1321. Trans Females Receiving Gender-Affirming Surgical Referrals are More Likely to Have Durable Virologic Suppression at Whitman-Walker Health, 2008–2017

Abstract

BackgroundTrans females bear a disproportionate burden of HIV infection yet little is known about their HIV care continuum participation. We characterized the care continuum among trans female people with HIV (PWH) at Whitman-Walker Health (WWH) in Washington, DC and explored the impact of gender-affirming care on continuum participation.MethodsThis IRB-approved review from 2008 to 2017 analyzed trans female and nontrans PWH cohorts. Trans females were selected via self-identification and chart review, based on hormone prescription or narrative charting. Chi-square analysis was performed to examine associations between gender identity and demographic factors, comorbidities, and achieving steps in the care continuum. Bivariate analysis using chi-square test of independence and point-biserial correlation was performed between predictor and outcome variables in the care continuum. Multivariate logistic regression analysis was performed to identify predictors of poor outcomes in the care continuum.ResultsWe analyzed 219 trans female and 456 nontrans PWH (Figure 1). Trans female PWH were more likely to be Black and/or Hispanic, have unstable housing, and be publically insured when compared with nontrans PWH (Table 1). There was no difference in ART initiation, retention in care (RiC), or durable virologic suppression (DVS) <200 copies/mL based on gender identity (Figure 2). Nontrans PWH had a higher odds of DVS at lower limits of detection (LLOD) than trans female PWH (OR 1.59, 95% CI 1.15–2.20). Hormone prescription did not impact trans female PWH continuum participation (Table 2). Surgical referral was found to impact DVS < 200 (P = 0.036) and DVS < LLOD (P = 0.021), but multivariate modeling could not be performed. Trans female PWH with surgical referrals were more likely to achieve DVS < 200 (OR 3.57, 95% CI 1.02–12.23) and DVS < LLOD (OR 2.85, 95% CI 1.14–7.12).ConclusionThis novel analysis of gender-affirming care and the HIV care continuum shows trans female PWH were less likely than nontrans to achieve durable VS < LLOD. Trans female PWH who received surgical referrals were 3.5 times more likely to achieve durable VS < 200 and almost three times more likely to achieve durable VS < LLOD. Further research is needed to explore this association between surgical referrals and DVS among trans female PWH. Disclosures All authors: No reported disclosures.