Transgender and nonbinary (TGNB) individuals are disproportionately impacted by HIV, particularly those who identify as racial/ethnic minorities and those who are socioeconomically disadvantaged. Pre-exposure prophylaxis (PrEP) is a highly effective medication to prevent HIV infection, but many TGNB individuals encounter barriers to PrEP uptake and adherence that limit fully realized preventive benefits. We developed PrEP Well, a multicomponent community-led program, to scale and sustain comprehensive PrEP services from a TGNB-led community organization that provides gender-affirming healthcare and social services. We used implementation science frameworks to evaluate initial program outcomes and contextual influences on program implementation. Preliminary data from August 2022 through January 2024 showed promising implementation and effectiveness outcomes. During that time, 113 primarily low-resourced TGNB clients were educated about PrEP and received an HIV test, of whom 60 (53%) attended a visit with a provider and received a PrEP prescription. At 30-day follow-up, urinalysis confirmed uptake of PrEP among 50 (83%) of the clients prescribed PrEP. At 90-day follow-up, 43 (72%) demonstrated continued use of PrEP and 40 (67%) showed protective levels of PrEP adherence. Qualitative interviews and surveys indicated that clients, staff, and leadership viewed the PrEP Well program as highly acceptable, feasible, and sustainable (including willingness to address persistent implementation barriers). Referral patterns and rates of PrEP uptake suggested increasing integration of PrEP Well into the TGNB community center over time. The PrEP Well program demonstrates the potential for TGNB communities to address HIV inequities by integrating community-led HIV prevention services with gender-affirming healthcare in TGNB-specific health centers.

Keywords: HIV Prevention; Health Equity; Implementation Strategies; PrEP; Transgender Community.

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

变性人和非二元性别（TGNB）个体受到艾滋病毒的影响尤为严重，尤其是那些自我认同为种族/族裔少数群体以及社会经济状况不利的人。暴露前预防（PrEP）是一种非常有效的药物，用于防止艾滋病毒感染，但许多 TGNB 个人在 PrEP 的获取和依从性方面遇到障碍，这限制了其完全实现的预防效果。我们开发了一个由社区主导的多组件项目——“PrEP Well”，以扩大并维持一个由 TGNB 领导的社区组织提供的全面 PrEP 服务，该组织提供性别确认医疗保健和社会服务。我们使用实施科学框架来评估初始项目成果和影响项目实施的背景因素。2022年8月至2024年1月期间的数据初步显示了有希望的实施效果。在此期间，共有113名主要来自低资源家庭的 TGNB 客户接受了关于 PrEP 的教育并进行了 HIV 检测，其中60人（53%）见到了提供者并收到了 PrEP 处方。在30天随访时，尿液分析确认了 50 名（83%）被处方了 PrEP 的客户已开始使用 PrEP。在90天的随访中，43名（72%）客户展示了持续使用 PrEP，并且有40名（67%）客户的 PrEP 遵从性达到了保护水平。定性和调查访谈表明，客户、员工和领导层认为“PrEP Well”项目具有高度可接受性、可行性和可持续性（包括愿意解决持久的实施障碍）。转诊模式和 PrEP 采用率表明，“PrEP Well”项目在 TGNB 社区中心中的整合程度随时间推移而增加。通过将社区主导的 HIV 预防服务与性别确认医疗保健结合，TGNB 社区可以通过在 TGNB 特定健康中心中实施“PrEP Well”项目来应对 HIV 不公平现象。

关键词：HIV预防；健康平等；实施策略；PrEP；变性人群体。

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.