Clinician Perspectives on Integrating Biomedical HIV Prevention with Gender-Affirming Care Delivered via Telehealth

Abstract

Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) continue to be underutilized among transgender people despite elevated HIV incidence in this population. Many transgender individuals report that their gender-affirming care (GAC) is their highest health care priority, and an increasing number seek this care via telehealth. We sought to understand clinician perspectives and needs regarding integrating HIV PrEP and HIV PEP into GAC in a telehealth model. We conducted semi-structured interviews with clinicians who self-identified as providing gender-affirming care via telehealth. We used the transdisciplinary approach to evidence-based practice to inform our interview guide and codebook and used thematic analysis to analyze the resulting data. Among our 20 participants interviewed in December 2023 and January 2024, there was enthusiasm to offer trans patients biomedical HIV prevention within GAC. Participants were most comfortable managing oral PrEP. Identified barriers include lab work cadence and issues getting medication to patients (especially the drugs for HIV PEP). PrEP navigators, patient self-advocacy, and trusting patient–clinician relationships were identified as facilitators of co-location. A clinician’s ability to offer a transgender patient both GAC and PrEP/HIV PEP in the same telehealth visit is a promising strategy to tackle the disproportionate incidence of HIV among trans people. Trusting clinical relationships facilitated by the provision of GAC can be utilized to more accurately assess HIV risk and more effectively offer PrEP and HIV PEP.