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Observational Study
. 2022 Nov 1;36(13):1841-1849.
doi: 10.1097/QAD.0000000000003339. Epub 2022 Jul 21.

Longitudinal HIV care outcomes by gender identity in the United States

Catherine R Lesko  1 , Jessie K Edwards  2 , David B Hanna  3 , Angel M Mayor  4 , Michael J Silverberg  5 , Michael Horberg  6 , Peter F Rebeiro  7 , Richard D Moore  8 , Ashleigh J Rich  9 , Kathleen A McGinnis  10 , Kate Buchacz  11 , Heidi M Crane  12 , Charles S Rabkin  13 , Keri N Althoff  1 , Tonia C Poteat  9
Affiliations
Observational Study

Longitudinal HIV care outcomes by gender identity in the United States

Catherine R Lesko et al. AIDS. .

Abstract

Objective: Describe engagement in HIV care over time after initial engagement in HIV care, by gender identity.

Design: Observational, clinical cohort study of people with HIV engaged in routine HIV care across the United States.

Methods: We followed people with HIV who linked to and engaged in clinical care (attending ≥2 visits in 12 months) in cohorts in the North American Transgender Cohort Collaboration, 2000-2018. Within strata of gender identity, we estimated the 7-year (84-month) restricted mean time spent: lost-to-clinic (stratified by pre/postantiretroviral therapy (ART) initiation); in care prior to ART initiation; on ART but not virally suppressed; virally suppressed (≤200 copies/ml); or dead (pre/post-ART initiation).

Results: Transgender women ( N = 482/101 841) spent an average of 35.5 out of 84 months virally suppressed (this was 30.5 months for cisgender women and 34.4 months for cisgender men). After adjustment for age, race, ethnicity, history of injection drug use, cohort, and calendar year, transgender women were significantly less likely to die than cisgender people. Cisgender women spent more time in care not yet on ART, and less time on ART and virally suppressed, but were less likely to die compared with cisgender men. Other differences were not clinically meaningful.

Conclusions: In this sample, transgender women and cisgender people spent similar amounts of time in care and virally suppressed. Additional efforts to improve retention in care and viral suppression are needed for all people with HIV, regardless of gender identity.

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Conflict of interest statement

Conflicts of Interest: Dr. Rebeiro received funding from Gilead and Johnson & Johnson for consulting work unrelated to this research in the prior 36 months. Dr. Althoff serves as a consultant to the All of Us Research Program, National Institutes of Health (funds paid to her), and TrioHealth (funds paid to her). Dr. Crane has received grant funding from ViiV to her institution not related to this project.

Figures

Figure 1.
Figure 1.
Conceptual framework for the HIV care continuum stages (boxes) and possible movement between them (arrows) employed in this analysis.
Figure 2.
Figure 2.
Crude (left) and adjusted (right), stacked proportion of people in each care continuum stage over 84 months (7 years) following linkage to HIV care stratified by gender identity, ART-naïve people at enrollment into the North American Transgender Cohort Collaboration, 2000–2018
See this image and copyright information in PMC

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