Barriers and Facilitators to PrEP Adherence among Transgender and Non-binary Individuals: A Mixed-Methods Analysis of Psychosocial Factors and Health Belief Model Constructs

D Paltin; M Prescott; J Ma; S Yeager; L Ham; S Serrano; J Narez; J Delgado; L Burke; B Gouaux; M Beckwith; S R Morris; D J Moore; J L Montoya

doi:10.1007/s10461-025-04810-y

Barriers and Facilitators to PrEP Adherence among Transgender and Non-binary Individuals: A Mixed-Methods Analysis of Psychosocial Factors and Health Belief Model Constructs

AIDS Behav. 2025 Jul 11. doi: 10.1007/s10461-025-04810-y. Online ahead of print.

Authors

D Paltin^{1

2}, M Prescott^{1

2}, J Ma^{1

3}, S Yeager², L Ham^{1

2}, S Serrano^{1

2}, J Narez², J Delgado², L Burke², B Gouaux^{2

4}, M Beckwith², S R Morris², D J Moore^{2

4}, J L Montoya^{5

6}

Affiliations

¹ San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
² University of California, San Diego, CA, USA.
³ San Diego State University, San Diego, CA, USA.
⁴ HIV Neurobehavioral Research Program, San Diego, CA, USA.
⁵ University of California, San Diego, CA, USA. jlmontoya@health.ucsd.edu.
⁶ HIV Neurobehavioral Research Program, San Diego, CA, USA. jlmontoya@health.ucsd.edu.

PMID: 40643829
DOI: 10.1007/s10461-025-04810-y

Abstract
in English, Spanish

Despite known benefits of Motivational Interviewing (MI) for medication adherence, its effectiveness in supporting pre-exposure prophylaxis (PrEP) adherence among transgender and nonbinary (TGNB) populations remains underexplored. This study applies mixed-methods analysis to understand PrEP adherence among TGNB individuals who received a daily individualized text-message intervention and phone-based MI for non-adherence to PrEP. Individuals who did not respond to three consecutive messages were identified as potential MI recipients. We had three objectives: (1) examine psychosocial differences between participants who needed MI (MI Indicated group; n = 81) versus those who did not (MI Not Indicated group; n = 48), (2) assess whether Health Belief Model (HBM) constructs were associated with PrEP adherence, and (3) identify adherence barriers and facilitators. This secondary analysis builds on primary intervention outcomes published in Morris et al. (J Acquire Immune Defic Syndr 91:453-459, 2022). We conducted multivariable linear regression on psychosocial measures and PrEP adherence, and inductive qualitative analysis on a subset of participants who completed at least one MI session (n = 60). Results were deductively mapped onto HBM constructs. Significant differences emerged between MI groups in HBM constructs, with the MI Indicated group reporting higher perceived HIV risk, stress, depressive symptoms, and poorer coping and self-efficacy. Findings highlight the need for personalized interventions to support PrEP adherence, mental health, and HIV risk perception among TGNB individuals. Future adherence interventions may benefit from assessing and addressing HBM constructs. To support the Ending the HIV Epidemic initiative, it is critical to enhance access to facilitators and mitigate barriers to PrEP adherence for this population.

A pesar de los beneficios conocidos de la Entrevista Motivacional (EM) para la adherencia a la medicación, su eficacia en la adherencia a la profilaxis preexposición (PrEP) entre poblaciones transgénero y no binarias (TGNB) sigue poco explorada. Este estudio aplica métodos mixtos para comprender la adherencia a la PrEP entre personas TGNB que recibieron una intervención diaria individualizada mediante mensajes de texto y EM telefónica por falta de adherencia. Quienes no respondieron a tres mensajes consecutivos fueron identificados como posibles destinatarias de EM. Tuvimos tres objetivos: (1) examinar diferencias psicosociales entre quienes necesitaron EM (grupo indicado; n = 81) y quienes no (grupo no indicado; n = 48), (2) evaluar si los constructos del Modelo de Creencias de Salud se asociaron con la adherencia, y (3) identificar barreras y facilitadores. Este análisis secundario se basa en resultados publicados en Morris et al. (J Acquire Immune Defic Syndr 91:453–459, 2022). Aplicamos regresión lineal multivariable sobre medidas psicosociales y adherencia, y un análisis cualitativo inductivo con quienes completaron al menos una sesión de EM (n = 60). Los resultados se mapearon según los constructos del Modelo de Creencias de Salud. Surgieron diferencias significativas entre los grupos: el grupo indicado reportó mayor riesgo percibido de VIH, estrés, síntomas depresivos y menor afrontamiento y autoeficacia. Los resultados subrayan la necesidad de intervenciones personalizadas que apoyen la adherencia, salud mental y percepción del riesgo de VIH. Futuras intervenciones podrían beneficiarse de abordar estos constructos. Mejorar el acceso a facilitadores y mitigar barreras a la PrEP es clave para apoyar la iniciativa ending the HIV Epidemic.

Keywords: HIV prevention; Motivational interviewing; Nonbinary; PrEP adherence; Transgender.

Abstract in English, Spanish

Grants and funding

Abstract
in English, Spanish