></mods:subject><mods:subject authority="fast" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/01202158"><mods:topic>Sexual minorities</mods:topic></mods:subject><mods:language><mods:languageTerm authority="iso639-2b">English</mods:languageTerm></mods:language><mods:recordInfo><mods:recordContentSource authority="marcorg">RPB</mods:recordContentSource><mods:recordCreationDate encoding="iso8601">20220706</mods:recordCreationDate></mods:recordInfo></mods:mods>