A recent study published in Medical Decision Making suggests that financial incentives and access to injectable hormone prescriptions could significantly improve adherence to long-acting pre-exposure prophylaxis (LA-PrEP) among transgender adults in the United States. The research, conducted through a discrete-choice experiment, found that younger transgender individuals responded positively to monetary rewards and integrated gender-affirming care. n nIn 2019, 671 new HIV diagnoses were reported among transgender individuals in the U.S., despite high awareness of PrEP. However, only 32% of transgender women without HIV were using the preventive treatment. To explore ways to close this gap, researchers from the Washington Priority Assessment in Trans Health Project surveyed 385 self-identified transgender or nonbinary adults in Washington state, with a mean age of 29 years. Most participants (99%) had health insurance, yet 79.2% had never used PrEP. Over half reported annual incomes below $50,000. n nThe study evaluated five key factors influencing adherence: incentive amount, format, delivery method, co-prescription of hormones, and counseling approach. Results showed a strong preference for electronic cash cards as the incentive method, with a coefficient of 0.090, and a positive response to higher incentive amounts, peaking at $1,200 annually. Participants valued blood testing over combined blood and hair testing and preferred in-person counseling. n nInjectable hormones were the most desired co-prescribed treatment during LA-PrEP visits. Respondents indicated a willingness to forgo $547 to receive injectable hormones, $112 for blood-based adherence monitoring, and $689 for cash over vouchers. Programs combining free gender-affirming care with LA-PrEP had a 45% selection probability among younger participants, though interest declined with age and higher income. n nThe findings suggest targeted incentive programs could be most effective for economically vulnerable, younger transgender adults. However, the study had limitations: participants were primarily White and from the Pacific Northwest, potentially affecting broader applicability. Pilot testing was limited, and real-world effectiveness will require validation through randomized controlled trials. n nThe authors concluded that integrating cash rewards and hormone prescriptions into PrEP programs could enhance engagement and adherence, offering public health officials a strategic framework for resource allocation. n— news from AJMCn
— News Original —nConditional Economic Incentives Could Be Effective in Improving Adherence to Long-Acting PrEP in Transgender Adults n nYoung adults in Washington state who identified as transgender were incentivized to continue using pre-exposure prophylaxis (PrEP) when offered prescriptions for injectable hormones during in-person care visits and cash incentives, according to a study published in Medical Decision Making.1 n nHIV was diagnosed in 36,801 individuals living in the US in 2019, of which 671 were among transgender people, making it a prevalent subgroup to curb incidence of HIV.2 PrEP is a means of preventing the spread of HIV but adherence needs to be high in order to curb the incidence of the virus. Adherence in transgender individuals has been lower than needed to prevent HIV in this population, with only 32% of transgender women without HIV using PrEP despite 92% knowing about the treatment. Conditional economic incentives may be able to increase adherence in this population and help them engage in treatment. This study aimed to use a discrete-choice experiment to figure out which factors mattered when it came to increasing adherence to long-acting injectable PrEP (LA-PrEP) in transgender adults who are HIV-negative.1 n nThe Washington Priority Assessment in Trans Health Project was used to embed the discrete-choice experiment. Participants had to be self-reported transgender and/or nonbinary, older than 18 years, and living in Washington state. All participants completed a survey that collected data on demographics, administered the experiment, and collected data on health care experiences and needs.They received a gift card for completing the survey. n nThe experiment included 5 attributes of 3 levels each to assess the amount of incentive to get high LA-PrEP adherence, the format of the incentive, the method of incentive, the hormone prescription type given during the visit for LA-PrEP, and counsel to increase adherence. Participants were asked to choose between hypothetical options for each attribute, including the amount of cash incentive and the means of testing the level of adherence. n nThere were 385 participants in the study who had a mean (SD) age of 29 (4.1) years and the majority were White (62.9%). A total of 99% of the participants were covered by health insurance but 79.2% had not taken PrEP. Annual income was less than $50,000 for more than half of those who responded to the survey. n nParticipants had a positive response to yearly incentives, with a positive coefficient of 0.013, with the increase of incentive increasing the probability of choosing an intervention program. Electronic cash card was the preferred method of receiving the incentive, with a coefficient of 0.090. Injectable hormones were the preferred coprescription over oral hormones or no prescription at all should the participants come in for their LA-PrEP. All participants preferred blood testing for measuring their adherence rather than blood and hair testing, and they preferred to receive counselling in person. n nThe maximum yearly incentive would be $1200. Participants were willing to part with $547 to receive a coprescription for injectable hormones, $112 to confirm adherence through blood test, and $689 to get a cash incentive rather than a voucher. Participants younger than 38 years chose the option for no incentive program less often than other age groups. n nPrograms that provided incentives for free gender-affirming care and LA-PrEP had a probability of being chosen of 45% in young adults who are transgender, but the probability decreased in adults who were older and had more income. This indicates that programs with cash incentives should be aimed toward individuals who are younger and less economically stable compared with older adults. n nThere were some limitations to this study. Pilot testing was limited in individuals who were not affiliated with the research, and specificity could have been lacking when participants were asked to make choices. All participants were from the Pacific Northwest and were primarily White, which could limit generalizability, and the sample having a preference to receiving hormone therapy may not be representative of all transgender people in the US. Also, time and effort are needed for participants to complete the experiment, and randomized controlled trials will be needed to confirm the finding. n nThe authors concluded that cash incentives and offering prescriptions for injectable hormones could help to increase adherence to PrEP in transgender young adults in the US. “Findings from this [discrete-choice experiment] can help already committed decision makers allocate available funding to programs that have the greatest likelihood of success,” the authors concluded. n nReferences n n1. Wilson-Barthes MG, Restar AJ, Operario D, Galárraga O. Incentivizing adherence to gender-affirming PrEP programs: a stated preference discrete-choice experiment among transgender and gender nonbinary adults. Med Decis Making. Published online August 16, 2025. doi:10.1177/0272989X251355971