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. 2017 Sep 19;20(1):21873.
doi: 10.7448/IAS.20.1.21873.

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Emilia M Jalil  1 , Erin C Wilson  2 , Paula M Luz  1 , Luciane Velasque  1   3 , Ronaldo I Moreira  1 , Cristiane V Castro  1 , Laylla Monteiro  1 , Ana Cristina F Garcia  1 , Sandra W Cardoso  1 , Lara E Coelho  1 , Willi McFarland  4 , Albert Y Liu  2 , Valdilea G Veloso  1 , Susan Buchbinder  2   4 , Beatriz Grinsztejn  1
Affiliations

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Emilia M Jalil et al. J Int AIDS Soc. .

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] J Int AIDS Soc. 2018 Jan 22;21(1):e25047. doi: 10.1002/jia2.25047. eCollection 2018 Jan. J Int AIDS Soc. 2018. PMID: 31329751 Free PMC article.

Abstract

Introduction: Evidence suggests that, of all affected populations, transgender women (transwomen) may have the heaviest HIV burden worldwide. Little is known about HIV linkage and care outcomes for transwomen. We aimed to estimate population-level indicators of the HIV cascade of care continuum, and to evaluate factors associated with viral suppression among transwomen in Rio de Janeiro, Brazil.

Methods: We conducted a respondent-driven sampling (RDS) study of transwomen from August 2015 to January 2016 in Rio de Janeiro, Brazil and collected data on linkage and access to care, antiretroviral treatment and performed HIV viral load testing. We derived population-based estimates of cascade indicators using sampling weights and conducted RDS-weighted logistic regression analyses to evaluate correlates of viral suppression (viral load ≤50 copies/mL).

Results: Of the 345 transwomen included in the study, 89.2% (95% CI 55-100%) had been previously tested for HIV, 77.5% (95% CI 48.7-100%) had been previously diagnosed with HIV, 67.2% (95% CI 39.2-95.2) reported linkage to care, 62.2% (95% CI 35.4-88.9) were currently on ART and 35.4% (95% CI 9.5-61.4%) had an undetectable viral load. The final adjusted RDS-weighted logistic regression model for viral suppression indicated that those who self-identified as black (adjusted odds ratio [aOR] 0.06, 95% CI 0.01-0.53, p < 0.01), reported earning ≤U$160/month (aOR 0.11, 95% CI 0.16-0.87, p = 0.04) or reported unstable housing (aOR 0.08, 95% CI 0.01-0.43, p < 0.01) had significantly lower odds of viral suppression.

Conclusions: Our cascade indicators for transwomen showed modest ART use and low viral suppression rates. Multi-level efforts including gender affirming care provision are urgently needed to decrease disparities in HIV clinical outcomes among transwomen and reduce secondary HIV transmission to their partners.

Keywords: Brazil; HIV; HIV testing; antiretroviral therapy; care continuum; transgender women.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Figure 1.
Figure 1.
The HIV care continuum among HIV-positive transgender women in Rio de Janeiro, Brazil (N = 141). Crude percentages in dark grey, respondent-driven sampling weighted population estimates in light grey, error bars represent 95% confidence intervals for population estimates. * N = 138 for denominator with undetectable viral load due to missing data.
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