HIV Testing and Associated Characteristics Among Black Cisgender and Transgender Women in the United States

Black women in the United States continue to be disproportionately affected by HIV. HIV testing is an important preventative step in the HIV continuum of care, however there is little known about HIV testing among these groups. Therefore, the purpose of this study is to examine the HIV testing behaviors of Black transgender women and explore differences in predictors of HIV testing among Black cisgender and transgender women. This study uses secondary data from the 2014-2017 modules of the Behavioral Risk Factor Surveillance System. Analyses included multiple hierarchical regression. There are no major differences in HIV testing between Black cisgender and transgender women. A number of sociodemographic characteristics have been shown to predict HIV testing among Black cisgender women, but only employment status and age were significant predictors of HIV testing among Black transgender women. A moderation analysis suggested that gender identity significantly moderates the association between employment status and HIV testing such that the relationship between employment status and receiving an HIV test differs by gender identity. The findings of this study highlight nuances in HIV testing among Black cisgender and transgender women that are useful for improving HIV testing as a mode of HIV prevention. Overall, the findings contribute to our understanding of HIV testing practices among Black cisgender and transgender women.

Improving Timely Linkage to Care among Newly Diagnosed HIV-Infected Youth: Results of SMILE

Delayed linkage to care deprives youth living with HIV of the benefits of HIV treatment and risks increased HIV transmission. Developing and testing linkage-to-care models that are capable of simultaneously addressing structural and individual obstacles are necessary to attain national goals for timely linkage of newly diagnosed youth to care. We assessed an integrated, multi-pronged strategy for improving youth's timely linkage to care carried out in eight adolescent medicine clinical trials units (AMTUs) in the USA. In phase I, the intervention strategy paired intensive medical case management with formalized relationships to local health departments, including granting of public health authority (PHA) to four of the AMTUs. In phase II, local coalitions run by the AMTUs to address structural changes to meet youth's HIV prevention and HIV testing needs began to advocate for local structural changes to improve timely access to care. Results of an ARIMA model demonstrated sustained decline in the average number of days to link to care over a 6-year period (ARIMA (1,2,1) AIC = 245.74, BIC = 248.70, p < .01)). By the end of the study, approximately 90% of youth linked to care had an initial medical visit in 42 or fewer days post-diagnosis. PHA improved the timeliness of linkage to care (b = - 69.56, p < .05). A piecewise regression suggested the addition of structural change initiatives during phase II made a statistically significant contribution to reducing time to linkage over and above achievements attained via case management alone (F (3,19) = 5.48, p < .01; Adj. R² = .3794). Multi-level linkage-to-care interventions show promise for improving youth's timely access to HIV medical care.