HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration’s Ryan White HIV/AIDS Program: A retrospective study


Autoři: Pamela W. Klein aff001;  Demetrios Psihopaidas aff001;  Jessica Xavier aff002;  Stacy M. Cohen aff001
Působiště autorů: Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America aff001;  Independent Consultant, Silver Spring, Maryland, United States of America aff002
Vyšlo v časopise: HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration’s Ryan White HIV/AIDS Program: A retrospective study. PLoS Med 17(5): e32767. doi:10.1371/journal.pmed.1003125
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003125

Souhrn

Background

In the United States, approximately one-fifth of transgender women are living with HIV—nearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men.

Methods and findings

We assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92–0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41–0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42–0.73, p < 0.001). A limitation of the study is that RWHAP data are collected for administrative, not research, purposes, and clinical outcome measures, including retention and viral suppression, are only reported to the RWHAP for the approximately 60% of RWHAP clients engaged in RWHAP-supported outpatient medical care.

Conclusions

In this study, we observed disparities in HIV clinical outcomes among Black transgender women. These results fill an important gap in national HIV data about transgender people with HIV. Reducing barriers to HIV medical care for transgender women is critical to decrease disparities among this population.

Klíčová slova:

Health services administration and management – HIV – HIV diagnosis and management – HIV epidemiology – Medicare – Socioeconomic aspects of health – Transgender people – Women's health


Zdroje

1. Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(3):214–22. doi: 10.1016/S1473-3099(12)70315-8 23260128.

2. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17. doi: 10.1007/s10461-007-9299-3 17694429.

3. Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006–2017. Am J Public Health. 2018:e1–e8. doi: 10.2105/AJPH.2018.304727 30496000.

4. Sabin CA, Howarth A, Jose S, Hill T, Apea V, Morris S, et al. Association between engagement in-care and mortality in HIV-positive persons. AIDS. 2017;31(5):653–60. doi: 10.1097/QAD.0000000000001373 28060018; PubMed Central PMCID: PMC5333728.

5. Insight Start Study Group, Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, et al. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015;373(9):795–807. doi: 10.1056/NEJMoa1506816 26192873; PubMed Central PMCID: PMC4569751.

6. Pitasi MA, Oraka E, Clark H, Town M, DiNenno EA. HIV Testing Among Transgender Women and Men—27 States and Guam, 2014–2015. MMWR Morb Mortal Wkly Rep. 2017;66(33):883–7. doi: 10.15585/mmwr.mm6633a3 28837547; PubMed Central PMCID: PMC5687817.

7. Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDS. 2013;27(11):621–7. doi: 10.1089/apc.2013.0245 24138486; PubMed Central PMCID: PMC3820140.

8. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915–21. doi: 10.2105/ajph.91.6.915 11392934; PubMed Central PMCID: PMC1446468.

9. Kenagy GP. HIV among transgendered people. AIDS Care. 2002;14(1):127–34. doi: 10.1080/09540120220098008 11798412.

10. Garofalo R, Deleon J, Osmer E, Doll M, Harper GW. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. J Adolesc Health. 2006;38(3):230–6. doi: 10.1016/j.jadohealth.2005.03.023 16488820.

11. Harper GW, Jadwin-Cakmak LA, Popoff E, Campbell BA, Granderson R, Wesp LM, et al. Transgender and Other Gender-Diverse Youth's Progression Through the HIV Continuum of Care: Socioecological System Barriers. AIDS Patient Care STDS. 2019;33(1):32–43. doi: 10.1089/apc.2018.0078 30601061; PubMed Central PMCID: PMC6338455.

12. Bukowski LA, Chandler CJ, Creasy SL, Matthews DD, Friedman MR, Stall RD. Characterizing the HIV Care Continuum and Identifying Barriers and Facilitators to HIV Diagnosis and Viral Suppression Among Black Transgender Women in the United States. J Acquir Immune Defic Syndr. 2018;79(4):413–20. doi: 10.1097/QAI.0000000000001831 30080750.

13. James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality, 2016.

14. Melendez RM, Exner TA, Ehrhardt AA, Dodge B, Remien RH, Rotheram-Borus MJ, et al. Health and health care among male-to-female transgender persons who are HIV positive. Am J Public Health. 2006;96(6):1034–7. doi: 10.2105/AJPH.2004.042010 16131645; PubMed Central PMCID: PMC1470610.

15. Sevelius JM, Carrico A, Johnson MO. Antiretroviral therapy adherence among transgender women living with HIV. J Assoc Nurses AIDS Care. 2010;21(3):256–64. doi: 10.1016/j.jana.2010.01.005 20347342; PubMed Central PMCID: PMC2859994.

16. Mizuno Y, Beer L, Huang P, Frazier EL. Factors Associated with Antiretroviral Therapy Adherence Among Transgender Women Receiving HIV Medical Care in the United States. LGBT Health. 2017;4(3):181–7. doi: 10.1089/lgbt.2017.0003 28498011.

17. Dowshen N, Matone M, Luan X, Lee S, Belzer M, Fernandez MI, et al. Behavioral and Health Outcomes for HIV+ Young Transgender Women (YTW) Linked To and Engaged in Medical Care. LGBT Health. 2016;3(2):162–7. doi: 10.1089/lgbt.2014.0062 26789394; PubMed Central PMCID: PMC4723288.

18. Mizuno Y, Frazier EL, Huang P, Skarbinski J. Characteristics of Transgender Women Living with HIV Receiving Medical Care in the United States. LGBT Health. 2015;2(3):228–34. doi: 10.1089/lgbt.2014.0099 26788671.

19. Santos GM, Wilson EC, Rapues J, Macias O, Packer T, Raymond HF. HIV treatment cascade among transgender women in a San Francisco respondent driven sampling study. Sex Transm Infect. 2014;90(5):430–3. doi: 10.1136/sextrans-2013-051342 24714446.

20. Reisner SL, Jadwin-Cakmak L, White Hughto JM, Martinez M, Salomon L, Harper GW. Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S. AIDS Behav. 2017;21(12):3312–27. doi: 10.1007/s10461-017-1938-8 29138982; PubMed Central PMCID: PMC5705332.

21. Kalichman SC, Hernandez D, Finneran S, Price D, Driver R. Transgender women and HIV-related health disparities: falling off the HIV treatment cascade. Sex Health. 2017;14(5):469–76. doi: 10.1071/SH17015 28870282.

22. Xia Q, Seyoum S, Wiewel EW, Torian LV, Braunstein SL. Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007–2016. Am J Public Health. 2018:e1–e6. doi: 10.2105/AJPH.2018.304748 30495998; PubMed Central PMCID: PMC6301388.

23. Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47(1):5–16. doi: 10.1007/s12160-013-9565-8 24317955; PubMed Central PMCID: PMC3925767.

24. Nguyen A, Katz KA, Leslie KS, Amerson EH. Inconsistent Collection and Reporting of Gender Minority Data in HIV and Sexually Transmitted Infection Surveillance Across the United States in 2015. Am J Public Health. 2018;108(S4):S274–S6. doi: 10.2105/AJPH.2018.304607 30383426; PubMed Central PMCID: PMC6215378.

25. Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2016. Published 2017. Available from: https://hab.hrsa.gov/data/data-reports. [cited 2018 July 26].

26. Matthews T, DeLorenzo L, Matosky M, Young S, Huang A, Feit B, et al. National performance measures within a changing environment: how a federal agency developed and improved the measurement for HIV care and treatment. J Health Care Poor Underserved. 2012;23(3 Suppl):225–35. doi: 10.1353/hpu.2012.0128 22864499.

27. Health Resources and Services Administration. Ryan White HIV/AIDS Program Performance Measure Portfolio 2019. Available from: https://hab.hrsa.gov/clinical-quality-management/performance-measure-portfolio. [cited 2020 Feb 1].

28. Health Resources and Services Administration. 2016 Annual Ryan White HIV/AIDS Program Services Report (RSR) Instruction Manual. Published 2017. Available from: https://hab.hrsa.gov/sites/default/files/hab/Global/2016%20RSR%20Manual%20508.pdf. [cited 2020 Feb 1].

29. U.S. Census Bureau. 2010 Census Regions and Divisions of the United States. Published 2010. Available from: https://www.census.gov/geographies/reference-maps/2010/geo/2010-census-regions-and-divisions-of-the-united-states.html. [cited 2020 Feb 1].

30. Doshi RK, Milberg J, Jumento T, Matthews T, Dempsey A, Cheever LW. For Many Served By The Ryan White HIV/AIDS Program, Disparities In Viral Suppression Decreased, 2010–14. Health Aff (Millwood). 2017;36(1):116–23. doi: 10.1377/hlthaff.2016.0655 28069854.

31. Mandsager P, Marier A, Cohen S, Fanning M, Hauck H, Cheever LW. Reducing HIV-Related Health Disparities in the Health Resources and Services Administration's Ryan White HIV/AIDS Program. Am J Public Health. 2018;108(S4):S246–S50. doi: 10.2105/AJPH.2018.304689 30383416.

32. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2015. Published 2017. Available from: https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. [cited 2018 July 26].

33. Rebeiro PF, Abraham AG, Horberg MA, Althoff KN, Yehia BR, Buchacz K, et al. Sex, Race, and HIV Risk Disparities in Discontinuity of HIV Care After Antiretroviral Therapy Initiation in the United States and Canada. AIDS Patient Care STDS. 2017;31(3):129–44. Epub 2017/03/11. doi: 10.1089/apc.2016.0178 28282246; PubMed Central PMCID: PMC5359655.

34. Korthuis PT, Saha S, Fleishman JA, McGrath MM, Josephs JS, Moore RD, et al. Impact of patient race on patient experiences of access and communication in HIV care. J Gen Intern Med. 2008;23(12):2046–52. Epub 2008/10/03. doi: 10.1007/s11606-008-0788-5 18830770; PubMed Central PMCID: PMC2596522.

35. Freeman R, Gwadz MV, Silverman E, Kutnick A, Leonard NR, Ritchie AS, et al. Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. Int J Equity Health. 2017;16(1):54. Epub 2017/03/28. doi: 10.1186/s12939-017-0549-3 28340589; PubMed Central PMCID: PMC5364619.

36. Clark H, Babu AS, Wiewel EW, Opoku J, Crepaz N. Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009–2014. AIDS Behav. 2017;21(9):2774–83. doi: 10.1007/s10461-016-1656-7 28035497; PubMed Central PMCID: PMC5491368.

37. Denson DJ, Padgett PM, Pitts N, Paz-Bailey G, Bingham T, Carlos JA, et al. Health Care Use and HIV-Related Behaviors of Black and Latina Transgender Women in 3 US Metropolitan Areas: Results From the Transgender HIV Behavioral Survey. J Acquir Immune Defic Syndr. 2017;75 Suppl 3:S268–S75. doi: 10.1097/QAI.0000000000001402 28604427; PubMed Central PMCID: PMC5769690.

38. Rodriguez A, Agardh A, Asamoah BO. Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens. Arch Sex Behav. 2018;47(4):973–85. doi: 10.1007/s10508-017-1028-z 28785919; PubMed Central PMCID: PMC5891571.

39. Reback CJ, Ferlito D, Kisler KA, Fletcher JB. Recruiting, Linking, and Retaining High-risk Transgender Women into HIV Prevention and Care Services: An Overview of Barriers, Strategies, and Lessons Learned. Int J Transgend. 2015;16(4):209–21. doi: 10.1080/15532739.2015.1081085 27110227; PubMed Central PMCID: PMC4838285.

40. Sevelius JM, Keatley J, Calma N, Arnold E. 'I am not a man': Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7–8):1060–75. doi: 10.1080/17441692.2016.1154085 26963756.

41. Sevelius JM, Saberi P, Johnson MO. Correlates of antiretroviral adherence and viral load among transgender women living with HIV. AIDS Care. 2014;26(8):976–82. doi: 10.1080/09540121.2014.896451 24646419; PubMed Central PMCID: PMC4054817.

42. Martinez J, Chakraborty R, American Academy of Pediatrics Committee on Pediatric AIDS. Psychosocial support for youth living with HIV. Pediatrics. 2014;133(3):558–62. doi: 10.1542/peds.2013-4061 24567016.

43. Gilliam PP, Ellen JM, Leonard L, Kinsman S, Jevitt CM, Straub DM. Transition of adolescents with HIV to adult care: characteristics and current practices of the adolescent trials network for HIV/AIDS interventions. J Assoc Nurses AIDS Care. 2011;22(4):283–94. doi: 10.1016/j.jana.2010.04.003 20541443; PubMed Central PMCID: PMC3315706.

44. Poteat T, Reisner SL, Radix A. HIV epidemics among transgender women. Curr Opin HIV AIDS. 2014;9(2):168–73. doi: 10.1097/COH.0000000000000030 24322537; PubMed Central PMCID: PMC5947322.

45. Perez-Brumer AG, Oldenburg CE, Reisner SL, Clark JL, Parker RG. Towards 'reflexive epidemiology': Conflation of cisgender male and transgender women sex workers and implications for global understandings of HIV prevalence. Glob Public Health. 2016;11(7–8):849–65. doi: 10.1080/17441692.2016.1181193 27173599; PubMed Central PMCID: PMC4931972.

46. Poteat T, German D, Flynn C. The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. Glob Public Health. 2016;11(7–8):835–48. doi: 10.1080/17441692.2015.1134615 26785751; PubMed Central PMCID: PMC4957661.

47. Parker R, Aggleton P, Perez-Brumer AG. The trouble with 'Categories': Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion. Glob Public Health. 2016;11(7–8):819–23. doi: 10.1080/17441692.2016.1185138 27193965.

48. National HIV/AIDS Strategy for the United States: Updated to 2020. Published July 2015. Available from: https://www.hiv.gov/federal-response/national-hiv-aids-strategy/nhas-update. [cited 2018 July 26].

49. National HIV/AIDS Strategy for the United States: Updated to 2020 Indicator Supplement. Published December 2016. Available from: https://www.hiv.gov/federal-response/national-hiv-aids-strategy/nhas-update. [cited 2018 July 26].

50. TARGET Center. Using Evidence-Informed Interventions to Improve Health Outcomes among People Living with HIV (E2i). Pulished 2017. Available from: https://targethiv.org/e2i. [cited 2018 July 26].

51. SPNS Transgender Women of Color Initiative Intervention Manuals. November 14, 2018. Available from: https://targethiv.org/library/spns-transgender-women-color-initiative-manual. [cited 2019 Jan 13].

52. National Minority AIDS Council. Building Leaders of Color Living with HIV (BLOC). Published 2016. Available from: http://www.blochiv.org/. [cited 2018 July 26].

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2020 Číslo 5

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Kurz originály vs. generika
nový kurz
Autoři:

Klinická farmakokinetika betablokátorů
Autoři:

Současné možnosti terapie osteoartrózy
Autoři: MUDr. Jakub Holešovský

Preferovaná úlevová léčba Asthma Bronchiale
Autoři: PharmDr. Petr Sedlák

Inhibitory karboanhydrázy v léčbě glaukomu
Autoři: MUDr. Petr Výborný, CSc., FEBO

Všechny kurzy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se