# PrEP Engagement Trajectories Among Transgender Women in the United States

> **NIH NIH F31** · JOHNS HOPKINS UNIVERSITY · 2022 · $44,037

## Abstract

PROJECT SUMMARY/ABSTRACT
Background: Transgender women (TW) shoulder the highest prevalence of HIV compared to other key
populations in the epidemic with 14% of all TW in the United States (US) living with HIV. HIV pre-exposure
prophylaxis (PrEP) has been available in the US since 2012 yet uptake has been slow and challenges related
to adherence have emerged. A comprehensive understanding of the socioeconomic, behavioral and systems
factors that contribute to PrEP uptake, adherence and persistence among TW will illuminate potential
mechanisms for optimizing PrEP engagement and reducing HIV incidence.
Study Goal and Aims: This study will identify factors that will optimize PrEP uptake, adherence and
persistence among transgender women at risk for HIV acquisition in the United States. Specific aims are to: 1)
Identify groups of TW with distinct longitudinal PrEP engagement trajectories; 2) Examine associations
between membership in each PrEP engagement group with demographic, socioeconomic, behavioral and
systems indicators; and 3) Develop a model for the mechanisms by which socioeconomic, behavioral and
systems factors impact TW's PrEP engagement trajectories.
Approach: This explanatory, sequential mixed-methods study will leverage the data and infrastructure of an
existing parent study, which has established a longitudinal cohort of 1,215 TW at risk of HIV acquisition in the
United States. Aims 1 and 2 will be secondary analyses of longitudinal survey data collected by the parent
study. Aim 1 will utilize group-based trajectory modeling, an extension of latent class analysis appropriate for
longitudinal data, to identify groups of TW who follow similar patterns of PrEP uptake, adherence and
persistence over 24-months of follow-up. Aim 2 will use multinomial logistic regression to identify factors
associated with membership in each PrEP trajectory group identified in Aim 1. Building on findings from Aims 1
and 2, Aim 3 will qualitatively explore the mechanisms by which socioeconomic, behavioral and systems
factors impact TW's PrEP engagement trajectories through in-depth interviews with TW and stakeholders.
Findings will be triangulated to develop a more nuanced understanding of this important topic.
Fellowship Information: The proposed research is the doctoral dissertation of Ms. Erin Cooney, PhD student
at Johns Hopkins Bloomberg School of Public Health. The training is mentored by experts in HIV prevention
including one Sponsor, two Co-sponsors, and two Scientific Advisors with complementary methodological and
topical expertise. The training plan outlines formal coursework, ongoing mentorship, research implementation,
and other advanced training opportunities to prepare Ms. Cooney to become a leading independent researcher
in HIV prevention. The proposed study directly aligns with the NIMH's Division of AIDS Research priorities of
expanding approaches to integrate behavioral science with effective biomedical strategies for HIV prevention.

## Key facts

- **NIH application ID:** 10461799
- **Project number:** 5F31MH124582-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Erin Eileen Cooney
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $44,037
- **Award type:** 5
- **Project period:** 2020-08-01 → 2023-05-19

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10461799

## Citation

> US National Institutes of Health, RePORTER application 10461799, PrEP Engagement Trajectories Among Transgender Women in the United States (5F31MH124582-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10461799. Licensed CC0.

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