Abstract
BackgroundIn Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. The stigma is one of the most important factors limiting their access to healthcare services. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW.MethodsA multidisciplinary team performed home-based HIV testing interventions in four cities of Argentina. Participants self-identified as TGW, older than 14 years and with a negative or unknown HIV status. Blood samples were screened by two rapid tests (RT), one based on antibodies (Determine™ HIV-1/2) and the other on antigen and antibodies (Determine™ HIV-1/2 Combo), and the subsequent blood processing via 4th generation ELISA (VIDAS HIV DUO). All reactive samples were confirmed with a viral load (VL). We compared the results of both RT with the ELISA. Samples were pooled in groups of 6 and a VL (Abbott Real Time) performed to identify acute HIV infections. Factors associated with HIV infection were evaluated with multivariate logistic regression analysis.ResultsA total of 260 TGW were tested, 51 tested positive (HIV prevalence 19.6%). There were no discordant results between both RTs nor between RTs and 4th generation ELISA, therefore the correlation was 100%. The VL identified 2 additional positive samples. The final analytic sample for positive cases consisted of 53 TGW. In the multivariate analysis, factors associated with a positive HIV result were history of other sexually transmitted infections (STIs) and not being previously tested for HIV. TGW tested for the first time were at 4 times greater risk of being HIV positive compared to those that were tested previously.ConclusionsA multidisciplinary home-based HIV testing service among TGW is feasible and effective to detect cases of HIV infection. The testing algorithm should start with an RT followed by molecular diagnosis. The history of STIs and never having been tested for HIV were the factors associated with HIV-positive results and should determine efforts to reach this population. Home-based testing reaches individuals that were not tested before and who have more risk of acquiring HIV.
Highlights
Worldwide, transgender women (TGW) have an extremely high HIV prevalence compared to other adults, with almost 50 times higher odds of infection [1]
There were no discordant results between both rapid tests (RT) nor between RTs and 4th generation ELISA, the correlation was 100%
The final analytic sample for positive cases consisted of 53 TGW
Summary
Transgender women (TGW) have an extremely high HIV prevalence compared to other adults, with almost 50 times higher odds of infection [1]. Social exclusion begins at an early age within their families and continues in the educational setting, limiting their later access to jobs and leading many TGW to engage in sex work. This scenario helps to understand the high rates of HIV among this population [4,5]. The Gender Identity Law guarantees the legal recognition of self-defined gender identity and endorses the access to gender affirmation procedures [9] In spite of these legal efforts, the inequities and social vulnerability among the TGW community still persist. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW
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