Catherine R Lesko1, Jessie K Edwards2, David B Hanna3, Angel M Mayor4, Michael J Silverberg5, Michael Horberg6, Peter F Rebeiro7, Richard D Moore8, Ashleigh J Rich9, Kathleen A McGinnis10, Kate Buchacz11, Heidi M Crane12, Charles S Rabkin13, Keri N Althoff1, Tonia C Poteat9. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 4. Department of Internal Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico. 5. Division of Research, Kaiser Permanente Northern California, Oakland, California. 6. Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland. 7. Division of Infectious Diseases and Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee. 8. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. 9. Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 10. Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut. 11. HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. 12. Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington. 13. Infections and Immunoepidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
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.
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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