Access, initiation and retention in PrEP among cisgender women and transgender people in Barcelona, Spain.

Cisgender women and transgender people remain underrepresented in pre-exposure prophylaxis (PrEP) programmes in Spain. This retrospective observational single-centre cohort study aimed to describe sociodemographic characteristics, access pathways and HIV and sexually transmitted infections (STI) prevention interventions among cisgender women and transgender people seeking PrEP at a specialised HIV/STI clinic in Barcelona, Spain, between January 2020 and December 2024. Secondary objectives were to evaluate PrEP initiation and retention and to compare outcomes between cisgender women and transgender participants. A total of 182 participants were included: 63.2% cisgender women, 34.6% transgender women and 2.2% transgender men, with a median age of 34 years. Most were migrants (87.5%), engaged in sex work (92.2%) and 45% reported active drug use. More than half (54.9%) accessed PrEP through community-based organisation referral, especially transgender individuals. PrEP initiation was high among those attending the first visit (86.5%), but retention was poor, with 46.7% considered lost to follow-up. STI prevalence was high before and after PrEP initiation, with transgender participants showing a significantly greater burden. Community-based, gender-affirming, integrated sexual health models are essential to improve equitable access, continuity of care and HIV prevention outcomes.Abbreviations: CBO: community-based organisation; GHB: gamma-hydroxybutyrate; HAV: hepatitis A virus; HBV: hepatitis B virus; HIV: human immunodeficiency virus; HPV: human papillomavirus; IQR: interquartilic range; LGBTIQ+: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and other identities; LGV: lymphogranuloma venereum; NA: not available; NGO: non-governmental organisation; PEP: post-exposure prophylaxis; PrEP: pre-exposure prophylaxis; STI: sexually transmitted infection; SW: sex worker​.