1 Fundación Huésped, Buenos Aires, Argentina

1. Engagement in the HIV care cascade among transgender women enrolled in a public HIV clinic in Buenos Aires, Argentina, 2000-2012 M.E. Socías1,2, O. Sued1,2, C. Frola2, A. Iacchetti2, T. Kerr3,4, I. Aristegui1, V. Zalazar1, H. Pérez2, P. Cahn1,2 1Fundación Huésped, Buenos Aires, Argentina 2Hospital Fernández, Infectious Diseases Division, Buenos Aires, Argentina 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada 4University of British Columbia, Department of Medicine, Vancouver, Canada

2. Background • In Argentina, transgender (TG) women are a highly vulnerable population • Life expectancy  35 years (vs. 79 in biological women) • Estimated HIV prevalence 34% (vs. 0.4% in the general population) • Argentina´s policies are promoting gender equity • 2007: Right to self-perceived gender identity in healthcare (Buenos Aires) • 2010: Same-sex Marriage Law • 2012: Gender Identity Law • Little is known about engagement in HIV care among TG women Argentina MoH, 2013

3. Objectives • To characterize engagement in the HIV continuum of care among TG women enrolled in a public HIV clinic in Buenos Aires, Argentina • To explore factors associated with virological suppression within the first year of HIV diagnosis

4. Methods I • Design • Retrospective clinical chart review • Study population • TG women newly diagnosed with HIV and starting care in Hospital Fernández (HF) (linked to HIV care) between 2000-2012 • Definitions: HIV care cascade indicators • Engaged in HIV care: ≥ 2 HIV-related visits at least 3 months apart within the first year of HIV diagnosis • Retained in HIV care at 1 year: 1 HIV-related visit and/or diagnostic tests at 12 ± 3 months of HIV diagnosis • On ART: ART initiation within the first year of HIV diagnosis • Virologically suppressed: VL <50 copies/mL at 12 ± 3 months of HIV diagnosis US DHHS, Health Resources and Services Administration Institute of Medicine, 2012

5. Methods II • Data analysis • Percentages at each step of the HIV care cascade within the first year of HIV diagnosis • Bi- and multivariable logistic regression analyses to investigate factors associated with virological suppression at 12 months of HIV diagnosis

6. Baseline characteristics of TG women enrolled in HF between 2000-12 N= 69 * Denominators for each variable may differ due to non-response on some questions

7. HIV care cascade during the first year of HIV diagnosis • Factors associated with ART initiation: • CD4 ≤250 cells/μL: aOR = 3.90, 95%CI: 1.05 – 14.50 • Age ≥30: aOR = 4.11, 95%CI: 1.13 – 14.91 69 42 32 (42.3% of TG women on ART) 26 11

8. Correlates of virological suppression (N = 69) * Significant at p < 0.10 and entered into the multivariable model

9. Correlates of virological suppression among transwomen on ART (n = 26)

10. Sub-analysis: Cascade of HIV care 2002-2006 and 2007-2012Impact of the new legislation

11. Limitations • Retrospective study • Focus on transwomen enrolled in HIV care • Small sample size

12. Conclusions • Low rates of engagement across the HIV Care Cascade • High proportion of substance use, sex work, and unemployment → broader risk environment of TGW shaping HIV outcomes • Novel and culturally appropriate interventions tailored for HIV-infected TG women are urgently needed

13. Challenges & future directions • Since August 2013 in Hospital Fernández: • Multidisciplinary team: infectious diseases, endocrinology, mental health, substance use, social services • Offer of comprehensive health services adapted to TG women needs

14. Acknowledgements • Infectious Diseases Division, Hospital Fernández • FundaciónHuésped eugenia.socias@huesped.org.ar