Assessing the HIV care continuum among transgender women during 11 years of follow‐up: results from the Netherlands’ ATHENA observational cohort

• Published in: Journal of the International AIDS Society Vol. 27; no. 8; pp. e26317 - n/a
• Main Authors: Jongen, Vita W., Daans, Ceranza, van Sighem, Ard, Schim van der Loeff, Maarten, Hage, Kris, Welling, Camiel, von Vaupel‐Klein, Alex, den Heijer, Martin, Peters, Edgar J. G., van der Valk, Marc, Reiss, Peter, Prins, Maria, Hoornenborg, Elske
• Format: Journal Article
• Language: English
• Published: Switzerland John Wiley & Sons, Inc 01.08.2024; Wiley
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; CD4 Lymphocyte Count; Cohort Studies; Continuity of Patient Care - statistics & numerical data; Estimates; Female; Follow-Up Studies; Gender identity; HIV; HIV acquisitions; HIV care continuum; HIV epidemiology; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Male; Middle Aged; Netherlands - epidemiology; transgender people; Transgender persons; Transgender Persons - statistics & numerical data; transgender women; Viral Load; Young Adult; Netherlands; transgender people; HIV care continuum; HIV; HIV acquisitions; HIV epidemiology; transgender women
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.26317

Introduction Transgender women are at increased risk of acquiring HIV. Earlier studies reported lower retention in HIV care, antiretroviral therapy uptake, adherence and viral suppression. We assessed the stages of the HIV care continuum of transgender women in the Netherlands over an 11‐year period. In addition, we assessed new HIV diagnoses and late presentation, as well as disengagement from care, between 2011 and 2021. Methods Using data from the Dutch national ATHENA cohort, we separately assessed viral suppression, as well as time to achieving viral suppression, among transgender women for each year between 2011 and 2021. We also assessed trends in new HIV diagnoses and late presentation (CD4 count of <350 cells/µl and/or AIDS at diagnosis), and disengagement from care. Results Between 2011 and 2021, a total of 260 transgender women attended at least one HIV clinical visit. Across all years, <90% of transgender women were virally suppressed (207/239 [87%] in 2021). The number of new HIV diagnoses fluctuated for transgender women (ptrend = 0.053) and late presentation was common (ranging between 10% and 67% of new HIV diagnoses). Of the 260 transgender women, 26 (10%) disengaged from care between 2011 and 2021 (incidence rate = 1.10 per 100 person‐years, 95% confidence interval = 0.75−1.61). Conclusions Between 2011 and 2021, less than 90% of transgender women linked to HIV care were virally suppressed. Late presentation at the time of diagnosis and disengagement from care were common. Efforts are needed to identify barriers to early HIV diagnosis and to optimize the different steps across the care continuum for transgender women.