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Xia Q, Farovitch L, Bertolino D, Romano A, Huang J, Misra K, Torian LV. Improvement in CD4+ cell count among people with HIV in New York City, 2007-2021. AIDS 2023; 37:2191-2198. [PMID: 37877276 DOI: 10.1097/qad.0000000000003685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND A higher CD4+ cell count among people with HIV (PWH) is associated with improved immune function and reduced HIV-related morbidity and mortality. The purpose of this analysis is to report the trend in CD4+ cell count among PWH in New York City (NYC). METHODS We conducted a serial cross-sectional analysis using the NYC HIV registry data and reported the proportion of PWH with a CD4+ cell count of 500 cells/μl or above, overall and by sex, race or ethnicity, and age. RESULTS The overall proportion of PWH in NYC with a CD4+ cell count of 500 cells/μl or above increased from 38.1% in 2007 to 63.8% in 2021. Among men, the proportion increased from 36.7% in 2007 to 62.3% in 2021 with an annual percentage change (APC) of 6.6% [95% confidence interval (95% CI): 5.8-7.5] in 2007-2013 and 2.6% (95% CI: 0.7-4.4) in 2013-2017, and no changes in 2017-2021 (APC: 0.0%; 95% CI: -1.1 to 1.0); among women, the proportion increased from 41.0% in 2007 to 67.6% in 2021 with an APC of 7.5% (95% CI: 5.2-9.8) in 2007-2010, 4.5% (95% CI: 3.5-5.4) in 2010-2015, and 0.8% (95% CI: 0.4-1.2) in 2015-2021. White people had a higher proportion than other racial/ethnic groups, 70.9, 59.3, 60.9, and 61.7%, respectively, among white, black, Latino/Hispanic, and Asian/Pacific Islander men, and 69.8, 68.0, 66.3, and 69.3%, respectively, among white, black, Latina/Hispanic, and Asian/Pacific Islander women in 2021. CONCLUSION CD4+ cell count among PWH in NYC improved during 2007-2021, but the improvement slowed in recent years.
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Affiliation(s)
- Qiang Xia
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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Chyten-Brennan J, Patel VV, Anastos K, Hanna DB. Brief Report: Role of Gender-Affirming Hormonal Care in HIV Care Continuum Outcomes When Comparing Transgender Women With Cisgender Sexual Minority Men. J Acquir Immune Defic Syndr 2022; 91:255-260. [PMID: 36252240 PMCID: PMC9577885 DOI: 10.1097/qai.0000000000003056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender women (transwomen) are frequently conflated with cisgender sexual minority men (cis-SMM) in HIV research. We examined the impact of socioeconomic and health conditions, and gender-affirming hormones in comparing HIV-related outcomes between cis-SMM and transwomen. SETTING Large tertiary care health system in the Bronx, NY. METHODS Retrospective cohort study of people with HIV receiving care in 2008-2017. We compared retention in care, antiretroviral therapy (ART) prescription, and viral suppression between cis-SMM and transwomen, using modified Poisson regression, adjusting for demographic and clinical factors. Transwomen were further stratified by receipt of estrogen prescription. RESULTS We included 166 transwomen (1.4%), 1936 cis-SMM (17%), 4715 other cisgender men (41%), and 4745 cisgender women (41%). Transwomen were more likely to have public insurance (78% vs 65%) and mental health (49% vs 39%) or substance use (43% vs 33%) diagnoses than cis-SMM. Compared with cis-SMM, transwomen prescribed estrogen (67% of transwomen) were more likely to be retained [adjusted risk ratio (aRR) 1.15, 95% confidence interval (CI) 1.08 to 1.23), prescribed ART (aRR 1.06, CI 1.01 to 1.11), and virally suppressed (aRR 1.08, CI 1.01 to 1.16). Transwomen not prescribed estrogen were less likely to be retained (aRR 0.92, CI 0.83 to 1.02), prescribed ART (aRR 0.90, CI 0.82 to 0.98), or virally suppressed (aRR 0.85, CI 0.76 to 0.95). CONCLUSIONS In the context of HIV, socioeconomic factors, comorbidities, and gender-affirming care distinguish transwomen from cis-SMM. Compared with cis-SMM, transwomen who were prescribed estrogen had better HIV care continuum outcomes; transwomen not prescribed estrogen had worse outcomes. These differences should be accounted for in HIV-related research.
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Affiliation(s)
- Jules Chyten-Brennan
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, United States
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Poteat T, Mayo-Wilson LJ, Pereira N, Wright BN, Smout SA, Sawyer AN, Cathers L, Zimmerman RS, Grigsby SR, Benotsch EG. U.S. transgender women's preferences for microeconomic interventions to address structural determinants of HIV vulnerability: a qualitative assessment. BMC Public Health 2021; 21:1394. [PMID: 34261464 PMCID: PMC8281671 DOI: 10.1186/s12889-021-11471-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background Transgender women in the United States (U.S.) experience a disproportionate burden of HIV infection and challenges to engagement in HIV prevention and care. This excess burden is driven by structural and economic inequities. Microeconomic interventions may be effective strategies for reducing HIV inequities for this population. However, few studies have explored transgender women’s preferences for microeconomic interventions to address structural determinants of HIV vulnerability. Methods We conducted individual interviews with 19 adult transgender women in 2 U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of transgender women were racial/ethnic minorities with mean age of 26.3 years. 89% were currently economically vulnerable; and 23% were employed full-time. 37% reported living with HIV. Participants expressed strong support for unrestricted vouchers, with many expressing the need for funds to support gender-affirming interventions. Assistance with how to budget and save and support for job acquisition, career planning, and employment sustainment were also preferred, including access to non-stigmatizing employment. Visible transgender leadership, group empowerment, and small (rather than large) numbers of participants were considered important aspects of intervention design for transgender women, including outreach through existing transgender networks to facilitate inclusion. Incorporating HIV counseling and testing to reduce vulnerability to HIV was acceptable. However, transgender women enrolled in the study preferred that HIV not be the focus of an intervention. Conclusions Flexible microeconomic interventions that support gender affirming interventions, improve financial literacy, and provide living-wage non-stigmatizing employment are desired by economically vulnerable transgender women. While not focused on HIV, such interventions have the potential to reduce the structural drivers of HIV vulnerability among transgender women.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, Chapel Hill, NC, 27516, USA.
| | - Larissa Jennings Mayo-Wilson
- Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA.,Global & Public Health Division, Johns Hopkins University School of Nursing, Community, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Nastacia Pereira
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, CB #7240, Chapel Hill, NC, 27516, USA
| | - Brittanni N Wright
- Department of Applied Health Sciences, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, 47405, USA
| | - Shelby A Smout
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Ashlee N Sawyer
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Lauretta Cathers
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
| | - Rick S Zimmerman
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, MI, 48202, USA
| | - Sheila R Grigsby
- University of Missouri St. Louis, College of Nursing, 221 NAB South Campus, University Blvd, St. Loius, MO, 63121, USA
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284, USA
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Davy-Mendez T, Napravnik S, Eron JJ, Cole SR, Van Duin D, Wohl DA, Gebo KA, Moore RD, Althoff KN, Poteat T, Gill MJ, Horberg MA, Silverberg MJ, Nanditha NGA, Thorne JE, Berry SA. Racial, ethnic, and gender disparities in hospitalizations among persons with HIV in the United States and Canada, 2005-2015. AIDS 2021; 35:1229-1239. [PMID: 33710020 PMCID: PMC8172437 DOI: 10.1097/qad.0000000000002876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine recent trends and differences in all-cause and cause-specific hospitalization rates by race, ethnicity, and gender among persons with HIV (PWH) in the United States and Canada. DESIGN HIV clinical cohort consortium. METHODS We followed PWH at least 18 years old in care 2005-2015 in six clinical cohorts. We used modified Clinical Classifications Software to categorize hospital discharge diagnoses. Incidence rate ratios (IRR) were estimated using Poisson regression with robust variances to compare racial and ethnic groups, stratified by gender, adjusted for cohort, calendar year, injection drug use history, and annually updated age, CD4+, and HIV viral load. RESULTS Among 27 085 patients (122 566 person-years), 80% were cisgender men, 1% transgender, 43% White, 33% Black, 17% Hispanic of any race, and 1% Indigenous. Unadjusted all-cause hospitalization rates were higher for Black [IRR 1.46, 95% confidence interval (CI) 1.32-1.61] and Indigenous (1.99, 1.44-2.74) versus White cisgender men, and for Indigenous versus White cisgender women (2.55, 1.68-3.89). Unadjusted AIDS-related hospitalization rates were also higher for Black, Hispanic, and Indigenous versus White cisgender men (all P < 0.05). Transgender patients had 1.50 times (1.05-2.14) and cisgender women 1.37 times (1.26-1.48) the unadjusted hospitalization rate of cisgender men. In adjusted analyses, among both cisgender men and women, Black patients had higher rates of cardiovascular and renal/genitourinary hospitalizations compared to Whites (all P < 0.05). CONCLUSION Black, Hispanic, Indigenous, women, and transgender PWH in the United States and Canada experienced substantially higher hospitalization rates than White patients and cisgender men, respectively. Disparities likely have several causes, including differences in virologic suppression and chronic conditions such as diabetes and renal disease.
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Affiliation(s)
- Thibaut Davy-Mendez
- Gillings School of Global Public Health
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sonia Napravnik
- Gillings School of Global Public Health
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joseph J Eron
- Gillings School of Global Public Health
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - David Van Duin
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David A Wohl
- Gillings School of Global Public Health
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly A Gebo
- Bloomberg School of Public Health
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard D Moore
- Bloomberg School of Public Health
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Keri N Althoff
- Bloomberg School of Public Health
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia Poteat
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD
| | | | - Ni Gusti Ayu Nanditha
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Stephen A Berry
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Klein PW, Psihopaidas D, Xavier J, Cohen SM. HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration's Ryan White HIV/AIDS Program: A retrospective study. PLoS Med 2020; 17:e1003125. [PMID: 32463815 PMCID: PMC7255591 DOI: 10.1371/journal.pmed.1003125] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/21/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the United States, approximately one-fifth of transgender women are living with HIV-nearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men. METHODS AND FINDINGS We assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92-0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41-0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42-0.73, p < 0.001). A limitation of the study is that RWHAP data are collected for administrative, not research, purposes, and clinical outcome measures, including retention and viral suppression, are only reported to the RWHAP for the approximately 60% of RWHAP clients engaged in RWHAP-supported outpatient medical care. CONCLUSIONS In this study, we observed disparities in HIV clinical outcomes among Black transgender women. These results fill an important gap in national HIV data about transgender people with HIV. Reducing barriers to HIV medical care for transgender women is critical to decrease disparities among this population.
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Affiliation(s)
- Pamela W. Klein
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
- * E-mail:
| | - Demetrios Psihopaidas
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Jessica Xavier
- Independent Consultant, Silver Spring, Maryland, United States of America
| | - Stacy M. Cohen
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
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