background: In the U.S., transgender and non-binary (trans) populations face high rates of HIV and may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP). Research is needed to assess the prevalence and distribution of PrEP prescribing in primary care settings to inform clinical practice and HIV prevention efforts.

methods: Electronic health record (EHR) data were abstracted from a cohort of transgender and non-binary adult patients who received primary care at Fenway Health in Boston, MA between January 2018-December 2019. Patients with documentation of a provider prescribing PrEP (yes/no) were included in this analysis (N=4126). Adjusted multivariable logistic regression models were fit to assess sociodemographic factors associated with being prescribed PrEP.

results: The sample median age was 28 years (IQR=10); 5.8% Black, 10.0% Hispanic/Latinx, and 44.3% assigned male at birth (AMAB). Overall, 4.1% (n=171) had a PrEP prescription. AMAB patients had increased odds of a PrEP prescription (aOR=3.06; 95%CI=2.13-4.39; p<0.0001) compared to assigned female at birth (AFAB) patients. Black patients had 2.72 (95%CI=1.59-4.65; p=0.010) times the odds of having a PrEP prescription relative to white patients. Patients ages 25-29 years (aOR=1.72; 95%CI=1.10-2.71; p=0.013) and ages 30-39 years (aOR=1.77; 95%CI=1.12-2.78; p=0.008) had increased odds and compared to those ages 18-24 years.

conclusion: The higher rate of PrEP prescribing to AMAB and racial/ethnic minority patients is consistent with HIV epidemic. Efforts are needed to increase PrEP prescriptions in the younger patient age group. Future research into underserved trans subgroups and provider behaviors will further HIV prevention delivery for trans community patients.