The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis

Stutterheim, Sarah E.; Dijk, Mart van; Wang, Haoyi; Jonas, Kai J.

doi:10.1371/journal.pone.0260063

Cited by 112 publications

(77 citation statements)

References 118 publications

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“…Systematic reviews and meta-analyses of population size, HIV prevalence, or ART coverage encompassing SSA have been conducted for FSW, 9,10 MSM, 11 and PWID. 12,13 Studies on transgender populations in SSA have been published, [14][15][16][17] but data were insufficient to conduct region-level meta-analysis of HIV prevalence. Several organisations have undertaken efforts to consolidate key population surveillance data, including the Joint United Nations Program on HIV/AIDS (UNAIDS) Key Population Atlas, the US Centers for Disease Control and Prevention (CDC), the Global Fund to Fight AIDS, TB, and Malaria (GF), and the Johns Hopkins University Global.HIV initiative.…”

Section: Introductionmentioning

confidence: 99%

“…Systematic reviews and meta-analyses of population size, HIV prevalence, or ART coverage encompassing SSA have been conducted for FSW, 9,10 MSM, 11 and PWID. 12,13 Studies on transgender populations in SSA have been published, [14][15][16][17] Atlas, the US Centers for Disease Control and Prevention (CDC), the Global Fund to Fight AIDS, TB, and Malaria (GF), and the Johns Hopkins University Global.HIV initiative. [18][19][20][21] These efforts aim to monitor the state of the epidemic, evaluate programmes, and make recommendations on key population data reporting and quality thresholds.…”

Section: Introductionmentioning

confidence: 99%

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Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Stevens

Sabin

Garcia

et al. 2022

Preprint

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Background: HIV programmes in sub-Saharan Africa (SSA) require information about HIV among key populations to ensure equitable and equal access to HIV prevention and treatment. Surveillance has been conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender populations, but is not systematically included in national HIV estimates. We consolidated existing KP surveys to create national-level estimates of key population size, HIV prevalence, and ART coverage for mainland SSA. Methods: Key population size estimates (KPSE), HIV prevalence, and ART coverage data from 38 countries from 2010-2021 were collated from existing databases, deduplicated, and verified against primary sources. We used Bayesian mixed-effects regression to spatially smooth KPSE, and regressed subnational key population HIV prevalence and ART coverage against age/sex/year/province-matched total population estimates. Findings: We extracted 1449 unique KPSE datapoints, 1181 HIV prevalence datapoints, and 242 ART coverage datapoints. Countries had data for a median of five of the twelve population/outcome stratifications. Across countries, a median of 1.44% of urban women were FSW (interquartile range [IQR] 0.83-1.89%); 0.60% of urban men were MSM; and 0.16% of urban adults injected drugs (IQR 0.14-0.24%). HIV prevalence in all key populations was higher than matched total population prevalence. ART coverage was correlated with, but lower than, total population ART coverage. Across SSA, key populations were estimated as 1.1% (95%CI 0.7-1.9%) of the population but 5.1% (95%CI 3.2-10.3%) of all PLHIV aged 15-49 years. Interpretation: Key populations in sub-Saharan experience disproportionate HIV burden and somewhat lower ART coverage, underscoring need for focused prevention and treatment services. However, large heterogeneity and incomplete data availability limit precise estimates for programming and monitoring trends. Future efforts should focus on integrating and strengthening key population surveys and routine data within national HIV strategic information systems.

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Section: Introductionmentioning

confidence: 99%

“…Systematic reviews and meta-analyses of population size, HIV prevalence, or ART coverage encompassing SSA have been conducted for FSW, 9,10 MSM, 11 and PWID. 12,13 Studies on transgender populations in SSA have been published, [14][15][16][17] Atlas, the US Centers for Disease Control and Prevention (CDC), the Global Fund to Fight AIDS, TB, and Malaria (GF), and the Johns Hopkins University Global.HIV initiative. [18][19][20][21] These efforts aim to monitor the state of the epidemic, evaluate programmes, and make recommendations on key population data reporting and quality thresholds.…”

Section: Introductionmentioning

confidence: 99%

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Stevens

Sabin

Garcia

et al. 2022

Preprint

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“…Limited recruitment of this population led to their omission from the comparative analyses in this study. Globally, both transgender men and women are disproportionately burdened by HIV [ 33 ] and can face unique barriers to HIV care and adherence to ART (e.g., transphobia, hormone use) [ 34 ]. Future research could be designed to assess the content validity of the final PROM specifically among transgender persons.…”

Section: Discussionmentioning

confidence: 99%

Content validation of a new measure of patient-reported barriers to antiretroviral therapy adherence, the I-Score: results from a Delphi study

Engler

Vicente

Mate

et al. 2022

J Patient Rep Outcomes

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Background Over a third of people living with HIV (PLHIV) have suboptimal adherence to antiretroviral therapy (ART). Measures of barriers to ART adherence often lack comprehensiveness. To help manage ART adherence barriers in HIV care, we are developing a new patient-reported outcome measure (PROM) of these barriers (the I-Score). Methods We assessed the content validity of 100 items (distinct barriers) to retain only those most relevant to both PLHIV and HIV health/social service providers. A web-based Delphi was conducted in Canada and France, collecting data from December 2018 to October 2019. Items were evaluated on relevance (the combined rated importance and actionability for HIV care of items among both PLHIV and providers); comprehensibility (rated item clarity); comprehensiveness (examined against our conceptual framework); cross-cultural equivalence (based on comparisons by questionnaire language (English, French) and country of residence). Pearson’s chi-square tests were used for comparisons by language, country, gender, and stakeholder group (PLHIV, providers). Results Panelists included 40 PLHIV and 57 providers (66% response rate). Thirty-one items were retained based on consensus thresholds for relevance (minimum: 50% for PLHIV, 60% for providers) and showed good comprehensibility and comprehensiveness, when compared to our conceptual framework (representation of: 6/6 domains, 15/20 subdomains). No significant difference in relevance based on language or country was found among retained items, suggestive of cross-cultural equivalence. Among all 100 items, only 6 significant differences on relevance were observed for gender. For 62 items, the relevance ratings of PLHIV and providers differed significantly, with providers showing greater endorsement of all items but one. Discussion The Delphi led to a much-needed item reduction. Remaining items highlight the panel’s multidimensional priorities for the PROM on ART adherence barriers, with few, if any, differences by language, country, and gender. While the analyses may lack generalizability and power, the sample size is considered adequate for a PROM validation study. Conclusion Retained items showed good content validity. The different patterns of item endorsement observed underscore the utility of engaging multiple stakeholder groups in PROM development for use in clinical practice. The greater endorsement of items by providers versus patients merits further investigation, including the implications of such differentials for measure development.

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“…Significantly, transgender women were 66 times more likely to be HIV positive than other individuals over the age of 16 years. On the other hand, transgender men were about 7 times more likely to be HIV infected than other individuals [ 4 ]. In sub-Saharan Africa, the HIV prevalence is high among transgender people.…”

Section: Introductionmentioning

confidence: 99%

“…The high prevalence has been attributed to high-risk behaviors including unprotected anal intercourse, STI coinfection and commercial sex work. In some settings, unsafe injection practices are an additional risk factor for HIV infection in this population [ 1 , 4 ]. In addition to the individual risk factors, transgender people face significant barriers to HIV services.…”

Section: Introductionmentioning

confidence: 99%

High-risk behaviors and factors for HIV and sexually transmitted infections among transgender people in Gaborone, Botswana: results from a national survey

Siamisang¹,

Nkomo²,

Kusi³

et al. 2022

Pan Afr Med J

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Introduction key populations and transgender people in particular are at a high risk of HIV infection. However, very little is known about risk behaviors of transgender people in Botswana. The aim of this study was to determine the prevalence of high-risk behaviors for HIV and sexually transmitted infections (STIs) among transgender people in Botswana. Methods data from the Botswana 2017 Biological and Behavioral Surveillance Survey of HIV/STIs among select key populations (BBSS-2) was used. The cross sectional survey documented behavioral risk factors for these infections. This paper only focused on the analysis of the transgender data. Descriptive analysis was done with IBM Statistical Software for the Social Sciences (SPSS) version 24. Results there were 56 transgender people identified of which 12 (21.4%) were transgender women. The median age was 24 (interquartile range (IQR) 22-28). Among transgender women, 2 (16.7%) reported concurrent sexual partners and 9 (75%) reported condom use at last intercourse. However, only 7 (58.3%) reported consistent lubricant use. About 45% of the respondents did not know the HIV status of their last male partner. Only one of the transgender women reported intercourse with at least 1 female in the last month. About a third reported that they had STI symptoms in the past year. Alcohol use was reported in 50% of respondents while 83% had disclosed gender identity and had been accepted by their families. However, 25% reported discrimination by a healthcare worker. Conclusion the high-risk behaviors were frequent among transgender women. This study underlines the need for sustained efforts to reach this key population.

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The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis

Cited by 112 publications

References 118 publications

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Content validation of a new measure of patient-reported barriers to antiretroviral therapy adherence, the I-Score: results from a Delphi study

High-risk behaviors and factors for HIV and sexually transmitted infections among transgender people in Gaborone, Botswana: results from a national survey

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