Linkage to care after HIV diagnosis among men who have sex with men and transgender women in Lima, Peru

In Lima, Perú, HIV prevalence is estimated to be 15% among men who have sex with men (MSM) and 30% among transgender women (TW). We investigated timely linkage of MSM and TW to HIV care, as linkage to antiretroviral therapy (ART) is critical to protect the health of those living with HIV and to prev...

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Bibliographic Details
Published inAIDS care Vol. 34; no. 5; pp. 580 - 584
Main Authors Primbas, Angela D., White, Edward, Long, Jessica E., Wilson, Julien, Pasalar, Siavash, Sanchez, Hugo, Cabello, Robinson L., Sanchez, Jorge, Meneses, Gonzalo, Villarán, Manuel V., Lama, Javier R., Duerr, Ann
Format Journal Article
LanguageEnglish
Published England Taylor & Francis 04.05.2022
Taylor & Francis Ltd
Subjects
Antiretroviral agents
Antiretroviral therapy
Clinics
Confidentiality
Decision making
Diagnosis
Female
Gays & lesbians
HIV
HIV care
HIV diagnosis
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - epidemiology
Homosexuality, Male
Human immunodeficiency virus
Humans
Linear analysis
linkage to care
Male
Medical diagnosis
Men
Men who have sex with men
Mens health
Peru - epidemiology
Prevalence
Proximity
Sex industry
Sexual and Gender Minorities
Sexually transmitted diseases
STD
Stigma
Transgender Persons
transgender women
Women
Peru
HIV care
HIV diagnosis
men who have sex with men
linkage to care
transgender women
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Summary:In Lima, Perú, HIV prevalence is estimated to be 15% among men who have sex with men (MSM) and 30% among transgender women (TW). We investigated timely linkage of MSM and TW to HIV care, as linkage to antiretroviral therapy (ART) is critical to protect the health of those living with HIV and to prevent onward transmission. We investigated linkage within 90 days of HIV diagnosis by matching data from two studies conducted in Lima between 2013 and 2015 to national ART program records. We used generalized linear modeling to assess predictors of timely linkage and late presentation to care. Of 487 newly-diagnosed MSM and TW, only 44% presented for care at an HIV clinic within 90 days. Timely linkage was less common among TW (aPR 0.7, 95% CI 0.5-1.0), those younger than 24 (aPR 0.8, 95% CI 0.6-1.0), and those reporting a history of sex work (aPR 0.7, 95% CI 0.6-0.9). Proximity to an ART program clinic was not associated with linkage; most participants linked to clinics offering "LGBTQ-friendly" care. The pattern of clinics selected by participants suggests the importance of concerns about confidentiality and stigma in decision-making about where to link to care.
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AD is the principal investigator of the parent study, Sabes, conceived the analysis, and oversaw all aspects of analysis and manuscript writing.
Authorship
JLS collaborated on the design on the parent study and critically reviewed the manuscript.
GM was responsible for assembling the GIS data for study participants in Lima, commented on study design, and critically reviewed the manuscript.
HS collaborated on the design on the parent study, assisted in collection of GIS data, and reviewed the manuscript.
ADP formulated the analysis, collected data, and performed preliminary analysis.
MVI was the primary consultant for data linkage and critically reviewed the manuscript.
JEL conducted the GIS analysis based on distance between homes and clinics and edited the manuscript.
SP created and maintained the dataset and reviewed the manuscript.
RLC collaborated on the design on the parent study and critically reviewed the manuscript.
JW derived mapping graphics, calculated geospatial probabilities, and reviewed the manuscript.
JRL is the site principal investigator in Lima, he collaborated closely on data collection and study design and critically reviewed the manuscript for content.
EW finalized the dataset and the analysis, and drafted the manuscript
ISSN:0954-0121
1360-0451
DOI:10.1080/09540121.2021.1929818