HIV care outcomes among transgender persons with HIV infection in the United States, 2006–2021

• Type of Material: Article
• Authors: Jeffrey S. Becasen, Centers for Disease Control and Prevention; Joseph D. Morris, Emory University; Christa L. Denard, ICF International, Inc.; Mary M. Mullins, Centers for Disease Control and Prevention; Krishna Kiran Kota, Centers for Disease Control and Prevention; Darrel H. Higa, Centers for Disease Control and Prevention
• Language: English
• Date: 2022-02-01
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097/QAD.0000000000003109
• Title of Journal or Parent Work: AIDS
• Volume: 36
• Issue: 2
• Start Page: 305
• End Page: 315
• Keywords: HIV; transgender persons; meta-analysis; healthcare; outcome assessment
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Objectives: HIV prevalence is an estimated 14% among transgender women (TW) and 3% among transgender men (TM). HIV care is vital for viral suppression but is hindered by transphobia and HIV stigma. We assessed HIV care outcomes among transgender persons (TG) with HIV in the United States. Design: Systematic review and meta-analysis of peer-reviewed journal articles. Methods: We searched multiple electronic databases and Centers for Disease Control and Prevention’s HIV Prevention Research Synthesis database for 2006–September 2020. Eligible reports were US-based studies that included TG and reported HIV care outcomes. Random-effects models were used to calculate HIV care outcome rates. The protocol is registered with PROSPERO (CRD42018079564). Results: Few studies reported outcomes for TM; therefore, only TW meta-analysis results are reported. Fifty studies were identified having low-to-medium risk-of-bias scores. Among TW with HIV, 82% had ever received HIV care; 72% were receiving care, and 83% of those were retained in HIV care. Sixty-two percent were currently virally suppressed. Among those receiving HIV care or antiretroviral therapy (ART), 67% were virally suppressed at last test. Sixty-five percent were linked to HIV care 3 months or less after diagnosis. Seventy-one percent had ever been prescribed ART. Approximately 66% were taking ART, and 66% were ART-adherent. Only 56% were currently adherent the previous year. Conclusions: HIV care outcomes for TW were not ideal, and research gaps exists for TM. High heterogeneity was observed; therefore, caution should be taken interpreting the findings. Integrating transgender-specific health needs are needed to improve outcomes of transgender persons across the HIV care continuum.