HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

• Published in: Journal of the International AIDS Society Vol. 20; no. 1; pp. 21873 - n/a
• Main Authors: Jalil, Emilia M., Wilson, Erin C., Luz, Paula M., Velasque, Luciane, Moreira, Ronaldo I., Castro, Cristiane V., Monteiro, Laylla, Garcia, Ana Cristina F., Cardoso, Sandra W., Coelho, Lara E., McFarland, Willi, Liu, Albert Y., Veloso, Valdilea G., Buchbinder, Susan, Grinsztejn, Beatriz
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 19.09.2017; John Wiley & Sons, Inc; Taylor & Francis
• Subjects: Acquired immune deficiency syndrome; Adult; Age; AIDS; AIDS/HIV; Antiretroviral agents; Antiretroviral drugs; antiretroviral therapy; Brazil; care continuum; Continuity of Patient Care; Councils; Epidemics; Estimates; Ethnicity; Female; Females; Gender identity; Health care; HIV; HIV Infections - diagnosis; HIV Infections - psychology; HIV Infections - therapy; HIV testing; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Internet; Mass Screening; Medical tests; Mental health; Middle Aged; Population; Prevention; Public health; Sexual Partners; Short Report; Studies; Systematic review; Transgender persons; Transgender Persons - statistics & numerical data; transgender women; Womens health; Young Adult; Brazil; Rio de Janeiro Brazil; San Francisco California; United States > US; Brazil; HIV testing; HIV; care continuum; antiretroviral therapy; transgender women
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.20.1.21873

Introduction: Evidence suggests that, of all affected populations, transgender women (transwomen) may have the heaviest HIV burden worldwide. Little is known about HIV linkage and care outcomes for transwomen. We aimed to estimate population‐level indicators of the HIV cascade of care continuum, and to evaluate factors associated with viral suppression among transwomen in Rio de Janeiro, Brazil. Methods: We conducted a respondent‐driven sampling (RDS) study of transwomen from August 2015 to January 2016 in Rio de Janeiro, Brazil and collected data on linkage and access to care, antiretroviral treatment and performed HIV viral load testing. We derived population‐based estimates of cascade indicators using sampling weights and conducted RDS‐weighted logistic regression analyses to evaluate correlates of viral suppression (viral load ≤50 copies/mL). Results: Of the 345 transwomen included in the study, 89.2% (95% CI 55–100%) had been previously tested for HIV, 77.5% (95% CI 48.7–100%) had been previously diagnosed with HIV, 67.2% (95% CI 39.2–95.2) reported linkage to care, 62.2% (95% CI 35.4–88.9) were currently on ART and 35.4% (95% CI 9.5–61.4%) had an undetectable viral load. The final adjusted RDS‐weighted logistic regression model for viral suppression indicated that those who self‐identified as black (adjusted odds ratio [aOR] 0.06, 95% CI 0.01–0.53, p < 0.01), reported earning ≤U$160/month (aOR 0.11, 95% CI 0.16–0.87, p = 0.04) or reported unstable housing (aOR 0.08, 95% CI 0.01–0.43, p < 0.01) had significantly lower odds of viral suppression. Conclusions: Our cascade indicators for transwomen showed modest ART use and low viral suppression rates. Multi‐level efforts including gender affirming care provision are urgently needed to decrease disparities in HIV clinical outcomes among transwomen and reduce secondary HIV transmission to their partners.