Characteristics and HIV epidemiologic profiles of men who have sex with men and transgender women in key population-led test and treat cohorts in Thailand

Seekaew, Pich; Pengnonyang, Supabhorn; Jantarapakde, Jureeporn; Sungsing, Thanthip; Rodbumrung, Piyanee; Trachunthong, Deondara; Cheng, Chun-liang; Nakpor, Thitiyanun; Reankhomfu, Ratchadej; Lingjongrat, Danai; Janyam, Surang; Charoenying, Sutinee; Mills, Stephen; Cassell, Michael M; Phanuphak, Praphan; Vannakit, Ravipa; Phanuphak, Nittaya

doi:10.1371/journal.pone.0203294

Cited by 44 publications

(33 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although greater than 5% of transgender youth age 18 to 24 years were already HIV positive, acquisition of infection appeared to rapidly accelerate to 3.5-fold by the late 20s and early 30s. This finding is similar to those of studies in Cambodia and Thailand [4,20] and consistent with a cumulative probability of being exposed to HIV over the life course [21]. The particularly steep rise in HIV prevalence from 25 to 35 may point to a critical period to intervene vigorously with behavioural and biological interventions, such as those being delivered by the "China AIDS Fund for Non-Governmental Organization" (CAFNGO) [22].…”

Section: Discussionsupporting

confidence: 87%

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

et al. 2019

View full text Add to dashboard Cite

Introduction Transgender women may face the highest prevalence of HIV of any population, experiencing a disproportionate burden of disease frequently confirmed in surveys throughout the developing and developed world. However, few studies have been conducted specifically for transgender women in China. This study aimed to measure HIV prevalence and explore risk factors for infection in a diverse sample of Chinese transgender women to help advocate for prevention and care interventions for this population. Methods From July 2018 to May 2019, we adapted a respondent‐driven sampling (RDS) approach to recruit a diverse sample of 250 transgender women through chains of peer referrals in two cities of eastern China, Nanjing and Suzhou. Eligible participants (i.e. 18 years of age or older, living in Jiangsu province and assigned male sex at birth but currently self‐identified as a gender different from male) completed a self‐administered questionnaire on a mobile phone to collect demographic characteristics and risk behaviours and underwent HIV testing. Results and discussion The survey sample was young (82% under age 35 years), with 28.8% having a university degree, 39.2% reporting work at entertainment venues, 47.6% ever having taken hormones and 6.4% being diagnosed with an STI in the last year. One in five (20.8%) reported having engaged in sex work. HIV prevalence was 14.8% (95% CI 10.6 to 19.8), with 75.6% of those testing HIV positive reporting they were already aware of their serostatus. In multivariate analysis, HIV prevalence was significantly higher among transgender women above the age of 24 years, those who work at entertainment venues, who never have taken hormones, and who had been diagnosed with an STI in the last year. Conclusions The prevalence of HIV among transgender women in our study, at 14.8%, is among the highest detected in any population in eastern China. Chinese transgender women may therefore follow the disparity in the burden of HIV noted worldwide. Data support policies to prioritize transgender women for HIV testing outreach, for in‐depth research to better understand the specific drivers of infection in this population, and for trans‐friendly HIV care and prevention programmes to address their specific needs.

show abstract

Section: Discussionsupporting

confidence: 87%

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

et al. 2019

View full text Add to dashboard Cite

show abstract

“…This study is a sub‐study of KP‐led Test and Treat study. In 2015, we initiated a prospective observational cohort study for the KP‐led Test and Treat study with six community‐based clinic sites throughout Thailand: RSAT Bangkok, SWING Bangkok, SWING Pattaya, Sisters (Pattaya), Caremat (Chiang Mai) and RSAT Songkhla . The primary objectives of the study were to determine the proportion of first‐time HIV testers and median CD4 count at HIV diagnosis among MSM and TGW receiving KP‐led Test and Treat services, as well as to determine the uptake of early CD4 count testing through point‐of‐care CD4 and ART initiation through KP‐led support of ART linkages.…”

Section: Methodsmentioning

confidence: 99%

“…The low HIV testing uptake among MSM and TGW may stem from several problems: Thai population has a stigmatizing attitude towards people living with HIV , which may generate fear of HIV stigma and being labelled as HIV positive, thereby preventing people from seeking out their HIV status ; systematic discrimination and stigma based on gender and sexual orientation, for instance in healthcare setting, can also deter some MSM and TGW from visiting healthcare provider and getting HIV testing . Despite the efforts to make HIV testing, treatment, and prevention services more approachable to MSM and TGW using an active case‐finding Reach‐Recruit‐Test‐Treat‐Retain approach by KP‐led community‐based organizations , low uptake of HIV testing among MSM and TGW persists and may be attributed to the false premise that they are not at risk of HIV acquisition . Several studies have reported that the major reason provided by those who refused to take an HIV test was that they did not perceive themselves to be at risk .…”

Section: Introductionmentioning

confidence: 99%

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

et al. 2019

Self Cite

View full text Add to dashboard Cite

Introduction Low uptake of HIV testing and services, including pre‐exposure prophylaxis (PrEP), in Thai men who have sex with men (MSM) and transgender women (TGW) may be due to the inaccuracy in self‐risk assessment. This study investigated the discordance between self‐perceived HIV risk and actual risk. Methods Data were obtained between May 2015 and October 2016 from MSM and TGW enrolled in key population‐led Test and Treat study in six community health centres in Thailand. Eligible participants were at least 18 years old, Thai national, had sex with men, had unprotected sex with a man in the past six months or had at least three male sex partners in the past six months, and were not known to be HIV positive. Baseline demographic behavioural characteristics questionnaires, including self‐perceived HIV risk, were self‐administered. Participants received HIV/STI (syphilis/gonorrhoea/chlamydia) testing at baseline. Participants who self‐perceived to have low risk, but engaged in HIV‐susceptible practices were categorized as having risk discordance (RD). Regression was conducted to assess factors associated with RD among MSM and TGW separately. Results Of the 882 MSM and 406 TGW participants who perceived themselves as having low HIV risk, over 80% reported at least one of the following: tested HIV positive, engaged in condomless sex, tested positive for a sexually transmitted infection sexually transmitted infection (STI; or used amphetamine‐type stimulants. Logistic regression found that living with a male partner (p = 0.005), having never tested for HIV (p = 0.045), and living in Bangkok (p = 0.01) and Chiang Mai (p < 0.001) were associated with increased risk discordance among MSM. Living with a male partner (p = 0.002), being less than 17 years old at sexual debut (p = 0.001), and having a low knowledge score about HIV transmission (p < 0.001) were associated with increased risk discordance among TGW. However, for TGW, being a sex worker decreased the chance of risk discordance (p = 0.034). Conclusions Future HIV prevention messages need to fill in the gap between self‐perceived risk and actual risk in order to help HIV‐vulnerable populations understand their risk better and proactively seek HIV prevention services.

show abstract

“…Transgender women (TGW) are heavily burdened by HIV infection, with an estimated prevalence of 19.1% and a 49‐fold increased risk of HIV acquisition compared to general population . While studies often subsume TGW within the men who have sex with men (MSM) population, TGW typically do not consider themselves as MSM, and hold unique and distinct medication exposure, social and behavioural characteristics compared to MSM, including lower education, lower income levels, higher proportion of engaging in sex work, and the use of feminizing hormone therapy (FHT) .…”

Section: Introductionmentioning

confidence: 99%

Drug‐drug interactions between feminizing hormone therapy and pre‐exposure prophylaxis among transgender women: the iFACT study

et al. 2019

Self Cite

View full text Add to dashboard Cite

Introduction Concerns over potential drug‐drug interactions (DDI) between feminizing hormone therapy (FHT) and pre‐exposure prophylaxis (PrEP) have hampered uptake and adherence of PrEP among transgender women (TGW). To determine DDI between FHT and PrEP, we measured the pharmacokinetic (PK) parameters of blood plasma estradiol (E2) and tenofovir (TFV) in Thai TGW. Methods Twenty TGW who never underwent orchiectomy and had not received injectable FHT within six months were enrolled between January and March 2018. FHT (E2 valerate and cyproterone acetate) were prescribed to participants at baseline until week 5, and then from week 8 until the end of study. Daily PrEP (tenofovir disoproxil fumarate/emtricitabine) was initiated at week 3 and continued without interruption. Intensive E2 PK parameters and testosterone concentration at 24 hours (C24) were measured at weeks 3 (without PrEP) and 5 (with PrEP), and intensive TFV PK parameters were measured at weeks 5 (with FHT) and 8 (without FHT). Results Median (interquartile range) age, body mass index, and creatinine clearance were 21.5 (21–26) years, 20.6 (19.0‐22.4) kg/m2, and 116 (101‐126.5) mL/min, respectively. The geometric mean (%CV) of area under curve from time zero to 24 hours (AUC0‐24), maximum concentration (Cmax), and C24 of E2 at weeks 3 and 5 were 775.13 (26.2) pg h/mL, 51.47 (26.9) pg/mL, and 15.15 (42.0) pg/mL; and 782.84 (39.6), 55.76 (32.9), and 14.32 (67.4), respectively. The geometric mean (%CV) of TFV AUC0‐24, Cmax, and C24 at weeks 5 and 8 were 2242.1 (26.5) ng h/mL, 353.9 (34.0) ng/mL, and 40.9 (31.4) ng/mL; and 2530.2 (31.3), 311.4 (30.0), and 49.8 (29.6), respectively. The geometric mean of TFV AUC0‐24 and C24 at week 5 were significantly less than that at week 8 by 12% (p = 0.03) and 18% (p < 0.001), respectively. There were no significant changes in E2 PK parameters and median C24 of bioavailable testosterone between week 3 and week 5. Conclusions Our study demonstrated lower blood plasma TFV exposure in the presence of FHT, suggesting that FHT may potentially affect PrEP efficacy among TGW; but E2 exposure was not affected by PrEP. Further studies are warranted to determine whether these reductions in TFV are clinically significant. Clinical Trial Number: NCT03620734.

show abstract

Characteristics and HIV epidemiologic profiles of men who have sex with men and transgender women in key population-led test and treat cohorts in Thailand

Cited by 44 publications

References 14 publications

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

High HIV prevalence and associated risk factors among transgender women in China: a cross‐sectional survey

Discordance between self‐perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross‐sectional assessment

Drug‐drug interactions between feminizing hormone therapy and pre‐exposure prophylaxis among transgender women: the iFACT study

Contact Info

Product

Resources

About