1 in+care Campaign Meet the Author November 12, 2013

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in+care CampaignMeet the Author

November 12, 2013

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Ground Rules for Webinar Participation

Actively participate and write your questions into the chat area during the presentation(s)

Do not put us on holdMute your line if you are not speaking

(press *6, to unmute your line press #6)Slides and other resources are available

on our website at incareCampaign.orgAll webinars are being recorded

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Welcome & IntroductionsWelcome & Introductions, 5minBaligh Yehia, MD, MPP, MSHP, 30minQ & A Session, 20minUpdates, Reminders & Evaluation, 5minIn the chat

room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency

Michael Hager, MPH MA NQC Manager,in+care Campaign ManagerNew York, NY

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Penn Medicine

Retention in Care and Health Outcomes of Transgender Persons Living with HIV

Baligh R. Yehia, MD, MPP, MSHPAssistant Professor of Medicine

University of Pennsylvania Perelman School of Medicine

Clin Infect Dis. 2013 Sep; 57(5):744-6

Penn Medicine

No Disclosures or Conflicts of Interests.

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Outline

Background

Transgender Individuals & HIV Barriers to Care Literature Review/Past Studies

Study Summary

Research Methods Results & Conclusions Limitations & Future Directions

Discussion/Q & A

Baligh R. Yehia, MD, MPP, MSHP 6

Penn Medicine

Transgender-Specific Research is Needed


LGBT individuals have unique

health experiences and needs, but

as a nation, we do not know

exactly what these experiences

and needs are.

Focus Areas:

Demographic Research

Social Influences

Health Care Inequities

Intervention Research

Transgender-specific Health

Needs

Penn Medicine

HIV Prevalence Among Transgender Individuals


Herbst, et al., AIDS Behav 2008

Meta-analysis of 29 studies conducted between 1990-2003 in the U.S. and Puerto Rico to estimate HIV prevalence and risk behaviors among MTF transgender women.

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Limited data on FTM transgender men, but estimated to be ~3%.

Penn Medicine

HIV Incidence Among Transgender Individuals


CDC, 2009

Based on 2009 data from the CDC, the incidence of HIV was 2.6% among transgender persons compared to 0.9% among cisgender males and 0.3% among cisgender females.

Highest among: Blacks (4.4%) and Hispanics (2.5%) transgender persons.

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Limited Access to and Delays in HIV Care


Discrimination Stigma Social Isolation Past negative experiences Prioritization of gender-related health care Concern about adverse interactions between ART

and hormone therapy

Sevelius et al., Women’s Health Issues 2011

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Discrimination by Medical Provider for Transgender People


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Postponement of Care Due to Discrimination


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Literature Review - Study 1: Decreased ART Use


Objective: Examine whether MTF transgender persons with HIV face greater difficulties accessing health services than cisgender people with HIV.

Methods: Adults in the Healthy Living Project, a trial designed to reduce sexual risk behaviors among HIV-infected persons.

- 59 MTF transgender persons - 300 matched cisgender person.

Melendez et al., AJPH 2006

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Limitations: Convenience Sample & Self-Reported Data


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Literature Review - Study 2: Decreased ART Adherence


Objective: Examine rates of self-reported ART adherence among transgender women compared to cisgender people with HIV.

Methods: Adults in the Healthy Living Project, a trial designed to reduce sexual risk behaviors among HIV-infected persons.

- 35 transgender women on ART- 2,770 cisgender persons on ART

Sevelius et al., JANAC 2010

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Limitations: Convenience Sample & Self-Reported Data

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Outline

Background

Transgender Individuals & HIV Barriers to Care Past Studies

Study Summary


Discussion/Q & A


Penn Medicine

Study Objective and Design


Objective: Examine whether retention in care, use of ART, and HIV viral suppression differed between cisgender and transgender people living with HIV.

Design: A retrospective cohort of HIV-infected adults enrolled in care at 13 US HIV clinics between 2001 and 2011.

Penn Medicine

Study Outcomes

Retention in CareJan 1 Dec 31

≥ 90 days

Jan 1 Dec 31

at any point

Use of ART

Jan 1 Dec 31

median

Viral Suppression

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Analyses


We compared demographics for each cisgender group to the transgender group using the χ2 test of independence.

CD4 count and HIV viral load at enrollment were compared using the Kruskal-Wallis test due to their non-normal distribution.

Multivariate logistic regression examined demographic (age, gender, race/ethnicity, HIV transmission risk, insurance coverage) and clinical factors (CD4 count) associated with each of the three outcomes, adjusting for calendar year and site of care.

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Results - Demographics


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Results - Outcomes


Retention in Care Use of ART Viral Suppression0%

20%

40%

60%

80%

100%

Cisgender Men Cissgender Women Transgender Persons

63%

80%76%

69%

82% 81% 77%74%

69%

Penn Medicine

Results – Multivariate Analyses


Retention Use of ART Suppression

GenderTransgender personsCisgender men Cisgender women

1 [Reference]1.15 (0.94-1.42)1.32 (1.08-1.64)

1 [Reference]0.98 (0.78-1.23)0.81 (0.64-1.02)

1 [Reference]1.11 (0.89-1.39)1.13 (0.90-1.42)

Penn Medicine

Conclusions


Reducing HIV-related disparities is a major goal of Healthy People 2020 and the National HIV/AIDS Strategy for the United States.

Compared to prior studies, these results reflect improvements in health equity for transgender patients infected with HIV.

Advances in HIV therapy and management have occurred since these studies were conducted, including expansion of available antiretroviral drugs, simplified dosing, greater tolerability, and improvements in evidence-based guidelines.

Penn Medicine

Limitations


Retrospective nature Focus on patients engaged in care Relative small number of transgender people with HIV Generalizability Unable to assess variations in health outcomes by

subgroups (MTF, FTM, gender expression, sexual

orientation)

Penn Medicine

Future Directions


Estimate the proportion of HIV-infected transgender

persons out of care.

Develop interventions designed to improve access

and linkage to care for transgender individuals.

Penn Medicine

Outline

Background

Transgender Individuals & HIV Barriers to Care Past Studies

Study Summary


Discussion/Q & A


Penn Medicine

Discussion/Q & A

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Campaign Update

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in+care Campaign in 2014

• Campaign database running through 2018!• Campaign website running through 2018!• Partners in+care Facebook maintained indefinitely• Campaign Newsletter moves to quarterly• Campaign Webinars move to quarterly• Partners in+care Webinars move to quarterly• Campaign Coaching integrates into NQC

Continuous TA Portfolios• Local Retention Groups that wish to continue

meeting should do so – NQC will support where possible

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2013-2014 in+care Campaign Activities

2013 2014

Activities JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

1-Campaign Webinar

2-Journal Club Webinar

3-Campaign Data Reporting Cycle by Participants

4-Availability of Database Benchmark Function

5-Improvement Strategy Cycle

6-in+care Website and Posting of Updates

7-Campaign Newsletter

8-Partners Webinar

9-Partners in+care Facebook

10-Campaign Coaching Availability

11-Local Retention Group Availability

12-Case Study Drafting

13-Final Report Drafting

14-Communications with participants around transition

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Upcoming Webinars: ― Partners in+care Webinar | Retaining New Patients

in+careThursday, November 14, 2013 | 2pm ET

― in+care Campaign Webinar | The Transgender Experience and Retention in HIV CareWednesday, November 20, 2013 | 1pm ET

― in+care Campaign Webinar | State-Level Efforts to Retain New Patients in HIV CareWednesday, December 4, 2013 | 2pm ET

Data Collection Submission Deadline: December 2, 2013

Improvement Update Submission Deadline: November 15, 2013

Upcoming Events and Deadlines

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Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone [email protected]

incareCampaign.orgyoutube.com/incareCampaign

Documents

1 in+care Campaign Meet the Author November 12, 2013