Abstract
Transgender women (TW) are highly burdened by HIV. There is increasing interest in digital (ie, through Internet-based interfaces) HIV research; yet few studies have assessed potential biases of digital compared with site-based data collection. This study examined differences in characteristics between TW participating through site-based versus digital-only modes in an HIV incidence cohort. Between March 2018 and Aug 2020, a multisite cohort of 1312 adult TW in the eastern and southern United States was enrolled in site-based and exclusively digital modes. We evaluated differences in baseline demographics, sociostructural vulnerabilities, health care access, gender affirmation, mental health, stigma, social support, and HIV acquisition risk comparing site-based vs digital modes using χ 2 tests and Poisson regression modeling with robust standard errors. The overall median age was 28 (interquartile range = 23-35) years and more than half identified as people of color (15% Black, 13% Multiracial, 12% Another Race, 18% Latina/e/x). A higher proportion of site-based (vs. digital mode) participants resided in the northeast, were younger, identified as people of color, experienced sociostructural vulnerabilities, had a regular health care provider, received medical gender affirmation, endorsed mental health symptoms and stigma, reported HIV acquisition risk but also greater experience with biomedical HIV prevention (preexposure and postexposure prophylaxis), and had larger social networks (all P < 0.05). Site-based and digital approaches enrolled TW with different demographics, life experiences, and HIV acquisition risks. A hybrid cohort model may achieve a more diverse and potentially representative sample of TW than either site-based or online cohorts alone for HIV research.
Published Version
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