1243. HIV Treatment Cascade Among Transgender Women in a Respondent Driven Sampling Study in San Francisco
Session: Oral Abstract Session: HIV: Detection, Linkage, and Utilization
Saturday, October 5, 2013: 11:42 AM
Room: The Moscone Center: 250-262
Background:

Male-to-female transgender women (transwomen) have a disproportionate burden of HIV worldwide—transwomen have 48.8 fold greater odds of being HIV-infected compared to the general adult population, according to pooled estimates of available data. In San Francisco, transwomen have the lowest 5-year survival probability of all gender groups and the least ART use. Despite their poor health outcomes compared to other groups, little is known about the treatment outcomes of transwomen with HIV. We sought to estimate population-level HIV-treatment cascade indicators among transwomen in San Francisco.

Methods:

We conducted a Respondent-Driven Sampling (RDS) study of 314 transwomen from August-December 2010. Participants were offered an HIV test and the study collected self-reported data on linkage and access to care, most recent CD4 count and viral load, and antiretroviral treatment (ART). We derived population-based estimates and 95% confidence intervals of cascade indicators using sampling weights adjusted for homophily and probability of being recruited into the study (social network size of transwomen) using established RDS methods.

Results:

The RDS-weighted population-based estimate of HIV prevalence was 39% (95%CI 32-47) among transwomen tested for HIV. Among HIV-positive transwomen, 77% (70-93) reported being linked to primary care within 3 months of their HIV diagnosis and 87% (76-98) had accessed care in the past 6 months. In addition, 35% (24-55) of HIV-positive transwomen reported a CD4 count below 350, 65% (54-75) were currently on ART, and less than half (44%; 21-58) reported being virologically suppressed (viral load ≤200 copies/mL).

Conclusion:

We observed a high prevalence of HIV in our population-based estimates of transwomen in San Francisco, coupled with modest ART use and low virologic suppression rates, indicating high potential for forward transmission. These findings are consistent with San Francisco surveillance data showing that HIV-positive transgender individuals have higher HIV community viral load and higher mortality rates than other HIV-positive populations. Taken together, these data suggest that multi-level efforts are urgently needed to ameliorate disparities in HIV clinical outcomes among transwomen and reduce secondary HIV transmission to their partners.

Glenn-Milo Santos, MPH1,2, Erin Wilson, DrPH1, Jenna Rapues, MPH1, Oscar Macias, MPH1, Tracey Packer, MPH1 and H. Fisher Raymond1, (1)San Francisco Department of Public Health, San Francisco, CA, (2)Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA

Disclosures:

G. M. Santos, None

E. Wilson, None

J. Rapues, None

O. Macias, None

T. Packer, None

H. F. Raymond, None

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